Transcript NRP 6th Edition Instructor Update - Mother

NRP 6th Edition…Teaching the Course
Major problems with current NRP
teaching methods 
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A “perfect” score does not help the learner.
We often learn best from our mistakes.
Simulation allows us to push learners to
fail in difficult situations and learn from
these failures.
Failure should happen during training,
NOT patient care
Instructor Requirements
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Each instructor watches the NRP Instructor
DVD and completes the post-test by
January 1, 2012.
Beginning January 1, 2013, every
instructor takes the online exam in the 2
years prior to renewal, at no cost.
Teach, or co-teach, 2 courses in 2 years
NRP Course Basics
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Lessons 1-4 and 9, minimum
Everyone can practice and perform every
skill.
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NRP does not certify competence or change
legal scope of practice.
Provider status is “renewed” every 2 years
NRP Course Revisions
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No separate provider and renewal courses
Minimal lecture and no slides
Students self-study the textbook and/or
DVD
Students take the online exam prior to class
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No more hard copy tests after Dec 31, 2011
Instructor:learner ratio = 1:3-4 learners
If your card “expires”???
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The institution decides the employee’s fate
Provider Course Components
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Performance Skills Station for practice
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Integrated Skills Station for evaluation
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Choose all or select skills based on student
expertise
Required
Simulation and Debriefing for learning
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Required
Structuring of renewals 
The one-person, quick check is an
inefficient use of instructor time and
interferes with simulation and debriefing.
The “solo” NRP skills check-off
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The learner should be aware of his/her
expiration date and plan accordingly.
Providing “solo” NRP skills check-offs is
NOT the instructor’s responsibility and IS
NOT how we will conduct NRP skills
check-offs at Cape Fear Valley.
Performance Skills Stations
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Reinforces cognitive learning
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This is where you may choose to quiz the learner’s
knowledge.
The learner practices or reviews hands-on skills
with an instructor
When the learner feels confident in his/her skills,
the instructor gives a short scenario that begins
with the Equipment Checklist.
There is no scoring or grading.
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The Performance Checklist is used as a reference.
Simulation & Debriefing
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Now a requirement of the Provider Course
Provides a safe setting for integration of
cognitive and technical skills, team
communication, and patient safety
Confidentiality is essential for participation
No one fails simulation and debriefing, but
this is where the learning happens!
The Art of Simulation
What’s wrong with how we have
been doing things?
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We have fallen into the trap of “feeding”
too much information to learners
With the loss of reality, we have a tendency
to let learners talk their way through
scenarios
Are we doing them a favor by continuing
this method? NO
Why simulation????
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The more objective clues that we can
provide to learners, the more realistic the
practice can be.
Hi-fidelity simulation requires…
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$$$ for purchase and maintenance
Space for secure storage
Staff who know how to run and maintain
the equipment
Technical knowledge for problem-solving
Low-tech simulation methods….
moulage…
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Spray blood – make your own with red
fingerpaint, blue dishwashing liquid, baby
oil
Meconium – pureed baby food
Vernix – Eucerin with potato flakes
Create the illusion, but don’t overdo it
CLEAN UP!!!
How are WE going to do it???
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Moulage….
Low-tech
Video
How are WE going to do it???
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Reorganized NRP teaching kits
Moulage…no, but….
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Red cloth = blood
Green cloth = meconium
Spray with water for wetness
If available, we will use a vacant warmer
Simulated equipment panel – Simply NRP
How are WE going to do it???
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Physiologic signs
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Breathing, crying
Tone
HR – metronome
O2 saturation
Preparing for effective simulation
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Supplies and equipment
Physiologic feedback
Team member orientation and role
designation
Confidentiality
Instructions and expectations
Supplies and Equipment
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Learners need to find the equipment and
handle it
Learners perform the equipment check
using the Quick Pre-Resuscitation
Checklist
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This will cue learners to be sure that they
have essential items.
Physiologic Feedback
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How will learners know the HR or if the
baby is breathing?
We have to familiarize learners with how
we will be giving this information
Information is not revealed until the learner
performs the appropriate assessment action
and/or asks for the information
Team Member Orientation and Role
Designation
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Let learners get to know each other
Learners should wear visible nametags
with their designated role
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Important especially if filling a role outside
their normal
Remind learners that acting in a role different
than their everyday role does not authorize
them to perform skills outside their scope of
practice in real life
Confidentiality – The Vegas Rule…
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Learners have the right to confidentiality and
confidence that scenarios will not be held against
them in a punitive way
All events are confidential
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Protects the learner
Protects the confidentiality of the scenario for use in
future classes
The events of simulation and debriefing are NOT
part of the learner’s performance evaluation
Confidentiality – The Vegas Rule…
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Consent for filming
If the exercise is filmed, the tape is erased at the
end of the course, unless the learner has given
written permission for its additional use
Instructions and Expectations
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Learners need to know the “rules of the game”.
Mistakes are acceptable!
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The best learning may come from an error.
The goal of simulation and debriefing is NOT
perfection….it is learning.
