VIRTUAL SIMULATION

Stroke-Virtual Simulation Activity

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 – інсульт). 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.

Stroke-Virtual Simulation Activity

The following virtual simulation has several activities with the priority focus being how you feel regarding your CNO Roles and Entry to practice competencies in light of this patient care scenario. Identify where you believe your strengths are in light of the CNO roles and where you would like to build your confidence and competence.

Filomena da Silva, a 65-year-old was admitted to the medical unit from the nursing home with pneumonia (accompanied by delirium and dehydration) for IV antibiotic therapy 8 days ago. Due to the delirium, she has been mainly bedridden. Past Hx-diabetes, hypertension, atrial fibrillation, and an 18-pack-year smoker (quit 30 years ago). Delirium is resolving, pneumonia is improving; goals are physio for ambulation. Meds: Xarelto 10mg po daily, Coversyl 8 mg po daily, metformin po 500 mg BID, ceftrizaone 1 g IV Q12H. Experiences sudden onset of left-sided hemiparesis (arm and leg), garbled speech, facial drooping. VS BP 186/88, Pulse 88, RR 24, SaO2 94%.

Learning Outcomes
  1. Conduct a comprehensive neurological examination for a patient who is experiencing a stroke to determine the priority intervention.
  2. Establish nursing and collaborative care priorities for a patient who is experiencing a stroke to prevent further deterioration of the patient’s health status.
  3. Reflect on communication strategies for a patient experiencing a stroke to promote therapeutic communication.
  4. Demonstrate leadership at the point of care to facilitate evidence-based stroke management

Activity #1: Complete the Learning Outcomes Self-Assessment Rubric on Stroke Management Prior to watching the Virtual Simulation

Learning Outcome Competency Indicators Competent Learner Intermediate Learner Novice Learner
1. Conduct a comprehensive neurological examination for a patient who is experiencing a stroke to determine the priority intervention.
  • Identifies the patient appropriately
  • Obtains consent
  • Completes a subjective inquiry
  • Assesses level of consciousness, orientation, motor function, pupillary changes, vital signs
  • Interprets results

Independently and accurately

completes all elements of a rapid neurological assessment

With minimal support,

completes all elements of a rapid neurological assessment

With support and prompting

completes most elements of a rapid neurological assessment

Comments Likert Scale 
6        5
 
4        3
 
2        1
Explanation of the scale: 6 feeling very confident to 1 feeling like you need a lot of support if this were a patient you are caring for in your nursing practice.
2. Establish priorities of nursing and collaborative care for a patient who is experiencing a stroke to prevent further deterioration of the patient’s health status.
  • Maintain adequate airway and oxygenation
  • Intervenes appropriately to maintain
  • Monitor for cardiac arrhythmias
  • Manage BP to maximize cerebral
  • Maintain glycemic control
  • Prevent complications such as pneumonia, DVT, urinary tract infections
  • Integrates patient safety in fall prevention, device-related infection

Independently,

identifies and prioritizes interventions based on assessment findings to optimize health status. 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
3. Reflect on communication strategies for a patient experiencing a stroke to promote therapeutic communication.
  • Minimize distraction, extraneous noises
  • Permit time for communication
  • Keep questions simple, using ‘Yes’ or ‘No’
  • Speak in a normal tone of voice and cadence
  • Selects the appropriate communication aid (i.e. writing, gestures, use of technology – cell phone, computer, communication boards

Consistently

identifies and uses appropriate therapeutic communication strategies to foster

With minimal support,

identifies and uses appropriate therapeutic communication strategies to foster

With significant support and prompting,

identifies and uses appropriate therapeutic communication strategies to foster

Comments Likert Scale 
6        5
 
4        3
 
2        1
4. Demonstrate leadership at the point of care to facilitate evidence-based stroke management practices
  • Uses SBAR to communicate important information to the healthcare team
  • Advocates for patient safety
  • Initiates appropriate neurological assessments for stroke
  • Aware of the Canadian Neurological Scal

Consistently

demonstrates leadership according to role, knowledge, and experience to support patient safety and quality care

With minimal support,

demonstrates leadership according to role, knowledge, and experience, to support patient safety and quality care

With significant guidance,

demonstrates leadership according to role, knowledge, and experience, to support patient safety and quality care

