Fundamentals Simulation #1
Date: 8/17/2014
File Name: Fundamentals
Simulation 1
Discipline: Nursing
Expected Simulation Run Time: 15
Location: Temple College (TC) Skills Lab
Student Level: Freshman
Guided Reflection Time: 5
Location for Reflection: TC
Skills Lab
Admission Date: 8/16/2014
Today’s Date: 8/17/2014
Brief Description of Client
Psychomotor Skills Required Prior
to Simulation
Skills lab practice on taking complete
set of vital signs, hand hygiene,
Name: Mary Abbot
Cognitive Activities Required
prior to Simulation [i.e. independent
Gender: F Age: 61 Race: Caucasian
reading (R), video review (V), skills lab
(SL), lecture (L)]
Weight: 76 kg
Height: 66 in
Religion: Roman Catholic
Major Support: Husband and Daughter
Allergies: NKDA
Immunizations: Up to date
Attending Physician/Team: Dr.
Ross/Ortho
Past Medical History: Healthy does not
take any medications and has no known
allergies.
History of Present illness: Patient had a
fall while walking up an icy staircase and
has severe pain in her right arm.
Social History: Does not smoke, drink or
take drugs.
Primary Medical Diagnosis: Right
R- Complete all readings assigned for
Lecture(s) and skills lab(s) below.
L- 1. Safety
2. Nursing Process
3. Therapeutic Communication
SL- 1. Infection Control
2. Hygiene
3. Vital Signs
V- Medcoms- 1. Safety
2. Basic Clinical Skills
humeral closed fracture
Surgeries/Procedures & Dates: none
Nursing Diagnoses:
Acute pain related to recent injury AEB:
Verbal report of pain
Observed evidence of trauma to right arm
Protective gestures/guarding
Impaired physical mobility related to
musculoskeletal impairment AEB:
Limited ability to perform gross motor skills.
Simulation Learning Objectives
Upon completion of this simulation scenario the student will:
1. Obtain a complete set of vitals signs (BP, Apical pulse/radial pulse, respirations,
temperature, pulse oximeter, and include pain level). (NCLEX: Physiological Integrity;
QSEN: Patient Centered Care)
2. Identify and correct any safety issues found in the patients room. (NCLEX: Safe and
Effective Care Environment; QSEN: Safety)
3. Report all findings to the charge nurse using the SBAR format. (NCLEX:
Management of Care; QSEN: Teamwork and Collaboration)
Fidelity (choose all that apply to this simulation)
Setting/Environment
Medications and Fluids
ER
Med-Surg
Peds
ICU
OR / PACU
Women’s Center
Behavioral Health
Home Health
Pre-Hospital
Other: Please ensure the bed is raised,
one side rail is down and the call light is
not within reach of the patient at the start
IV Fluids:
Oral Meds:
IVPB:
IV Push:
IM or SC:
Diagnostics Available
Labs
X-rays (Images)
12-Lead EKG
Other:
of the scenario.
Simulator Manikin/s Needed: One
SimMan manikin
Props: sling for right arm
Equipment attached to manikin:
IV tubing with primary line
fluids running at
mL/hr
Secondary IV line
running at
mL/hr
IV pump
Foley catheter
mL output
PCA pump running
IVPB with
running at
mL/hr
02
Monitor attached
ID band
Other: Heplocked IV, Blood Pressure
cuff, pulse oximeter, stethoscope and
thermometer at bedside.
Documentation Forms
Physician Orders
Admit Orders
Flow sheet
Medication Administration Record
Kardex
Graphic Record
Shift Assessment
Triage Forms
Code Record
Anesthesia / PACU Record
Standing (Protocol) Orders
Transfer Orders
Other:
Recommended Mode for Simulation
(i.e. manual, programmed, etc.)
Full Scale Simulation- “using a
computerized full-body manikin that
can be programmed to provide realistic
physiological responses to student
actions (Cant & Cooper, 2010).”
Equipment available in room
Bedpan/Urinal
Foley kit
Straight Catheter Kit
Incentive Spirometer
Fluids
IV start kit
IV tubing
IVPB Tubing
IV Pump
Feeding Pump
Pressure Bag
02 delivery device (type)
Crash cart with airway devices and
emergency medications
Defibrillator/Pacer
Suction
Other:
Roles/Guidelines for Roles
Primary Nurse
Student Information Needed Prior to
Scenario:
Secondary Nurse
Clinical Instructor
Family Member #1
Family Member #2
Observer/s
Recorder
Physician/Advanced Practice Nurse
Respiratory Therapy
Anesthesia
Pharmacy
Lab
Imaging
Social Services
Clergy
Unlicensed Assistive Personnel
Code Team
Other:
Important Information Related to
Roles:
Observer will shadow the student in the nurse
role. Being that this is the student’s first
simulation experience the student in the nurse
role will be able to “phone a friend” and ask
for assistance if they are having trouble.
Observer will be allowed to provide assistance
if needed.
