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College of Nursing Critical Care Nursing 2015 Critical Care Skills Laboratory Prepared By Dr. Radwa Hamdi Assistant Professor of Critical Care College of Nursing University of Dammam UNIVERSITY OF DAMMAM COLLEGE OF NURSING CRITICAL CARE NURSING SKILLS & SIMULATION LAB 1. OBJECTIVES 2. STUDENT CODE OF CONDUCT 3. SCHEDULES 4. LIST OF PROCEDURES 5. DOCUMENTS 6. WORKSHOPS AND TRAINING 7. CHECKLISTS 8. SIMULATION 9. INVENTORIES UNIVERSITY OF DAMMAM COLLEGE OF NURSING CRITICAL CARE NURSING SKILLS & SIMULATION LAB UNIVERSITY OF DAMMAM COLLEGE OF NURSING CRITICAL CARE NURSING SKILLS & SIMULATION LAB Critical Care skills Laboratory Objectives The critical care laboratory in the college of nursing is a fully equipped state-of-the-art laboratory designed to recreate the atmosphere of the critical care unit, the latest in laboratory and simulation technology such as high fidelity human patient simulators, digitalized video, bedside computer charting, and electronic supply and static mannequins are all included within the lab. The lab also provides a space for debriefing and reflective thinking exercises that allow the students time to review their decisions and actions with the instructor and their classmates. Mission: Preparing graduate nurses qualified for caring for critically ill patients according to the universal standards of nursing practice. Objectives: Enhance learning using simulation technology and related resources. Provide educational materials for students, faculty, and staff. Provide hands-on learning experiences specific to critical care nursing course objectives as directed by the nursing curriculum. Provide a safe environment for students to practice critical care nursing skills Bridge the gap between theoretical learning and clinical training Encourage independent student learning opportunities Integrate Clinical Simulation into critical care Nursing curriculum Increase preparedness of nursing students before introduction to hospital training Introduce physiology/ pharmacology/health assessment, etc. into cases critical care students Increase preparedness for dealing with high acuity and critical cases Enhance communication skills Demonstrate the value of team-work and collaboration UNIVERSITY OF DAMMAM COLLEGE OF NURSING CRITICAL CARE NURSING SKILLS & SIMULATION LAB UNIVERSITY OF DAMMAM COLLEGE OF NURSING CRITICAL CARE NURSING SKILLS & SIMULATION LAB RESPONSIBILITIES AND CONDUCT OF STUDENTS IN CLINICAL SIMULATION LAB Review the skills to be practiced and/or demonstrated as well as having read the assigned chapters by your instructor prior to lab attendance. Gather and return the equipment used for skill performance. Inform instructor when unable to locate equipment, supplies or resources Approach situations and scenarios as if they are actual patient interactions Handle simulators and equipment with care and respect Follow safety measures at all times Maintain cleanliness of the area Dispose of sharps appropriately Demonstrate respect and consideration for self and others. All students should display professional conduct. Allow others the opportunity to practice Alert the instructor of allergies including latex Inform instructor if supplies are running low. Any damage or malfunction of mannequins or equipment should be reported to the lab faculty immediately. Inform the instructor of any particular learning needs. UNIVERSITY OF DAMMAM COLLEGE OF NURSING CRITICAL CARE NURSING SKILLS & SIMULATION LAB UNIVERSITY OF DAMMAM COLLEGE OF NURSING CRITICAL CARE NURSING SKILLS & SIMULATION LAB Clinical Master in Critical Care Nursing Second Semester Schedule Critical Care Nursing ACADEMIC YEAR 2015-2016 Monday Tuesday Wednesday Thursday 8-10 10-12 1212:30 12:30-2:30 Clinical (Hospital) Dr. Radwa H. Bakr Dr. Fatma Mokabel Dr. Omnia H.Salem Dr. Rima Algarni Clinical (Hospital) Dr. Radwa H. Bakr Dr. Fatma Mokabel Dr. Omnia H.Salem Dr. Rima Algarni Advanced Applied Health Pharmacology Assessment Dr. Radwa Dr. Fawzia H. Bakr* Noshine* Dr. Abeer Ali Dr. Rima Algarni Critical Care Nursing I Dr. Fatma Mokabel* Dr. Radwa H. Bakr Dr. Omnia H.Salem Dr. Rima Algarni Advanced Health Assessment Dr. Radwa H. Bakr* Dr. Abeer Ali Dr. Rima Algarni Prayer Time Date / Time Sunday * Course Coordinator Program Coordinator Dr. Radwa Hamdi Pathophysiology of critical illness Dr. Omnia H.Salem* Dr. Fatma Mokabel UNIVERSITY OF DAMMAM COLLEGE OF NURSING CRITICAL CARE NURSING SKILLS & SIMULATION LAB MASTER OF SCIENCE IN CRITICAL CARE NURSING LABORATORY ROTATION SECOND SEMESTER ACADEMIC YEAR 2015- 2016 Date Activity Staff member 1st week Saturday Examination of the critically ill patient : simulated clinical experience Vascular access Dr. Radwa Hamdi Monday Clinical skills revision : ECG, ABG, XRAY, redominstration and screening 2nd week Dr. Radwa Hamdi Saturday Assessment of the trauma patient : simulated clinical experience NGT insertion , gavage, lavage , feeding Tracheal suctioning Insertion of an indwelling catheter Dr. Radwa Hamdi Sunday Sunday Monday Program Coordinator Dr. Radwa Hamdi Dr. Radwa Hamdi Dr. Radwa Hamdi Dr. Radwa Hamdi UNIVERSITY OF DAMMAM COLLEGE OF NURSING CRITICAL CARE NURSING SKILLS & SIMULATION LAB CRITICAL CARE NURSING POSTGRADUATE COURSES Course Simulated clinical experience (SCE) Care of the CRITICAL CARE NURSING patient who develops cardiopulmonary resuscitation ACLS protocols ADVANCED HEALTH ASSESSMENT Assessment of the cardiovascular system Assessment of the respiratory system Objectives - Recognizes and responds appropriately to a crisis situation - Correctly identifies cardiopulmonary arrest , calls for help and responds to the code leader’s orders for interventions - Adheres to ACLS protocols and algorithms - Correctly administers cardiovascular medications - Correctly defibrillates the patient using safety precautions - Documents interventions and the patient’s response - Correctly takes history from simulated patient - Inspects the chest and identifies findings - Palpates for excursion, TVF, and pulsations - Percuses the chest over MCL and MAL, back - Auscultates the chest over MCL and MAL -Identifies normal and abnormal breath sounds and adventitious sounds and heart sounds and their significance - Documents findings - Communicates effectively with patient and team members Duration Logistics Six sessions Critical Care Lab II Four sessions Critical Care Lab II UNIVERSITY OF DAMMAM COLLEGE OF NURSING CRITICAL CARE NURSING SKILLS & SIMULATION LAB Clinical Skills& Simulation Lab Schedule 2015-2016 First Semester Nursing Labs SUN MON TUE WED Medical & Surgical Nursing Lab Medical Surgical Nursing Medical Surgical Nursing Fundamentals of Nursing Maintenance Fundamental Nursing Lab Medical Surgical Nursing Medical Surgical Nursing Fundamentals of Nursing Obstetric & GYNE Nursing Lab Medical Surgical Nursing Fundamental Nursing Pediatric Nursing Lab Medical Surgical Nursing Medical Surgical Nursing OB/GYNE Nursing Bridging Medical Surgical Nursing New Born Nursing Lab Fatat Al khaleej Program OB/GYNE Nursing Bridging Maintenance Critical Care Nursing lab 1 Post graduated Medical Surgical Nursing Post graduated Medical Surgical Nursing Post graduated Medical Surgical Nursing Fundamentals of Nursing Health Assessment Bridging Fundamentals of Nursing Health Assessment Bridging Fundamental Nursing Health Assessment Bridging Pediatric Nursing Health Assessment Bridging Pediatric Nursing Health Assessment Bridging Maintenance Post graduated Medical Surgical Nursing Critical Care Nursing Lab 2 Operating Room Lab Emergency Room Lab Home Care Nursing Lab Medical Surgical Nursing Medical Surgical Nursing Medical Surgical Nursing Nursing Management Medical Surgical Nursing Medical Surgical Nursing Medical Surgical Nursing Nursing Management Maintenance Fundamental Nursing Fundamental Nursing Fatat Al khaleej Program Maintenance Computer lab (Big) Computer Lab (small) Nursing Management Nursing Management Post graduated Statistics Maintenance Fundamental Nursing Fundamental Nursing Maintenance Fatat Al khaleej Program Maintenance Maintenance Clinical Skills & Simulation Lab Coordinator Dr. Radwa H Bakr THUR Maintenance Maintenance Pediatric Nursing Pediatric Nursing Post graduated Medical Surgical Nursing Maintenance Fatat Al khaleej Program UNIVERSITY OF DAMMAM COLLEGE OF NURSING CRITICAL CARE NURSING SKILLS & SIMULATION LAB UNIVERSITY OF DAMMAM COLLEGE OF NURSING CRITICAL CARE NURSING SKILLS & SIMULATION LAB CRITICAL CARE I LABORATORY OCCUPANCY ACADEMIC YEAR 2015-2016 FIRST SEMESTER Course Year Semester Medical / Third First No of Days students occupying Total lab (per/ses sion) Sunday and Surgical Year Semester 50 (8 Nursing I Duration Description 16 weeks Students will Monday practice procedures per and simulation as session) part of their clinical training Clinical Master Third Master in progra semester Medical m Sunday and 3 4 weeks Students will Monday practice procedures Tuesday and simulation as surgical part of their clinical nursing training Fundamentals 2nd First of nursing Year Semester Wednesday 16 weeks Students will 50 (8 and practice procedures per Thursday and simulation as