Scenario Writing 101 Cheryl Feken Dixon RN MS Assistant Professor of Nursing Clinical Simulation Coordinator Tulsa Community College cfeken@tulsacc.edu

Goal of the Session Describe resources available for identifying simulations applicable to the facility or educational needs Discuss resources that facilitate the process for simulation writing Identify tools needed for simulation writing Develop a simulation

Resources Risk Management Team http://www.medlaw.com/healthlaw/HOSPITAL/6_2/nurse-charged-with-felony.shtml Joint Commission (National Patient Safety Goals) http://www.jointcommission.org/ http://www.jointcommission.org/patientsafety/nationalpatientsafetygoals/ IOM http://www.iom.edu/ Hospital Education Department Malpractice cases/Nurse Lawyers Risk Management Teams are hospital-wide programs for the prevention, monitoring, and control of areas of potential liability exposure (patient and employees) Your institutions RM team can be a wealth of ideas for near misses or common errors. The literature has already told us that those simulations that have been created based on true life events have more meaning to the learner Joint Commission – resouce Hospital Education Departments have a wealth of information. Individuals in the education department may be very aware of needs. Unit managers may identify learning needs for seasoned staff nurses as well as new graduates. Malpractices cases and Nurse Lawyers also provide resources.

Resources for Simulation Ideas Assess for unit needs or course needs Essential experiences needed Psychomotor skills Education Theory content Case studies Clinical experiences Care plans Journal articles often include history, symptoms, lab values etc Essential experiences – High risk low opportunity - chest pain, poisoning in children, drug overdose etc. Hospital units with a new or changed protocols

Resources to Guide the Process International Association for Clinical Simulation Learning (INACSL) www.INACSL.com http://www.inacsl.org/2009Conference.pdf Society for Simulation in Health Care http://www.ssih.org/public/ Simulation Innovative Resource Center (SIRC) www.SSIR.com INACSL – mission statement is to promote and provide the development and advancement of clinical simulation and learning resource centers. This includes helping with collaboration, networking, mentoring etc SSIR is a multi-disciplinary, multi-specialty, international society. Individuals from various arenas participate in this organization such as nursing, allied health paramedical personnel, physicians and industry to name a few SIRC is an online e-learning site where individuals (states nursing faculty) can learn how to develop and integrate simulation into their particular environment. It provides 9 courses including designing and developing simulations, integrating concepts, debriefing and others 

Resources to Guide the Process University of Miami http://academy.sonhs.miami.edu/content/view/43/126 Laerdal http://www.laerdal.com/default.asp http://www.laerdal.com/usa/flash/vitalsim/ Meti http://www.meti.com/index.html University of Miami – provides training & certification Laerdal and Meti both have sites which provide resources. Meti does have an annual conference as well as a forum. Laerdal provides regional Simulation User Network meetings and has a forum as well.

Designing the Scenario Determine Purpose Knowledge acquisition/skills proficiency/critical thinking evaluation Determine environment Flow of the simulation Participants Type of manikin Operation mode of manikin Equipment requirements Peer review/Revisions Purpose – acquisition, evaluation Environment – Acute, chronic, home health, long term care Flow of simulation – what happens first, next desired performance, specific completion criteria, risks, complications, failure criteria Participants – identify the roles, don’t put the participants in roles outside their own. Don’t make the nurse assume the role of a physician or respiratory therapist Mode – on the fly or preprogrammed Equipment – fidelity is paramount Peer Review – have someone else review for content Revisions – may want to make a few changes after the first time, but discourage changing them frequently.

