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Development and Implementation of Hybrid Medical/Surgical Simulation Clinical Experiences in an A.D.N. Program. Christina C. Olson RN, MSN Pamela Gonzales RN, MSN. Today’s Nursing Education Challenges. Increased demand for nurses Shortages in clinical sites Shortages of nursing faculty

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Development and Implementation of Hybrid Medical/Surgical Simulation Clinical Experiences in an A.D.N. Program

Christina C. Olson RN, MSN

Pamela Gonzales RN, MSN

today s nursing education challenges
Today’s Nursing Education Challenges

Increased demand for nurses

Shortages in clinical sites

Shortages of nursing faculty

Lack of facilities for classroom and lab instruction space.

Increased patient acuity.

  • Grant Funding – Methodist Healthcare Ministries Goals
    • Increase nursing faculty
    • Develop new clinical experiences
    • Increase student enrollment
    • Increase number of qualified nurse in community.
solutions begin with definitions
Solutions begin with definitions…..

“the art and science of recreating clinical scenarios in artificial setting.” Jeffries, 2005

a strategy, not technology, to mirror , anticipate or amplify real situations with guided experiences in a fully interactive way.”

Lassiter, 2007

goals for implementation of simulation into clinical courses
Goals for implementation of simulation into clinical courses…

Blending tradition with simulation

Varying learning opportunities

Encouraging critical thinking

Creating a safe environment

Providing opportunities not always available – like the RN role

Be creative.

faculty tasks
Faculty tasks….
  • Medical/Surgical nursing faculty were tasked with development of :
    • High fidelity clinical simulation scenarios
    • Using various scenario products
    • Or developing them from scratch
    • Specifying them to our course outcomes
    • Specifying clinical grading tools, templates and agendas
defining these developmental responsibilities
Defining these developmental responsibilities…
  • “best outcomes occur when a theoretical framework is used for structure and integrated across entire curriculums.”
  • Starkweather & Karding-Edgren, 2008
other essentials
Other essentials…

SIRCI Training

Laerdal training

Audio/visual equipment training

scenarios were developed according to
Scenarios were developed according to…..
  • Quality Safety Education for Nurses Guidelines(QSEN)
  • And the proposed targets for Acquisition of Knowledge, Skills, Attitudes (KSA’s) in all scenarios.
    • NLN SIRCI guidelines
simulation course faculty scf teams
Simulation Course Faculty (SCF) teams….

Med./Surg. course faculty member.

BSN Clinical Teaching Assistant – also a graduate nursing student.

Grant set-up

faculty responsibilities
Faculty Responsibilities…

Develop scenario templates from nursing clinical knowledge and experience.

Tailor clinical situations/diagnoses to content theory taught in co-requisite clinical, typical diagnoses found in clinical area and incorporate competencies specific to course leveling.

Write new or adapt existing scenario products (such as NLN or Elsevier).

faculty responsibilities12
Faculty Responsibilities…

Develop scenario template..described in greater detail later.

Develop daily student clinical grading tool based on clinical course tool but adapted to simulation experiences.

Develop daily student clinical worksheets also based on those used in clinical setting.

Develop clinical rotation schedule for the 15 student groups.

faculty responsibilities13
Faculty Responsibilities…

Develop virtual patient medical records needed for each scenario, in keeping with adult medical/surgical, hospital records.

Loading all student course tools on accessible Blackboard Vista learning modules.

sac student support
SAC Student Support
  • BBV pre-work which contains:
    • Required-directed reading/videos.
    • Pre-worksheets to be completed
    • Simulation specific learning objectives
    • Simulation specific daily grading tool.
    • Orientation to San Antonio Hospital Simulation Experience
    • Orientation to “roles” assigned.
scenario development
Scenario Development
  • In the Beginning
    • Pediatrics – 4 Scenarios developed
        • Acetaminophen Overdose
        • Asthma
        • Pyloric Stenosis
        • VSDDeveloped by Simulation Grant Committee
        • 15 Students in Simulation
        • Scenarios ran 45 minutes
        • Debriefing 1 to 1.5 hours
scenario development20
Scenario Development
  • Current Scenarios Developed
    • Fundamentals
    • OB
    • Pediatrics
    • Medical Surgical
      • Medical Surgical 1
      • Medical Surgical 2
      • Critical Care

Currently 195 students in Simulation

Scenarios run from 1.0 to 2 hours in length

Debriefing run from 1.5 to 2.5 hours in length

cta role
CTA Role

Greet students

Check Pre-work and grading criteria pertaining to role of “Member of the Profession.”

Assign roles

Run Simulation scenario either trended or spontaneous-script based

guidelines for cta s
Guidelines for CTA’s
  • Board of Nursing Requirements
  • MHM Grant Requirements
  • Simulation Faculty Meetings
  • Simulation Coordinator
pre work example
Pre-work Example
  • Modules on Blackboard Vista
  •  Setting: SICU
  • Past Medical History: DM, CHF, HTN, CHF, Depression
  • History of Present Illness: CHI S/P MVC
  • Primary Medical Diagnosis: CHI with HA
  • Surgeries/Procedures & Dates: Gallbladder removal Cognitive Activities Required prior to Simulation:
  • Independent Reading (Lewis)
    • Acute Intracranial Problems, including management of ICP monitor. ( pg 1467-87)
    • Describe the pathophysiology of Cushings Triad pg 1469
    • Full Neurological Assessment pg. 1456-1461
    • Adult IV insertion and assessment
    • Foley insertion
    • Five rights of medication administration
    • Adult assessment
    • Documentation- Glascow Coma Scale pg 1476
pre work questions
Pre Work Questions
  • Describe nursing considerations of a patient on a vent with an ICP monitor?
  • What are the two types of posturing that can occur and describe how they appear?
  • What are the potential complications of a patient with an ICP monitor?
  • What is the normal range for ICP and CPP?
  • What daily diagnostic tests would you expect to see ordered for this client?
  • What are the primary nursing considerations for caring for a client with an ICP monitor?
  • How would the client’s development task and/or psychosocial needs affect his/her nursing care:
  • What are the safety considerations when administering the following medications:
scenario coversheet
Scenario Coversheet


roles during scenario
Roles During Scenario

Primary RN

Student Nurse


Family member


miscellaneous samples
Miscellaneous samples


Lab reports

Diagnostic reports

Hard patient medical record, computerized charting available and Blackboard Vista module specific to complete pre-work for scenario assigned.

Documentation now required of students in every scenario.




diagnostic reports


DATE: today TIME: 15 minutes ago

Test: chest PA/Lateral Findings: Atelectasis RUL

cta tnt role in debriefing
CTA/TNT Role in Debriefing
  • Most critical time in this learning experience
  • Length should be 2-3 times the length of the simulation itself.
  • Must include the guided reflection questions.
  • Facilitator views videotape with students and directs conversation, questions and learning in a positive manner
  • Scenario specific discussion questions.
  • General Guided Reflection Questions for This Simulation
  • How did you feel throughout the simulation experience?
  • Describe the objectives you were able to achieve?
  • Which ones were you unable to achieve (if any) and why?
  • Did you feel you had the knowledge and skills to meet objectives?
  • Were you satisfied with your ability to work through the simulation?
  • To Observer: Could the nurses have handled any aspects of the simulation differently?
  • If you were able to do this again, what would you have done differently?
  • What did the group do well?
  • What did the team feel was the primary nursing diagnosis?
  • What were the key assessments and interventions?
  • Is there anything else you would like to discuss?