session) part of their clinical training UNIVERSITY OF DAMMAM COLLEGE OF NURSING CRITICAL CARE NURSING SKILLS & SIMULATION LAB CRITICAL CARE II LABORATORY OCCUPANCY ACADEMIC YEAR 2015-2016 FIRST SEMESTER Days occupying lab Duration Description Third Semester No of students Total (per/ses sion) First 50 Sunday and 16 weeks Students will Year Semester Monday Course Year Medical / surgical nursing I (8 per practice procedures session) and simulation as part of their clinical training Fundamentals 2nd First of Nursing Year Semester Wednesday 50 (8 and thursday 16 weeks Students will practice procedures per and simulation as session) part of their clinical training UNIVERSITY OF DAMMAM COLLEGE OF NURSING CRITICAL CARE NURSING SKILLS & SIMULATION LAB UNIVERSITY OF DAMMAM COLLEGE OF NURSING CRITICAL CARE NURSING SKILLS & SIMULATION LAB Critical Care Nursing Laboratory Rotation LIST OF PROCEDURES SYSTEM Cardiovascular System PROCEDURE Drawing blood from a vein Insertion of an IV line Assiting insertion of a central venous line Central venous line care CVP measurment Drawing an arterial sample Inserting an arterial line Cardiopulmonary resuscitation Defibrillation Respiratory System: Maintaining patent airway Inserting an oropharyngeal airway Bag valve mask ventilation Suctioning the airway ETT care Tracheostomy care Managing ventilator emergencies Gastrointestinal and Genitourinary System Feeding via NGT Inserting a urinary catheter Caring for a patient with an indwelling catheter Inserting a nasogastric tube UNIVERSITY OF DAMMAM COLLEGE OF NURSING CRITICAL CARE NURSING SKILLS & SIMULATION LAB UNIVERSITY OF DAMMAM COLLEGE OF NURSING CRITICAL CARE NURSING SKILLS & SIMULATION LAB STUDENT EVALUATION OF SIMULATED CLINICAL EXPERIENCE Student name: ………………………... Student Number…………….………………… Program:………………………………. Year……………….. Semester ……………… Simulated clinical experience:……………..……………………………………………. Instructor:………………………………........................Date:…………………………... Serial 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. Strongly Agree 5 Agree 4 Uncertain 3 Disagree 2 Strongly Disagree 1 The instructor prompts guided me I thinking critically I feel more confident in my ability to deal with real patients I developed better understandings of drugs used in the simulated clinical experience I feel more prepared for decision making My physical examination and assessment skills have improved I feel more able to predict what pathophysiological changes may occur in a real patient The simulated clinical experience has reinforced my theoretical knowledge The simulated clinical experience has challenged me to think and make decisions I have learned a great deal from observing my colleagues I have learned ways to improve my communication skills with patients and colleagues Debriefing sessions and discussions were valuable Comments : ………………………………………………………………………..………………… ………………………………………………................................................................... ........................................................................................................................................... UNIVERSITY OF DAMMAM COLLEGE OF NURSING CRITICAL CARE NURSING SKILLS & SIMULATION LAB Simulated Clinical Experience Evaluation Sheet Simulation: ………………………………………………… Instructor: ……………... Student Name: …………….……… Student Number: …………..……………………. Date : ……………………………..…Group: ………………………………………..….. Done Incomplete Not done Serial Theme Comments 2 1 0 ASSESSMENT : (TOTAL 12 grades) 1. 2. 3. 4. 5. 6. Proper equipment used Systematic approach Appropriate techniques Identifies significance of findings Refers to appropriate personnel Evaluates after intervention COMMUNICATION : ( TOTAL 8 grades) 1. Communicates effectively with members of healthcare team 2. Uses appropriate verbal and non- verbal communication 3. Communicates effectively with patient and family members 4. Uses terms appropriate to patient’s level of education NURSING MANAGEMENT : (TOTAL 14 GRADES) 1. 2. 3. 4. 5. 6. 7. Uses best practices Prioritizes interventions Uses appropriate protocols / procedures/ treatments /interventions Uses Critical thinking / problem solving Delegates appropriately Proper Fluid/ blood /drug administration Coordinates appropriately with interdisciplinary team KNOWLEDGE AND COGNITIVE SKILLS (TOTAL 6 GRADES) 1. Post SCE written exam PSYCHOMOTOR SKILLS (TOTAL 10 GRADES) 1. Procedure checklist TOTAL GRADE (50) Instructor’s signature:______________________________ Date:_________________ UNIVERSITY OF DAMMAM COLLEGE OF NURSING CRITICAL CARE NURSING SKILLS & SIMULATION LAB CLINICAL SIMULATION LABORATORIES PHOTOGRAPHY RELEASE I , ___________________________________ hereby agree to allow ___________________________________ to record or photograph my performance in the clinical simulation lab , for use in simulation sessions for teaching purposes or for use in educational materials , brochures, manuals and presentations. Date : _____________________________________________________ Name : ____________________________________________________ Signature : _________________________________________________ UNIVERSITY OF DAMMAM COLLEGE OF NURSING CRITICAL CARE NURSING SKILLS & SIMULATION LAB Clinical Skills & Simulation Laboratory Confidentiality Agreement As a nursing student enrolled in the College of Nursing University of Dammam .I will be actively participating in clinical nursing simulations. I understand that the content of these simulations will be kept confidential in order to maintain the integrity of the learning experience for me and my fellow students. It would be unethical for me to share any information regarding simulation scenarios with my fellow students. I will also be observing fellow students within the clinical simulation laboratory, and I will not discuss their performance with anyone outside of the simulation laboratory. I fully understand and acknowledge that the unauthorized release, mishandling of confidential information or inappropriate exchange of information is prohibited, and serious consequences may occur if I violate this agreement. I will exemplify the College of Nursing University of Dammam values of integrity, respect for human dignity, and confidentiality. Student name : ___________________________________________________ Student signature: _________________________________________________ Date: ___________________________________________________________ Year/ Level __________________________Course:______________________ Instructor:________________________________________________________ UNIVERSITY OF DAMMAM COLLEGE OF NURSING CRITICAL CARE NURSING SKILLS & SIMULATION LAB Clinical Skills & Simulation Laboratory Injury/Incident Report Accident/Date: _________________ Time: _________ Today’s Date: ____________ Name/Address: _______________________________________________________________________ _______________________________________________________________________ Age: ______ Sex: ________ Telephone # _____________________________________ Details of Incident: ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ Nature of Injury: ________________________________________________________________________ ________________________________________________________________________ Treatment Rendered: ________________________________________________________________________ ________________________________________________________________________ Referred to: ________________________________________________________________________ CSL Faculty Signature : ____________________Date: _________________________ UNIVERSITY OF DAMMAM COLLEGE OF NURSING CRITICAL CARE NURSING SKILLS & SIMULATION LAB UNIVERSITY OF DAMMAM COLLEGE OF NURSING CRITICAL CARE NURSING SKILLS & SIMULATION LAB CRITICAL CARE LABORATORY SCHEDULED TRAINING ACTIVITIES & WORKSHOPS ACADEMIC YEAR 2015 – 2016 FIRST SEMESTER Workshop / training Date Instructor Location Duration Pediatric ECS (CAE ) Maintenance and training Saturday September 12TH 2015 Dr. Rashad (CAEImanco) Critical Care Lab II 1 day ECS Maintenance and training Saturday October 10th 2015 Dr. Manan (CAELeader) Critical Care Lab II 1 day SIMMAN 3G Maintenance and Technical training October 11th October 31st Dr. Ashraf (LaerdalBeta) Critical Care Lab I 1 day AV System Maintenance and Technical training November 14th 2015 Dr. Ashraf (LaerdalBeta) Critical Care Lab I 1 day UNIVERSITY OF DAMMAM COLLEGE OF NURSING CRITICAL CARE NURSING SKILLS & SIMULATION LAB high fidelity simulation workshop with : pedia sim by meti® INSTRUCTOR : DR. RADWA HAMDI Participants : Pediatric Nursing Academic Staff and Demonstrators Duration: One day Timing: Tuesday October 13th 2015 Venue: College of Nursing - Critical Care II Skill Lab UNIVERSITY OF DAMMAM COLLEGE OF NURSING CRITICAL CARE NURSING SKILLS & SIMULATION LAB Workshop Rationale: This workshop is designed to acquaint pediatric nursing faculty with the high fidelity simulator designed by METI ; Pediatric Emergency care simulator (PEDIA SIM), as well as the educational modules of the Program of Nursing Curriculum Integration (PNCI) , a four-semester guide which provides simulated clinical experiences (SCE). That are integrated within