Simulation Design Template
Date: 2/3/09 File Name: Mr. Burns Pain Simulation
Discipline:Nursing Student Level:Freshmen
Expected Simulation Run Time: 5-10min Guided Reflection Time: 15-20
Location: LRC Location for Reflection: LRC
Admission Date: 2/1/09Today’s Date: 2/3/09Brief Description of Patient:
Name: Mr. Melvin Burns Gender: M Age: 63 Race: Caucasian
Weight: _70kg Height: _180_cm
Religion: Protestant Major Support: Wife
Phone:
Allergies: NKA
Immunizations: Flu Vaccine 11/08
Attending Physician/Team: Dr. Vivian
Past Medical History: 3 days post R knee replacement. Physical therapy daily
History of Present illness: Surgery on 2/1/09
Social History: Lives with wife of 30 years
Primary Medical Diagnosis:
Surgeries/Procedures & Dates: Total R knee 2/1/09 / Psychomotor Skills Required prior to simulation:
Students should have attended "communication lecture" as well as "comfort therapy lecture" in N111.
Basic understanding of empathy and using therapeutic communication skills.
Basic understanding of non-pharmocologic comfort measures for patients experiencing pain.
Cognitive Activities Required prior to Simulation: i.e. independent reading (R), video review (V), computer simulations (CS), lecture (L)
Lecture: Therapeutic Communication
Reading: " "
Lecture: Comfort/Pain Therapy
Reading: " "
Video: Introductory Video to Mr. Burns Simulation, 5 minutes in length.
Simulation Learning Objectives:
1. The student will be able to assess Mr. Burns' level of comfort using the nursing process.
2. The student will be able to provide nursing interventions to address the need for increased level of comfort.
3. The Student will be able to formulate a nursing diagnosis and plan of care for Mr. Burns as a post-reflection activity.
Quality and Safety Education For Nurses(Chose applicable QSEN Competencies) / 'QSEN Coordinated'
Student Learning Objectives for Simulation Experience
(KSA's)
√ Patient-centered Care:
Recognize the patient or designee as the source of control and full partner in providing compassionate and coordinated care based on respect for patient's preferences, values, and needs. / Knowledge
1. Integrate understanding of multiple dimensions of patient-centered care: Patient / family / community preferences, values; Coordination and integration of care; Information, communication, and education; Physical comfort and emotional support; Involvement of family and / or friends; Transition and continuity
2. Examine how the safety, quality, and cost-effectiveness of healthcare can be improved through the active involvement of patients and families
3. Describe strategies to empower patients and families in all aspects of the health care process
4. Discuss principles of effective communication
5. Examine nursing roles in assuring coordination, integration, and continuity of care
Skills
1. Provide patient centered care with sensitivity and respect
2. Assess presence and levels of pain as well as physical and emotional comfort
3. Engage patients and surrogates in active partnerships that promote health, safety and well-being and self-care management
4. Communicate care provided and needed at each transition in care
Attitude
1. Respect and encourage individual expression of patient values, preferences and expressed needs
2. Appreciate the role of the nurse in relief of all types and sources of pain and suffering
3. Value active partnerships with patients or designated surrogates in planning, implementation, and evaluation of care
4. Value continuous improvement of own communication and conflict resolution skills
√ Teamwork and
Collaboration:
Function effectively within nursing and inter-professional teams, fostering open communication, mutual respect, and shared decision-making to achieve patient care. / Knowledge
1. Recognize contributions of individuals and groups to help patients / family achieve health goals
2. Discuss effective strategies for communicating and resolving conflict
3. Describe examples how team functioning impacts safety and quality of care
4. Identify barriers and facilitators of effective team functioning
5. Examine strategies for improving systems to support team functioning
Skills
1. Act with integrity, consistency, and respect for differing views
