Simulation in Schools of Nursing:Teaching with Pre-Programmed

ScenariosDarren P. Lacroix

Educational ServicesLaerdal Medical America’s

Statement of DisclosureParticipants must attend the entire session in order to earn contact hour credit.

Verification of participation will be noted by learner initial/signature on the roster.

Planners and presenters have declared the absence or presence of any real or perceived conflict of interest which might influence the planning of this activity.

Darren Lacroix has identified the following real or perceived conflicts of interest:

Darren Lacroix is an employee of Laerdal.

No commercial support has influenced the planning of the educational objectives or the content of this activity.

If there were any commercial support provided for this activity, it would be used for events that are not related to continuing education.

There is no endorsement of any product by the provider or NCNA associated with this activity.

It is expected that no presentation will relate to products governed by the Food and Drug Administration. But, during the course of this activity, if there is discussion related to such

products, FDA-approved and non-approved uses will be disclosed to participants.

Course Objectives

• Identify components of Pre-programmed Scenarios

• Discuss preparation requirements for a simulation to increase the simulation's psychological fidelity.

• Using a Pre-programmed scenario handout, locate and review the scenario's learning objectives, proposed correct treatment and debriefing content.

• Discuss the instructor’s role in planning, facilitating, and debriefing simulations.

• Demonstrate planning, facilitation, and debriefing of a clinical simulation.

So where do I get a pre-programmed scenario?

Purchased Scenario Packages

From your colleague or through networking

Begin With An End In Mind

• Assess curriculum and determine most appropriate scenario for your needs– Objectives and content in alignment with the

course goals and objectives– Appropriate level for learners

• Know when to end your simulation– Objectives met?– Time constraints

• Time for debrief– Instructor prepared to facilitate

• Instructors, learners, and facility are available

Review learning Objectives

• Verify that objectives match the program’s learning goals and the learner’s current skill level.

• When learning objectives are revised, update the content areas that are inter-dependent such the scenario file, props and other cues, and debriefing points

Review Correct Treatment

• Review the correct treatment guidelines – determine what behavior the learner should demonstrate during the simulation.

• Remember, any changes made to this area must also be addressed in the learning objectives and other interdependent content areas.

Review Debriefing Points

• Debriefing topics are usually anchored to the scenario’s learning objectives and educational content.

• Instructors are encouraged to remain flexible when formulating debriefing topics. Unexpected events may occur during a case that warrants exploration during the debriefing.

Review Scenario Files

Open then Scenario Editor

Review Scenario File

• The scenario file contains frames, actions, and event triggers.

• View using scenario editor.• Frames are like storyboards.• Key Terms:

– Actions– Events– Trends– Handlers

Anatomy of a Scenario File

¬ Patient information and patient monitor.

¬ Actions: control simulator.

¬ Handler: link learner’s performance and actions (optional).

¬ Event Output: trigger movement between frames.

¬ Trend: physiological change over time.

Review Event Menu

• Electronic checklist of customizable events.

• Events appear in Event Log when clicked by operator.

• Event may drive a change in simulator behavior

Review Physiological Trend

• Trends enable changes to vital signs over time.

• Trends may be altered to meet specific learning objectives.

• Saved trends may be inserted into any scenario

Review Event Handler

• Handlers link events to actions to create an automated response.

• Handlers may be customized and inserted into any scenario.

Prepare the Environment and Simulator

• According to evidence within the simulation literature, the psychological fidelity (realism) of a simulation is important to learners.

• Learner prefer cases that feel real

• “Simulated” simulation is not recommended!

Use Realistic Materials

Prepare Environment & Simulator

• Assemble Equipment and Medications – ECG monitor– Stethoscope and BP cuff– Crash cart– Chart– Medications

• Prepare the Environment– Examination room – Sounds (phones ringing, etc.)– People (assistants, physician, and technicians)

• Prepare the Simulator– Dress appropriately– Moulage as needed (blood, emesis, etc.)– Provide Props (pill bottles, inhaler, prayer beads, etc.)

Prepare the Learners

• Learners are more likely to succeed when they know what is expected of them

• Examine the simulator prior to the simulation. Review features and capabilities (voice, pulse points, drug administration, etc.)

• Permit the learners to acclimate to the new learning environment

• Review learning objectives.

• Discuss roles

• Report to student

Guidelines for the Lab

• Confidentiality is critical.• Set Expectations. • Treat the simulator as you would treat a real patient.• Act like you would in a real clinical situation.

– No food and drinks– No cell phones or text messaging– Dress appropriately

• Most labs require students to sign confidentiality agreements.• Develop Fiction Contract

Instructor’s Role during Simulation

• Behavioral guidelines for facilitating a healthcare simulation– Welcome the learners and communicate your expectations about

their clinical performance, affective behavior and professionalism. For example:

• “Welcome – You are about to participate in a simulated patient case. The patient has a chief complaint – I expect you to assess the patient and manage her to the best of your ability. Treat the simulated patient as an actual human patient. This case lasts approximately 10 minutes. We’ll debrief as a team following the case.”

– Emphasize the simulator’s features. For example: • “I expect that you will ask the patient questions and actually

assess their vital signs – please do not ask me for this information.”

– Permit the learners to ask questions prior to the simulation.

Instructor’s Role during Simulation

• Begin the case when the learners are ready• Observe the learners performance• Register events using the Graphic User Interface (optional)• The instructor must decide under what conditions they would

interrupt the simulation.– For example, safety-related violations that may injure a

learner warrant intervention while a learner’s deviation from the learning objectives is an opportunity for all parties to learn and may not warrant interruption

Let’s simulate!

1. Central Simulation, need volunteers to role play1. Primary Instructor (work with students)2. Secondary Instructor/Tech (work with computer)3. Primary Student Nurse4. Secondary Student Nurse5. Crowd: Observers

2. Divide into groups and replicate same central simulation1. Laerdal Representative at each table2. Prep/Run session ~10-15 min

3. Debrief as a group to share learning/discovery

Questions or Comments

Next Steps

• Practice….• Set realistic goals• Develop an action plan• Faculty enrichment/Continuing Education/Staff Development• Budget for formal training

– Time: Hands-on time with Simulator– Financially: Custom training with Simulation Experts

• Networking• Set time lines and realistic goals

Simulation User Networkhttp://simulation.laerdal.com

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