Nursing skills course

1. Nursing skills course Designed for the Simulation Laboratory Kim K. Oelke APN, FNP-C

2. 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

3. Simulation laboratories

4. Advantages of using a skills laboratory • “Safe” environment • Immediate detailed feedback and debriefing • Increase student confidence • Practice skills • Introduce challenges

5. Advantages continued • Self-paced learning • Remediation • Applies theory to practice

6. Disadvantages of using a skills laboratory • Interpersonal interactions • Professional judgement • Clinical environment • Skills loss • Misdirected focus • Cost

7. Maximize the advantages MINIMIZE THE DISADVANTAGES

8. 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

9. 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

10. COURSE COMPONENTS SYLLABUS SKILLS OUTLINE CASE SCENARIOS CLINICAL CHECKLISTS

11. 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.

12. 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

13. 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

14. Syllabus: LEARNING ACTIVITIES • Case scenarios for role playing • Work in pairs • Work in small groups

15. Syllabus: Student evaluation • Group discussions • Positive feedback • Constructive criticism • Instructor evaluation • Group debriefing • One to one discussion • Case scenarios • Video-taped performance • Graded performance

16. 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

17. 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

18. 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

19. CASE SCENARIOS • Multiple scenarios for each skill • Simple to complex • Incorporate clinical knowledge and professional judgement • Multisystem scenarios available to reflect reality

20. IV rehydration • Teaching intermittent self-catheterization • Hydrocolloid gel burn dressing SimpleCase scenario examples

21. 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

22. 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

23. Case scenario METHOD FOR USE WITH THE SIMULATION COURSE

24. 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

25. 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

26. 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

27. Students alone • Student follows checklist to complete the skill • Student may record session for review and feedback from other students or the instructor

28. WAYS TO IMPLEMENT THE COURSE TO MEET THE NEEDS OF YOUR FACILITY

29. Adjunct to a Medical Surgical Nursing Course

30. Skills instruction or review

31. Individual testing

32. References For this presentation

33. 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.

34. Thank you for your attention “The most wasted of all days is one without laughter.” e.e. cummings