the nursing curriculum. Human patient simulation provides an innovate learning environment where nursing students can practice clinical and critical thinking skills without fear of harming a real person, the result is increased self-confidence, and ultimately competence. Simulation offers multiple opportunities for student training and clinical experience that help overcome the limitations of clinical areas, However simulators are often under- utilized due to insufficient staff training. The aim of this workshop is to train paediatric Nursing academic staff on the use of high fidelity simulators to prepare them for the use of simulation in undergraduate and postgraduate student clinical training . Workshop objectives: As a result of successful completion of the workshop, participants will be able to: Identify the parts of the high fidelity simulator Familiarize with simulator software and applications Demonstrate how to operate the high fidelity simulator Familiarize with educational modules of the Program of Nursing Curriculum Integration (PNCI) UNIVERSITY OF DAMMAM COLLEGE OF NURSING CRITICAL CARE NURSING SKILLS & SIMULATION LAB Demonstrate how to run a scenario on the high fidelity simulator Demonstrate how to write new scenarios by editing existing ones Demonstrate how to create new scenarios Demonstrate how to conduct a clinical simulation session Demonstrate how to conduct a debriefing session UNIVERSITY OF DAMMAM COLLEGE OF NURSING CRITICAL CARE NURSING SKILLS & SIMULATION LAB High fidelity Simulation Workshop Pedia Sim by METI® Instructor : Dr. Radwa Hamdi Program Day : Time: Tuesday 13/10/15 8.00-8.30: Identify the parts of the high fidelity simulator 8.30-9.30: Familiarize with simulator software and applications Demonstrate how to operate the high fidelity simulator 9.30-10.00: Familiarize with educational modules of the Program of Nursing Curriculum Integration (PNCI) Practical application : how to run a scenario on the high fidelity simulator 10.00 - 10.30: 10.30- 11.00 11.00 – 12.00 12.30 – 1.30: 1.30 – 2.00: Activity: Writing new scenarios by editing existing ones Creating new scenarios Practical application : conducting a clinical simulation session Demonstrate how to conduct a debriefing session Prayer break Practical application : Conducting a debriefing session UNIVERSITY OF DAMMAM COLLEGE OF NURSING CRITICAL CARE NURSING SKILLS & SIMULATION LAB simulation training workshop with : ® simman 3g Instructor : Dr. Ashraf Al-Riyati -- BETA COMPANY Participants : College of Nursing Academic Staff and Demonstrators Duration: One day Timing: Saturday October 10th 2015, to be repeated Saturday 17th Oct 2015 Venue: College of Nursing - Critical Care I Simulation Laboratory 2015 UNIVERSITY OF DAMMAM COLLEGE OF NURSING CRITICAL CARE NURSING SKILLS & SIMULATION LAB Workshop Rationale: This workshop is designed to acquaint nursing faculty with the most recent high fidelity simulator designed by SIMMAN ; SIMMAN 3G. Human patient simulation provides an innovate learning environment where nursing students can practice clinical and critical thinking skills without fear of harming a real person, the result is increased self-confidence, and ultimately competence. Simulation offers multiple opportunities for student training and clinical experience that help overcome the limitations of clinical areas, However simulators are often under- utilized due to insufficient staff training. The aim of this workshop is to acquaint Nursing academic staff on the use of SIMMAN 3G high to prepare them for the use of simulation in undergraduate and postgraduate student clinical training . Workshop objectives: As a result of successful completion of the workshop, participants will be able to: Identify the parts of the high fidelity simulator Familiarize with simulator software and applications Demonstrate how to operate the high fidelity simulator Familiarize with educational modules Demonstrate how to run a scenario on the high fidelity simulator Demonstrate how to write new scenarios by editing existing ones Demonstrate how to create new scenarios Demonstrate how to conduct a clinical simulation session UNIVERSITY OF DAMMAM COLLEGE OF NURSING CRITICAL CARE NURSING SKILLS & SIMULATION LAB Simulation Training Workshop With : SimMan 3G ® Instructor : Dr. Ashraf Al-Riyati -- BETA COMPANY Program Day : Time: Saturday 10/10/2015 8.00-8.30: 8.30-9.30: 9.30-10.00: 10.00 10.30: 10.30- 11.00 11.00 – 12.00 12.30 – 1.30: 1.30 – 2.00: Activity: Identify the parts of the high fidelity simulator SIMMAN 3G Familiarize with simulator software and applications Demonstrate how to operate the high fidelity simulator Familiarize with educational modules Practical application : how to run a scenario on the high fidelity simulator Writing new scenarios by editing existing ones Creating new scenarios Practical application : conducting a clinical simulation session Prayer break Practical application : conducting a clinical simulation session UNIVERSITY OF DAMMAM COLLEGE OF NURSING CRITICAL CARE NURSING SKILLS & SIMULATION LAB UNIVERSITY OF DAMMAM COLLEGE OF NURSING CRITICAL CARE NURSING SKILLS & SIMULATION LAB Hands on Workshop Simulation-Based training to Improve Quality of Care During Cardiac Arrest Team Response With : ECS by METI® INSTRUCTORS : Dr. Radwa Hamdi Ms. Zeinab Alsaba, Ms. Heba Massoud Target : This workshop will be of interest to nurses, physicians, Health care professionals, medical and nursing students Duration: One day Timing: Tuesday 1/1/2015 Venue: College of Nursing - Critical Care II Skill Lab 2015 UNIVERSITY OF DAMMAM COLLEGE OF NURSING CRITICAL CARE NURSING SKILLS & SIMULATION LAB Workshop Rationale: This workshop utilizes high fidelity simulation to refresh participants knowledge on the practice of a rapid response to a cardiac arrest situation in a high acuity unit. The cardiac arrest simulation workshop will begin with a presentation reviewing key elements of response to a code blue that enhance the chances of survival and also a review of the importance of each team member's role in a resuscitation attempt. Following this presentation, attendees will be confronted with a sudden cardiopulmonary arrest scenario. The critical care skill lab is set up with state-of-the-art equipment in the form of a simulated ICU suite, where participants will be allowed to participate firsthand in a resuscitation code. The event will allow attendees to observe an unexpected collapse of an individual and the ensuing response. Participants will undertake CPR, airway management and the administration of drugs according to ACLS protocols using a highfidelity simulator (ECS , METI ®).After a session of orientation on the simulator the cardiac arrest scenario will be started participants will be divided into two groups the first group of students will participate in the simulation while the other group will be asked to sit and observe the group in action while noting comments on management, teamwork and communication skills, roles will be reversed subsequently. Then both groups will join together for a debriefing session. The aim of this workshop is to allow participants the chance to make mistakes without hurting patients and to debrief regarding both medical, nursing, and teamwork principles in an effort to bridge the gap between theoretical principles and active application. UNIVERSITY OF DAMMAM COLLEGE OF NURSING CRITICAL CARE NURSING SKILLS & SIMULATION LAB Workshop objectives: Apply ACLS guidelines to manage a cardiac arrest situation in a high acuity unit Discuss the importance of each team member's role in a resuscitation attempt. Practice CPR, airway management, defibrillation and the administration of drugs according to ACLS protocols using a high fidelity simulator Reinforce management, teamwork and communication Content of the workshop: Introduction to simulation Orientation to the simulator Advanced cardiac life support : a review Basic arrhythmia : a review Teamwork in cardiac arrest response Simulated clinical experience : management of the patient who develops sudden cardiac arrest in a high acuity unit Debriefing and evaluation UNIVERSITY OF DAMMAM COLLEGE OF NURSING CRITICAL CARE NURSING SKILLS & SIMULATION LAB Simulation-Based training to Improve Quality of Care During Cardiac Arrest Team Response INSTRUCTORS : Dr. Radwa Hamdi , Mrs. Rana Alamry, Ms. Zeinab Alsaba, Ms. Heba Massoud Program Day : Tuesday 11/1/11 Time: Activity: 1.00-1.15: Introduction to simulation 1.15 -1.30: Orientation to the simulation 1.30-2.00: Advanced cardiac life support : a review 2.00 – 2.15: Teamwork in cardiac arrest response 2.15– 2.45 Group 1 : Simulated clinical experience : management of the patient who develops sudden cardiac arrest in a high acuity unit Group 2 : Simulated clinical experience : management of the patient who develops sudden cardiac arrest in a high acuity unit Video viewing 2.45 – 3.15: 3.15-3.30: 3.30 – 4.00: Debriefing and evaluation UNIVERSITY OF DAMMAM COLLEGE OF NURSING CRITICAL CARE NURSING SKILLS & SIMULATION LAB Round Table Discussion High Fidelity Simulation : Observation of a Course Instructor: Dr. Radwa Hamdi The use of simulation is an expanding domain in medical, nursing, and allied medical, Education. Many faculty and staff members wish to introduce simulation in their colleges but are reluctant due to the novelty of the experience. Some have already acquired the simulators but are not clear on how to incorporate it in student teaching. This workshop is designed to acquaint faculty, staff members or directors of training centers on how to use simulation in teaching by observing a course in action. Participants will attend the orientation session and will observe the hands on simulation training and then attend the debriefing session. Once the course is over a round table discussion will take place, during which the participants will have a chance to take part in an interactive discussion, ask questions and get explanations on the practical issues related to the use of clinical simulation in student teaching. Objectives : Acquaint faculty, staff members or directors of training centers on how to use simulation in teaching by observing a course in action. Identify approaches utilized in conducting a debriefing session Discuss practical issues related to the use of clinical simulation in student teaching. UNIVERSITY OF DAMMAM COLLEGE OF NURSING CRITICAL CARE NURSING SKILLS & SIMULATION LAB UNIVERSITY OF DAMMAM COLLEGE OF NURSING CRITICAL CARE NURSING SKILLS & SIMULATION LAB Emergency Care: The Golden Hour and Beyond HANDS ON WORKSHOP: Simulation-Based training to Improve Quality of Care during Cardiac Arrest Team Response This workshop utilizes high fidelity simulation to refresh participants’ knowledge of the practice of rapid response to a cardiac arrest situation in a high acuity unit. The cardiac arrest simulation workshop will begin with a hands-on review session of the key elements of response to a code blue that enhance the chances of survival and also a review of the importance of each team member's role in a resuscitation attempt. Following this session, attendees will be confronted with a sudden cardiopulmonary arrest scenario. Participants will be allowed to participate firsthand in a resuscitation code. The event will allow attendees to observe an unexpected collapse of an individual and the ensuing response. Participants will undertake CPR, airway management, and the administration of drugs according to ACLS protocols using a highfidelity simulator (SimMan3G®). After a session of orientation on the simulator the cardiac arrest scenario will be started.Participants will be divided into two groups the first group of students will participate in the simulation while the other group will be asked to sit and observe the group in action while noting comments on code management, teamwork, and communication skills. Roles will be UNIVERSITY OF DAMMAM COLLEGE OF NURSING CRITICAL CARE NURSING SKILLS & SIMULATION LAB reversed subsequently, then both groups will join together for a debriefing session. The aim of this workshop is to allow participants the chance to make mistakes without hurting patients and to debrief regarding both medical, nursing, and teamwork principles in an effort to bridge the gap between theoretical principles and active application. Objectives: Apply techniques and protocols learned in ACLS training. Review the importance of each team member's role in a resuscitation attempt. Undertake CPR, airway management, and the administration of drugs according to ACLS protocols using a high fidelity simulator. Enhance management, teamwork, and communication skills. Debrief regarding strengths and areas for improvement. Venue: Preconference workshop:College of Nursing - Clinical Skill Labs Conference :University of Dammam main campus- Building 11 Duration:Two days Target audience: The symposium and workshop are directed toward nurses, physicians, surgeons, and health care professionals committed to acute care, trauma, and emergency medicine and nursing. Number of Participants: Symposium: Open attendance Hands-on workshop: 30 participants UNIVERSITY OF DAMMAM COLLEGE OF NURSING CRITICAL CARE NURSING SKILLS & SIMULATION LAB Emergency Care: The Golden Hour and Beyond PROGRAM Preconference Workshop Wednesday, February 4th, 2015 Hands on Workshop: Simulation-Based training to Improve Quality of Care During Cardiac Arrest Team Response Registration 8:00- 9:00 9:00- 11:30 Session (1): THE BASICS ACLS algorithms ECG interpretation CPR AED Airway management 11:30- 12:00 Instructors: Dr. Ahmed Aljlaoud Mrs. BadreyaAltaleb Mrs. HebaMassoud Prayer and Coffee break Session (2): Instructors: SIMULATION BASED TRAINING 12:00- 2:00 High fidelity simulation session: Management of cardiopulmonary arrest Dr. RadwaBakr Ms. ZainabAlsabaa Mrs. BothaynaFathy 2:00- 3:00 Session (3): Facilitator DEBREIFING Debriefing session Dr. RadwaBakr 3:00- 4:00 Lunch break 4:00 End of program UNIVERSITY OF DAMMAM COLLEGE OF NURSING CRITICAL CARE NURSING SKILLS & SIMULATION LAB UNIVERSITY OF DAMMAM COLLEGE OF NURSING CRITICAL CARE NURSING SKILLS & SIMULATION LAB Training Workshop Evaluation Form Please provide feedback regarding the training session that you attended. Your opinion is valuable to us and will guide us in planning future training workshops . Workshop: ……………………………………………………………………………………………… Instructor(s): ……………………………………………………………………………………………… Please check the box corresponding to the degree to which you believe the training workshop achieved its goals: SN 1. Strongly Agree 5 Agree 4 Uncertain 3 Disagree 2 Strongly Disagree 1 Objectives for the workshop were met 2. Questions were answered to my satisfaction 3. I better understand the components of the simulator 4. I better understand how to operate the simulator 5. I better understand how to run a simulation scenario 6. I received guidance on how to use simulation in my course 7. I better understand how I can integrate simulation into my curriculum 8. I am better prepared to assume the role of facilitator in a simulation setting 9. I am better prepared to make the simulator and its environment more realistic 10. I better understand the importance of debriefing 11. I feel confident in my ability to use the simulator with my student 12. Overall I am satisfied with the workshop/ training Comments : ……………………………………………………………………………… ……………………………………………………………………………… ……………………………………………………………………………… UNIVERSITY OF DAMMAM COLLEGE OF NURSING CRITICAL CARE NURSING SKILLS & SIMULATION LAB Training Workshop Attendance Sheet Workshop/Training Session:………………………………………………. Instructor :………………………………………………………………….. Date :………………………………………………………………………… Attendance Serial Name Signature 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15. Lab manager s:……………………………………………………….. Lab coordinator: Dr. Radwa Bakr UNIVERSITY OF DAMMAM COLLEGE OF NURSING CRITICAL CARE NURSING SKILLS & SIMULATION LAB UNIVERSITY OF DAMMAM COLLEGE OF NURSING CRITICAL CARE NURSING SKILLS & SIMULATION LAB INTRAVENOUS CATHETER INSERTION STUDENT’S NAME:…………………………………… STUDENT’S NUMBER: ………………………………………… PROCEDURE CHECKLIST 1 2 3 4 5 6 7 8 IC (1) Not Done (0) COMMENTS Explains the procedure and obtains consent. Observes universal precautions Applies local anesthetic Places tourniquet above the intended site and palpates the vein. Cleanses skin and fixes vein Inserts catheter, bevel up, parallel to the vein at a 30 degree angle to the skin. Advances into the vein. Decreases angle when flashback occurs. 9 Advances 0.5 then retracts needle from catheter. 10 Advances catheter until port is flush with the skin. 11 Occludes the distal end of the catheter and connects IV tubing 12 Done (2) Checks flow through catheter. 13 Secures the catheter Grade : ………………………………………………………………………………………………………………………….. Date of evaluation: …………………………………………………………………………………………………………. Clinical supervisor: ………………………………………………………………………………………………………….. UNIVERSITY OF DAMMAM COLLEGE OF NURSING CRITICAL CARE NURSING SKILLS & SIMULATION LAB UNIVERSAL PRECAUTIONS FOR INVASIVE PROCEDURE STUDENT’S NAME:…………………………………… STUDENT’S NUMBER: ………………………………………… PROCEDURE CHECKLIST 1 2 3 4 5 6 7 8 9 Done (2) IC (1) Not COMMENTS Done (0) Checks Patient identity Checks relevant documents Obtains informed consent Marks procedure site Positions patient correctly Displays Images and results properly Prepares blood products, implants, devices, or special equipment Administers required antibiotics or fluids Observes safety precautions based on history and medications Grade : ……………………………………………………………………………….……………………………………………………….. Date of evaluation: ………………………………………………………………………..……………………………………………. Clinical supervisor: …………………………………………………………….……………………………………………………….. UNIVERSITY OF DAMMAM COLLEGE OF NURSING CRITICAL CARE NURSING SKILLS & SIMULATION LAB ARTERIAL LINE INSERTION ( Radial artery ) STUDENT’S NAME:…………………………………… STUDENT’S NUMBER: ………………………………………… PROCEDURE CHECKLIST 1 2 3 4 5 6 Done (2) IC (1) Not COMMENTS Done (0) Explains procedure and obtains consent. Observes universal precautions. Positions limb for arterial cannulation: supinates the arm and dorsiflexes the wrist Follows aseptic technique Palpates the artery. Infiltrates the insertion site with 1% lidocaine. 