2. Assume the role of team member or team leader based on the situation
3. Integrate the contributions of others who play a role in helping patient / family achieve goals
4. Solicit input from other team members to improve individual, as well as team performance
5. Follow communication practices that minimize risks associated with handoffs among providers and across transitions in care
Attitude
1. Respect the unique attributes that members bring to a team
2. Appreciate importance of intra- and inter-professional collaboration
3. Value teamwork and the different styles of communication used by patients, families and health care providers
4. Appreciate the risks associated with patient information handoffs
Fidelity (choose all that apply to this simulation)
Student Information Needed Prior to Scenario:- Has been oriented to simulator
- Understands guidelines /expectations for scenario
- Has accomplished all pre-simulation requirements
- All participants understand their assigned roles
- Has been given time frame expectations
Time: Approximately 5-10 minutes
References, Evidence-Based Practice Guidelines, Protocols, or Algorithms used for this scenario: (site source, author, year, and page)
NCLEX Test Plan Category (bolded areas are included in the simulation)
Safe, Effective Care Environment
Management of Care
- Advanced DirectivesClients RightsCollaboration
- AdvocacyConfidentialityDelegation
- Case ManagementEstablishing PrioritiesInformed Consent
- Legal rights and responsibilitiesPerformance ImprovementReferrals
- Staff EducationResource managementSupervision
Safety and Infection Control
- Accident PreventionDisaster PlanningError Prevention
- Emergency Response PlanHandling Hazardous and Infectious Materials
- Injury PreventionMedical and Surgical AsepsisSecurity Plan
- Reporting of Incident EventSafe Use of EquipmentRestraints
- Standard / Transmission Based Precautions
Health Promotion and Maintenance
- Aging ProcessAnte/Intra/Postpartum and Newborn Care
- Developmental StagesDisease PreventionFamily Planning
- Expected Body Image ChangesFamily SystemsGrowth and Develop
- Health and WellnessHealth PromotionHealth Screening
- High Risk BehaviorsHuman SexualityImmunizations
- Lifestyle choicesSelf CarePhysical Assessment
Psychosocial Integrity
- Abuse / NeglectBehavioral InterventionsCrisis Intervention
- Chemical DependencyCoping MechanismsCultural Diversity
- End of LifeFamily DynamicsGrief and Loss
- Mental Health ConceptsPsychopathologyStress Management
- Religious and Spiritual InfluencesSensory / Perceptual AlterationsSupport Systems
- Situational Role ChangesTherapeutic Communications
- Therapeutic EnvironmentUnexpected Body Image Changes
Physiologic Integrity
Basic Care and Comfort
- Alternative and Complimentary TherapiesAssistive Devices
- EliminationMobility / ImmobilityRest and Sleep
- Non-Pharmacologic ComfortPalliative / Comfort CarePersonal Hygiene
- Nutrition and Oral Hydration
Pharmacological and Parenteral Therapies
- Adverse Effects/Contraindications and Side EffectsDosage Calculation
- Blood and Blood ProductsCentral Venous Access DeviceIntravenous Therapy
- Expected Outcomes / EffectsMedication AdministrationParenteral Fluids
- Pharmacologic InteractionsPharmacologic Pain ManagementTPN
Reduction of Risk Potential
- Diagnostic TestsLaboratory ValuesVital Signs
- Monitoring Conscious SedationPotential for Alteration in Body Systems
- Potential for Complications from Surgical Procedures and Health Alterations
- System Specific AssessmentTherapeutic Procedures
Physiologic Adaptation
- Alteration in Body SystemsFluid and Electrolyte ImbalancesHemodynamics
- Illness ManagementInfectious DiseasesMedical Emergencies
- Unexpected Response to TherapiesRadiation TherapyPathophysiology
Scenario Progression Outline
Timing(approximate) / Manikin Actions / Expected Interventions / May use the following Cues:
2 minutes / Poor position in bed, wound bandaged, moaning and groaning. Asking "Can I have something for this pain?" / Student nurses should begin to assess Mr. Burns pain. Have him rate his pain on a scale of 1-10, identify the location and quality of pain. Remind Mr. Burns he is not due for his Tylenol #3 yet.
