APNA 29th Annual Conference Session 3034: October 30, 2015 - PDF document

APNA 29th Annual Conference Session 3034: October 30, 2015 Understand the process of the development of high- 1. fidelity simulation experiences for nursing students. Describe the nursing faculty role in high-fidelity 2. simulation. Joanne M. Matthews DNP, APRN, PMHN-CS, BC Recognize the importance of student and faculty 3. University of Kentucky College of Nursing feedback to promote improvement in the simulation Lexington, Kentucky experience. Speaker has no disclosures to reveal. SIMULATION EXPERTS NURSING FACULTY Tammy Courtney MSN, RN Leslie Beebe, MSN, RN   Jennifer Dent MSN, RN Holly Gray DNP, RN   Understand the process of Paula Kral MSN, RN Joanne Matthews, DNP, APRN,   the development of PMHCNS-BC Mary Jayne Miller BSN, RN  high-fidelity simulation Stephanie Steele, BSN, RN Greg Williams MBA   experiences for nursing students. Terminology Needs Assessment I. 1. Measurable objectives Professional Integrity of Participants 2. II. Clinical case or scenario 3. III. Participant Objectives Select the format 4. IV. Facilitation Fidelity 5. Facilitator Briefing / Pre-briefing V. 6. VI. Debriefing Debriefing 7. Evaluation VII. Evaluation 8. Participant preparation 9. VIII. Simulation-Enhanced Interprofessional Education Pilot testing 10. Simulation Design IX. Matthews 1

APNA 29th Annual Conference Session 3034: October 30, 2015 Why this topic? Why use simulation? All nurses care for patients with substance use disorders (SUDs).   Approximately 25-40% of all hospitalized non-mental health Simulation experiences promote a safe, non-competitive  patients have a substance use disorder. learning environment fostering student clinical judgment and Increased the number of patients admitted to inpatient psychiatric reasoning.  units with a dual diagnosis. Inconsistent practice for patients experiencing withdrawal. Provide feedback to students and instructors.    Leading to confrontational nurse-patient interactions  Decreased nurse and patient satisfaction Highly rated by students to enhance retention of content.   Poorer patient care outcomes. Suicide has been ranked one of the top 5 sentinel events 2004-2014.  Identifies the signs and symptoms of sedative-hypnotic 1. (alcohol) and opioid withdrawal. 1. Millie Potter: Applies the nursing process in safely caring for a patient 2. Caring for a patient experiencing severe alcohol during medically assisted withdrawal. withdrawal with delirium tremens and Uses a standardized assessment protocol to determine 3. medication management of withdrawal symptoms. hallucinations with history of falls and c/o vomiting Cooperates with others using an objective approach in 4. blood.. problem solving. Applies knowledge to influence decisions regarding plan 5. 2. Randy Smith: of care for patient based on the patient’s assessment. Caring for a patient experiencing opioid withdrawal Initiates correct nursing skill based on assessment of 6. patient. with a suspected overdose and suicidal ideation with Identifies changes in patient condition. 7. IV drug abuse and psychosocial needs . Demonstrates therapeutic communication with patient. 8. Collaborates effectively with team members. 9. 2 one-hour simulation experiences  First semester senior nursing students enrolled in Psychiatric  Nursing High fidelity mannequins  Mock hospital rooms  Audio/visual observation  Respond to students in real time.  EBP assessment instruments  Realistic treatment protocols  Mock Hospital Room Matthews 2

