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Nursing skills course. Designed for the Simulation Laboratory Kim K. Oelke APN, FNP-C. outcomes. Discuss advantages and disadvantages of utilizing the nursing skills laboratory for basic and advanced skills instruction Describe the components of the skills course
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Nursing skills course Designed for the Simulation Laboratory Kim K. Oelke APN, FNP-C
outcomes • Discuss advantages and disadvantages of utilizing the nursing skills laboratory for basic and advanced skills instruction • Describe the components of the skills course • Identify three teaching methods that can be employed using this course • Describe use of the course as an adjunct to a Medical/Surgical Nursing course, as skills units, or as individual skills to be practiced prior to clinical assignments
Advantages of using a skills laboratory • “Safe” environment • Immediate detailed feedback and debriefing • Increase student confidence • Practice skills • Introduce challenges
Advantages continued • Self-paced learning • Remediation • Applies theory to practice
Disadvantages of using a skills laboratory • Interpersonal interactions • Professional judgement • Clinical environment • Skills loss • Misdirected focus • Cost
Maximize the advantages MINIMIZE THE DISADVANTAGES
maximize • School • Attract students • Decrease liability • Clinical settings • Students with required skills • Less dependence on staff nurses • Safer care of patients • Students • Supervised learning in “safe” environment • Practice • Resources • NLN SIRC • SSH experts • Other programs
minimize • Role playing • Interpersonal interactions • Professional judgement • Adjunct to clinical experiences • Interpersonal interactions • Professional judgement • Redirect focus - skill as part of total patient care • Costs • Funding opportunities • Shared facilities and equipment
COURSE COMPONENTS SYLLABUS SKILLS OUTLINE CASE SCENARIOS CLINICAL CHECKLISTS
SYLLABUS Course Description: • Clinical course for nursing simulation lab • Incorporates • basic med/surg nursing skills • use of resources • critical thinking skills • cooperation skills • patient education • Active student participation required.
Syllabus: COURSE OUTCOMES • Upon completion of each system unit, the student will be able to: • Identify skills for specific systems • Discuss patient education points • Assemble equipment needed • Identify patients • Obtain informed consent • Perform procedure or skill. • Discuss nursing measures • patient safety • comfort • privacy • Demonstrate correct documentation
Syllabus: CONTENT OUTLINE • Content Outline: • Skills and procedures • Patient education • reason for procedure • prep for procedure • expected experience • risks and side effects • expected follow-up • Informed consent • Documentation of nursing education • Documentation of procedure
Syllabus: LEARNING ACTIVITIES • Case scenarios for role playing • Work in pairs • Work in small groups
Syllabus: Student evaluation • Group discussions • Positive feedback • Constructive criticism • Instructor evaluation • Group debriefing • One to one discussion • Case scenarios • Video-taped performance • Graded performance
SKILLS OUTLINE • Skills organized by body systems • Respiratory • Cardiovascular • Gastrointestinal • Genitourinary • Integumentary • Musculoskeletal • Nervous • Skills outlined in steps • Patient education • Equipment/supplies • Patient identification • Technique • Documentation
CASE CHECKLISTS • Skills - examples • Tracheostomy care • Chest tube • Insertion • Routine care • Discontinuation • Outline format • Information and patient education • Assembling equipment/supplies • Identification of patient • Performing procedure • Documentation of education, procedure, and patient status
