SIMULATION DESIGN & PLANNING TEMPLATE
Scenario Name: Pneumonia (Target audience: Senior level
RN/RT)
Program/Curriculum Specific Objectives:
Focus on interdisciplinary communication, collaboration, and care.
Learners will complete respiratory assessment, will provide reassurance to nonverbal
patient, establish need for input from Respiratory therapy, prepare for and suction the
trach correctly
Demonstrate effective teamwork
Measurable Objectives:
1. The healthcare practitioners will properly identify self and communicate plan to patient throughout
scenario.
2. The learner(s) will continually reassure and comfort non-verbal patient.
3. Provide patient education regarding patient symptoms (SOB, mucous production) and disease
process (pneumonia) and treatment plan (suction)
4. The learner(s) will interpret patient cues as a need for respiratory assessment and identify
ineffective airway clearance interventions include monitoring vital signs, proper positioning of
patient, respiratory assessment and need for suction.
5. The learner(s) will accurately perform respiratory assessment in a timely manner.
6. The learner(s) will collaborate using SBAR, properly identifying themselves, the patient, the
patient’s diagnosis, include that the patient has a trach, thick mucus, report lung sounds, respiratory
effort, cough, current vital signs and SPO2, immediate problem (need for suction) .
a. RT will ask clarifying questions as needed to determine optimal plan of care.
7. Respiratory therapy and nursing will collaborate on appropriate next step.
a. RT will arrive, identify themselves, perform respiratory assessment, compare findings
with RN.
b. RT will provide education to patient and RN regarding trach management as needed,
such as: proper suction technique (sterile), proper use of BVM, evaluate proper
functioning of oxygen delivery device (aerosol), removal and insertion of new inner
cannula, cuff management (pressure), assessing trach ties and neck for proper fit and
skin break down
8. Respiratory therapy and nursing will share the task of suctioning the patient using proper
technique.
Authors Names’: Elizabeth Hinkson Renton Technical College
Scott Mahoney Providence Regional Medical Center
Date Submitted: Spring 2013
HEET V Grant Simulation Scenario Template 2013. Excerpts adapted and used by permission
from National League for Nursing's & Laerdal Medical Corporation's Simulation Design Template
(2008), and Northwest Medical Center's Scenario Planning Worksheet (last accessed March 2013).
1
SIMULATION DESIGN & PLANNING TEMPLATE
Will There Be Any Pre-Simulation Lecture?
Expected Scenario Time: 20 minutes
Yes
Duration: 10 minutes
Expected Debrief Time:
30 minutes
Report and Information Provided To Learner(s)s Prior To Simulation
Face sheet (see attached), MD orders (see attached), patient history (see attached),
(review of systems as report-see attached)
Please see report for student in “patient information” below.
“This is Valencia Johnson, a 73 year old African American lady admitted through the
ER a few days ago with right sided pneumonia. She is a full code. She’s had COPD for
about 8 years. She has a tracheostomy but hasn’t taken care of it and that is the likely
source of the pneumonia. She’s underweight and seems withdrawn.
Review of systems:
Neuro: The patient is A&O * 3, but nonverbal. She communicates by writing.
CV: Heart sounds are normal, pulses are present, and there is some edema (1+ or 2+)
Her skin is cool with decreased hair growth.
Resp: Lungs sounds are diminished; she has a lot of thick sputum which she has trouble
expectorating. Her respiratory rate is in the 20’s with marked increase in effort. Her sat
is in the upper 80’s to low 90’s. You may want to call R.T. to help you with this lady.
GI: Positive bowel sounds and dentures. She says she is too tired to eat. She has lost
about 25 pounds without trying.
GU: Urge incontinence
Skin: is intact but will need watching for pressure areas
HEET V Grant Simulation Scenario Template 2013. Excerpts adapted and used by permission
from National League for Nursing's & Laerdal Medical Corporation's Simulation Design Template
(2008), and Northwest Medical Center's Scenario Planning Worksheet (last accessed March 2013).
