Simulation as a Capstone Clinical Performance Assessment

1. Simulation as a Capstone Clinical Performance Assessment Diane Joyce, RN, MSN, APNP Connie Lindmeier, RN, MSN

2. Objectives Discuss how the PCNI can be adapted within an individual nursing course Explain how simulation is used within a clinical capstone nursing course Demonstrate how student individual clinical performance is assessed against the course competencies

4. Introduction Wisconsin Technical College System 16 nursing programs Course Competencies and performance standards created

5. Nursing Clinical Transition: Course Description This clinical experience prepares the student to assume the role of graduate nurse. The course promotes clinical decision-making, delegation, and collaboration to achieve client and organizational outcomes. Continued professional development is fostered.

6. Introduction Description of our lab: 2 Sims, 1 METI, 1 NOEL, 2 Vita Sims, 1 I-Stan coming to EMS nursing can share�. 2 Description of our lab: 2 Sims, 1 METI, 1 NOEL, 2 Vita Sims, 1 I-Stan coming to EMS nursing can share�. 2

11. Objective 1 Adapting PNCI

12. Objective 1 Adapting PNCI Start with the Shift Report History/information from PCNI is great baseline Adopt for your area This is a 52 year old female, who came in last pm. Shirley Jones DOB 2-1-1955, with a 10 year hx of alcohol abuse. She is married with 1 grown daughter. She is employed full time but has been increasing absent from work in past 6 months due to complaints of lethargy and fatigue. PMH is alcoholic cirrhosis dx 18months ago. Endoscopic banding for varices 6 months ago. Home medications: Lactulose, an antibiotic (name unknown) for bronchitis � (she was seen in the office 4 days ago and dx with bronchitis), oral metronidazole, and aldactone. During the noc, she was swatting at flies in the air that were not there, insisted that there were spiders crawling on the wall,and stated she �wanted to leave the house to catch a bus�. Some colleges just take it right out of the PCNI book, we chose not to, important to also talk about how we have to let Charlie know about stages to know when to change or pause the program. Now we know more/3rd/COPD/Heart failure/Diabetes/ 2nd/maternal child/ Some colleges just take it right out of the PCNI book, we chose not to, important to also talk about how we have to let Charlie know about stages to know when to change or pause the program. Now we know more/3rd/COPD/Heart failure/Diabetes/ 2nd/maternal child/

13. Objective 1 Our Faculty Worksheet Discuss: PNCI and the states and faculty direction Get a copy to discuss��.bring a copy of theirsDiscuss: PNCI and the states and faculty direction Get a copy to discuss��.bring a copy of theirs

14. Objective 1 Mandatory Student Preparation Prep Questions Adaptation from PNCI Be sure to compare to your required texts We add additional, for example more pharmacology and related labs, developmental tasks, community resources So all students are prepared, accountability, teamwork.. Students get frustrated when not prepared�� Students report they have more difficulty if they just memorize facts versus use questions to broadly care for a client with a disease of the system. IT is a system focus not a disease like on the PNCISo all students are prepared, accountability, teamwork.. Students get frustrated when not prepared�� Students report they have more difficulty if they just memorize facts versus use questions to broadly care for a client with a disease of the system. IT is a system focus not a disease like on the PNCI

15. Objective 2 Explain how simulation if used within a clinical capstone nursing course. 2 credit clinical course Math competency Seven weeks of 5 hour simulations Eight student in each clinical group Four students simulation/four case studies Four hours of presentations on community agency Capstone paper on how the student met the program outcomes 40 hours of precepted experience in one week Hybrid course/discussion groups Two hour capstone individual simulation test out. Many key features to this course: Community research agency presentation (expose students to the agencies in the area that they may refer to as a graduate nurse) Self-reflection Capstone Paper Identifying how the student met the program outcomes. Many key features to this course: Community research agency presentation (expose students to the agencies in the area that they may refer to as a graduate nurse) Self-reflection Capstone Paper Identifying how the student met the program outcomes.

16. Objective 2 Key features to this course Simulation is key to expose to what a graduate nurse will be involved with Taking telephone MD orders Calling MD with change in client condition Role of the RN from assessment, medication administration, communication, critical thinking, documentation Delegation Teamwork

17. Objective 2 Key Features Case studies Sound and worth the student effort Case studies that involve calling MD and giving report Receiving telephone orders Critical thinking and identifying if the MD order is appropriate for the client or not and if not provide the rationale why not

18. Objective 2 Key Features Community research agency presentation Expose students to the agencies in the area that they may refer to as a graduate nurse Self Reflection Capstone Paper Identifying how the student meet there program outcomes

19. Objective 2 Roles of team Lead RN Documentation/Debriefing leader Medication Resource The literature and previous presentations here at METI gave us this direction for roles. However, We strongly believe in NO MORE than 4 in the room at a time�.. Tell the story of Pam and non-compliant/non-team playing faculty. This can become an issue amongst faculty and students. Watching but NOT connected to the scenario.The literature and previous presentations here at METI gave us this direction for roles. However, We strongly believe in NO MORE than 4 in the room at a time�.. Tell the story of Pam and non-compliant/non-team playing faculty. This can become an issue amongst faculty and students. Watching but NOT connected to the scenario.