7 Uses Catheter-over-needle technique: Inserts needle and catheter at a 20- to 40-degree angle to the skin. When a flash of blood appears in the hub, drops angle to near 0 degrees and advances about 1 mm. Slides the catheter off the needle into the artery. Puts pressure on the artery and removes the needle from the catheter. 8 Connects the catheter to the transduction system and observes arterial waveform and pressure. 9 Secures the catheter with sterile dressing and tape. Grade : ………………………………………………………………………………………………………………………….. Date of evaluation: ………………………… Clinical supervisor: ……………………………….. UNIVERSITY OF DAMMAM COLLEGE OF NURSING CRITICAL CARE NURSING SKILLS & SIMULATION LAB SUCTIONING A PATIENT WITH AN ENDOCTRACHEAL TUBE (ETT) STUDENT’S NAME:…………………………………… STUDENT’S NUMBER: ………………………………………… PROCEDURE CHECKLIST 1 Explains the procedure to the patient. 2 Observes aseptic technique 3 Opens sterile gloves and suction catheter. 4 Monitors oxygen saturation during procedure. 6 Pre-oxygenates patient with AMBU bag on a 100% O2 for 2 minutes Turns on suctioning equipment with suction tubing and places near head of patient. Places sterile gloves on dominate hand and connects suction catheter to suction tubing. Using aseptic technique, passes suction catheter , while occluded , through ET tube until patient coughs. Applies suction and withdraws suction catheter with a rotating motion at 5 second intervals. Ventillates patient with ambu bag using 100% oxygen Cleans out patient oropharyngeal airway with suction catheter . 8 9 10 11 12 13 14 15 IC (1) Not COMMENTS Done (0) Places clean Latex glove on non-dominate hand. 5 7 Done (2) Discards suction catheter Rinses suction tubing with water. Monitors patients breathing and oxygen saturation. Notes amount, colour and consistency of tracheal aspiration Grade : ………………………………………………………………………………………………………………………….. Date of evaluation: …………………………………………………………………………………………………………. 16 Clinical supervisor: ………………………………………………………………………………………………………….. UNIVERSITY OF DAMMAM COLLEGE OF NURSING CRITICAL CARE NURSING SKILLS & SIMULATION LAB SUCTIONING A PATIENT WITH A TRACHEOSTOMY TUBE STUDENT’S NAME:…………………………………… STUDENT’S NUMBER: ………………………………………… PROCEDURE CHECKLIST Done (2) 1 Explains the procedure to the patient. 2 Observes aseptic technique 3 Opens sterile gloves and suction catheter. 4 Monitors oxygen saturation during procedure. 6 Pre-oxygenates patient with AMBU bag on a 100% O2 for 2 minutes Turns on suctioning equipment with and places near head of patient. Places sterile glove on dominate hand and connects suction catheter to suction tubing. Using aseptic technique, passes suction catheter through connector down into tracheal tube entering the patients upper airway until patient coughs. Applies suctioning while withdrawing suction catheter with a rotating motion at 5 second intervals. 8 9 10 11 12 13 14 Not COMMENTS Done (0) Places clean Latex glove on non-dominate hand. 5 7 IC (1) Ventilates patient with AMBU bag on a 100% 02 Clean out patient oral pharyngeal airway with either suction catheter Discards suction catheter Rinse suction tubing with water. Monitors patients breathing and oxygen saturation. Notes amount, colour and consistency of tracheal 16 aspiration Grade : ………………………………………………………………………………………………………………………….. 15 Date of evaluation: …………………………… Clinical supervisor: ……………………………………….. UNIVERSITY OF DAMMAM COLLEGE OF NURSING CRITICAL CARE NURSING SKILLS & SIMULATION LAB DRAWING AN ARTERIAL SAMPLE (radial artery) STUDENT’S NAME:…………………………………… STUDENT’S NUMBER: ………………………………………… PROCEDURE CHECKLIST 1 2 3 4 5 6 7 8 9 10 11 12 13 14 Done (2) IC (1) Not COMMENTS Done (0) Explains the procedure to the patient Observes universal precautions for invasive procedures Applies local anesthesic if appropriate Prepares skin with antiseptic solution Uses sterile technique. Performs modified Allen test. Positions patient supine and extends wrist to 30 to 45 degrees. Palpates artery distal to the radial styloid Holds the syringe like a dart with the lumen of the needle facing the flow of blood. Enters the skin at a 45-degree angle, at a point 2 to 3 cm proximal to the volar wrist crease. Slowly advances the needle toward the point of maximal arterial impulse. Allows blood to fill the syringe. Collects sample then withdraws the needle. Expels air bubbles in the syringe,caps and labels. Grade : ………………………………………………………………………………………………………………………….. Date of evaluation: ………………………….. Clinical supervisor: ….………………………………. UNIVERSITY OF DAMMAM COLLEGE OF NURSING CRITICAL CARE NURSING SKILLS & SIMULATION LAB BAG MASK VENTILATION STUDENT’S NAME:…………………………………… STUDENT’S NUMBER: ………………………………………… PROCEDURE CHECKLIST 1 Provides O2 supplementation and monitoring 2 Observes universal precautions. 3 Opens the patient's airway with head-tilt or jaw-thrust. 4 Chooses a proper size face mask and connects to oxygen 5 One-handed technique: (C E ) Holds the mask with the thumb and forefinger in a "C" shape and hold the jaw with the other fingers (E ) 6 Two-handed technique: Places thumb and of one hand on one side of the mask and places other hand similarly on the other side of the mask. Uses remaining fingers to pull the mandible into the mask Uses correct sized bag to ventilate: 250 mL for neonates, 500 mL for pediatric , 1000 to 1500 mL for adults 7 Done (2) IC (1) Not COMMENTS Done (0) Grade : ………………………………………………………………………………………………………………………….. Date of evaluation: …………………………………………………………………………………………………………. Clinical supervisor: ………………………………………………………………………………………………………….. UNIVERSITY OF DAMMAM COLLEGE OF NURSING CRITICAL CARE NURSING SKILLS & SIMULATION LAB BASIC AIRWAY MANAGEMENT STUDENT’S NAME:…………………………………… STUDENT’S NUMBER: ………………………………………… PROCEDURE CHECKLIST 1 2 3 4 5 6 7 8 Done (2) IC (1) Not COMMENTS Done (0) Uses universal precautions. Head-tilt chin-lift maneuver : Applies downward pressure on the forehead and uses fingers to lift mandible. Jaw-thrust maneuver : Places heels of hands on sides of the patient's head and grasps angles of mandible with fingers and push jaw anteriorly. Oropharyngeal airway (OPA) insertion : Selects correct size OPA (from mouth to the angle of the mandible). Inserts OPA inverted, then rotates 180 degrees at the posterior pharynx. Nasopharyngeal airway (NPA) insertion : Selects correct size NPA (from tip of nose to angle of mandible). Lubricates NPA and inserts along floor of the nasal cavity. Bag-valve mask ventilation : Opens airway, then applies mask using either one- or two-handed technique ventilates at rate of 10 to 12 breaths per minute, at a tidal volume of 8 to 10 mL/kg. Grade : …………………………………………………………………………………………………………………………….. Date of evaluation: …………………………………………………………………………………………………………. Clinical supervisor: ………………………………………………………………………………………………………….. UNIVERSITY OF DAMMAM COLLEGE OF NURSING CRITICAL CARE NURSING SKILLS & SIMULATION LAB DRAWING BLOOD FROM A VEIN STUDENT’S NAME:…………………………………… STUDENT’S NUMBER: ………………………………………… PROCEDURE CHECKLIST 1 2 3 4 5 6 7 8 9 10 Done (2) IC (1) Not COMMENTS Done (0) Explains procedure and obtains consent. Observes universal precautions. Positions the patient supine and places all supplies within reach. Places tourniquet 5 to 10 cm proximal to selected venipuncture site. Cleanses overlying skin with antiseptic solution. Applies traction distal to the vein. Holds butterfly needle with bevel facing upward. Inserts needle into vessel and observes for flash of blood. Inserts vacuum tube into the vacuette tube and collects sample. Releases tourniquet and removes needle. Grade : ………………………………………………….………………………………………………………………………….. Date of evaluation: ……………………………………….…………………………………………………………………. Clinical supervisor: ………………………………………………………………………………………………………….. UNIVERSITY OF DAMMAM COLLEGE OF NURSING CRITICAL CARE NURSING SKILLS & SIMULATION LAB VENTILATOR EMERGENCY STUDENT’S NAME:…………………………………… STUDENT’S NUMBER: ………………………………………… PROCEDURE CHECKLIST 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 Problems Associated With Mechanical Ventilator: Detaches patient from ventilator and manually ventilate patient using Resuscitator (attached to endotracheal tube) and high flow oxygen. If the patient is "easy" to manually ventilate and settles once removed from the ventilator – identifies ventilator as primary source of the emergency. While one nurse manually ventilates the patient, second nurse inspects ventilator and performs performance check If problem cannot be identified and rectified, replaces ventilator with another. Orders malfunctioning ventilator to be sent to biomedical engineering for review. Problems Associated With The Endotracheal Tube: If patient is "easy" to manually ventilate but an audible air leak is present, checks cuff pressure with manometer. If leak persists or is unsealable, checks tube position, length and air entry. Reinserts tube to correct length if necessary Checks for absence of cuff leak and equal air entry. Documents event. If patient is "difficult" to ventilate, attempts to pass asuction catheter. If the suction catheter cannot be passed further than 5 cm - verifies that patient is not biting on tube. Inserts oropharyngeal airway and attempts to suction patient again. If the suction catheter cannot be passed further than 10-15 cm, positions patient's head in neutral position and attempts suction again. If suction catheter cannot be passed further than the tip of the endotracheal tube: Deflates cuff and passes suction catheter. Done (2) IC (1) Not COMMENTS Done (0) UNIVERSITY OF DAMMAM COLLEGE OF NURSING CRITICAL CARE NURSING SKILLS & SIMULATION LAB PROCEDURE CHECKLIST 16 Reinflates cuff to pressure of 15 to 25 cm H2O and attempts to pass suction catheter again. 