Virtual Simulation

Multi-patient Prioritization Virtual Simulation

Анотація.Маленьке пояснення, що містить навчальний блок. Ви побачите цілі навчання для віртуальної симуляції на першій сторінці, а потім таблицю, яка містить інструмент самооцінювання. Очікується, що студенти подумають про те, як вони ставляться до своїх знань, навичок та суджень, перш ніж завершити симуляцію. Далі ви знайдете посилання для самої віртуальної симуляції. Натисніть на посилання, і це переведе вас до віртуальної симуляції, де ви побачите «акторів», які працюють над клінічними ситуаціями (в цьому блоці – клінічний кейс вимагає від студентів визначення пріоритету допомоги серед кількох пацієнтів). Ви помітите, що відео зупиняється і просить студентів відповісти на запитання, щоб рухатися далі. Якщо вони відповідають неправильно, вони повинні повернутися назад і знову відповісти на запитання, щоб рухатися далі. Після симуляції студент повинен оцінити себе, зосередившись на сприйнятті своїх знань та навичок.

Multi-patient Prioritization Virtual Simulation

Three patients have been assigned to Nurse Aaliyah, a newly hired RN on a medical unit at a community hospital. Aaliyah has been orientated to the unit and is now independent, with an experienced mentor to support her transition to the unit. Aaliyah’s assignment for the shift is three GI patients: a 60-year-old with cirrhosis of the liver with ascites; a 45-year-old with pancreatitis; a 28-year-old with Crohn’s Disease with bowel obstruction.

The focus of this virtual simulation is to help you prepare for the final semester of your nursing education. Pay close attention to the College of Nurses of Ontario (CNO) roles and Entry to practice (ETP) competencies that you are developing as this scenario unfolds.

Learning Outcomes
  1. Identify signs and symptoms of acute anaphylaxis to initiate early interventions
  2. Determine priority actions based on patient status to prevent further deterioration.
  3. Apply principles of medication administration for the prevention and treatment of anaphylaxis.
  4. Demonstrate effective interprofessional communication within the context of an emergency situation.

Activity #1: Self-Assessment Pre-Simulation Rubric

Learning Outcomes Assessment Rubric Pre-simulation Multi-patient Prioritization

Learning Outcome Competency Indicators Competent Learner Intermediate Learner Novice Learner
Recognizes relevant cues (salient features) that reflects the patient's status to make a timely Intervention.
  • Maintains adequate airway and oxygenation
  • Intervenes appropriately to maintain normothermia
  • Monitors for cardiac arrhythmias
  • Manages BP to maximize cerebral and peripheral perfusion
  • Maintains normal fluid & electrolytes
  • Prevents complications

Consistently

identifies salient cues to prevent patient deterioration

With minimal support,

identifies salient cues to prevent patient deterioration

With cueing

identifies salient cues to prevent patient deterioration

Comments Likert Scale 
6        5
 
4        3
 
2        1
Demonstrates ability to synthesize relevant information to determine evidence-based priority care needs.
  • Utilizes relevant data (i.e. ABCs) to create a plan of care
  • Identifies key priorities to initiate an intervention in a timely manner (what needs to be done stat, what is safe to leave for the next hour, next shift)
  • Determines the intervention which provides the best outcome for the patient
  • Identifies clinical deterioration
  • Assesses consequences of actions

Independently,

identifies and prioritizes interventions based on assessment findings to optimize health status.

With minimal support,

identifies and prioritizes interventions based on assessment findings to optimize health status.

With significant support

identifies and prioritizes interventions based on assessment findings to optimize health status.

Comments Likert Scale 
6        5
 
4        3
 
2        1
Determine within the context of competing priorities, the ability to assess, plan, implement and evaluate care.
  • Identifies the patient appropriately
  • Obtains consent
  • Completes a comprehensive assessment
  • Interprets results appropriately
  • Implements a plan of care
  • Evaluates plan of care

Independently

identifies and prioritizes interventions

With minimal support,

identifies and prioritizes interventions

With significant support and prompting,

identifies and prioritizes interventions

Comments Likert Scale 
6        5
 
4        3
 
2        1
Demonstrate the ability to advocate for patient safety within the context of prioritization.
  • Identifies potential threats to patient safety
  • Advocates for appropriate resources to meet the patient’s needs
  • Delegates appropriately

Consistently

demonstrates advocacy to support patient safety and quality care

With minimal support,

demonstrates advocacy to support patient safety and quality care

With significant support and prompting,

demonstrates advocacy to support patient safety and quality care

Comments Likert Scale 
6        5
 
4        3
 
2        1
Effectively communicate essential information with the IP team to mobilize resources
  • Uses SBAR communication
  • Provides information in an emergency situation in a succinct manner
  • Delegates appropriately

Consistently

uses effective communication strategies to advocate for the patient

With minimal support,

uses effective communication strategies to advocate for the patient

With significant support and prompting,

uses effective communication strategies to advocate for the patient

Comments Likert Scale 
6        5
 
4        3
 
2        1
more

Activity #2 Complete the Virtual Simulation

Prioritization of Care Among Multiple Patients

Try Virtual Simulation

Activity #3 Complete the Self-Assessment Rubric after viewing the virtual simulation