Should take his vital signs / Role member providing cue: TA
Cue: Is there a way we can assess his pain?
2 minutes / Wife interacts with Mr. Burns and begins demanding the student nurses do something for his pain. / Students should assess the site, offer to elevate the R knee, change his position, ask about what activities may help to keep his mind off the pain (music, TV, playing cards). / Role member providing cue: TA
Cue: Should we assess the site?
Are there any activities that would provide distraction?
2 minutes / Wife continues to be demanding and very emotional...Mr. Burns continues to complain of pain. / The student nurses should look to alter his environment:
dim the lights, provide privacy, and some quiet time. Perhaps ask Mrs. Burns to "take a break" and "leave Mr. Burns rest. / Role member providing cue: TA
Cue: Should we ask Mrs. Burns to leave?
Debriefing / Guided Reflection Questions Utilizing QSEN Competencies:
(Adopted from the NLN Debriefing/Guided Reflection QSEN Overview for Laerdal Simulations, Volume II))
General opening questions frequently used to start the debriefing session:
Can someone give me a summary of the experience?
How did the experience feel?
What problems were identified?
What went well?
Patient-Centered Care:
Definition: recognize the patient or designee as the source of control and full partner in providing compassionate and coordinated care based on respect for the patient’s preferences, values, and needs.
Describe how you involved family members in the patient care being provided.
How did the patient describe his/her symptoms?
What have you learned from this patient?
Describe your assessment of this patient’s physical pain. Was this thorough? Did you miss anything?
Did you assess emotional pain/suffering? Why or why not?
Was the patient’s expression of pain impacted by culture/ethnicity?
What intervention did you apply for the patient’s pain? Was it effective? How do you know this?
How did you feel that you managed to “share decision making” with your patient?
Describe your communication with your patient. Appropriate boundaries? Therapeutic? Mutual respect?
Describe the level of “caring” that was demonstrated in your communication with your patient.
How did you handle the conflict between patient’s rights and organizational responsibility for patient care?
Discuss the level of empowerment you felt your patient exhibited. What did you do to facilitate empowerment?
How was your patient informed?
How was consent provided for procedures?
Did you feel that the patient received coordinated, continuous care during a transition of care? Why or why not?
Teamwork and Collaboration:
Definition: function effectively within nursing and inter-professional teams, fostering open communication, mutual respect, and shared decision-making to achieve quality patient care.
Describe your personal strengths and limitations as a team member.
Did you identify a leader in the clinical simulation experience?
Can you describe who the leader was?
Why do you think this person became a leader?
Describe the scope of practice of all participants in the scenario.
Did you feel that everyone functioned within the scope of practice? Why or why not?
Describe who you called for help.
What lead up to this request for help?
Describe your collaborative efforts.
Describe your utilization of resources available.
Were roles clear?
Was communication closed loop and clear? How do you know this?
Were all the contributions acknowledged and respected?
Was there a conflict? Was the conflict resolved? How?
Describe “systems” that support effective teamwork and ineffective teamwork.
Debriefing/Guided Reflection Overview
General wrap-up questions frequently used to close the debriefing session:
What will you take away from this experience?
What would you do differently next time?
What discoveries have you made?
What did you learn about yourself?
Complexity – Simple to Complex
Suggestions for changing the complexity of this scenario to adapt to different levels of learners:
Have participants repeat the simulation, selecting different roles the second time.
Have Mr. Burns develop shortness of breath or chest pain for a sophomore level/med/surg experience.
Include a heart monitor and have him develop Atrial Fibrillation.
Evaluation Log & Checklist of Competencies in Simulation Experience:
Simulation Topic:
Date of Experience:
Level of Student:
# of Students Participating:
Faculty Person Coordinating:
LRC Person Coordinating:
TAs Participating:
QSEN Competencies ID Attained Appropriateness/Barriers/Areas for Improvement
○ Patient Centered Care ○Y ○ N Provide Feedback:
○ Teamwork /Collaboration ○Y ○ N Provide Feedback: