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 • 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 • 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 • 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 • 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 • Benner Model for nursing competency • Novice • Advance Beginner • Competent • Proficient • Expert • Synergy Model • Needs and characteristics are matched • Competencies • Improve outcomes
Dale’s Cone of Learning: Active Learning yields 90% retention through use of simulation
UNIT BASED ORIENTATION • 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 • Knowledge Assessment Tool • Basic Knowledge Assessment Tool (BKAT) • Evaluation tools • Daily • Weekly • Coach • On-line teaching • Resource book • Program Evaluation tools • Casey-Fink Survey • Burnout Self-check • Nursing Satisfaction Scale
Resource Binder • Detailed time-line • 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 • Daily and weekly • Monthly Team conferences
Incorporating Simulation • 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 findingsand discussed treatment options
Incorporating Simulation • Multidisciplinary approach • Doctor’s • Pharmacist • Respiratory therapist • Pre-programmed scenarios: Appendicitis, Asthma, Near Drowning, Hypovolemic shock • Debriefing with team members immediately following scenarios
DENISE GOES ON A ROAD TRIP • CT • MRI • Radiology • Transfers to and from PICU/10West
Facilitator Observations • 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 • “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?