20. Objective 2 7 Simulations in the course anaphylaxsis, liver failure, renal failure, DKA, heart failure, SIADH/DI, pulmonary emboli The goal for a consistent learning experience** Academic freedom. New faculty/adjunct, this way we can mentor her students, same experiences for all. However, we have done both successfully but faculty were consistent with evaluation methodolgies.Academic freedom. New faculty/adjunct, this way we can mentor her students, same experiences for all. However, we have done both successfully but faculty were consistent with evaluation methodolgies.

21. Confidentiality Statement We enforce HIPPA by expecting no discussion of scenarios with other students outside of the scheduled course just as we would expect this in an actual clinical setting. Example: When you found the papers at the hospital by the printer during clinical. Example: We facilitate no cheating. We keep all prep work, repeating students resubmitting work Example: When you found the papers at the hospital by the printer during clinical. Example: We facilitate no cheating. We keep all prep work, repeating students resubmitting work

22. Videotaping Videotaping��.. Critique each other� So they can actually see what we are seeing.. Especially if they are failing� Faculty can review and see at a later time student performance since you seem to miss a few things when are in the sim lab and the scenario is running. Again, rationale for 4 in at a time. Give examples: Abigail/Cyndy/Tracy Hair touching, unsterile techniques, skills and assessments.Give examples: Abigail/Cyndy/Tracy Hair touching, unsterile techniques, skills and assessments.

23. Objective 3:Demonstrate how student individual clinical performance is assessed against the course competencies This is a performance-based course designed around 9 competencies. Again, these competencies were created as part of the WTCS and we can not change them.

24. #1. Adapt communication style based on analysis of the situation One student calls MD for report One student calls pharmacy or lab for clarification of meds or to obtain stat lab data One student communicates with wife � role played by staff member of our learning lab One student needs to write a nursing note on the simulation. How PNCI adapt to evaluate students: First student � completes and verbalizes the abnormal findings (key hear is to guide the student to only tell you the abnormal) Next student � review the assessment assist if anything is missing and then critically analyze the data and verbalize what you anticipate is happening How PNCI adapt to evaluate students: First student � completes and verbalizes the abnormal findings (key hear is to guide the student to only tell you the abnormal) Next student � review the assessment assist if anything is missing and then critically analyze the data and verbalize what you anticipate is happening

25. #2. Assess the needs of clients, families, and groups within the community One student completes the physical assessment One student interprets the lab and correlates it with the patient assessment One student responsible for assess the family needs and/or discharge needs One student based on the physical assessment decides what medications need to be administered and if they should be administered.

26. #3. Make relatively independent clinical decisions One student decides when to call MD All students write down the anticipated orders from the MD or what they think the MD should order before the call is made One student may start the O2 if saturation is low One student will look at the environmental picture and put side rails up or call light.

27. #4 Accept accountability for care Show up and are on time for clinical Have prep questions completed and turned in Practice or verbalize whether they can complete certain orders ie pull ETT Maintain confidentiality of simulations

28. #5 Manage Multiple Priorities Assess priorities of how they implement the MD orders Give IV fluids before start IV antibiotic Put Oxygen on when saturations warrant Lower or raise the head of bed based on assessment Delegate to other students to get vital signs and oxygen saturations

29. Objective 3 Competencies Continued #6 Work collaboratively to achieve client and organizational outcomes #7 Delegate Nursing Care # 8 Provide safe and effective care that considers the uniqueness of the client Check name bands Check for allergies Know the medications and reasons why they are to be given Safely performs skills against schools checklists #9 Assume responsibility for professional development

30. Our research n=73 Really explain Pam didn�t chose deliberately to provide the opportunity to do.Really explain Pam didn�t chose deliberately to provide the opportunity to do.

31. Survey:Two open ended questions Please write in suggestions and comments below. What worked, what didn�t work, and any suggested changes. What specifically did you learn that you will use in your practice.

32. Themes Want longer time in the sim lab Liked Calling MD and doing MD orders Teamwork Prioritization Confidence Delegation Importance of having to know labs/meds #2 was a conflicting message. ___% that agreed to time, yet this was the highest write-in comment about wanting more time� #2 was a conflicting message. ___% that agreed to time, yet this was the highest write-in comment about wanting more time�

33. Favorites �Get a good long orientation� �Think on my feet� �More time spent learning this type of material here than in clinical� �Learned my areas of weaknesses and what I need to improve in� �I learned to trust what I heard, felt, saw, etc�� �Believing in myself�

34. Simulation In Nursing Education: From Conceptualization to Evaluation (2007) Jeffries, P.R. DNS, RN, FAAN

35. Contact us: Diane Joyce joyce@ntc.edu Connie Lindmeier lindmeie@ntc.edu