APNA 29th Annual Conference Session 3034: October 30, 2015 Voiceover  Practice scenarios  Instruments:   The Clinical Institute Withdrawal Assessment of Alcohol Scale, Revised (CIWA-Ar)  The Clinical Opiate Withdrawal Scale (COWS)  CAGE-Aid  ASQ Suicide Risk Assessment Divided clinical groups into TEAMS: 4-5 for each scenario Ask positive questions first.  Defined role descriptions and responsibilities What went well?    Team leader What did you like most?   Assessment What did you learn?   Documenter Do you have any questions ?   Medication administration Socratic Questioning Given SBAR report to all students. How did the team make the   Introduced to room /room boundaries. decision to give acetaminophen  instead of ibuprofen? Opportunity to ask questions.  What other interventions might Team conferenced to set plan of action.   have been considered to decrease the patient’s anxiety? One take-away point from  each participant. What was the impact of the  patient’s behavior (hallucinations Acted as summary  and yelling) on the team’s ability to think critically or provide care? Utilize INACSL standards  Obtain peer review of content   and scenarios Describe the Collaborate with simulation experts  nursing faculty role  Content development in high-fidelity simulation.  During simulation  In debriefing Foster positive learning environment  Matthews 3

APNA 29th Annual Conference Session 3034: October 30, 2015 Faculty Role Start Administer CIWA-Ar per protocol Stop Qty/ Alert Recognize the importance PRN / ONE TIME DOSE / OTHER / LISTED BELOW of student and faculty Start Valium 10mg prn per protocol Stop PO Qty/ For repeat CIWA-AR score of 15 or feedback to promote Alert greater Start Vistaril 25mg – 50 mg improvement in the Stop PO Qty/ Every 8 hours prn for sleep or simulation experience. Alert anxiety Start Phenergan 25mg Stop IM Qty/ every 4-6 hours prn for observed Alert vomiting Start Ibuprofen 600 mg Stop PO Qty/ q6h prn pain Alert Start Trazadone 50mg Stop PO Qty/ qhs prn sleep. May repeat in 1 Alert hour. Start Acetaminophen 650 mg Stop PO Qty/ q4h prn pain or fever above 101 Nurture, nurture, nurture. Alert degrees F Students provided voluntary unsupervised feedback via a  Performed a retrospective review of nursing student responses computerized survey. to survey questions evaluating a simulation experience. Responses were anonymous with no identifying information.  The exercise was formative and ungraded.  Responses were collated by the simulation team and sent to the Total responding: n = 118   faculty coordinator/PI of study.  81 students in Fall 2014 (n = 66)  80 students in Spring 2015 (n = 52) Age range between 20 and 35 years  University of Kentucky IRB Exemption Certification # 15-0507-X2B Quantitative Results Added The Following Questions Fall 2014 & Spring 2015 Quantitative Evaluation in Spring 2015 Qualitative Evaluation Active Learning What skill or aspect   challenged you the most? Collaboration  Did you feel prepared to Diverse Ways of Learning   handle it? High Expectations  What would you change Objectives and Information   about this simulation to Support  improve it for future Problem Solving  students? Feedback / Guided Reflection What did you find   Fidelity / Realism particularly helpful or  weak about the debrief Satisfaction with Current  discussion? Learning Self-Confidence in Learning  Matthews 4

APNA 29th Annual Conference Session 3034: October 30, 2015 Qualitative Results Quantitative Results What skill or aspect of this simulation challenged you the most? 30 21 8 6 2 3 2 n = 66 Qualitative Results Qualitative Results 79% 20 20 6 5 4 2 21% Qualitative Results Patient centered care  Teamwork and collaboration  Using EBP  Safety  QI  Informatics  Matthews 5

APNA 29th Annual Conference Session 3034: October 30, 2015 Pre-Briefing  Medication Order Sheet Have fun!   Be open to Opioid Protocol   feedback! Fidelity  Encourage learning! Scenario   Be willing to change!  Courtney, T. (2015). Debriefing. PowerPoint presentation at the  University of Kentucky College of Nursing, Lexington, KY. Gore, T. (2015, August). Curriculum Integration of the INASCL  Standards of Best Practice: Simulation. PowerPoint presentation at the University of Kentucky College of Nursing, Lexington, KY. Jeffries, F.R. (2005). A Framework for designing, implementing, and  evaluating: Simulations used as teaching strategies in nursing. Nursing Education Perspectives 26 (2)96-103. The International Nursing Association for Clinical Simulation &  Learning accessed at http://www.inacsl.org/i4a/pages/index.cfm?pageid=1 Matthews 6