Comments Likert Scale 
6        5
 
4        3
 
2        1
more

Activity #2 Complete the virtual simulation activity-use the following on

Stroke management

Try Virtual Simulation

Activity #3 Complete the Learning Outcomes Self-Assessment Rubric on Stroke Management after watching the Virtual Simulation

Learning Outcome Competency Indicators Competent Learner Intermediate Learner Novice Learner
1. Conduct a comprehensive neurological examination for a patient who is experiencing a stroke to determine the priority intervention.
  • Identifies the patient appropriately
  • Obtains consent
  • Completes a subjective inquiry
  • Assesses level of consciousness, orientation, motor function, pupillary changes, vital signs
  • Interprets results

Independently and accurately

completes all elements of a rapid neurological assessment

With minimal support,

completes all elements of a rapid neurological assessment

With support and prompting

completes most elements of a rapid neurological assessment

Comments Likert Scale 
6        5
 
4        3
 
2        1
Explanation of the scale: 6 feeling very confident to 1 feeling like you need a lot of support if this were a patient you are caring for in your nursing practice.
2. Establish priorities of nursing and collaborative care for a patient who is experiencing a stroke to prevent further deterioration of the patient’s health status.
  • Maintain adequate airway and oxygenation
  • Intervenes appropriately to maintain
  • Monitor for cardiac arrhythmias
  • Manage BP to maximize cerebral
  • Maintain glycemic control
  • Prevent complications such as pneumonia, DVT, urinary tract infections
  • Integrates patient safety in fall prevention, device-related infection

Independently,

identifies and prioritizes interventions based on assessment findings to optimize health status. 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
3. Reflect on communication strategies for a patient experiencing a stroke to promote therapeutic communication.
  • Minimize distraction, extraneous noises
  • Permit time for communication
  • Keep questions simple, using ‘Yes’ or ‘No’
  • Speak in a normal tone of voice and cadence
  • Selects the appropriate communication aid (i.e. writing, gestures, use of technology – cell phone, computer, communication boards

Consistently

identifies and uses appropriate therapeutic communication strategies to foster

With minimal support,

identifies and uses appropriate therapeutic communication strategies to foster

With significant support and prompting,

identifies and uses appropriate therapeutic communication strategies to foster

Comments Likert Scale 
6        5
 
4        3
 
2        1
4. Demonstrate leadership at the point of care to facilitate evidence-based stroke management practices
  • Uses SBAR to communicate important information to the healthcare team
  • Advocates for patient safety
  • Initiates appropriate neurological assessments for stroke
  • Aware of the Canadian Neurological Scal

Consistently

demonstrates leadership according to role, knowledge, and experience to support patient safety and quality care

With minimal support,

demonstrates leadership according to role, knowledge, and experience, to support patient safety and quality care

With significant guidance,

demonstrates leadership according to role, knowledge, and experience, to support patient safety and quality care

Comments Likert Scale 
6        5
 
4        3
 
2        1
more

Asynchronous online debrief

This asynchronous involves a debrief using a discussion board platform where participants post responses to reflective debriefing questions. Other participants and facilitators then respond to reflective postings

Activity #4 Complete the Reflective Questions1

  1. Reflecting on the scenario, did you feel adequately prepared for this patient scenario if you were the primary nurse?
  2. After completing the virtual simulation experience, how do plan on building on your strengths and addressing any perceived gaps?
  3. What would be the most effective way to communicate with this patient if she was said to have Broca’s Aphasia?
  4. If this patient experiences urinary incontinence, what strategies should the nurse initiate to manage this?
  5. If this patient demonstrated expressive aphasia, right hemiparesis, and dysarthria what steps does the nurse need to take prior to administering ASA 325 mg PO?
  6. How would the nurse intervene if the patient experienced a hemorrhagic stroke with increased ICP?
  7. How would the nurse know that the patient is having increased ICP?
  8. If this patient demonstrated significant cognitive deficits, what assessments would need to be completed in order for the patient to achieve a greater level of independence?
  9. Discuss indications and contraindications for administration of a thrombolytic for an ischemic stroke in this patient.
  10. When discussing the patient’s discharge to home, identify safety precautions that will support her at home.
  11. Thinking back to the interprofessional team involved in this patient’s care, who would be involved and what is their role within the team?
  12. How would the teaching be individualized for this patient when planning the discharge teaching?
  13. In keeping with the patient safety agenda, discuss how the bedside transfer of accountability or handover would be beneficial?

Activity #5 Debriefing the virtual simulation.