Learning Outcome Competency Indicators Competent Learner Intermediate Learner Novice Learner
Recognizes relevant cues (salient features) that reflects the patient's status to make a timely Intervention.
  • Maintains adequate airway and oxygenation
  • Intervenes appropriately to maintain normothermia
  • Monitors for cardiac arrhythmias
  • Manages BP to maximize cerebral and peripheral perfusion
  • Maintains normal fluid & electrolytes
  • Prevents complications

Consistently

identifies salient cues to prevent patient deterioration

With minimal support,

identifies salient cues to prevent patient deterioration

With cueing

identifies salient cues to prevent patient deterioration

Comments Likert Scale 
6        5
 
4        3
 
2        1
Demonstrates ability to synthesize relevant information to determine evidence-based priority care needs.
  • Utilizes relevant data (i.e. ABCs) to create a plan of care
  • Identifies key priorities to initiate an intervention in a timely manner (what needs to be done stat, what is safe to leave for the next hour, next shift)
  • Determines the intervention which provides the best outcome for the patient
  • Identifies clinical deterioration
  • Assesses consequences of actions

Independently,

identifies and prioritizes interventions based on assessment findings to optimize health status.

With minimal support,

identifies and prioritizes interventions based on assessment findings to optimize health status.

With significant support

identifies and prioritizes interventions based on assessment findings to optimize health status.

Comments Likert Scale 
6        5
 
4        3
 
2        1
Determine within the context of competing priorities, the ability to assess, plan, implement and evaluate care.
  • Identifies the patient appropriately
  • Obtains consent
  • Completes a comprehensive assessment
  • Interprets results appropriately
  • Implements a plan of care
  • Evaluates plan of care

Independently

identifies and prioritizes interventions

With minimal support,

identifies and prioritizes interventions

With significant support and prompting,

identifies and prioritizes interventions

Comments Likert Scale 
6        5
 
4        3
 
2        1
Demonstrate the ability to advocate for patient safety within the context of prioritization.
  • Identifies potential threats to patient safety
  • Advocates for appropriate resources to meet the patient’s needs
  • Delegates appropriately

Consistently

demonstrates advocacy to support patient safety and quality care

With minimal support,

demonstrates advocacy to support patient safety and quality care

With significant support and prompting,

demonstrates advocacy to support patient safety and quality care

Comments Likert Scale 
6        5
 
4        3
 
2        1
Effectively communicate essential information with the IP team to mobilize resources
  • Uses SBAR communication
  • Provides information in an emergency situation in a succinct manner
  • Delegates appropriately

Consistently

uses effective communication strategies to advocate for the patient

With minimal support,

uses effective communication strategies to advocate for the patient

With significant support and prompting,

uses effective communication strategies to advocate for the patient

Comments Likert Scale 
6        5
 
4        3
 
2        1
more

Asynchronous online debrief

This asynchronous involves a debrief using a discussion board platform or hold a synchronous discussion via Google Meet/ZOOM where participants post responses to reflective debriefing questions. Other participants and facilitators then respond to reflective postings.

Activity #4 Complete the Reflective Questions1

  1. Did you feel adequately prepared for the simulation experience?
  2. How would you manage a multiple-patient assignment as a new grad?
  3. What strategies may be helpful when prioritizing multiple patients?
  4. How do you shift priorities or re-prioritize after you have evaluated outcomes?
  5. What were your thoughts after listening to the Introduction, Situation, Background, Assessment, Recommendation framework (ISBAR) report? What further information would you like to ask?
  6. How would a DNR order change any of the priorities?
  7. How would the nurse address any of the abnormal lab results?
  8. Think about the IP team. How would the new nurse delegate to other team members to assist in times of increased patient acuity/workload? i.e., other RNs, RPNs, physiotherapists, RTs, PSWs
  9. Did you have any clinical concerns for the 3 patients?
  10. Were you concerned about the onset of delirium tremors due to the abrupt cessation of alcohol?
  11. What if the patient with Crohn’s disease and a bowel obstruction refused the NGT re-insertion? What would be your next approach?
  12. Why was the patient with cirrhosis experiencing unresponsiveness?
  13. You overheard the healthcare team speak about the ‘alky in bed 10’ referring to the patient with non-alcoholic fatty liver disease (NAFLD). How would your response be?
  14. How will this simulation experience change your practice?

Resources

  1. How to prioritize your patient assignment. To access the video, Click here
  2. New nurse time management tips. To access the video,Click here
  3. Kohtz, C., Gowda, C., & Guede, P. (2017). Cognitive stacking: Strategies for the busy RN. Nursing 2017, 47(1) 1-3. Click here
  4. 4. Patterson, E., Ebright, P., & Saleem, J. (2011). Investigating stacking: How do registered nurses prioritize their activities in real time? International Journal of Industrial Ergonomics, 41, 389-393. Click here