Transcript What if it were your child?

What if it were
your child?
Incorporating Patient Simulation Into New
Graduate Orientation
Wendi Bowers, RN, BSN, CCRN-P,
Pediatric Clinical Coordinator
Pediatrics and Pediatric Critical Care
WHO WE ARE
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Pediatric Services devised of:
 26 bed general pediatric medical/surgical unit
 Care of children ranging from birth to 18 years of age
 10 bed Pediatric Intensive Care Unit (PICU)
 Care of critically ill children ranging from birth to 18 years
of age
Two Pediatric Intensivists
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Dr. Griggs
Dr. Banner
Average length of stay (LOS):
 Pediatric unit 2.8 days
 PICU 6.8 days
Turnover rate 2007 was 12.38%
 Organizational goal is less than 10%
PEDIATRIC MISSION STATEMENT
Our mission is to make a positive
difference in the lives of children
and their families by providing
supportive and compassionate
healthcare throughout all stages
of life.
WHAT WE KNOW
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Preparing beginner nurses to provide care
to complex patients is difficult.
Challenges are amplified when the patient
is a child.
Limited exposure to the variety of ages
and diseases unique to the pediatric
patient.
Child at risk if the nurse is unable to
properly identify pediatric emergencies.
WHAT WE KNOW
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Incorporating Pediatric simulation
scenarios into unit based new graduate
orientation provides the beginner nurse
with the opportunity to enhance
assessment and critical thinking skills.
Development of these skills reduces the
incidence of “failure to rescue”, builds
clinical confidence and competence which
all contribute to enhanced job satisfaction
and retention
MODELS
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Benner Model for nursing competency
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Novice
Advance Beginner
Competent
Proficient
Expert
Synergy Model
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Needs and characteristics are matched
Competencies
Improve outcomes
SYNERGY MODEL
•Dale’s Cone of Learning: Active
Learning yields 90% retention through
use of simulation
UNIT BASED ORIENTATION
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16 week Pediatric ICU orientation/13
week Pediatric Orientation
Orientee paired with coach
Coaches present for guidance and support
Simulation time scheduled monthly
beginning in week 3
Non-threatening environment
Pedia sim is housed in an actual patient
room with nurse server, wall mounts,
monitors, etc.
TOOLS
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Knowledge Assessment Tool
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Evaluation tools
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Basic Knowledge Assessment Tool (BKAT)
Daily
Weekly
Coach
On-line teaching
Resource book
Program Evaluation tools
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Casey-Fink Survey
Burnout Self-check
Nursing Satisfaction Scale
Resource Binder
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Detailed time-line
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skills day
Patient care days (8 hours)
Case study preparation/presentation
On-line modules (4 hours)
Simulation (4 hours)
Forms
Articles
Skills Checklist
Evaluation tools
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Daily and weekly
Monthly Team conferences
Incorporating Simulation
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Explanation of goals: confidential, not to
embarrass, keep learning experience REAL
Basic overview of skills performed first: orientee
and coach performed head-to-toe assessment of
standard child.
Reviewed findings with coach and charted on
flow-sheet.
Facilitators made changes to manikin then
orientees/coaches reassessed, identified changes
and documented their findings and discussed
treatment options
Incorporating Simulation
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Multidisciplinary approach
Doctor’s
 Pharmacist
 Respiratory therapist
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Pre-programmed scenarios:
Appendicitis, Asthma, Near
Drowning, Hypovolemic shock
Debriefing with team members
immediately following scenarios
WHAT IF IT WERE YOUR CHILD?
DENISE MEETS DR. GRIGGS
DENISE GOES ON A ROAD TRIP
 CT
 MRI
 Radiology
 Transfers
to and from
PICU/10West
Facilitator Observations
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Use of high-fidelity mannequin,
realistic atmosphere, and appropriate
clinical supplies and equipment
support learning in a safe
environment.
Simulation allows for true evaluation
of the learners clinical performance.
Improved satisfaction of our
orientation program.
PARTICIPANT EVALUATIONS
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“very helpful seeing the physiologic changes
occur based on treatment”
“less stressful knowing that no harm was done to
a real patient if I chose the wrong treatment”
“great having experienced support staff to
collaborate with”
“debriefings provided great performance
feedback”
 Reassurance that the right things were done
 insight into how things could be done
differently
“loved simulation!”
WHAT IF IT WERE YOUR CHILD?
 QUESTIONS?