1. Designed for the Simulation Laboratory Kim K. Oelke APN, FNP-C NURSING SKILLS COURSE

2.  Discuss advantages and disadvantages of utilizing the nursing skills laboratory for basic and advanced skills instruction  Describe the components of the skills course  Identify three teaching methods that can be employed using this course  Describe use of the course as an adjunct to a Medical/Surgical Nursing course, as skills units, or as individual skills to be practiced prior to clinical assignments OUTCOMES

3. SIMULATION LABORATORIES

4.  “Safe” environment  Immediate detailed feedback and debriefing  Increase student confidence  Practice skills  Introduce challenges ADVANTAGES OF USING A SKILLS LABORATORY

5.  Self-paced learning  Remediation  Applies theory to practice ADVANTAGES CONTINUED

6.  Interpersonal interactions  Professional judgement  Clinical environment  Skills loss  Misdirected focus  Cost DISADVANTAGES OF USING A SKILLS LABORATORY

7. MINIMIZE THE DISADVANTAGES MAXIMIZE THE ADVANTAGES

8.  School  Attract students  Decrease liability  Clinical settings  Students with required skills  Less dependence on staff nurses  Safer care of patients  Students  Supervised learning in “safe” environment  Practice  Resources  NLN SIRC  SSH experts  Other programs MAXIMIZE

9.  Role playing  Interpersonal interactions  Professional judgement  Adjunct to clinical experiences  Interpersonal interactions  Professional judgement  Redirect focus - skill as part of total patient care  Costs  Funding opportunities  Shared facilities and equipment MINIMIZE

10. SYLLABUS SKILLS OUTLINE CASE SCENARIOS CLINICAL CHECKLISTS COURSE COMPONENTS

11. Course Description:  Clinical course for nursing simulation lab  Incorporates  basic med/surg nursing skills  use of resources  critical thinking skills  cooperation skills  patient education  Active student participation required. SYLLABUS

12.  Upon completion of each system unit, the student will be able to:  Identify skills for specific systems  Discuss patient education points  Assemble equipment needed  Identify patients  Obtain informed consent  Perform procedure or skill.  Discuss nursing measures  patient safety  comfort  privacy  Demonstrate correct documentation SYLLABUS: COURSE OUTCOMES

13.  Content Outline:  Skills and procedures  Patient education  reason for procedure  prep for procedure  expected experience  risks and side effects  expected follow-up  Informed consent  Documentation of nursing education  Documentation of procedure SYLLABUS: CONTENT OUTLINE

14.  Case scenarios for role playing  Work in pairs  Work in small groups SYLLABUS: LEARNING ACTIVITIES

15.  Group discussions  Positive feedback  Constructive criticism  Instructor evaluation  Group debriefing  One to one discussion  Case scenarios  Video-taped performance  Graded performance SYLLABUS: STUDENT EVALUATION

16.  Skills organized by body systems  Respiratory  Cardiovascular  Gastrointestinal  Genitourinary  Integumentary  Musculoskeletal  Nervous  Skills outlined in steps  Patient education  Equipment/supplies  Patient identification  Technique  Documentation SKILLS OUTLINE

17.  Skills - examples  Tracheostomy care  Chest tube  Insertion  Routine care  Discontinuation  Outline format  Information and patient education  Assembling equipment/supplies  Identification of patient  Performing procedure  Documentation of education, procedure, and patient status CASE CHECKLISTS

18. Case Checklist 2.2 IV catheter site care 2.2.1 Describes the education provided to the patient  Introduces self  Explains purpose of procedure  Explains procedure  Describes expected results 2.2.2 Assembles all necessary equipment and supplies  Tape  Occlusive clear dressing if not changed in past 72 hours  Alcohol prep pads 2.2.3 Identifies patient using 2 identifiers  Wrist band  Verifies name and date of birth 2.2.4 Performs catheter site care  Performs hand hygiene  Raises bed to working position and lowers side rail  Dons non-sterile gloves  Assesses site for possible infection or infiltration  Removes and replaces any soiled tape and/or dressing  Records date and time on new dressing  If catheter has been in place 72 hours, removes dressing and catheter  Holds pressure until bleeding stops  Restarts IV in another site  Returns bed to control position and raises side rail  Removes and disposes of used equipment and gloves  Assesses patient and provides comfort measures as needed 2.2.5 Documents patient teaching and performance of procedure  States education provided and who was educated  Records the patient identifiers used  Briefly describes the procedure, the outcomes, and patient comfort provided Education - ____ /4 Organization - ____ /3 Identification - ____ /2 Skill performance - ____ /12 Documentation - ____ /3 Total score - ____ /24

