What if it were What if it were your child?your child?

Incorporating Patient Simulation Into New Incorporating Patient Simulation Into New Graduate OrientationGraduate Orientation

Wendi Bowers, RN, BSN, CCRN-P, Wendi Bowers, RN, BSN, CCRN-P, Pediatric Clinical CoordinatorPediatric Clinical Coordinator

Pediatrics and Pediatric Critical CarePediatrics and Pediatric Critical Care

WHO WE AREWHO WE ARE Pediatric Services devised of:Pediatric Services devised of:

26 bed general pediatric medical/surgical unit 26 bed general pediatric medical/surgical unit Care of children ranging from birth to 18 years of ageCare of children ranging from birth to 18 years of age

10 bed Pediatric Intensive Care Unit (PICU)10 bed Pediatric Intensive Care Unit (PICU) Care of critically ill children ranging from birth to 18 Care of critically ill children ranging from birth to 18

years of age years of age

Two Pediatric IntensivistsTwo Pediatric Intensivists Dr. GriggsDr. Griggs Dr. BannerDr. Banner

Average length of stay (LOS):Average length of stay (LOS): Pediatric unit 2.8 daysPediatric unit 2.8 days PICU 6.8 daysPICU 6.8 days

Turnover rate 2007 was 12.38%Turnover rate 2007 was 12.38% Organizational goal is less than 10%Organizational goal is less than 10%

PEDIATRIC MISSION PEDIATRIC MISSION STATEMENTSTATEMENT

Our mission is to make a positive difference in the lives of children and their families by providing supportive and compassionate healthcare throughout all stages of life.

WHAT WE KNOWWHAT WE KNOW Preparing beginner nurses to provide Preparing beginner nurses to provide

care to complex patients is difficult. care to complex patients is difficult. Challenges are amplified when the Challenges are amplified when the

patient is a child. patient is a child. Limited exposure to the variety of Limited exposure to the variety of

ages and diseases unique to the ages and diseases unique to the pediatric patient. pediatric patient.

Child at risk if the nurse is unable to Child at risk if the nurse is unable to properly identify pediatric properly identify pediatric emergencies. emergencies.

WHAT WE KNOWWHAT WE KNOW Incorporating Pediatric simulation Incorporating Pediatric simulation

scenarios into unit based new graduate scenarios into unit based new graduate orientation provides the beginner orientation provides the beginner nurse with the opportunity to enhance nurse with the opportunity to enhance assessment and critical thinking skills. assessment and critical thinking skills.

Development of these skills reduces Development of these skills reduces the incidence of “failure to rescue”, the incidence of “failure to rescue”, builds clinical confidence and builds clinical confidence and competence which all contribute to competence which all contribute to enhanced job satisfaction and retentionenhanced job satisfaction and retention

MODELSMODELS Benner Model for nursing competencyBenner Model for nursing competency

NoviceNovice Advance BeginnerAdvance Beginner CompetentCompetent ProficientProficient ExpertExpert

Synergy Model Synergy Model Needs and characteristics are matchedNeeds and characteristics are matched Competencies Competencies Improve outcomes Improve outcomes

SYNERGY MODELSYNERGY MODEL

•Dale’s Cone of Learning: Active Learning yields 90% retention through use of simulation

•Dale’s Cone of Learning: Active Learning yields 90% retention through use of simulation

UNIT BASED UNIT BASED ORIENTATIONORIENTATION

16 week Pediatric ICU orientation/13 16 week Pediatric ICU orientation/13 week Pediatric Orientationweek Pediatric Orientation

Orientee paired with coach Orientee paired with coach Coaches present for guidance and Coaches present for guidance and

supportsupport Simulation time scheduled monthly Simulation time scheduled monthly

beginning in week 3 beginning in week 3 Non-threatening environmentNon-threatening environment Pedia sim is housed in an actual Pedia sim is housed in an actual

patient room with nurse server, wall patient room with nurse server, wall mounts, monitors, etc.mounts, monitors, etc.

TOOLSTOOLS Knowledge Assessment ToolKnowledge Assessment Tool

Basic Knowledge Assessment Tool (BKAT)Basic Knowledge Assessment Tool (BKAT)

Evaluation toolsEvaluation tools DailyDaily WeeklyWeekly CoachCoach On-line teachingOn-line teaching Resource bookResource book

Program Evaluation toolsProgram Evaluation tools Casey-Fink SurveyCasey-Fink Survey Burnout Self-checkBurnout Self-check Nursing Satisfaction Scale Nursing Satisfaction Scale

Resource BinderResource Binder Detailed time-lineDetailed time-line

skills dayskills day Patient care days (8 hours)Patient care days (8 hours) Case study preparation/presentationCase study preparation/presentation On-line modules (4 hours)On-line modules (4 hours) Simulation (4 hours)Simulation (4 hours)

FormsForms ArticlesArticles Skills ChecklistSkills Checklist Evaluation toolsEvaluation tools

Daily and weeklyDaily and weekly Monthly Team conferencesMonthly Team conferences

Incorporating SimulationIncorporating Simulation Explanation of goals: confidential, not to Explanation of goals: confidential, not to

embarrass, keep learning experience REALembarrass, keep learning experience REAL Basic overview of skills performed first: Basic overview of skills performed first:

orientee and coach performed head-to-toe orientee and coach performed head-to-toe assessment of standard child. assessment of standard child.

Reviewed findings with coach and charted Reviewed findings with coach and charted on flow-sheet. on flow-sheet.

Facilitators made changes to manikin then Facilitators made changes to manikin then orientees/coaches reassessed, identified orientees/coaches reassessed, identified changes and documented their findingschanges and documented their findings and and discussed treatment optionsdiscussed treatment options

Incorporating Incorporating SimulationSimulation

Multidisciplinary approachMultidisciplinary approach Doctor’sDoctor’s PharmacistPharmacist Respiratory therapistRespiratory therapist

Pre-programmed scenarios: Pre-programmed scenarios: Appendicitis, Asthma, Near Appendicitis, Asthma, Near Drowning, Hypovolemic shockDrowning, Hypovolemic shock

Debriefing with team members Debriefing with team members immediately following scenariosimmediately following scenarios

WHAT IF IT WERE YOUR WHAT IF IT WERE YOUR CHILD?CHILD?

DENISE MEETS DR. DENISE MEETS DR. GRIGGSGRIGGS

DENISE GOES ON A ROAD DENISE GOES ON A ROAD TRIPTRIP

CT CT MRI MRI RadiologyRadiology Transfers to and from Transfers to and from

PICU/10WestPICU/10West

Facilitator Facilitator ObservationsObservations

Use of high-fidelity mannequin, realistic atmosphere, and appropriate clinical supplies and equipment support learning in a safe environment.

Simulation allows for true evaluation of the learners clinical performance.

Improved satisfaction of our Improved satisfaction of our orientation program. orientation program.

PARTICIPANT EVALUATIONSPARTICIPANT EVALUATIONS

““very helpful seeing the physiologic changes very helpful seeing the physiologic changes occur based on treatment”occur based on treatment”

““less stressful knowing that no harm was done less stressful knowing that no harm was done to a real patient if I chose the wrong to a real patient if I chose the wrong treatment”treatment”

““great having experienced support staff to great having experienced support staff to collaborate with”collaborate with”

““debriefings provided great performance debriefings provided great performance feedback”feedback” Reassurance that the right things were doneReassurance that the right things were done insight into how things could be done insight into how things could be done

differentlydifferently ““loved simulation!”loved simulation!”

WHAT IF IT WERE YOUR WHAT IF IT WERE YOUR CHILD?CHILD?

QUESTIONS?QUESTIONS?