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Evolving Residency Programs - Tracks. Medical/surgical specialties Pediatrics/PICU Critical Care Perinatal (Birthing Pavilion) Intensive Care Nursery. Overview of Residency Program. Twelve week program General Orientation Five full didactic days Health Systems Safety
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Evolving Residency Programs - Tracks • Medical/surgical specialties • Pediatrics/PICU • Critical Care • Perinatal (Birthing Pavilion) • Intensive Care Nursery
Overview of Residency Program • Twelve week program • General Orientation • Five full didactic days • Health Systems • Safety • Information Management • Clinical Topics • All nurse residents, of all tracks, participate collectively in this portion.
Health Systems • Nursing at DHMC • Professional Conduct • Reflective Practice • Scope of Practice
Information Management • CIS • Nursing Documentation • Communication • Electronic • Telephone • Pager • Email • Verbal • Nurse/Nurse • Nurse/Physician • Interagency
Information Management • Medical Records • Admission and Discharge Process • Chart Review • Patient Education
Safety • Human Factors • Infection Control • Medication Safety • Intranet • Latex Allergy • Device Management • Abbott Pump • Hill-Rom Bed • Glucometer • PCA Pump • Quick Signs
Clinical Topics • Skin and Wound Care • Ostomy, Tubes, and Drains • Pain Assessment/Comfort Promotion • Point of Care Testing Verification
Weekly Schedule: Weeks 2 - 9 • Functional Content Review: 4 hours • Respiratory Management • Tissue Perfusion/Vascular • Tissue Perfusion/Cardiac • Psychosocial/Spiritual • Neurological • Elimination/Nutrition
Weekly Schedule: Weeks 2 – 9 • Simulation Training to reinforce selected functional focus area: • At least 4 hours/week
Weekly Schedule: Week 10 • Residency *Integration* • Demonstrate competency in randomly selected events through simulation exercises
Weekly Schedule: Weeks 11 - 12 • Unit- based continuation of residency.
Underlying Tenets • Five, eight hour days through early weeks of residency program • This varies by clinical area and preceptor resources • Weekly clinical focus on identified functional area • Simulations developed from actual clinical practice
Simulations in Medical-Surgical Specialties Residency • Respiratory • Moderate sedation and airway management • Chest tube insertion/care • COPD with pneumonia • Tracheotomy care • Peripheral Vascular • Heparin protocol/DVT • Blood administration • Cardiac • Shockable and non-shockable rhythms
Cardiac (continued) Acute coronary syndrome Hypovolemic shock Tachyrhythms Neurological Stroke Seizure ICP Confused patient/restraints Nutrition/Elimination Diabetes Tight glycemic control Renal failure Simulations in Medical-Surgical Specialties Residency
Responses from Participants “At the moment when the scenario begins to deteriorate the simulation feels much like an actual crisis on the floors. There is confusion, most of which is related to my own inexperience. Repeated simulations will help build confidence as well as competency.”
Simulations in Medical-Surgical Specialties Residency • Selection of Scenarios: • Ability to make scenarios effective: • Incorporate equipment and processes. • Incorporate communication and teamwork. • Incorporate medication management. • Select scenarios that have significant impact on “failure to rescue”.
Simulations – Scenario Selection • Met with CNS/Educator group • Identify clinical content and clinical scenarios that should be included in the residency program • Developed “Curriculum Outline Template”
Simulations – Scenario Development • Pick a real patient • Review chart for clinical details: • Vital signs, lab results, tests, symptoms • Develop basic scenario to fit clinical situation • Include equipment, policies • Utilized scenario programming template