Significant Lab Values:
none
Physician Orders:
Vitals Q4H
Activity OOB as tolerated
Morphine Sulfate 10mg PO Q6H PRN.
Motrin 800mg PO Q8H
Has been oriented to simulator
Understands guidelines
/expectations for scenario
Has accomplished all presimulation requirements
All participants understand their
assigned roles
Has been given time frame
expectations
Other:
Report Students Will Receive Before
Simulation
Time: 1000- Morgan Abbot is a 62-year-old
female who is an inpatient on the medsurg floor for pain management while
awaiting and ORIF of her right humerus.
She had a fall on the ice yesterday resulting
in a fracture of her arm. Past medical
history is insignificant, and she takes no
regular medications. No known allergies.
Patient received her morning meds and
assessment was completed. You received
report from the charge nurse to cover this
patient while her primary nurse is off the
floor. Patient is due for a full set of vital
signs to include pain assessment. After
completion you are to report back to the
charge nurse with your findings.
References, Evidence-Based Practice Guidelines, Protocols, or
Algorithms Used For This Scenario (site source, author, year, and page):
Latchman J., 2014. Improving pain management at the nursing education level:
evaluating
knowledge and attitudes. J Adv Pract Oncol. 5(1):10-6.
Whittingham KA, Oldroyd LE, 2014. Using an SBAR - keeping it real! Demonstrating
how
improving safe care delivery has been incorporated into a top-up degree
programme. Nurse Educ Today. 34(6):e47-52.
Schwappach DL, Gehring K, 2014. Silence That Can Be Dangerous: A Vignette Study
to
Assess Healthcare Professionals' Likelihood of Speaking up about Safety
Concerns.
PLoS One, 12;9(8).
Faculty Role: The facilitator of the simulation scenario will be responsible for ensuring
that the simulation is set up appropriately and that students are briefed and have an
understanding of the objectives and what they need to accomplish. Faculty member will
follow the script and the progression as closely as possible to ensure all students have
equivalent learning experiences.
Faculty member will fill out the checklist found in this simulation guide.
Facilitator of the simulation scenario will also lead the debriefing portion using the 3D
Model of Debriefing: Defusing, Discovering, and Deepening. Please refer to the
handbook for more information on debriefing method or refer to the following article as
needed: Zigmont, J. J., Kappus, L. J., & Sudikoff, S. N. (2011, April). The 3D model of
debriefing: Defusing, discovering, and deepening. Seminars in Perinatology, 35(2), 5258.
Checklist that will be found in student syllabus for this scenario.
Simulation Checklist for Satisfactory
Needs
Fundamentals Scenario 1
Improvement
Washes hands
Introduces Self
Identifies the patient
(name, ID Band, DOB)
Obtains vitals
(BP, Apical pulse/radial pulse,
respirations, temperature,
SpO2).
Conducts a pain
assessment using a pain
scale.
Conducts a safety survey
and corrects and safety
issues
Report is given to the
charge nurse using
SBAR format.
Scenario Progression Outline
Timing
(approximate)
5 Minutes
5 to 10 Minutes
10 to 15
Minutes
Manikin Actions
Expected
Interventions
May Use the
Following Cues
Vocal sounds:
Answers questions
regarding
identification:
“My name is Mary
Abbot and my
birthday is on
September 7, 1952.”
Wash hands
Role member
providing cue:
Patient
Identifies patient by
name and ID band
Cue: “Who are
you?” If student
fails to introduce
self
Vocal sounds:
Asks: “Is everything
OK?”
Informs patient
regarding the need to
obtain viral signs
Role member
providing cue:
Patient
Introduces self
States, “Oh wow, that Obtains vital signs
thing on my arm is
way to tight!”
Cue: If student fails
to ID the patient.
“You are the first
person who hasn't
checked my
bracelet I guess you
guys really know
who I am by now
anyway.”
Vocal sounds:
Pain assessment:
“It is throbbing, I
would rate it a 5 out
of 10.”
Role member
providing cue:
Charge Nurse
Completes a pain
assessment
Addresses safety
issues in the room
“I really don't want to Report is given to
charge nurse
become addicted to
(instructor)
these pain pills.”
Cue: Patient will ask
for call bell if
student is not
addressing safety
issues
May prompt student
by asking questions
if information is left
out on report.
Complexity – Simple to Complex
Suggestions for Changing the Complexity of This Scenario to Adapt to
Different Levels of Learners
This is a very basic scenario meant to be the first high fidelity experience for the
novice nursing student. This scenario can be a base for any other scenario. A head
to toe assessment could be added on easily to elevate this scenario to a slightly
higher level. The patients’ prior medical history could also be changed and the
scenario could address the issues you would face with a diabetic who is NPO prior to
surgery. Since this is at the most basic level individual instructors can tweak this
scenario to address whatever case they need to in this high fidelity scenario. The
scenario could also be made even more basic by having the visit take place in the
office for a well visit with no broken