What%20if%20it%20were%20your%20child?

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What if it were your child?

• Incorporating Patient Simulation Into New
  Graduate Orientation
• Wendi Bowers, RN, BSN, CCRN-P,
• Pediatric Clinical Coordinator
• Pediatrics and Pediatric Critical Care

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WHO WE ARE

• Pediatric Services devised of
• 26 bed general pediatric medical/surgical unit
• Care of children ranging from birth to 18 years
  of age
• 10 bed Pediatric Intensive Care Unit (PICU)
• Care of critically ill children ranging from
  birth to 18 years of age
• Two Pediatric Intensivists
• Dr. Griggs
• Dr. Banner
• Average length of stay (LOS)
• Pediatric unit 2.8 days
• PICU 6.8 days
• Turnover rate 2007 was 12.38
• Organizational goal is less than 10

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PEDIATRIC MISSION STATEMENT

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

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WHAT WE KNOW

• Preparing beginner nurses to provide care to
  complex patients is difficult.
• Challenges are amplified when the patient is a
  child.
• Limited exposure to the variety of ages and
  diseases unique to the pediatric patient.
• Child at risk if the nurse is unable to properly
  identify pediatric emergencies.

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WHAT WE KNOW

• Incorporating Pediatric simulation scenarios into
  unit based new graduate orientation provides the
  beginner nurse with the opportunity to enhance
  assessment and critical thinking skills.
• Development of these skills reduces the incidence
  of failure to rescue, builds clinical
  confidence and competence which all contribute to
  enhanced job satisfaction and retention

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MODELS

• Benner Model for nursing competency
• Novice
• Advance Beginner
• Competent
• Proficient
• Expert
• Synergy Model
• Needs and characteristics are matched
• Competencies
• Improve outcomes

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SYNERGY MODEL
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• Dales Cone of Learning Active Learning yields
  90 retention through use of simulation

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UNIT BASED ORIENTATION

• 16 week Pediatric ICU orientation/13 week
  Pediatric Orientation
• Orientee paired with coach
• Coaches present for guidance and support
• Simulation time scheduled monthly beginning in
  week 3
• Non-threatening environment
• Pedia sim is housed in an actual patient room
  with nurse server, wall mounts, monitors, etc.

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TOOLS

• Knowledge Assessment Tool
• Basic Knowledge Assessment Tool (BKAT)
• Evaluation tools
• Daily
• Weekly
• Coach
• On-line teaching
• Resource book
• Program Evaluation tools
• Casey-Fink Survey
• Burnout Self-check
• Nursing Satisfaction Scale

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Resource Binder

• Detailed time-line
• skills day
• Patient care days (8 hours)
• Case study preparation/presentation
• On-line modules (4 hours)
• Simulation (4 hours)
• Forms
• Articles
• Skills Checklist
• Evaluation tools
• Daily and weekly
• Monthly Team conferences

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Incorporating Simulation

• Explanation of goals confidential, not to
  embarrass, keep learning experience REAL
• Basic overview of skills performed first
  orientee and coach performed head-to-toe
  assessment of standard child.
• Reviewed findings with coach and charted on
  flow-sheet.
• Facilitators made changes to manikin then
  orientees/coaches reassessed, identified changes
  and documented their findings and discussed
  treatment options

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Incorporating Simulation

• Multidisciplinary approach
• Doctors
• Pharmacist
• Respiratory therapist
• Pre-programmed scenarios Appendicitis, Asthma,
  Near Drowning, Hypovolemic shock
• Debriefing with team members immediately
  following scenarios

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WHAT IF IT WERE YOUR CHILD?
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DENISE MEETS DR. GRIGGS
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DENISE GOES ON A ROAD TRIP

• CT
• MRI
• Radiology
• Transfers to and from PICU/10West

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Facilitator Observations

• Use of high-fidelity mannequin, realistic
  atmosphere, and appropriate clinical supplies and
  equipment support learning in a safe environment.
• Simulation allows for true evaluation of the
  learners clinical performance.
• Improved satisfaction of our orientation program.
  

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PARTICIPANT EVALUATIONS

• very helpful seeing the physiologic changes
  occur based on treatment
• less stressful knowing that no harm was done to
  a real patient if I chose the wrong treatment
• great having experienced support staff to
  collaborate with
• debriefings provided great performance feedback
• Reassurance that the right things were done
• insight into how things could be done differently
• loved simulation!

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WHAT IF IT WERE YOUR CHILD?

• QUESTIONS?