Essential Assessment/Diagnosis Essential for developing Identify what the participant needs to know Essential for developing Tool – writing the simulation Determine outcomes/learning objectives Level the experience appropriate for the participant Evaluate participant’s current skill sets Evaluate participant’s critical thinking (Novice/Advanced Beginner/Competent/Proficient/Expert) Assessment/Diagnosis – what are the participants struggling with on their unit. What new requirements are needed to be proficient in their job. Plan – starting point Specify the requisite skills participant needs to complete the simulation experience

Plan Have to have a plan. Speaking from experience

Tool – writing simulation Why use a tool Organize thoughts Outcome objectives & cognitive skills Identify needs – for the mannequin, props for the room etc Guide the set up Guide the participant preparation Scenario Planning Tool Simulation in Nursing Education From Conceptualization to Evaluation INACSL list-serve Simulation User Network http://simulation.laerdal.com A tool helps the writer stay focused; Leveled appropriately for the participant; what props are needed for the mannequin, props for the room etc. Using the same format whom ever the participants are is beneficial since it helps to maintain some consistency, makes setting up easier - especially if the same individual is setting a variety of simulations for various education or professional groups.

Tool available from Laerdal

Identify Outcomes/Objectives What do you want the participant to gain from this experience? Leveled appropriately Right mannequin Right equipment Recognize and manage post-operative complications Administer blood products utilizing hospital protocol Before you can begin writing you have to know what it is you want the participant (nurse, student, etc) to gain from this learning experience. Level the simulation appropriately. Simulations that are too difficult result in poor outcomes and negative experiences. Use the right kind of simulation mannequin. Level 4: Plan may be to make sure students are safe with skills they have learned in previous semesters. Correlate assessment data including vital signs and lab values Recognize and manage symptoms of hypoxia. Recognize and manage complications associated with hypoxia Implement interventions to promote oxygenation

Cognitive Skills What knowledge does the participant need to bring to this simulation experience? Care of post-op client Pain management Pharmacologic and non-pharmacologic What knowledge does the participant need to bring to this simulation experience? Care of the client experiencing altered oxygenation, sterile technique, oxygen therapy, therapeutic communication

Critical Components Adequate preparation Demeanor of the individual running the simulation the simulation Debriefing at the conclusion of the experience

Getting Started

Writing and Programming a Scenario Live Demonstration

Picking the Right Manikin for the Job

Vital Sim Capabilities Variety of sounds with volume settings 0-9 Heart sounds - 8 normal, systolic & diastolic murmur, aortic stenosis, Austin flint murmur, friction rub, mitral valve prolapse, Heart Rhythm – 24 Breath sound- 8 L and/or R lung normal, course & fine crackles, pleural rub, pneumonia, rhonchi, stridor, wheezes, no sounds) Heart Sounds: normal, systolic & diastolic murmur, aortic stenosis, Austin flint murmur, friction rub, mitral valve prolapse, HR: SR w/Unifocal PVC’s, couplet PVC’s, multifocal PVC’s, VT very course, course, medium, fine to very fine, heart block 1st degree, 2nd degree type 1, 2nd degree type 2, 3rd degree

Vital Sim Capabilities Bowel sounds - 4 Fetal heart sounds Vocal sounds - 7 Breathing rate 0-60 in increments of 2 BP - increments of 2 IV therapy Wound sets Bowel sounds: normal, hyper, hypo, borborygmus, no BS, Vocal sounds: cough, moan, vomit, SOB, scream, yes, no

Vital Sim Capabilities Wounds Secretions

Vital Sim Capabilities Broken Bones Ostomy

Vital Sim Capabilities PEG Feedings Head Injury

High Fidelity SimMan G3 SimMan istan MetiMan http://www.laerdal.com/doc/33202760/SimMan-3G.html SimMan http://www.laerdal.com/doc/7320252/SimMan.html istan http://www.meti.com/products_ps_istan.htm MetiMan http://www.meti.com/downloads/metiman_nurse_031609.pdf

References Bremner, M., Aduddell, K, Bennett, D. VanGeest, J. The use of human patient simulators: best practices with Novice nursing students. Nurse Educator. 2006; 31(4): 170-174. Jeffries, R. A framework for designing implementing, and evaluating simulations used in teaching strategies in nursing. Nursing Education Perspectives. 2005; 26(2):96-103. Lamontagne, C., McColgan, J., Fugiel, L., Woshinsky, D., Hanrahan, R. Clinical simulation in nursing education. 2008; 4(1) Seropian, M., Brown, K., Gavilanes, J., Driggers, B. An approach to simulation program development. Journal of Nursing Education. 2004; 43(4) : 170-174.