1. Bridging the Gap: Simulation in Orientation

2. Course Objectives Identify opportunities to utilize simulation as a tool in Orientation to bridge the gap for new graduate nurses Identify simulation modalities and determine the appropriate use

3. Hospital Based Simulation Center –3 Hospital System –4,500+ Employees –450 Patients Community Focused Faith Based

4. 22,700 Square Feet –2 ICU/ED/Med-Surg Simulation Rooms –OR Suite –12 Bed Simulation Lab –Pediatric Simulation Lab –Cardiac Simulation Lab –6 Task Training Rooms

5. Our Team

6. “With the growing knowledge that millions of patients are being harmed daily throughout the world as a consequence of preventable adverse events, the urgency could not be greater for patient safety solutions that will help practitioners and health care organizations avoid these tragic occurrences.” - Dennis S. O’Leary

7. Simulation as an Orientation Strategy Simulation has been demonstrated to be an effective strategy for education healthcare professionals Simulation is beneficial for transitioning new graduates into professional roles Simulation can be used to evaluation clinical judgment and competence (Olejniczak, Schidt & Brown, 2010)

8. Study of Graduate Nurse Health Assessment Knowledge & Skills Learning Modalities –Self Directed Learning Packet (SDLP) –SDLP plus Power Point –SDLP plus High Fidelity Human Patient Simulations 80 GN’s assigned to random groups Upon completion of Orientation participants were individually tested using low fidelity HPS

9. Study of Graduate Nurse Health Assessment Knowledge & Skills – Results of Correctly Completed Assessments 87% HPS Group 72% SDLP Only 53.8% Power Point (Shepherd, et al, 2007)

10. Bridging the Gap Socialization into the professional role Development of confidence and competence Simulation provides a safe environment in which to learn (Olejniczak, Schidt & Brown, 2010)

11. Simulation Based Orientation Goals & Objectives Identify opportunities to use simulation to enhance the orientation experience for new graduate nurses and experienced nurses Streamline and personalize the orientation experience Improve outcomes by enhancing teamwork, communication, and clinical skills through the use of high fidelity human patient simulation

12. Simulation in Nursing Orientation Cognitive Domain –Initial Learning & Application of Knowledge –Critical thinking, problem solving & conflict resolution Psychomotor Domain –Technical Skills & Tasks Affective Domain –Values & Attitudes –Integrity, Communication, Commitment to Professional Development and Reflective Practice (Bloom, 1956)

13. Simulation in Nursing Orientation Traditional Skills Lab –Task Trainers Scenario Based Orientation –High Fidelity Human Patient Simulation –Standardized Patients –Confederates Non-Technical Skills –SMART Training

14. Traditional IV Pump & Tubings Glucometer Pain Pump Restraints Feeding Pumps Safety Devices Skills Lab IV Catheter Insertion Foley Blood Administration Wound Care Dressing Changes Drains & Tubes

15. Scenario Based Orientation Recognize signs & symptoms Implement appropriate nursing interventions Set priorities Determine plan of care and incorporate patient and family

16. Scenario Based Orientation COPD Pneumonia Post-Op Patient Trauma Assessment

17. SMART Training Based on principles of Crew Resource Management (CRM) Teamwork Communication Situational Awareness Assertiveness

18. Crew Resource Management A flexible, systemic method for optimizing human performance in general, and increasing safety in particular, by Recognizing the inherent human factors that cause errors and the reluctance to report them

19. Crew Resource Management Recognizing that in complex, high risk endeavors, teams rather than individuals are the most effective fundamental operating units Cultivating and instilling customized, sustainable and team-based tools and practices that effectively use all available resources to reduce the adverse impacts of those human factors.

20. Communication Introductions SBAR Hand-Off Communication Team Lead One Voice Closed Loop Communication

21. Situational Awareness

22. Assertiveness “A single hesitant attempt to communicate important data fails to discharge individual responsibility.” Kanki & Palmer

23. Assertiveness Opening State a concern or owned emotion State the problem Offer a solution Obtain agreement

24. SMART Scenarios Hemorrhagic CVA DKA DVT/PE Asthma CHF SVT COPD Pneumonia

25. Desired Outcomes Improved Quality of Care Reduced Errors Reduced Turnover Rates Improved Patient & Staff Satisfaction

26. Questions?

27. References Bloom, B. (1956). Taxonomy of Educational Objectives: Handbook 1: The Cognitive domain. New York. David McKay. Olejniczak, E. A., Schmidt, N. A., & Brown, J. M. (2010). Simulation As an orientation Strategy for New Nurse Graduates: An Integrative Review of the Evidence. Simulation in Healthcare, 52 - 57. Shepherd, I., Kelly, C., Skene, F., & White, K. (2007). Enhancing Graduate Nurses' Health Assessment Knowledge and Skills Using Low-Fidelity Adult Human Simulation. Simulation in Healthcare, 16- 24. Marshall, David. (2010). Crew Resource Management: From Patient Safety to High Reliability. Safe Health Care.