2
SIMULATION DESIGN & PLANNING TEMPLATE
Patient Information
Patient Name:
Valencia Johnson
Age: 52
Birth date: 02/29/19XX
Gender:
F
Weight: 50.9 Kg
Height: 5 ft 2in
ID band MR #986723-8 Acct. #
x. Present Illness: The Patient was admitted through the Emergency Department with a recurrence
of severe dyspnea and probable pneumonia. She has had her tracheostomy for about 16 months and
documentation from the ED suggests that it has been poorly managed. It seems that the inner cannula
had neither been cleaned or changed in at least a week and it was a bit surprising she hadn’t occluded it
with mucous. The patient reports some improvement in her shortness of breath now that the situation
has been rectified, but she still is observed to be using accessory muscles. She is requiring more
oxygen than usual.
Social History:
Incidentally, she is reporting some self-image concerns. She seems to think her
grandchildren are afraid of her and this is why they do not visit. She spent about 3 months in rehab
and has been living at home with home health assistance. Her husband is a former accountant with
health issues of his own and their family lives in Atlanta. Social Service will need to consult as there
has been some question about the suitability of the home environment for Mrs. Johnson.
Religion:
Baptist
Support System: Husband/home health
Allergies:
PCN
Immunizations: Needs PNA and flu vaccine before discharge
Attending Physician:
Michelle Toth, MD
Past medical history:
She has been treated for emphysema for about 12 years. She smoked
from the age of 16 to about 45. She experiences dyspnea with ADL’s and frequent fatigue that
prevents her from leaving her home. She says she has occasional coughing fits, generally in the
morning. Her FEV 1 is 45% of predicted. She is noted to have lost 25 pounds in the past 18 months
without trying. CXR shows hyperinflation and right lower lobe pneumonia. A sputum sample will be
sent. More troubling, Mrs. Johnson has 2+ peripheral edema of the lower extremities and some mild
JVD.
About a year and a half ago, Ms. Johnson received a tracheostomy following a case of ARDS
that occurred during treatment of a strep A pneumonia. She was on the ventilator for about 13 days
prior to the tracheostomy and for another 16 after.
HEET V Grant Simulation Scenario Template 2013. Excerpts adapted and used by permission
from National League for Nursing's & Laerdal Medical Corporation's Simulation Design Template
(2008), and Northwest Medical Center's Scenario Planning Worksheet (last accessed March 2013).
3
SIMULATION DESIGN & PLANNING TEMPLATE
Physical description of how you want the manikin to present at start of scenario?
Moulage:
 Middle-aged African American woman, Dressed in a hospital gown
 Use black wig, lipstick/eye shadow to denote gender
 Sputum for trach, soiled trach dressing

Size 4 shiley dct tracheostomy, Foam trach tie, Trach collar with aerosol delivery
Assignment Of Roles (Please indicate below roles to be assigned):
Primary Nurse
Respiratory therapist (Primary)
Observer(s)
Secondary Nurse
Respiratory therapist (Secondary)
Physician available via phone
Important Information Related To Roles:
Secondary role is supportive and to assist with problem solving, collaboration and to
accept delegated responsibilities.
Observers are responsible for noting specific behaviors as noted on checklist.