17 If passage of catheter is impossible and ventilation is absent: removes tube. 18 19 20 Done (2) IC (1) Not COMMENTS Done (0) Calls for assistance of ICU physician immediately. Manually ventilates patient using Resuscitator and appropriately sized mask. Prepares for reintubation. Grade : ………………………………………………………………………………………………………………………….. Date of evaluation: …………………………………………………………………………………………………………. Clinical supervisor: ………………………………………………………………………………………………………….. UNIVERSITY OF DAMMAM COLLEGE OF NURSING CRITICAL CARE NURSING SKILLS & SIMULATION LAB TRACHEOSTOMY DRESSING STUDENT’S NAME:…………………………………… STUDENT’S NUMBER: ………………………………………… PROCEDURE CHECKLIST 1 2 3 4 5 6 7 8 9 10 11 Done (2) IC (1) Not COMMENTS Done (0) Explains procedure to patient Aseptically prepares equipment Prepares dressing pack at bedside Suctions patient Removes old dressings and ties Swabs around tracheal stoma with normal saline Folds sterile gauze squares in half and place on under each wing of tracheostomy tube. Attaches cotton tape to tracheostomy tube by passing doubled cotton tape up through opening then threading loose ends up through loop. Passes two long portions of cotton tape behind patients head. Ties long end to short leaving a two finger space between patient and tie tapes. Measures cuff pressure Grade : ………………………………………………………………………………………………………………………….. Date of evaluation: …………………………Clinical supervisor: ………………………………………………………… UNIVERSITY OF DAMMAM COLLEGE OF NURSING CRITICAL CARE NURSING SKILLS & SIMULATION LAB SET UP AND INSERTION ENDOTRACHEAL TUBE STUDENT’S NAME:…………………………………… STUDENT’S NUMBER: ………………………………………… EQUIPMENT: Oxygen Suction 10ml syringe Laryngoscope Magills forceps Lubricant Airway Resuscitation bag and mask Suction Catheter Drugs as ordered Stethoscope Leucoplast tape STANDARDS: * Emergency intubation to be undertaken by the medical officer skilled in this procedure. Persons warranting E.I. must have a registered nurse in constant attendance. IV access made available. Cricoid pressure to be applied prior to intubation and removed only after cuff inflation. Cuff inflated to 200mmHg and no more than 30mmHg. Positioning of the ETT is verified by observing chest movement. - Auscultation of the chest and stomach. Chest x-ray (reviewed by medical officer). ETT sizes ranging from 2.5mm to 9.5mm. Selection appropriate to patient size. Necessary drugs are prescribed and administered at medical officers request. OUTCOMES: Patient airway available with means to maximise respiratory function. UNIVERSITY OF DAMMAM COLLEGE OF NURSING CRITICAL CARE NURSING SKILLS & SIMULATION LAB PROCEDURE CHECKLIST 1. 2. 3. 4. 5. Done (2) IC (1) Not COMMENTS Done (0) Removes Excess secretions/foreign bodies from oropharynx prior to procedure. Pre-oxygenates patient with 100% oxygen Places patient in supine position with adequate access to the head. Keeps prepared drugs available close to IV access Starts Manual ventilation once ETT IS INSITU 6. Records size of ETT and placement at the lips. 7. Observes and records respiratory observations. Grade : ………………………………………………………………………………………………………………………….. Date of evaluation: …………………………………………………………………………………………………………. Clinical supervisor: ………………………………………………………………………………………………………….. UNIVERSITY OF DAMMAM COLLEGE OF NURSING CRITICAL CARE NURSING SKILLS & SIMULATION LAB CENTRAL VENOUS CATHETER CHANGE STUDENT NAME :………………………………….. STUDENT NUMBER; ………………………………………………. PROCEDURE CHECKLIST Done IC Not COMMENTS (2) (1) Done (0) 1 Explains the procedure and obtains consent. 2 3 4 5 Observes universal precautions. Prepares dressing pack at bedside prior to positioning patient. Hangs new IV solution and new IV set ( protecting distal end from contamination by placing it on open dressing pack). Primes IV line with appropriate solution 6 Stops infusion pump and clamps IV line, with roller clamp on CVC lumen extension being changed 7 Clamps off line of CVC pigtail being changed with slide clamp. Places new IV administration set and IV solution into Infusion Pump. 8 9 10 11 12 13. Places CVC pigtail and IV line on sterile towel from dressing pack and allows solution to dry Starts Infusion Pump and allow fluid to run into sterile field of dressing pack. Connects new IV line too CVC pigtail and removes slide clamp from CVC pigtail. Labels IV administration set with time and date of change. Documents the procedure Grade : ………………………………………………………………………………………………………………………….. Date of evaluation: …………………………………………………………………………………………………………. Clinical supervisor: …………………………………………………………………………………………………………. UNIVERSITY OF DAMMAM COLLEGE OF NURSING CRITICAL CARE NURSING SKILLS & SIMULATION LAB UNIVERSITY OF DAMMAM COLLEGE OF NURSING CRITICAL CARE NURSING SKILLS & SIMULATION LAB Critical Care Nursing Laboratory Rotation Simulated Clinical Experience Objectives During their laboratory rotation critical care master students will be exposed to several simulated clinical experiences tailored to mimic situations to which they will be exposed in the ICU environment , this will provide an opportunity for students to practice skills and interventions in a safe risk free environment as well as implement teamwork leadership, and communication skills. The simulated clinical cal experience will be followed by a debriefing session during which strengths and areas for improvement will be discussed with the instructor. As a result of each simulated clinical experience students will be expected to: Integrate theoretical knowledge to practice Utilize evidence base, critical thinking and the nursing process as afrme work for nursing care Determine the priorities for nursing utilizing individualized plans of care Evaluate the effectiveness of therapeutic interventions implemented Document nursing and medical interventions Implement best nursing practices for the simulated patient Apply interdisciplinary collaboration Communicate effectively with healthcare providers regarding patient progress UNIVERSITY OF DAMMAM COLLEGE OF NURSING CRITICAL CARE NURSING SKILLS & SIMULATION LAB Integration of simulation in Critical Care Nursing curriculum Human patient simulation is one such strategy to address the multiple issues faced in teaching critical care nursing today. Patient simulation allows teach multiple objectives while brings learning alive in a multidimensional environment, and increases the confidence of the learner, which leads to competence. This is of particular importance for nurses who will be working in a high acuity environment where skill and self confidence are of utmost importance . The Program for Nursing Curriculum Integration (PNCI) by METI provides an answer to assist faculty with this transition and make more efficient use of their time as they embark on the use of patient simulation to facilitate learning and to assess competency. Areas of practice Critical Care Nursing: Selected topics of the critical care curriculum will be chosen to be taught using human patient simulation in an effort to bridge the gap between theory and knowledge while enhancing skill, knowledge and self confidence. The following is a list of the critical care topics included in the program of nursing curriculum integration , the high lighted items are presently being used in postgraduate teaching Assessment of the cardiovascular system UNIVERSITY OF DAMMAM COLLEGE OF NURSING CRITICAL CARE NURSING SKILLS & SIMULATION LAB Assessment of the respiratory system Traumatic Brain Injury RSV Bronchiolitis Meningitis Fluid and Electrolyte Imbalance Cystic Fibrosis Chronic Heart Failure and COPD Bioterrorism End-of-Life Care Sickle Cell Crisis Chronic Osteomyelitis on Home Antibiotic Therapy Acquired Immune Deficiency Syndrome Cardiac Rehabilitation Dementia and UTI Intentional Overdose of a Hypnotic Cardiopulmonary Arrest DIC Acute respiratory distress syndrome Mechanical ventilation Acute Coronary Syndrome and AMI COPD Exacerbation with Respiratory Failure Postoperative Pulmonary Embolism Closed Head Injury with Increasing ICP Multiple Patient Care Management UNIVERSITY OF DAMMAM COLLEGE OF NURSING CRITICAL CARE NURSING SKILLS & SIMULATION LAB ROADMAP FOR INTEGRATION PROGRAM OF NURSING CURRICULUM INTEGRATION CRITICAL CARE NURSING Concept Changes in Vital Signs in Relation to Critically Ill Patients Interventions and Treatment of Abnormal Vital Signs in Life Threatening Disorders: ECG, Pulse Oximetry, Arterial Lines, Respiratory and Temp. Monitoring Suctioning; Endotracheal Tubes, Artificial Airways Oxygen Delivery Systems; Mechanical Ventilation Glasgow Coma Scale; Trauma Patient ICP monitoring , arterial lines , pulmonary artery cathters Cardiac pacemakers Inclusion of pertinent pharmacology in critical care Antidysrhythmic Agents Thrombolytic Agents; Vasopressors; Blood products Adult Drug Overdose and Poisoning Neurologically Compromised Patient Ventilator Dependent Patients Simulated clinical experience Acute heart failure exacerbation Basic dysrhythmias recognition and management Acute Respiratory Distress/ Failure Secondary to Trauma, Post-Anesthesia and pneumonia Gunshot wound Herniation syndrom Motor vehicle collision with abdominal injuryy and internal bleeding and hypovolemic shock Pulmonary artery catheter Syncope Secondary to Bradycardia Requiring Transthoracic Pacing Prior to the Insertion of a Permanent Pacemaker Cardiopulmonary arrest Brain attack with thrombolytic therapy Intentional Overdose of a Hypnotic Cocaine Overdose with Cardiac Arrest Spinal cord injured patient with neurogenic shock Postoperative pulmonary embolism UNIVERSITY OF DAMMAM COLLEGE OF NURSING CRITICAL CARE NURSING SKILLS & SIMULATION LAB Simulated clinical experience Debriefing guide Simulation: ………………………………………………………………. Instructor : ………………………………………………………...