nal policy and procedure manual

8/8/2019 NAL Policy and Procedure Manual

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Table of Contents

PageGoal 3

Philosophy 3

Lab Objectives3

General Information4

Skills Videos 4

Lab conduct/Behavior5

Clean up 5

Attendance 6

Guidelines for Missed NAL Time6

NAL Referral Form 7

Appointments8

Lab Kits8

Safety Guidelines 9Infection Control PolicyLatex Warning

Needle Stick / InjurySecurity / Emergencies

Dress Code 10

Grading Criteria11

Critical Elements/ MEIHIPPPPP12

Faculty Return Demonstration Guidelines13

2nd

/3rd

Attempt of Skills Return Demonstration Form14

List of Skills by Course15

High Fidelity Simulation (SimMan/SimBaby)16

Video recording

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17Confidentiality

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Policy and Procedure ManualValencia Community College Nursing Arts Lab

Goal

The goal of the Nursing Arts Lab (NAL) is to provide a safe, life-likeenvironment to learn and practice essential nursing skills, without the risk ofharm to actual patients. Once learned, these skills can be taken and utilizedin the clinical setting to provide safe, knowledgeable and effective nursingcare.

Philosophy

The NAL uses simulation to prepare students for their clinicalexperiences. Using scenarios that progress from simple to complex, studentsget hands-on experience to prepare for clinical practice. The NAL provides aninteractive environment where students are encouraged to ask questions andparticipate in active, hands-on learning. Simulation is used to assess andevaluate the students skill acquisition, and eases the transition between laband clinical practice. Simulation scenarios mimic the clinical setting and helpthe student develop problem solving and decision making skills. Because ofthe individuality of each client situation, the student may see minor variationsin technique. Students will learn that there are many ways of doing a skillcorrectly, as long as basic concepts, such as sterility, are maintained. Facultymembers may present different methods of performing a skill; however thetheory behind the skills are always the same.

The NAL staff and Nursing department faculty are available to helpstudents succeed. Students can help ensure their success by coming to theNAL prepared. This will include watching the appropriate videos and readingthe content associated with a skill before coming to the NAL. Practicing a skillprior to a check off is essential. Nursing is a profession that requires a greatdeal of practice to acquire a level of expertise, not only for accuracy andpatient safety, but for the comfort and safety of the practitioner as well.

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Repetition in skill practice is similar to sports, music, etc. where organizationand coordination are needed.

Objectives

During NAL simulations and scenarios, students will:

1. Perform skills safely and within the designated time period.2. Demonstrate flexibility, efficiency and critical thinking during skill

performance.3. Incorporate the following components into each procedure:

Course contentHumanistic aspects (comfort, privacy, etc.)Communication with patientRationale

General Information

Valencia has two nursing labs, one on West Campus and one onOsceola Campus. See the Valencia website for campus maps and drivingdirections. Students are allowed to use either lab for practice regardless ofcourse enrollment. See the link on the NAL website for diagrams of the roomlayout and pictures of the labs on both campuses.

The West campus NAL is located on the second floor of the HSBbuilding and has several rooms. Room 224 is a 4 bed practice room with twomedium fidelity simulators (Vital Sim) and two low fidelity simulators

(mannequins). Students can practice skills and get supervised practice inroom 224. Room 225 is a large lab with 4 practice rooms each containing thesame equipment as room 224. This room is used by Nursing I and othercourses for lab instruction. Room 228 mirrors room 225 and is used primarilyby Nursing III. Room 227 is used by Nursing III as a newborn nursery. It isalso used by Nursing V for Virtual IV practice. The West campus NAL hasvarious equipment (Hoyer lift, wheelchairs, NIBP monitors, etc) available forstudent practice. Most rooms have computers for students to watch nursingskill videos and electronic chart access. In addition, Rooms 225 and 228 eachhave a simulation room, with two high fidelity simulators (SimMan andSimBaby).

The Osceola campus NAL is located on the second floor of building 3,Room 3-200. It has 4 practice rooms each with two medium fidelitysimulators (Vital Sim) and two low fidelity simulators. There are two nursingstations with computers where students can access patient charts. There isalso a study room with a computer where students can watch nursing skillvideos. The Osceola campus NAL has various equipment (Hoyer lift,wheelchairs, NIBP monitors, etc) available for student practice. In addition,

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there is a simulation room, with one high fidelity simulator (SimMan). VirtualIV and SimBaby are not available at Osceola.

Both labs provide Instructional Assistants (RNs) and Learning Assistants(student peers) who are available for tutoring and skill check offs. Lab hours

and staff availability are posted on the doors of the lab, as well as on thesecure nursing website. The NAL hours are subject to change due tostaff availability. Check the secure nursing website under schedules forthe current operating hours. Appointments with lab staff can be made thruAccutrack or Accuweb. Instructions for its use are on the NAL website.Students without appointments will be seen if the schedule permits.

Skills Videos

Nursing I and AVS students purchase a set of Mosbys Nursing SkillsVideos, 3rd edition with

their text book. These are the only videos that should be viewed whenpreparing for skill practice.

A set of these videos is avilable at each lab and may be requested from the labstaff to view in the

lab. A complete list of the videos is also posted by the computers.

Lab Conduct/Behavior

The NAL is considered a clinical site. As such, all policies listed in theNursing Program Student Handbook for clinical responsibilities apply to thelab. All users of the NAL must act in a manner that does not disturb theacademic activities occurring in the lab. No lab user shall infringe upon theprivacy, rights, privileges, health, or safety of other lab users. The labinstructors offices are located within the lab. These spaces are for facultyonly.

There is no eating or drinking allowed in the lab, with the exception ofwater in the classroom area only. Students are not allowed to use labphones. Cell phones and pagers MUST be turned off during all lab

experiences. Refer to the Nursing Program Student Handbook.

All lab mannequins are to be treated as if they were livepatients. Do not sit on the beds; the bed is considered the patients privatespace. Students are only allowed in the patient beds when assuming the roleof the patient. Please remove your shoes when doing so. Mannequins are notto be removed from the beds unless it is part of the skill assignment (ex.mechanical lift). These mannequins are very expensive. Please get the

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assistance of lab staff if you need a mannequin moved. If you need tochange parts on a mannequin, please get the assistance of lab staff. Siliconespray is used as mannequin lubricant for skills such as airway suctioning,foley catheter insertion, etc., and should be used sparingly. Do Not allowlubricant to contact the floor as it is extremely slippery. Do Not use any

other lubricant other than silicone spray. Please do not use newspaper,Betadine, or ink pens near the mannequins it will indelibly stain them.Donot use lab equipment for any purpose other than its intended use. Anyoneabusing lab equipment will be asked to leave the lab, and may be heldresponsible for broken or missing equipment. If you notice something isbroken, please notify lab staff immediately. If you notice anything that needsrestocking (gloves, paper towels, etc) please notify lab staff. Students maybe dismissed from the Nursing Program as a result of conduct thatis unsafe, unethical, inappropriate, or unprofessional; this includesconduct in the NAL. Refer to the Nursing Program Student Handbook.

Clean up

The NAL staff is not responsible for cleaning up after students usingthe lab. Clean up

after you practice; leave the lab in as good as or better condition than youfound it. Beds should

be remade properly and left in the lowest position with side rails up. Pullback the curtains and

return the overbed table to the foot of the bed. All lab equipment usedshould be returned to

its proper place. In this way other students may enjoy their lab experience.

Attendance

Attendance in the lab is part of course credit hours and is mandatory.An attendance sheet will be available for record keeping purposes. It is the

responsibility of the student to sign in/out of the lab. Do not sign infor another student - this is unethical and unacceptable behavior. If you arelate to class or if you do not sign in, faculty will meet with you to determinethe consequences. Missed NAL time must be made up. See Guidelines forMissed NAL Time below.

Students are expected to arrive on time for class, simulation, andpractice in the NAL. In case of emergency that will require being late or

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absent from lab, the student must call at least hour prior to the scheduledstart time. Calling a classmate to relay a message regarding absenceor tardiness is not acceptable. If you will be late or absent for class in thelab, call 407-582-1582 for West Campus, or 407-582-4865 for Osceola.Calling in an absence does not excuse the student from making up missed

lab time. Students will not enter class (lab) late, but must wait to enterduring the first break. Students who show a pattern of tardiness will becounseled by faculty. Students who are habitually late may be removed fromthe nursing program. Refer to the Nursing Program Student Handbook.

Guidelines for Missed NAL Time

If a student is absent, late , or fails to sign in for a scheduled NAL class, a labreferral will be made and the student will meet with faculty to discuss plans tomake up the hours missed. Students in clinical may also be referred to the lab for

extra practice as deemed necessary by clinical instructors. A Nursing Lab Referralform (page 7), with the assignment to be completed, will be filled out by facultyand signed by the student. A copy of this form will be given to the student. Therest of the form is given to the NAL staff and filed in the NAL referral book. The labreferral and assigned make-up time must be done within 2 weeks. Assignmentsmay need to be turned in. Upon completion of the referral, the faculty will benotified by lab staff.

Missed lab time must be made up due to state regulations for clinicaltime and accreditation.

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STUDENT NAME: __________

DATE OF REFERRAL: ________

ACTIVITIES TO BE REVIEWED: (

________________________

________________________________________________

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Appointments

Making appointments with lab staff for remediation or skill check offs isdone using Accutrack/Accuweb. On West campus, go to Room 224 and usethe computer provided. On Osceola Campus, use the two nursing station

computers in the main classroom. Accuweb can also be used with anycomputer that has internet access. The URL is:

http://nursing.valenciacc.edu/accuweb

Instructions for the use of Accutrack/Accuweb are located in both labs. OnWest campus, there is a binder with instructions by the computer in Room224. On Osceola Campus, there are binders with instructions located at bothnursing stations. Instructions are also on the NAL website. Do not makeappointments for fellow students; this is an individual responsibility.

If you will be unable to show up for an appointment that you scheduled

in Accutrack/Accuweb, cancel it in the computer as soon as possible. If it is alast minute cancellation, call 407-582-5465 if the appointment is on Westcampus, or 407-582-4865 if it is on Osceola campus. You may leave amessage at either number. Students who fail to show up for scheduledappointments will be considered tardy and referred to the Director of Nursingfor mandatory counseling after the second missed appointment. Studentsmay be removed from the nursing program for excessive tardiness. Refer tothe Nursing Program Student Handbook.

Lab Kits

Lab kits are mandatory for every nursing course using the lab. Whenpurchasing your kit, specify the course number to make sure you buy theright kit for the course in which you are enrolled. For example, students inNursing I would ask for the NUR 1021C kit. If you are repeating a course, youdo not need to repurchase an entire new kit. The bookstore will havereplacement kits with the supplies you will need. All kits must be purchasedfrom the bookstore. DO NOT use equipment or supplies from work or othersources. The kits sold in the bookstore have the appropriate sizes andmaterials that will not harm the lab mannequins. All kits look the same;make sure you label everything with your name. The lab is not responsiblefor lost or missing items. Do not throw anything away, including the

wrappers of your supplies - youll reuse them numerous times for practiceand return demonstration.

Bring all the necessary equipment and supplies for lab as needed foreach skill. The lab does not have extra equipment. If you do not bring whatyou need, you may lose valuable practice time. Coming unprepared for a skillcheck off will result in a failure for that skill. Being prepared includes havingall equipment and supplies necessary for completion of that skill.

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Be aware that syringes and needles may be seen by law enforcementas drug paraphernalia. Keep these items at home until needed for lab. Whentransporting these items, keep them out of sight, and have your student IDso that you can prove you are a nursing student if stopped.

Safety Guidelines

Infection Control Policy

Everything in the NAL is simulated there are no real body fluids.However, when participating in NAL activities, students will need to be awareof and follow Standard Precautions and Transmission Specific Precautions(droplet, airborne, contact). Everything that comes in contact with thepatients body fluids is considered contaminated and needs to be handledaccordingly. The following are some basic guidelines to follow:

Wash hands before and after patient careUse barrier protection (gloves, masks, gowns, etc)Dispose of equipment and other materials appropriately (ex. sharps

containers)

Latex warning

Some lab equipment may contain latex. If a student has a knownsensitivity/allergy to latex, please notify faculty immediately. All gloves usedin the lab are latex free.

Needle stick / injury

In the event of a needle stick or other injury in the NAL, please followthese guidelines:

Inform faculty immediately; do not try to hide the injuryRender first aid as necessary (For serious injury dial 911)

Call security (West campus ext. 1000, Osceola campus ext.4000) and fill out

required incident formGo to West campus Health Sciences office and fill out the

required insuranceform for Valencia

Security and Emergencies

For emergencies in the NAL, please call security and follow the CriticalIncident Plan Guidelines located by all lab computers. The number on WestCampus is ext. 1000: on Osceola Campus the number is ext. 4000. For life

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threatening emergencies call 911.

Students are NOT allowed to bring children or guests to the lab. This is aliability issue. Anyone who violates this rule will be asked to leaveimmediately. If you do not comply, security will be called to escort the

offending party off campus. There are no exceptions. Refer to the NursingProgram Student Handbook.

Dress Code/Hygiene

The dress code applies to all students using the lab during class or scheduled

appointments for remediation or skill check offs. Refer to the NursingProgram Student Handbook for details.

Lab coatNavy blue Valencia polo shirtKhaki pants (no Capris, no shorts)Name tag and Valencia student IDClosed toed, closed heel shoes (no sandals, flip flops, heels)Hair pulled back and off collarMinimal make-up or jewelryNo perfume/cologne or other strong odors

The lab is considered a clinical area. Therefore, if a student is not in properdress, they will not be allowed to use the lab. Proper dress includes thewearing of the Valencia student ID, which serves as our institutionalidentification credential. A lab coat over the Community NursingUniform is required in the NAL for all Lab Activities, including PeerReturn Demonstrations.

Students coming to the lab for practice only may wear street clothes (referto the Nursing Program Student Handbook for what is considered appropriateattire). Wear clothing/shoes which are appropriate for activities; sandals/flip-

flops/heels are not supportive or safe for practice. Be aware of your ownhygiene status: breath, body odor, foot odor, clean feet. Perfume can causeallergic reaction in classmates/clients/patients. Keep hair and jewelryprofessional while in the nursing lab; large bracelets, rings and hair in yourface are unprofessional, get in the way of lab activities, and compromisepatient safety and your own. Practice only means that you have not made anappointment with lab staff. Anyone with an appointment needs to be dressedin community uniform. There are no exceptions.

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Your name tag is required at all times in the NAL, even if you are justpracticing.

Faculty Return Demonstration Grading Criteria for Nursing I

Pass: The student completed the skill satisfactorily with no more than threeprompts.

Prompt: The student needed assistance or was Unable to Perform/NotPerformed (NP) a step

during the skill return demonstration.

Fail & Redo:The student needed more than 3 prompts or missed a criticalelement.

Definitions for evaluation criteria of nursing skills return demonstration:

Able to Perform / Satisfactory (S)Performs skill accurately without prompts from instructorCriteria of assessment and skill carried out in correct orderDemonstrates dexterityCompletes skill in set time frame

Able to Perform with Assistance / Unsatisfactory (U)Performs skill accuratelyRequires occasional prompts during performance of taskDemonstrates coordination, but uses some unnecessary energy to

complete activityCompletes skill in reasonable timeCriteria of assessment not always completed in correct order but

corrected by student

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Unable to Perform / Not Performed (NP)Performs, but not accuratelyRequires continuous promptsDemonstrates lack of skill, uncoordinated in majority of behavior

Skill completed with considerable delay (or stopped because of delay)

Students MUST come prepared for their lab experience. Preparationincludes all skill check offs (learning assistant and faculty), as well as skillinstruction. Read the textbook, watch the videos, and practice, practice,practice. Students who come to the lab unprepared may be sent out toresearch and prepare before returning to the lab.All return demonstrationsmust be performed satisfactorily to pass the course. All lab skills will be doneaccording to the scheduled date listed in the course calendar. If you are notready to complete the skill on the scheduled day, it will count as a failure.