Fidelity (choose all that apply to this simulation)
Setting/Environment
Med-Surg
Props:
Equipment attached to manikin:
Foley catheter 100 ml output; Urine color yellow
O2 40% cool aerosol (O2 flow meter at 15L/min)
Monitor attached: Bedside monitor “big numbers”
ID band
Other
Equipment available in room:
O2 delivery device 40% cool aerosol
(O2 flow meter at 15L/min)
Suction
Other: Ambu bag, trach obturator, suction kits (2) trach
care kits (2), normal saline 250ml, inner cannula (2), spare
trach in box
Other Props: Large purse with bible, glasses on chain
Physician Orders see attached
Medications and Fluids:
Other: Small volume nebulizer and unit dose
albuterol and saline
Diagnostics Available:
Labs Values (CBC, ABG, Chem 7) see attached
X-Rays (Images) (See attached)
Documentation Forms:
Physician Orders
MAR
Shift Assessment
Other: face sheet and history
Recommended Mode for Simulation
Manual
Manikin to be used Simman 3G (high fidelity)
Significant Lab Values see attached
HEET V Grant Simulation Scenario Template 2013. Excerpts adapted and used by permission
from National League for Nursing's & Laerdal Medical Corporation's Simulation Design Template
(2008), and Northwest Medical Center's Scenario Planning Worksheet (last accessed March 2013).
4
SIMULATION DESIGN & PLANNING TEMPLATE
Scenario Progression Outline
Verbalization
(Pt/Manikin
Cues)
Patient
verbalization
Baseline Vital Signs Patient NonTPR: 39C/102.2F,
Verbal.
94, 28
BP:
144/82
Has a note
SPO2: 89% on
pad that says
40% cool aerosol
“I’m Thirsty”
trach collar
Cardiac Rhythm
NSR with
PAC's
Breath Sounds
Dimished t/o,
"PNA" in Right
Lower Lobe
Heart Sounds
normal S1, S2
Abdominal Sounds
normal bowel
sounds
Other Symptoms:
Eyes open, frequent
coughing
Stage 1
Initial Amount
Time in Initial
Stage- 5 mins
Expected
Interventions
Incorrect
Treatment Choice
That Will Affect Outcome
Introduce self
and state
purpose of
visit.
If learner(s)s fail to
Respiratory Therapy
recognize that patient is non- and Physician available
verbal or fail to verbalize
via phone.
their plan of care, patient
will exhibit sings of
increasing anxiety including;
increased HR, increased RR,
increased BP and decreased
SpO2. If fluids are
available, patient may cry as
well.
Perform Hand
Hygiene
Recognize
Patient is nonverbal
Raise head of
bed.
Confederate
Actions/Additional
Role Player Cues
If learner(s)s give the patient
any un-thickened liquid, a
coughing fit will ensue.
Trending:
VS ↑ or↓ over time
HEET V Grant Simulation Scenario Template 2013. Excerpts adapted and used by permission
from National League for Nursing's & Laerdal Medical Corporation's Simulation Design Template
(2008), and Northwest Medical Center's Scenario Planning Worksheet (last accessed March 2013).
5
SIMULATION DESIGN & PLANNING TEMPLATE
Correct Treatment Choice:
Stage 2
Timing Sequence
5 minutes
Baseline Vital Signs
T 102.2F / 39C
P 94
R
32
BP 144/82
SPO2 86% on 40%
aerosol trach collar
Cardiac Rhythm NSR
with PAC's
Breath Sounds
Dimished t/o, "PNA"
in Right Lower
Lobe
Heart Sounds normal
S1, S2
Abdominal Sounds
normal bowel
sounds
Other Symptoms:
Eyes open, increasingly
frequent coughing
Verbalization
non-verbal
Expected
Interventions
RN will perform
respiratory
assessment.
RT will arrive
during assessment
and perform their
own assessment
of the patient (RT
will need cue to
arrive).
Both RN and RT
should work side
by side to assess
patient and
communicate to
patient at all
times.
Incorrect Treatment choice:
Stage 2A
Timing Sequence
5 minutes
T 102.2 / 39
P 106
R
36
BP 162/90
SPO2 80% on 40%
aerosol trach collar
Cardiac Rhythm NSR
with PAC's
Breath Sounds
Dimished t/o, "PNA"
in Right Lower
Lobe
Heart Sounds normal
S1, S2
Abdominal Sounds
normal bowel
sounds
Expected
Interventions
If RN and RT fail
to communicate
with one another or
fail to reassure
patient, or one of
them backs off and
does not perform
their assessment,
patient will grow
agitated and begin
to decompensate.
