Figure 5.2: Planning a learning experience using new technology
For any scenario, you should incorporate the following elements into your development process.
These items give you an idea of what you will need to think about to plan the learning
experience:
1.
Title (acute myocardial infarction, adolescent trauma)
2.
Setting (emergency department, critical care unit)
3.
Learning objective(s)
4.
Equipment needed
5.
Simulation modalities to be used
6.
Back story for patient presentation (e.g., emergency medical services (EMS) brings into the
emergency department a 50-year-old gunshot victim complaining of difficulty breathing)
7.
Expected actions from the learners
8.
Case progression description
9.
Criteria for completion (e.g., learners recognize asystole and begin effective CPR)
10. Elements to include in guided reflection/debriefing
Example of a blended simulation scenario
The following is an example of a straightforward scenario that uses a variety of the simulation
modalities discussed in Chapters 4 and 5. Not all of the different modalities have to be used, but
rather this serves as an illustration for how rich a scenario can be if different modalities are used.
The EMS providers can be integrated into the scenario before nursing is introduced to the
patient, as they could be dispatched to a home and have to assess, treat, and transport the patient.
Title: Acute myocardial infarction (MI)
Setting: Emergency department
Learning objective: Demonstrate basic assessment and stabilization for an acute MI patient
Equipment: Oxygen tubing and setup, bag valve mask, IV supplies.
Patient presentation: EMS brings in a 70-year-old female (computerized patient simulator or
standardized patient) with vague GI complaints and feelings of fatigue and malaise.
Vital signs:
 Heart rate: 55
 Respirations :14
 Blood pressure: 100/60
 Temperature: 98.6° F
 Diaphoresis noted
EMS reports to nurses that they put the patient on 4 liters of oxygen via nasal cannula but were
not successful in starting an IV after two attempts. (The computerized interactive IV start device
is available for the EMS providers and nurses to go through the IV start process for a difficult
start. Task trainer IV arms are also available to practice IV starts).
(Expected actions: Hand off report from EMS to nursing, nursing reassess patient’s ABCs, puts
patient on monitor, starts IV, continues with oxygen, considers 12-lead EKG based on patient
signs and symptoms.)
Monitor confirms sinus bradycardia. Nursing calls for 12-lead EKG, which shows ST elevation
in leads II, III, and avf, which is indicative of a right-sided MI.
(Expected actions: Notify physician to see the patient, draw labs, start IV fluids, give aspirin per
protocol, do not give nitroglycerin, only consider morphine if pain is present and if blood
pressure will tolerate it.)
Husband comes running into the ED (standardized patient) demanding to know what is going on.
(Expected actions: One nurse goes to husband and directly communicates with him. This
becomes his or her only task at this point. SP will evaluate nurse on his or her therapeutic
communication skills).
Monitor starts alarming, as patient is now in ventricular fibrillation.
(Expected actions: Nurse defibrillates per ACLS protocol, team starts CPR, nurse assigned to
husband stays with him and appropriately explains what is happening to his wife.)
Depending on how the team does, the educator can elect to keep the code going until satisfied
that the team is demonstrating excellent CPR and ACLS skills. The educator can decide if he or
she wants to go down the medication path of the ACLS algorithm if appropriate for the learners.
TeamSTEPPS concepts, such as SBAR, can be used when the physician arrives to report on what
is happening.
Prior to the simulation, the group could participate in a tabletop role-play, in which EMS
responds to the patient and brings her in. Then, the EMS providers can transfer the patient, and
the nurses can continue the role-play. In this case, the role-play could act as a rehearsal, as the
learners could talk through the scenario and then go to the hands-on portion, thereby reinforcing
the material.