The check-off sheets are your record of completing a skill satisfactorily andare considered required equipment for a skill check off. Please keep themfor future reference. If you get nervous when watched, have students andfaculty work with you early in the term to help you get over yournervousness.

Critical Elements Guide for Patient Safety

The critical elements identified with each skill must be accomplished in orderto pass the skill evaluation. * All critical elements before and after the skill

must be performed or a skills failure results. Skills in which you do notdemonstrate mastery must be practiced until the level of mastery, asidentified in the critical elements, is achieved.

The following actions are to be done prior to each procedure:*1 Check medical record and physicians order*2 Gather supplies*3 Identify self to client*4 Hand hygiene/use standard precautions*5 Identify client using at least two identifiers*6 Check for allergies

*7 Adherence to the 10 Rights for medication administration(client, drug, dose, time, route, + assessment, documentation, education,

evaluation, refusal)*8 Pause for the Cause*9 Provide client privacy*10 Assess pain/ client comfort/readiness for procedure*11 Explain procedure to client*12 Positioning of client and caregiver for safety

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*13 All sterile/clean procedures must be free from contamination.After completion of each procedure, the following actions are to be done:*1. Ensure client comfort and safety*2. Remove used items using standard precautions/perform hand hygiene

3. Assess clients response and understanding of procedure*4. Complete and document appropriate teaching

*These actions will be part of the required critical elements of each skillevaluation.

MEIHIPPPPP After the procedure, beforeleaving the room:

M edical record review Bed in low position

E quipment, gather Siderails upI ntroduce self Call lightH and hygiene ComfortI dentify patient and allergies Hand hygieneP ause for the cause DocumentP rivacy, provideP ain, assessP rocedure, explainP osition, accordingly

FACULTY RETURN DEMONSTRATION GUIDELINES

1. Students must demonstrate satisfactory performance of all nursingskills to pass the course. Reasons for failure of a skill include morethan three prompts, non-completion of a critical element, beingunprepared (this includes not having essential supplies or equipment,or all necessary paperwork), or refusal to complete the skill on thescheduled day.

2. A student who has an unsatisfactory return demonstration of a nursingskill will require a 2nd attempt. After the first unsuccessful attempt,the faculty will fill out a 2nd/3rd Attempt of Skills form (page 14) and

give it to the student. This form must be brought by the student foreach step in the remediation process. The student must remediate bypracticing the skill. After practice, an appointment must be made witha Learning Assistant or NAL instructor for a supervised observation ofthe skill demonstration to determine if the student is ready for thesecond attempt. The supervised observation cannot be the same dayas the day of the unsuccessful attempt.

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3. The student will make an appointment with a lab instructor or facultymember for the second attempt at demonstrating the skill. Only after alearning assistant or NAL instructor makes the determination that thestudent is ready can a second attempt be scheduled.

4. Should a 3rd attempt be necessary, repeat steps #2 and #3. The 3rd

attempt will be evaluated by two full time tenured faculty. Failure ofthe skill on the 3rd attempt will result in failure of the course.

5. A student who is required to redo any four faculty return demos duringthe course will be considered unsuccessful in Nursing I and will receivea failing grade. Inability to perform any return demonstration ofnursing skills on the scheduled date will result in failure of the skill anda 2nd attempt will be required.Skills must proceed according to thecalendar and must be completed on due date. No succeedingreturn demonstration of skills will proceed if the skill that was failed

builds onto the next skill (examples: sterile field/gloving-wounddressing change or PO medication administration-Subcutaneousinjections).

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STUDENT'S 2nd/3rd Attempt of Skills Return Demonstration Evaluated by Faculty

Skill: Campus:Date:

Student Name: Faculty Name:

Student Signature: Faculty Signature:

SECOND ATTEMPT: Please complete the following steps

You MUST have this form for observation and 2ndattempt returndemonstration

1. Make an appointment for supervised observation by either a Learning Assistant(LA) or NAL staff the LA or NAL staff will evaluate your readiness for your 2nd

attempt.