Other Symptoms:
Eyes open, increasingly
frequent coughing,
crying and oral
secretions, “difficulty
breathing”
HEET V Grant Simulation Scenario Template 2013. Excerpts adapted and used by permission
from National League for Nursing's & Laerdal Medical Corporation's Simulation Design Template
(2008), and Northwest Medical Center's Scenario Planning Worksheet (last accessed March 2013).
6
SIMULATION DESIGN & PLANNING TEMPLATE
Correct Treatment Choice
Stage 3
Timing Sequence
5 minutes
Baseline Vital Signs
T 102.2 / 39
P 94
R
32
BP 144/82
SPO2 86% on 40%
aerosol trach collar
Cardiac Rhythm NSR
with PAC's
Breath Sounds
Diminished t/o, "PNA"
in Right Lower
Lobe
Heart Sounds normal
S1, S2
Abdominal Sounds
normal bowel
sounds
Other Symptoms:
Eyes open, increasingly
frequent coughing
Verbalization
non-verbal
Expected
Interventions
RN and RT
collaborate and
exhibit
professional
behaviors using
SBAR
communication to
establish plan of
care. Both
healthcare
practitioners
should continue to
involve patient in
plan of care
making sure that
they understand
each step.
Incorrect Treatment choice
Stage 3A
Timing Sequence
5 minutes
Baseline Vital Signs
T 102.2 / 39
P 110
R 38
BP 170/94
SPO2 78% on 40%
aerosol trach collar
Expected
Interventions
If communication
delays care, patient
will continue to
decompensate.
Cardiac Rhythm Sinus
Tach with PAC's
Breath Sounds
Diminished t/o,
"PNA" in Right Lower
Lobe
Heart Sounds normal
S1, S2
Abdominal Sounds
normal bowel
sounds
Other Symptoms:
Cyanosis and
diaphoresis,
increasingly frequent
coughing
Verbalization
non-verbal
HEET V Grant Simulation Scenario Template 2013. Excerpts adapted and used by permission
from National League for Nursing's & Laerdal Medical Corporation's Simulation Design Template
(2008), and Northwest Medical Center's Scenario Planning Worksheet (last accessed March 2013).
7
SIMULATION DESIGN & PLANNING TEMPLATE
Correct Treatment Choice
End
Expected
Stage 4
Timing Sequence
Interventions
5 minutes
Baseline Vital Signs
T 102.2 / 39
RN and RT will
P 88
increase oxygen
R
28
to 50% and
BP 136/82
collect supplies
SPO2 93% on 50%
necessary to
aerosol trach collar
suction patient
Cardiac Rhythm NSR
while continually
with PAC's
providing
Breath Sounds
reassurance to
Dimished t/o, "PNA"
patient.
in Right Lower
Lobe
Heart Sounds normal
S1, S2
Abdominal Sounds
normal bowel
sounds
Other Symptoms:
Eyes open, decreased
coughing
Verbalization
non-verbal
What will be discussed in debrief:
 Was the SBAR complete?
 Did the learners demonstrate effective teamwork?
 Was the respiratory assessment completed properly by both professions, and were findings
shared?
 Did learner progress through the scenario efficiently? Did communication unnecessarily delay
treatment of patient?
 Was there evidence of collaboration?
 Did professional communication occur between disciplines AND include the patient?
 Did both disciplines fulfill their professional responsibilities, or did they defer to the other
discipline?
HEET V Grant Simulation Scenario Template 2013. Excerpts adapted and used by permission
from National League for Nursing's & Laerdal Medical Corporation's Simulation Design Template
(2008), and Northwest Medical Center's Scenario Planning Worksheet (last accessed March 2013).