Laughing and joking are not acceptable during
resuscitation…so, they are not acceptable during
simulation!
The instructors NEVER trick the learners (ie.
sabotaging the scenario)
Instructions and Expectations
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Learners need to think out loud.
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Helps other team members and instructor know what
they are thinking and why
Helps to promote a common “mental model”
Learners need to actually perform the actions,
NOT simply say they are doing or would do
something
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The exception to the rule is administration of fluid
and epinephrine. Draw up the med first. Then expel
on bed linen and simulate administration.
Instructions and Expectations
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Everyone participates during a simulation.
Team members may help each other in any
way that is plausible to the scenario.
Communication and teamwork are
encouraged and expected!
The instructor, NOT the learner, indicates
when the scenario has ended.
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“The scenario is over. Let’s debrief.”
Instructor Roles
What do I do as an instructor?
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It is difficult for one instructor to do
everything during a scenario.
Instructor #1 – watch the scenario and
responses and give the physiologic cues
Instructor #2 – video, take notes about
what happens and plan for debriefing
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Set video recorder on tri-pod
Conducting a scenario
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Learners benefit from participation in more
than one scenario.
Once learners know the ground rules, begin
with a simple scenario. Then, progress to
more complex scenarios that push learners
outside their comfort zones.
Conducting a scenario
Preparation for the actual scenario
 Prepare the manikin with the appropriate
visual cues.
 Define instructor roles.
 Read the scenario.
 Allow learners to ask about relevant
perinatal history.
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Gestational age, fluid color, etc.
Conducting a scenario
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Allow learners to –
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Designate roles – assign leaders and tasks
Check supplies and equipment
Ask additional questions if needed
Announce when the scenario has begun.
Depending on the complexity of the
scenario, other “players” may be used to
provide cues and enhance reality.
Conducting a scenario
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Once the scenario begins, stay out of the way as
much as possible.
For complex scenarios, be prepared to answer
questions about information like confirmation of
endotracheal tube placement and other
resuscitation indicators.
DO NOT give hints or additional information
beyond what learners must ask to assess the
effects of their actions!
Conducting a scenario
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Allow learners to take the scenario down
the path they choose without interruption,
coaching, or feedback.
Preparing for the debriefing
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Use the Scenario Template form to take notes.
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Video helps…the camera doesn’t lie!
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Check off the interventions performed as they
happen.
Note unexpected occurrences.
Pay attention to which behavioral objectives were
met and how that occurred.
Note which segments hold key information.
Note the learners who are especially dominant or
submissive.
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This can effect the debriefing strategies you use.
Managing the unexpected
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Unexpected things can happen during a scenario
(ie. equipment dropped, med error, mental model
not shared).
If this is an event that can happen in real life,
learners should solve the problem.
If the scenario continues for a long time and drifts
far off-track, the instructor may need to assess the
need to end the scenario and debrief without
successfully resuscitating the baby.
Managing the unexpected
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When a scenario problem or need for
redirection occurs, the instructor can send
in a “confederate” to play a certain role for
a specific purpose.
The “confederate” is not one of the learners
participating in the scenario.
Examples of using a “confederate”
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A learner cannot stop giggling. So, the
instructor sends in the “baby’s grandfather”
to remedy the situation by saying – “I’m
this baby’s grandfather, and I’d like to
know what is so funny. This looks like a
pretty serious situation to me.”
Examples of using a “confederate”
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Some scenarios can be very complicated
and involve may players with a planned
script. It is appropriate to have the
“confederate” play a set role.
Ending a scenario
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End the scenario with an objective
statement like – “That ends your scenario.
Let’s debrief now.”
The instructor does not end a scenario with
a judgmental statement like –
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“That was great”. OR
“Well, okay. We have a lot to talk about.”
Ending a scenario
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Is it okay for a scenario to end with the
baby’s death?
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Yes, if that is part of the learning objectives
or if there is an egregious error.
NEVER to “punish” the resuscitation team
for errors made during the scenario.
Debriefing
Debriefing is the most challenging
new skill for NRP instructors
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We’ve been taught to lecture and give feedback.
New role is direction of a team-centered
discussion by asking open-ended questions.
The learners will discover for themselves what
went well, what needs improvement, and how
NRP Behavioral Skills impact the outcome.
Give input at the end of the discussion.
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Summary of main points, next steps,
acknowledgement of good efforts
Ready, Set, Go….
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Review “Ready, Set, Go Instructor Prep
Sheet” and “Simulation Preparation, Tips,
and Sample Debriefing Questions”
References
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Kattwinkel, J., Perlman, J.M., Aziz, K., Colby, C., et. al.
(2010). Special Report - Neonatal Resuscitation: 2010
American Heart Association Guidelines for
Cardiopulmonary Resuscitation and Emergency
Cardiovascular Care. Pediatrics, 126(5), e1400-e1413.
Zaichkin, J. (Editor). (2011). Neonatal Resuscitation:
Instructor Manual. American Academy of Pediatrics.