19.  Multiple scenarios for each skill  Simple to complex  Incorporate clinical knowledge and professional judgement  Multisystem scenarios available to reflect reality CASE SCENARIOS

20.  IV rehydration  Teaching intermittent self- catheterization  Hydrocolloid gel burn dressing examples SIMPLE CASE SCENARIO

21.  Heart failure patient  Respirations 18, slightly labored  Pulse oximetry 88%  Nail beds cyanotic  Breath sounds slightly diminished  Gurgling  Assess  Oropharyngeal suctioning  Provider notification example COMPLEX CASE SCENARIO

22.  MVA patient  Coma  Respirator  Chest tube  Thomas splint  Vasopressors  Antibiotics  Skills  Oral care  Neurological checks  Suction ET tube  Bed bath /skin assessment  Chest tube care  Issues  Organization  Complications  Assistance example MULTISYSTEM CASE SCENARIO

23. FOR USE WITH THE SIMULATION COURSE CASE SCENARIO METHOD

24.  Scenario provided  Decisions made by student  Skill demonstrated  Instructor provides immediate or delayed feedback  Scenario may change  Instructor may record session for review and feedback INSTRUCTOR SINGLE STUDENT

25.  Instructor assigns student roles  Scenario provided  Decisions made with group input  Skill demonstrated  Students and instructor provide feedback  Students rotate performing skill INSTRUCTOR GROUP OF STUDENTS

26.  One student performs the skill  One student may assist  Another student completes the checklist  Other students provide feedback  Students rotate positions STUDENTS SMALL GROUP SETTINGS

27.  Student follows checklist to complete the skill  Student may record session for review and feedback from other students or the instructor STUDENTS ALONE

28. TO MEET THE NEEDS OF YOUR FACILITY WAYS TO IMPLEMENT THE COURSE

32. For this presentation REFERENCES

33. Durham, C.F., & Alden, K.R. (2008). Chapter 51: Enhancing patient safety in nursing education through patient simulation. In Patient safety and quality: An evidence-based handbook for nurses. Rockville, MD: Agency for Healthcare Research and Quality. Retrieved from http://www.ncbi.nlm.nih.gov/books/NBK2628/ http://www.ncbi.nlm.nih.gov/books/NBK2628/ Grant, J., Epps, C., Moss, J., & Watts, P. (2009). Promoting reflective learning of students using human patient simulators. Clinical simulation in nursing, 5(3), S6. Kneebone, R., Scott, W., Darzi, A., & Horrocks, M. (2004). Simulation and clinical practice: strengthening the relationship. Medical Education, 38(10), 1095-1102. Retrieved from EBSCOhost. Kowalak, J.P. (Ed.) (2009). Lippincott’s nursing procedures (5 th ed.). Hong Kong (China): Lippincott Williams & Wilkins. Monahan, F.D., Sands, J.K., Neighbors, M., Marek, J.F., & Green, C.J. (Eds.) (2007). Phipps’ medical -surgical nursing: Health and illness perspectives (8 th ed.). St. Louis, MO: Mosby Elsevier Morgan, R. (2006). Using clinical skills laboratories to promote theory-practice integration during first practice placement: an Irish perspective. Journal of Clinical Nursing, 15(2), 155- 161. Retrieved from EBSCOhost. Wilson, A., & Godson, N. (2007). Evaluating the use of clinical skills laboratories for teaching student nurses. British Journal of Nursing (BJN), 16(19), 1178. Retrieved from EBSCOhost.

34. THANK YOU FOR YOUR ATTENTION “The most wasted of all days is one without laughter.” e.e. cummings