Ready for 2nd Attempt? _______Comments__________________________________________________________Signature of Observer: _____________________________________________ Date:

_______________________2. Practice

3. Make an appointment with NAL staff for your 2nd attempt.

PASS FAIL Comments:_______________________________________________________________Signature of Faculty: ______________ _________________________________ Date:

_____________________Signature of Student :________________________________________________ Date:

_____________________

Third attempt: please complete the following steps

As per the Nursing Handbook and Syllabus, the 3rd attempt must becompleted successfully to pass Nursing I. You MUST have this form forobservation and 3rd attempt return demonstration.

1. Make an appointment to review the areas needed for improvement withNAL staff or Faculty ONLY(No LAs)

Ready for 3rd Attempt? _______Comments_________________________________________________________Signature of Observer: ____________________________________________ Date:

_____________________

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STUDENT'S 2nd/3rd Attempt of Skills Return Demonstration Evaluated by Faculty

Skill: Campus:Date:

Student Name: Faculty Name:

Student Signature: Faculty Signature:2. Practice

3. For your 3rd attempt, you will be required to perform your demo with (2)tenured faculty. Please email Mrs. Stone via Web CT to make anappointment.

PASS FAIL Comments:_______________________________________________________________

Prompts:_____________________________________________________________________________________

Signature of Faculty: ____________________ Signature of Faculty: __________________ Date: ______________

Signature of Student:____________________________________________________ ___Date: ______________

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Nursing IFacult

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High Fidelity Simulation (SimMan/SimBaby)

Simulation in nursing education does not replace the need for studentsto learn in clinical practice but complements other teaching and learningapproaches in preparing student nurses for their role in practice. High fidelity

simulation such as SimMan/SimBaby provides students with an environmentconducive to focusing on critical thinking, clinical reasoning, and clinicaljudgment skills as well as acquiring new knowledge. Simulation in nursingeducation offers many advantages, including:

Realistic patient situations can be reproduced with all variablescontrolled

No threat to patient safety; ethical concerns are minimizedActive hands-on learning can occurSpecific and unique patient simulations can be createdErrors can be corrected and discussed immediately

Consistent and comparable experiences can occur for allstudents

Maximal amount of learning timeExperimentation and creativity are allowed and encouragedSelf evaluation is promotedFeedback can be elicitedDecision making can be promoted safely

Students will be oriented to simulation theory prior to running ascenario. If the student is not comfortable, learning will not take place andscenario objectives may not be met. All scenarios are prepared by faculty

using NLN guidelines. Students participating in NAL scenarios will beevaluated on their general patient assessment techniques and adherence toall critical elements. The faculty will provide debriefing and feedbackimmediately after the scenario. Debriefing is a reflective critical thinkinganalysis and communication tool for participants of the simulation exercise.The debriefing assessment provides an intensive post conference and activeevaluative process driven by peers and instructor, focusing on positiveaspects, and allowing for major learning experience. Students will selfanalyze their performance and use critical thinking during the reflectionprocess. Sample questions would be:

Explain the rationale behind the actions

Was it appropriate? Safe?What would you do different if you were to perform the

simulation over?What, if any, obstacles did you encounter?

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Video recording

Experiences in the high fidelity simulation rooms may be recorded.Recordings are for educational purposes and debriefing opportunities withthe appropriate faculty, staff, and students.The confidentiality agreementsigned by students protects privacy and discourages inappropriatediscussion of the video contents or the students performance in thesimulation scenario. Any viewing or publication outside of theclassroom is unacceptable and unethical and may result in thedismissal from the nursing program. Photography, videotaping, and/oraudio recording is not allowed in the lab without faculty permission.Students

and faculty should conduct themselves professionally as they would in anyclinical setting since all interactions can be recorded.

Confidentiality

All simulation scenarios and practice sessions involving studentsand/or recordings are considered confidential. Discussion of scenarios orinformation is considered a violation of the NAL privacy policy. All studentsare required to sign a confidentiality statement before going to clinical. Thisconfidentiality statement also applies to students using the lab. Students are

not to discuss their lab experiences or scenarios outside of the appropriateclassroom context. Students will be reminded throughout the course ofconfidentiality issues. Students are expected to uphold all requirements ofthe Health Insurance Portability and Accountability Act (HIPPA).

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nal policy and procedure manual

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