…….. Objectives : Enhance learning through reflection Self evaluate knowledge and abilities Assess of teamwork and communication skills Enhance critical thinking and problem solving Process of debriefing : Explore personal reactions Assess and analyse interventions Discuss prioritization of care Discuss communication and collaboration Discuss safety Review documentation Link to clinical and real world Video playback Review what went well and what did not Identify areas for improvement Evaluate simulated clinical experience UNIVERSITY OF DAMMAM COLLEGE OF NURSING CRITICAL CARE NURSING SKILLS & SIMULATION LAB Clinical Master in Critical care nursing Edited Cases for Simulation Case 1: History: Mrs Gamela is a 29 year old Saudi woman She is 7m pregnant Complains of dizziness, palpitations and easy fatigability also complains of being out of breath (gets breathless on doing light housework) The condition started about 1 month ago but has markedly worsened over the last two days The condition worsens by effort and improves when she lies down She sleeps on two pillows This is her first pregnancy she is on irregular antenatal care The patient also complains of indigestion, heart burn and constipation Past history : Received monthly shots for one year when about 12 does not know for what Tonsillectomy at age 13 no DM , HTN No allergies medication : only takes vitamins prescribed by her obstetrician Family History Mother is diabetic Father and mother are first cousins UNIVERSITY OF DAMMAM COLLEGE OF NURSING CRITICAL CARE NURSING SKILLS & SIMULATION LAB Clinical Master in Critical Care Nursing Edited Cases for Simulation Case 2: Mr Amar is a 87 year old Saudi man who lives in a nursing home his wife died 1 year ago, he has two children who live abroad and call him once a week The patient experiences shortness of breath and palpitation when he gets up from bed to go to the bathroom this has been going on ever since his last surgery, he sleeps sitting up in bed and feels more dyspnic when he lies down Over the last two weeks the patient has lost 4 pounds Past history: DM type II of 20 years duration The patient had two CABG surgeries one of three vessels ten years ago and the second of four vessels 3 months ago. His current medications include: (The patient does not know the name of the drugs but has them with him) Metformin 1000mg X 2 Furosimide X 2 Lisinopril X1 Nadolol X 3 Digoxin X 1 except Friday Family history: DM, HTN , heart disease two of his brothers died of a heart attack UNIVERSITY OF DAMMAM COLLEGE OF NURSING CRITICAL CARE NURSING SKILLS & SIMULATION LAB Clinical Master in Critical care nursing Edited Cases for Simulation Case 3: Noora is a 45 year old Saudi female she is married and has four children The patient complains of abdominal pain and diarrhea for the last couple of days, diarrhea (8/ day) with nausea but no vomiting she reports that this has happened since she had eaten a meal at a local restaurant she also reports feeling frequently as if her heart is missing a beat The patient also complains of tingling and numbness in the fingers of her right hand that is increased by cold weather this has been going on for the last few years The patient is obese and is diabetic on insulin for the last 15 years Past history: Hysterectomy 2 years ago, for bleeding Arthritis for the last 5 years Her current medications include: Insulin Prednisolone tablets x 1 for arthritis Family history: DM (mother) HTN (mother) 2 of her children havesickle cell disease UNIVERSITY OF DAMMAM COLLEGE OF NURSING CRITICAL CARE NURSING SKILLS & SIMULATION LAB Clinical Master in Critical Care Nursing Edited Cases for Simulation Case 4: SAID is a 27 year old Egyptian male who works in a ceramic factory he is married and has two children the patient complains of severe fatigue and weakness that has been going on for the last month, two days ago the patient experienced two attacks of fainting from which he recovered by lying down, the patient also complains of palpitations the patient has had bronchial asthma for the last 6 years but recently his attacks were exacerbated by dusty weather Past history: The patient has a history of scarlet fever at the age of 10 He recalls having several attacks of arthritis during his childhood He was dispensed from military service for having a bad heart His current medications include: Simbicort inhaler x3 or as needed Family history: Irrelevant UNIVERSITY OF DAMMAM COLLEGE OF NURSING CRITICAL CARE NURSING SKILLS & SIMULATION LAB Simulated Clinical Experience Evaluation Sheet Simulation: ………………………………………………… Instructor: ……………... Student Name: …………….……… Student Number: …………..……………………. Date : ……………………………..…Group: ………………………………………..….. Done Incomplete Not done Serial Theme Comments 2 1 0 ASSESSMENT : (TOTAL 12 grades) 7. 8. 9. 10. 11. 12. Proper equipment used Systematic approach Appropriate techniques Identifies significance of findings Refers to appropriate personnel Evaluates after intervention COMMUNICATION : ( TOTAL 8 grades) 5. Communicates effectively with members of healthcare team 6. Uses appropriate verbal and non- verbal communication 7. Communicates effectively with patient and family members 8. Uses terms appropriate to patient’s level of education NURSING MANAGEMENT : (TOTAL 14 GRADES) 8. 9. 10. 11. 12. 13. 14. Uses best practices Prioritizes interventions Uses appropriate protocols / procedures/ treatments /interventions Uses Critical thinking / problem solving Delegates appropriately Proper Fluid/ blood /drug administration Coordinates appropriately with interdisciplinary team KNOWLEDGE AND COGNITIVE SKILLS (TOTAL 6 GRADES) 2. Post SCE written exam PSYCHOMOTOR SKILLS (TOTAL 10 GRADES) 2. Procedure checklist TOTAL GRADE (50) Instructor’s signature:______________________________ Date:_________________ UNIVERSITY OF DAMMAM COLLEGE OF NURSING CRITICAL CARE NURSING SKILLS & SIMULATION LAB Simulated clinical experience: care of the patient who develops respiratory failure Description of the activity: Students will be exposed to a simulated clinical experience involving a 26 year old patient who develops ARDS and progressive respiratory failure following exposure to a motor vehicle accident causing bilateral lung contusions. One student will assume the role of nurse in charge while the others will as observers and the roles will be reversed subsequently .Students will be expected to : Perform initial assessment Evaluate data and document findings Assess surgical wounds, drains Assist healthcare provider in endotracheal intubation Check ventilator settings Evaluate effecyiveness of ventilator settings Monitor pumps and infusions and check for patency Assess vitals , ABG and xray and report to healthcare provider Administer oral care Do cuff pressure checks Document assessment, interventions and response to treatment The objectives of this simulated clinical experience are: Identify the pathophysiology and causes of ARDS Perform assessment of the critically ill patient Prioritize interventions for a mevchanically ventilated patient Describe the nursing management of a person to be weaned from mechanical ventillation Discuss the modes of ventilator settings for a mechanically ventilated patient SIMULATED CLINICAL EXPERIENCE OBSERVATION SHEET Appropriate nursing intervention UNIVERSITY OF DAMMAM COLLEGE OF NURSING MASTER PROGRAM CRITICAL CARE NURSING Areas for improvement Simulation: …………………………………………………………………………………………………………………………………..