Case Checklist 2.2 IV catheter site care • 2.2.1 Describes the education provided to the patient • Introduces self • Explains purpose of procedure • Explains procedure • Describes expected results • 2.2.2 Assembles all necessary equipment and supplies • Tape • Occlusive clear dressing if not changed in past 72 hours • Alcohol prep pads • 2.2.3 Identifies patient using 2 identifiers • Wrist band • Verifies name and date of birth • 2.2.4 Performs catheter site care • Performs hand hygiene • Raises bed to working position and lowers side rail • Dons non-sterile gloves • Assesses site for possible infection or infiltration • Removes and replaces any soiled tape and/or dressing • Records date and time on new dressing • If catheter has been in place 72 hours, removes dressing and catheter • Holds pressure until bleeding stops • Restarts IV in another site • Returns bed to control position and raises side rail • Removes and disposes of used equipment and gloves • Assesses patient and provides comfort measures as needed • 2.2.5 Documents patient teaching and performance of procedure • States education provided and who was educated • Records the patient identifiers used • Briefly describes the procedure, the outcomes, and patient comfort provided Education - ____ /4 Organization - ____ /3 Identification - ____ /2 Skill performance - ____ /12 Documentation - ____ /3 Total score - ____ /24
CASE SCENARIOS • Multiple scenarios for each skill • Simple to complex • Incorporate clinical knowledge and professional judgement • Multisystem scenarios available to reflect reality
IV rehydration • Teaching intermittent self-catheterization • Hydrocolloid gel burn dressing SimpleCase scenario examples
Heart failure patient • Respirations 18, slightly labored • Pulse oximetry 88% • Nail beds cyanotic • Breath sounds slightly diminished • Gurgling • Assess • Oropharyngeal suctioning • Provider notification Complex case scenario example
MVA patient • Coma • Respirator • Chest tube • Thomas splint • Vasopressors • Antibiotics • Skills • Oral care • Neurological checks • Suction ET tube • Bed bath /skin assessment • Chest tube care • Issues • Organization • Complications • Assistance Multisystemcasescenario example
Case scenario METHOD FOR USE WITH THE SIMULATION COURSE
InstructorSingle Student • Scenario provided • Decisions made by student • Skill demonstrated • Instructor provides immediate or delayed feedback • Scenario may change • Instructor may record session for review and feedback
Instructor Group of Students • Instructor assigns student roles • Scenario provided • Decisions made with group input • Skill demonstrated • Students and instructor provide feedback • Students rotate performing skill
Students small group settings • One student performs the skill • One student may assist • Another student completes the checklist • Other students provide feedback • Students rotate positions
Students alone • Student follows checklist to complete the skill • Student may record session for review and feedback from other students or the instructor
WAYS TO IMPLEMENT THE COURSE TO MEET THE NEEDS OF YOUR FACILITY
Adjunct to a Medical Surgical Nursing Course
References For this presentation
Durham, C.F., & Alden, K.R. (2008). Chapter 51: Enhancing patient safety in nursing education through patient simulation. In Patient safety and quality: An evidence-based handbook for nurses. Rockville, MD: Agency for Healthcare Research and Quality. Retrieved from http://www.ncbi.nlm.nih.gov/books/NBK2628/ Grant, J., Epps, C., Moss, J., & Watts, P. (2009). Promoting reflective learning of students using human patient simulators. Clinical simulation in nursing, 5(3), S6. Kneebone, R., Scott, W., Darzi, A., & Horrocks, M. (2004). Simulation and clinical practice: strengthening the relationship. Medical Education, 38(10), 1095-1102. Retrieved from EBSCOhost. Kowalak, J.P. (Ed.) (2009). Lippincott’s nursing procedures (5th ed.). Hong Kong (China): Lippincott Williams & Wilkins. Monahan, F.D., Sands, J.K., Neighbors, M., Marek, J.F., & Green, C.J. (Eds.) (2007). Phipps’ medical -surgical nursing: Health and illness perspectives (8th ed.). St. Louis, MO: Mosby Elsevier Morgan, R. (2006). Using clinical skills laboratories to promote theory-practice integration during first practice placement: an Irish perspective. Journal of Clinical Nursing, 15(2), 155-161. Retrieved from EBSCOhost. Wilson, A., & Godson, N. (2007). Evaluating the use of clinical skills laboratories for teaching student nurses. British Journal of Nursing (BJN), 16(19), 1178. Retrieved from EBSCOhost.
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