Author: Annette Ray, MSN, RN
Title: Assistant Professor
Institution: The University of South Dakota
Coauthors: Amy Hunsley-McTighe, MSN, RN, Assistant Professor University of South Dakota Lori Koenecke, MS, RN, Assistant Professor, University of South Dakota Lisa Feller, MS, RN, Assistant Professor, Univers
Patient-Centered Care, Safety, Teamwork and Collaboration
Pre-Licensure ADN/Diploma, Pre-Licensure BSN
Skills or Simulation Laboratories
Patient Centered Care Knowledge: Identify common complications and priorities related to the care of a post cardiac surgery patient. Skill: Perform targeted post-CABG assessment. Attitude: Value the patient’s health concerns.
Safety Knowledge: Integrate understanding of universal medication safety strategies and utilization of SBAR. Skill: Demonstrate effective use of medication safety strategies. Demonstrate effective use of SBAR. Attitude: Value nursing role in preventing errors.
Teamwork and Collaboration Knowledge: Describe own strengths, limitations, and values in functioning as a member of a team. Discuss effective strategies for communicating with patient, family members, and members of health care team. Skill: Implement therapeutic communication techniques with post-op client. Communicate with team members, adapting own style of communicating to needs of team and situation. Attitude: Value the importance of adapting communication style to each unique health care situation.
A low-fidelity manikin was utilized to simulate a patient who was two days post-CABG. Students assumed the roles of Primary Nurse, Charge Nurse, Patient Spouse, and Observer. Prior to the start of the simulation, the Primary Nurse and Charge Nurse received information about the client (AM assessment information). Scripts for the roles of patient spouse and observer were distributed. The simulation began with the primary nurse entering the room to administer the scheduled 9AM IV antibiotic. Shortly after the start of the simulation, the patient experienced atrial fibrillation, a common complication associated with CABG surgery. Participants were expected to assess the patient, communicate with the patient, family member, and members of the healthcare team, and implement safe and effective nursing care.
Equipment used to care for a post-CABG client was attached to a low-fidelity manikin and available in the simulated patient room. A nurse’s station was created that included a telephone, client records, cardiac monitor, and medication room. A pre-programmed alarm sound was initiated indicating a dysrhythmia on the cardiac monitor. As this happened, a rhythm strip with atrial fib was placed on the cardiac monitor by a faculty person. Students were expected to respond to the dysrhythmia, assess the patient, communicate with the physician and pharmacy, and implement new orders. New orders included a potential drug-drug incompatibility requiring students to identify and take appropriate measures.
Immediately following the simulation, students participated in a 30-minute debriefing activity. Faculty guided students to consider a set of questions related to the simulation experience. Discussion focused on students’ thoughts and feelings as they worked through the simulation. They were asked to reflect on their strengths and on how they may have handled the situation differently. Simulation observers were asked to share their thoughts related to the same questions, along with their observations from an audience perspective—especially on issues related to safety, teamwork, and communication. All students were asked to describe their ability to achieve the simulation objectives.
The attached simulation rubric includes information about equipment, props, scripts, and other information necessary to implement this simulation.
This experience was not graded and instead focused on safety and process. Following the simulation, students completed an evaluation form that addressed the following: Learning, Expectations, Collaboration, Satisfaction, and Self-Confidence. Anecdotal feedback was obtained from course evaluations.
Because of their positive experience with this simulation, the majority of students requested additional simulations be added to the curriculum. Students described the simulation as realistic requiring them to make decisions and implement nursing interventions in a manner very similar to the clinical environment.
Faculty found this to be a valuable learning experience. Based on student feedback, the evaluation tool will be revised to gather more specific information about what students learned during the simulation.