Simulation Scenario Submission Form
Your Contact Information
Your Name:
Your Position and Department:
Your School:
Your email:
The best phone number to reach you at if we have a question:
Go! Simulation Scenario: [Insert Title Here]
Faculty Set-up Instructions
Discipline applications
This activity is intended for ________. The student will need to use the EHR and additional
resources to prepare for this skill. These resources may include demonstration, videos,
textbooks and/or online websites.
Faculty instructions
1.
2.
3.
4.
Review the chart and the activity before assigning to your students.
The chart of ___________________ is included in this activity.
Follow the simulation set-up below to prepare for the simulation.
Print ___________________ barcodes and wristband if you will be using them in
simulation. If you do not have a barcode scanner, you may still have the students
administer and document the administration of medications in the patient chart.
5. Provide the link for the _________________ activity to your students by doing one of
the following:
a. Copy and paste the link in your LMS, or
b. Copy and paste the link in an email to your students, or
c. Write the link on a piece of paper or on the board.
6. If you plan to have students work in groups to complete this simulation, assign
one student in each group the role of “scribe.” That student will be responsible
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for documentation for the group in the EHR and will be submitting a progress
report on the group’s behalf.
7. Students are instructed to submit their work to your LMS. If you would like them
to submit their work in a different manner (e.g. email, on paper), please provide
them with those instructions.
Simulation set-up
Example:
What you will need (the basics to get started):
 Link to ________________________ activity provided to students, or available in
simulation
Manikin settings at initial state (optional-if using manikin):
 The last set of vital signs were:
Simulation scenarios
Example wording of a simulation: This
application activity is a scenario for the use of
Jane Shriver’s chart in simulation. In this
simulation the student will be expected to
complete certain skills, document an SBAR note
in Jane’s chart and notify the physician.
This can be 1-2 sentences
pointing out something of
importance!
1. (Example) Patient Fall Scenario: Jane
Shriver is allowed to use the bathroom but has been instructed to use her call
button for assistance. Because she is weak, having shortness of breath, running a
fever, and getting morphine, she is a fall risk. Her Alert reads, “Fall Risk” and her
order reads, “Patient is a Fall Risk. Support with 1:1 assist when ambulating. Apply
bed alarm and rails when in room.” Prior to the start of the simulation, Jane uses
the call button but doesn’t wait for an answer. She manages to get to a sitting
position on the side of the bed but has moved too far and slides to the floor. The
student(s) walk into the room and find Jane has slid off of the mattress and is
sitting on the floor next to her bed in a puddle of urine. Jane is crying and
breathing deep and rapid.
Student Expectations: Students will assist Jane back into bed, take her vital
signs, note her respiratory distress and apply oxygen. They will then assess her
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respiratory status and examine her for injuries. Students will document the vital
signs and a Quick Head to Toe Assessment in Jane’s chart. A SBAR note will be
completed in the EHR and the students will contact the physician.
Debriefing objectives
1.
2.
3.
4.
5.
Review simulation events
Sort out and clarify thinking
Release emotional tension
Reinforce specific teaching points
Correct misconceptions
Reviewing student work
Students will complete documentation in the Go! EHR as instructed. When they are
finished, students will download their Progress Report in Go!, save the document, and
upload it to your Learning Management System (LMS).
Note: If your students worked in groups and you assigned one student in the group to
be the scribe, that student will be responsible for documentation for the group in the
EHR and will be submitting a progress report on the group’s behalf.
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Acknowledge for Submission:
ARCHETYPE INNOVATIONS’ NEEHR PERFECT ASSIGNMENT AGREEMENT
By submitting your content to Neehr Perfect via teaching@neehrperfect.com, you are acknowledging and accepting the following. Do not
submit content that you do not have rights to assign to Neehr Perfect per this agreement.
THIS ASSIGNMENT AGREEMENT, is entered into by and between the author and copyright owner named below (“Assignor”) and Archetype
Innovations, LLC ("Assignee").
FOR GOOD AND VALUABLE CONSIDERATION, the receipt and sufficiency of which are hereby acknowledged, Assignor and Archetype agree as
follows:
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copyrighted materials listed in Exhibit A attached hereto and incorporated by reference herein (hereinafter, the “Materials”).
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the Materials, including but not limited to all registered, unregistered, statutory and common law copyrights. Assignor further represents that
Assignor is not prohibited, prevented, or otherwise restricted by law, contract, or any other means, from freely and voluntarily assigning to
Assignee all of Assignor’s right, title and interest in and to the Materials.
3. Assignor agrees that Assignor will, any time and from time to time, upon receipt of written request, execute and deliver to Assignee,
including its successors and assigns, any new or confirmatory instruments which may be necessary in order to protect or fully assign and
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forth in this Neehr Perfect Content Submission. This Agreement shall be governed by and construed in accordance with the laws of the state of
Minnesota, without giving effect to the conflict of laws principles thereof. This Agreement shall be binding upon and inure to the benefit of the
successors and assignees of Assignor and Assignee.
Thank you for your submission! We are always open to new educational content to benefit
healthcare education and individual faculty and students. Your submission assists us in helping
educators to teach and prepare the next generation of healthcare professionals.
It is our policy to review and consider all requests for a chart, or a request for edit in a current
chart. You will receive an email from us advising you of the status of your submission on the
next of the following dates: February 15th, June 15th, or October 15th. Best of luck!
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