8
SIMULATION DESIGN & PLANNING TEMPLATE
References:
Mandell, L.A, Wunderink, R. G., Anzueto, A., Bartlett, J. G., Campbell G. D., Dean
N. C., Dowell S.F., File T.M. Jr, Musher D. M., Niederman M.S., Torres A.,
Whitney C. G. (2007). Infectious diseases Society of America/American Thoracic
Society consensus guidelines on the management of community-acquired pneumonia
in adults. Clinical Infectious Diseases, 44 (Suppl 2), S27-72.
File, T. M., Bartlett, J. G., Thorner, A. R. (2013). Treatment of community acquired
pneumonia in adults who require hospitalization. UpToDate. Retrieved from
http://www.uptodate.com/contents/treatment-of-community-acquired-pneumonia-inadults-who-require-hospitalization
Instructor Check List
(return to CHESC assistant at the end of class)
Pre-Scenario Check List
1.
Equipment is staged as requested.
2.
The learner has been oriented to the simulator.
3.
The learner understands the guidelines/expectations for the
scenario.
4.
Learner(s)s understand their assigned roles.
5.
The time frame Expectations for simulation met: Yes No.
6.
The time frame Expectations for debrief met:
Yes
No.
7.
Audio/Visual Consent signed and turned into CHESC sheet.
8.
Attendance sheet completed and given to CHESC staff.
Post Scenario
If you could change anything next time, what would it be?
Comments:
________________________________________________________
________________________________________________________
________________________________________________________
HEET V Grant Simulation Scenario Template 2013. Excerpts adapted and used by permission
from National League for Nursing's & Laerdal Medical Corporation's Simulation Design Template
(2008), and Northwest Medical Center's Scenario Planning Worksheet (last accessed March 2013).
9
SIMULATION DESIGN & PLANNING TEMPLATE
CHESC Assistant Name:
Did the person provide excellent support for the scenario?
Yes
No Comment
Instructor signature ________________________________
Date
________________________
HEET V Grant Simulation Scenario Template 2013. Excerpts adapted and used by permission
from National League for Nursing's & Laerdal Medical Corporation's Simulation Design Template
(2008), and Northwest Medical Center's Scenario Planning Worksheet (last accessed March 2013).
10
SIMULATION DESIGN & PLANNING TEMPLATE
Learner(s) Check List
(return to Instructor at the end of class)
Pre-Scenario Check List
1.
2.
3.
4.
5.
I have been oriented to the simulator.
I understand the guidelines/expectations for the scenario.
I understand the assigned role.
My questions about the simulation have been answered.
I have all necessary equipment for the simulation.
Post Scenario
If you could change anything next time, what would it be?
Comments:
________________________________________________________
________________________________________________________
________________________________________________________
________________________________________________________
Learner(s) Signature ____________________________________
Date
________________________
HEET V Grant Simulation Scenario Template 2013. Excerpts adapted and used by permission
from National League for Nursing's & Laerdal Medical Corporation's Simulation Design Template
(2008), and Northwest Medical Center's Scenario Planning Worksheet (last accessed March 2013).
11
SIMULATION DESIGN & PLANNING TEMPLATE
Simulation Post-Assessment Methods
Checklist
Tests
Evaluations
Turning Point
Jeopardy
Other
Optional Literature References
Debriefing Guidelines
(Remember to identify important concepts or curricular threads that are specific to your
program)
1. Leave the simulation room and go to a conference room, if possible. It allows for deescalation of emotions.
2. Solicit and validate emotions briefly. Validate simisms (the simulation isn’t 100% accurate
due to different equipment, personnel etc)
3. What went WELL in this simulation?
4. What DID NOT go well in this simulation?
5. If you could do it again, what would you do differently?
6. Summarize:
“What I hear you saying is . . .”
HEET V Grant Simulation Scenario Template 2013. Excerpts adapted and used by permission
from National League for Nursing's & Laerdal Medical Corporation's Simulation Design Template
(2008), and Northwest Medical Center's Scenario Planning Worksheet (last accessed March 2013).
12