… Student name: ………………………………………………………………………………………………………….. ……………………… Assessment : Proper equipment used Systematic approach Appropriate techniques Identifies significance of findings Management: Evaluates data and document findings Administers appropriate patient care Assist healthcare provider in procedures when indicated Checks ventilator settings Evaluates effecyiveness of ventilator settings Monitor pumps and infusions and check for patency Assesses vitals , ABG and XRAY and report to healthcare provider Documents interventions and response to treatment Team work and Communication : Communicates effectively with patient Uses verbal and non verbal communication Communicates effectively with family members Uses terms appropriate to patients background and level of education Collaborates appropriately with colleagues and healthcare team Simulated clinical experience observation sheet: Simulation: assessment of the respiratory system Appropriate nursing intervention UNIVERSITY OF DAMMAM COLLEGE OF NURSING MASTER PROGRAM CRITICAL CARE NURSING Areas for improvement Student name: …………………………………………………………………………………………………………... Assessment : Proper equipment used Systematic approach Appropriate techniques Identifies significance of findings Communication : Communicates effectively with patient Uses verbal and non verbal communication Communicates effectively with family members Uses terms appropriate to patients background and level of education Simulated clinical experience observation sheet: Simulation: assessment of the cardiovascular system Appropriate nursing intervention UNIVERSITY OF DAMMAM COLLEGE OF NURSING MASTER PROGRAM CRITICAL CARE NURSING Areas for improvement Student name: …………………………………………………………………………………………………………... Assessment : Proper equipment used Systematic approach Appropriate techniques Identifies significance of findings Communication : Communicates effectively with patient Uses verbal and non verbal communication Communicates effectively with family members Uses terms appropriate to patients background and level of education SIMULATED CLINICAL EXPERIENCE OBSERVATION RUBRICS SCE:ASTHMA ATTACK IN THE PEDIATRIC PATIENT: II. ADMISSION AND MANAGEMENT IN THE PICU Group B students: ………………………..………………………………………………… ………………………………………………………………………… ………………………………………………………………………… ………………………………………………………………………… ………………………………………………………………………… ………………………………………………………………….……… ………………………………………………………………………….. Serial Minimal Expected Behavior State#4: Admission to PICU 1. Completes assessment 2. Evaluates data 3. Documents findings 4. 5. Obtains and interprets oxygen saturation Identifies worsening condition 6. Endorses PICU nurse 7. Provides age appropriate communication to and reassurance to patient 8. Allows child to remain in position of comfort 9. Arranges for arterial blood gases and lab work to be drawn 10. Obtains chest XRAY 11. Notifies respiratory therapist of continuous nebulizer treatments 12. Maintains correct IV flow rate 13. Notifies healthcare provider of findings State #5:no Improvement in PICU Appropriate nursing intervention Done Incomplete Not done Areas for improvement 1. Repeats assessment 2. Evaluates data 3. Documents findings 4. Identifies worsening condition 5. Uses bag valve mask device to administer oxygen Provides age appropriate communication and reassurance to patient Allows child to remain in position of comfort Arranges for ABG to be drawn Requests and interprets results Maintains correct IV flow rate Correctly draws and administers medication according to the 5 rights Notifies health care provider of the deteriorating condition Prepares for endotracheal tube insertion Assists physician in endotracheal tube insertion 6. 7. 8. 9. 10. 11. 12. 13. 14. Group : ………………………….. …………………………………… Date of simulation: Clinical supervisor: ……….…………………………………………………………… SIMULATED CLINICAL EXPERIENCE OBSERVATION RUBRICS SCE:ASTHMA ATTACK IN THE PEDIATRIC PATIENT: II. ADMISSION AND MANAGEMENT IN THE PICU Group B students: ………………………..………………………………………………… ………………………………………………………………………… ………………………………………………………………………… ………………………………………………………………………… ………………………………………………………………………… ………………………………………………………………….……… ………………………………………………………………………….. Serial Minimal Expected Behavior State#4: Admission to PICU 14. Completes assessment 15. Evaluates data 16. Documents findings 17. 18. Obtains and interprets oxygen saturation Identifies worsening condition 19. Endorses PICU nurse 20. Provides age appropriate communication to and reassurance to patient 21. Allows child to remain in position of comfort 22. Arranges for arterial blood gases and lab work to be drawn 23. Obtains chest XRAY 24. Notifies respiratory therapist of continuous nebulizer treatments 25. Maintains correct IV flow rate 26. Notifies healthcare provider of findings State #5:no Improvement in PICU Appropriate nursing intervention Done Incomplete Not done Areas for improvement 15. Repeats assessment 16. Evaluates data 17. Documents findings 18. Identifies worsening condition 19. Uses bag valve mask device to administer oxygen Provides age appropriate communication and reassurance to patient Allows child to remain in position of comfort Arranges for ABG to be drawn Requests and interprets results Maintains correct IV flow rate Correctly draws and administers medication according to the 5 rights Notifies health care provider of the deteriorating condition Prepares for endotracheal tube insertion Assists physician in endotracheal tube insertion 20. 21. 22. 23. 24. 25. 26. 27. 28. Group : ………………………….. …………………………………… Date of simulation: Clinical supervisor: ……….…………………………………………………………… Critical Care Nursing Skills Laboratory 1 (CC1) Inventory May 2015 Cabinet Equipment/Supplies # 3 VHS Tapes Suctioning Oxygenation 1 1 Simulaids Touch Tools DELL Towels Patient’s Gown Face Towel Pillow Pillow Cases Blanket Blue Linens Tracheostomy Care Simulator 1 1 1 2 2 2 1 1 1 2 1 Ostomy Care Simulator 1 Manikin Accessories Hungry Manikin 2 CDs 6 7 8 Quantity Remarks Cabinet Equipment/Supplies # Interchangeable Catheterization/ Enema Trainer 10 11 12 Quantity 1 Pocket Masks Buttocks Wound Care Model/Gluteal Ulcer Tracheostomy Simulator Chester Chest 2 1 Little Anne Manikin 1 NGTube & Tracheo Care Trainer/Respiratory & Wound Care Task Trainer 1 1 2 Remarks Cabinet Equipment/Supplies # 13 14 15 16 Choking Charlie Arterial Puncture Arm w/ Accessories Airway Management Trainer Central Venous Simulator IV Arm Accessories Nebulizer Laryngoscope Otoscope/Ophthalmoscope Extension Wire Littmann Stethoscope Aneroid Sphygmomanometer Screw Driver Pliers Venatech Trainer Pulse Oximeter Accu-Check Glucometer Quantity 1 1 1 1 1 1 1 1 5 3 2 1 3 1 1 Remarks External Equipments Quantity Remarks Electronics Monitor Computer Dell CPU Optiplex Computer Dell Monitor Computer Dell CPU Optiplex Computer Dell Monitor Smartboard Data Show w/ Remote Printer Sony Bravia Plasma w/ Remote 1 1 1 1 1 1 1 1 1 3G Manikin (Laerdel) in bed Instructor & Patient Monitor Laptop 1 2 Inside the vault Computer Table Conference Table Swivel Chairs Wall Painting Vault IV Stand Yellow Back Strap Orange Stretcher Suction Machine 2 1 20 2 1 1 1 1 1 1-inside lab Use for lecture Use for lectrue Inside control room Inside control room Simulators Furnitures Shifted to ER (Laerdel) Inventory done by: Mrs. Lilibeth V. Reyes Lab Manager Critical Care Lab-l Noted by: Dr. Omnia Salem Coordinator Critical Care Lab-1 Dr. Radwa Hamdi Bakr Overall Coordinator Nursing Skills Laboratory CRITICAL CARE NURSING SKILLS LABORATORY 2 (CC2) Inventory May 2015 Cabinet # Equipment/Supplies Quantity Remarks 2 Pulse Oximeter Venatech IV Trainer Nebulizer Rebreather Mask (White & Blue) Pocket Masks Nursing Education /Meti Modules Chester Chest 1 2 1 2 2 5 2 Adult Sternal Intraosseous Infusion Simulator 1 3 6 7 9 10 Central Venous Simulator Arterial Puncture Arm Arterial Stick Arm VATA-Peter PICC (Peripherally Inserted Central Catheter) Line 1 1 1 Auscultation Trainer Linens Blankets Towels Face Towels Pillow Cases Patient’s Gown Central Venous Simulator 1 9 2 2 2 2 1 1 1 Cabinet # 11 12 13 14 15 Equipment/Supplies Quantity Remarks Little Anne AED-Advance External Defibrillator Choking Charlie Manikin Abdominal Aortic Aneurysm Simulator Tracheostomy Care Simulator Catheterization/Enema Model Laryngoscope Ophthalmoscope/Otoscope Omron Fat Loss Monitor Littmann Stethoscope Accu-Check Glucometer Vascular Dopplex Accu-Check Glucometer 2 2 External Equipment 1 1 2 1 2 1 1 5 2 1 1 1-With CC1 Quantity Remarks Electronics Meti-Laptops (Adult) Meti-Laptops (Pedia) Meti-MSI Touchscreen Monitors Meti-MSI keyboards w/ mouse Computer Dell CPU Optiplex Computer Dell Monitor with keyboard & mouse Computer Dell CPU Optiplex Computer Dell Monitor with keyboard & mouse Computer Dell CPU Optiplex Computer Dell Monitor with keyboard & mouse Smartboard Data Show w/ Remote Printer LG DVD Player LG VCR Player Sony Bravia Plasma w/ Remote 2 2 2 New (silver MacPro) Old (white MacBook) Adult &Pedia 2 Inside the vault 1 1 1 1 1 1 1 1 1 1 1 1 Inside the control room Inside the Glass door exclusively used for the virtual IV For lecture purposes External Equipment Quantity Remarks Simulators Airway Management Trainer Meti-Adult Manikin in bed Meti-Pedia Manikin in bed Servo-Ventilator Arterial Puncture Wrist with Circulation Pump Tracheostomy Simulator Portable Suction Machine 1 1 1 1 1 Digital Weighing Scale ECG Machine with leads 1 1 Computer Table Multipurpose Cart w/ 4 drawers Multipurpose Cart w/ 7 drawers Medicine Cart 3 1 Conference Table Swivel Chairs Wall Painting Vault Crash Cart IV Stand Yellow Back Strap 1 20 2 1 1 1 1 1 2 1-yellow(Laerdel) – no seal rubber 1-white(New Aspiret) Furnitures 1 3 Inventory done by: Mrs. Lilibeth V. Reyes Lab Manager Critical Care Lab-2 Noted by: Dr. Radwa Hamdi Bakr Coordinator-Critical Care Lab-2 Overall Coordinator-Nursing Skills Laboratory 1-shifted to ER 1-shifted to MS New – no division Shifted to ER
