Simulation as a Capstone Clinical Performance Assessment

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Simulation as a Capstone Clinical Performance
Assessment

• Diane Joyce, RN, MSN, APNP Connie Lindmeier, RN,
  MSN

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Objectives

• Discuss how the PCNI can be adapted within an
  individual nursing course
• Explain how simulation is used within a clinical
  capstone nursing course
• Demonstrate how student individual clinical
  performance is assessed against the course
  competencies

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Northcentral Technical College, Wausau, WI
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Introduction

• Wisconsin Technical College System
• 16 nursing programs
• Course Competencies and performance standards
  created

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Nursing Clinical Transition Course Description

• This clinical experience prepares the student to
  assume the role of graduate nurse. The course
  promotes clinical decision-making, delegation,
  and collaboration to achieve client and
  organizational outcomes. Continued professional
  development is fostered.

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Introduction
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Objective 1 Adapting PNCI
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Objective 1 Adapting PNCI

• Start with the Shift Report
• History/information from
• PCNI is great baseline
• Adopt for your area
• This is a 52 year old female, who came in last
  pm. Shirley Jones DOB 2-1-1955, with a 10 year
  hx of alcohol abuse. She is married with 1 grown
  daughter. She is employed full time but has been
  increasing absent from work in past 6 months due
  to complaints of lethargy and fatigue. PMH is
  alcoholic cirrhosis dx 18months ago. Endoscopic
  banding for varices 6 months ago. Home
  medications Lactulose, an antibiotic (name
  unknown) for bronchitis (she was seen in the
  office 4 days ago and dx with bronchitis), oral
  metronidazole, and aldactone. During the noc,
  she was swatting at flies in the air that were
  not there, insisted that there were spiders
  crawling on the wall,and stated she wanted to
  leave the house to catch a bus.

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Objective 1 Our Faculty
Worksheet
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Objective 1 Mandatory Student
Preparation

• Prep Questions
• Adaptation from PNCI
• Be sure to compare to your required texts
• We add additional, for example more pharmacology
  and related labs, developmental tasks, community
  resources

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Objective 2 Explain how simulation if used within
a clinical capstone nursing course.

• 2 credit clinical course
• Math competency
• Seven weeks of 5 hour simulations
• Eight student in each clinical group
• Four students simulation/four case studies
• Four hours of presentations on community agency
• Capstone paper on how the student met the program
  outcomes
• 40 hours of precepted experience in one week
• Hybrid course/discussion groups
• Two hour capstone individual simulation
• test out.

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Objective 2 Key features to this course

• Simulation is key to expose to what a graduate
  nurse will be involved with
• Taking telephone MD orders
• Calling MD with change in client condition
• Role of the RN from assessment, medication
  administration, communication, critical thinking,
  documentation
• Delegation
• Teamwork

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Objective 2 Key Features

• Case studies
• Sound and worth the student effort
• Case studies that involve calling MD and giving
  report
• Receiving telephone orders
• Critical thinking and identifying if the MD order
  is appropriate for the client or
• not and if not provide the rationale why not

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Objective 2 Key Features

• Community research agency presentation
• Expose students to the agencies in the area that
  they may refer to as a graduate nurse
• Self Reflection Capstone Paper
• Identifying how the student meet there program
  outcomes

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Objective 2 Roles of team

• Lead RN
• Documentation/Debriefing leader
• Medication
• Resource

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Objective 2 7 Simulations in the
course

• anaphylaxsis, liver failure, renal failure, DKA,
  heart failure, SIADH/DI, pulmonary emboli
• The goal for a consistent learning experience

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Confidentiality Statement

• We enforce HIPPA by expecting no discussion of
  scenarios with other students outside of the
  scheduled course just as we would expect this in
  an actual clinical setting.

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Videotaping

• Videotaping.. Critique each other
• So they can actually see what we are seeing..
  Especially if they are failing
• Faculty can review and see at a later time
  student performance since you seem to miss a few
  things when are in the sim lab and the scenario
  is running.
• Again, rationale for 4 in at a time.

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Objective 3Demonstrate how student individual
clinical performance is assessed against the
course competencies

• This is a performance-based course designed
  around 9 competencies.
• Again, these competencies were created as part of
  the WTCS and we can not change them.

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1. Adapt communication style based on analysis
of the situation

• One student calls MD for report
• One student calls pharmacy or lab for
  clarification of meds or to obtain stat lab data
• One student communicates with wife role played
  by staff member of our learning lab
• One student needs to write a nursing note on the
  simulation.

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2. Assess the needs of clients, families, and
groups within the community

• One student completes the physical assessment
• One student interprets the lab and correlates it
  with the patient assessment
• One student responsible for assess the family
  needs and/or discharge needs
• One student based on the physical assessment
  decides what medications need to be administered
  and if they should be administered.

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3. Make relatively independent clinical
decisions

• One student decides when to call MD
• All students write down the anticipated orders
  from the MD or what they think the MD should
  order before the call is made
• One student may start the O2 if saturation is low
• One student will look at the environmental
  picture and put side rails up or call light.

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4 Accept accountability for care

• Show up and are on time for clinical
• Have prep questions completed and turned in
• Practice or verbalize whether they can complete
  certain orders ie pull ETT
• Maintain confidentiality of simulations

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5 Manage Multiple Priorities

• Assess priorities of how they implement the MD
  orders
• Give IV fluids before start IV antibiotic
• Put Oxygen on when saturations warrant
• Lower or raise the head of bed based on
  assessment
• Delegate to other students to get vital signs and
  oxygen saturations

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Objective 3
Competencies Continued

• 6 Work collaboratively to achieve client and
  organizational outcomes
• 7 Delegate Nursing Care
• 8 Provide safe and effective care that
  considers the uniqueness of the client
• Check name bands
• Check for allergies
• Know the medications and reasons why they are to
  be given
• Safely performs skills against schools checklists
• 9 Assume responsibility for professional
  development

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Our research n73
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SurveyTwo open ended questions

• Please write in suggestions and comments below.
  What worked, what didnt work, and any suggested
  changes.
• What specifically did you learn that you will use
  in your practice.

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Themes

• Want longer time in the sim lab
• Liked Calling MD and doing MD orders
• Teamwork
• Prioritization
• Confidence
• Delegation
• Importance of having to know labs/meds

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Favorites

• Get a good long orientation
• Think on my feet
• More time spent learning this type of material
  here than in clinical
• Learned my areas of weaknesses and what I need
  to improve in
• I learned to trust what I heard, felt, saw,
  etc
• Believing in myself

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Simulation In Nursing Education From
Conceptualization to Evaluation (2007) Jeffries,
P.R. DNS, RN, FAAN
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Contact us

• Diane Joyce
• joyce_at_ntc.edu
• Connie Lindmeier
• lindmeie_at_ntc.edu