Student Orientation
to Multiple-patient Simulation
Learning Objectives: (Note: you may choose not to tell students you will be assessing
safety competencies prior to the simulation)
1. Demonstrate leadership and management skills as you provide care for four adult
medical-surgical clients.
2. Demonstrate safety competencies as you provide care for four adult medicalsurgical clients.
The entire simulation experience will take approximately one hour. This one hour
experience includes time to orient you, a 20 minute simulation, a 20 minute debriefing
and then time to fill out evaluations of the simulation. Your participation in the
simulation is required for your course work. You will not be graded on this experience.
Expectations:
1. The Lewis text or Davis Drug Guide may be used at anytime. They are available
on the cart.
2. This is a learning activity only and you will not be assigned a grade. You are
only expected to try your best and learn. One faculty member will be evaluating
the scenario in order to provide you with feedback.
3. Participants will be involved in a scenario and then debrief/reflect upon their
performance afterwards.
4. Everything done in the sim lab stays in the sim lab. Participants are asked not
share their experiences with students who have not yet attended. This sharing
would interfere with the other students’ learning.
5. Endeavor to think out loud and communicate with your peers as you participate in
the experience.
6. Participants will suspend disbelief. Ignore the less real aspects of the situation in
order to get the most out of the experience. Please treat your “clients” as if they
are real (i.e. – talk to them, ask questions).
7. We are working in “real time”. If you need to recheck a blood pressure in 10
minutes, you need to wait the actual ten minutes.
8. Perform all procedures required. If you need to take a blood pressure you must
actually place the cuff, inflate it, etc. Feedback will either be provided by the
equipment (i.e. – SimMan) or the observer.
This is a 20 minute scenario. You have been randomly assigned a role for this scenario.
Student #1 will be an RN. Student #2 will be an RN who has just been hired at the
hospital and is on the last day of the 2 week orientation (tomorrow he/she will be on
his/her own). Student #3 will be a family member. Students #4 and #5 will be observers.
The setting is a four bed step down unit (i.e. – step down from the ICU) called a
Progressive Care Unit or PCU. The patients in this unit may or may not be on cardiac
monitors depending on the nature of their illness.
Together student #1 and #2 will receive a taped report and the chart summaries (aka
medication administration records) on these four patients for January 16th, 2007 at 0700 and
you will work together as a team in assessing them and caring for them.
A unit secretary is available by phone should you need to page anyone (eg – your nursing
supervisor is a possible resource should you have any questions, a physician/NP for
orders, the pharmacist for medications not available at the bedside, radiology for chest xrays, etc) or request supplies, tests, etc.
Questions? Now I will orient you to the SimMan, the manikins, the unit and then your
roles in the scenario.
SimMan Orientation (If available)
□ pulse checks on left radial (light touch) , BP (manual), femoral, carotids, no pedal
pulses
□ heart, lung, bowel sounds
□ touch screen monitor for BP’s (not automatic and resort to manual if necessary), note
the silence button, screen change
□ ignore “blood”, computer, compressor
□ IV’s/blood draws can be done on the right arm. You may actually infuse the fluid/draw
blood.
□ allow students time to listen to sounds, etc, if not had the chance before
□ Questions?
Manikin Orientation
□ tell the observers what you are doing so that they may provide any feedback (e.g.- “I
am checking pedal pulses”. And the observer can respond, “Pedal pulses are strong and
regular.” Or, “I am checking his blood pressure.” The observers can respond with,
“Blood pressure is 120/62.” If you do not ask about it, the observer will not be able to
provide you with the needed information.
Unit/Supplies Orientation
□ med drawers- please examine the contents
□ O2 sat monitor
□ foley
□ nasal cannula, flow meter
□ syringes
□ IV tubing, IVPB
□ accucheck
□ crash cart – airways, intubation equipment, meds, defibrillator, pads, NRB, ambu bag
□ 12 lead EKG
□ sharps container
□ phone – call --------- for the unit secretary and she can direct your calls
□ drug book available, textbook available
□ documentation in bedside chart on progress notes only – narrative, orders contained
here too
□ each of you will receive a copy of the chart summary review (aka medication
administration report/MAR)
Orientation for Active Observers Role
You will observe all the activities that the two “RN’s” complete. Observer #1 will follow
RN #1 and observer #2 will follow RN #2 (the new orientee). At times you may find that
you are all in the same room and that is OK. You each have a clipboard with the same
responses for all 4 patients. The list of patient responses include vital signs, chest sounds,
verbal responses, etc. You will need to provide all the feedback to the nurses as to the
findings if they are working with a static manikin (i.e. – “You hear coarse breath
sounds”). We have a “don’t ask, don’t tell” policy. This means if the RN does not ask
what his RR is or appear to be measuring it, then don’t not give it. Also, if they do not
actually get the O2 saturation monitor and attach it, don’t tell them what the O2
saturation is. Additionally we ask that you ad lib some of his responses that may not be
scripted (e.g. – “Good morning. How are you.” etc. Just take care not to stray too far from
the script in terms of pain level, etc). If you are working with the SimMan you will only
need to provide verbal responses. Otherwise please do not try to help problem solve for
the “RN’s”.
The nurses will receive a report on 4 patients in a PCU. You will also listen to this report.
Initially all the patients are stable. However, approximately 7 minutes into the scenario
one patient, the “focus patient” will experience a change in their status and a family
member will interrupt the nurses and have them come to look at him. The new vital signs
and actions for the “focus patient” are also noted on your list of responses under “@ 7
minutes status changes”. These will now apply. Continue to follow and provide feedback
to your assigned nurse for the remainder of the scenario.
Please take some time to look at the list of patient responses. Do you have any questions?
Gather all 5 students together to hear this final portion of orientation and then begin the
scenario. It is nice to have the family member listen to the report so that person will get
more out of the scenario.
Orientation for 2 RN’s
Student #1 will be an RN. Student #2 will be an RN who has just been hired at the
hospital and is on the last day of the 2 week orientation. You will receive a taped report
from night shift regarding the 4 patients in the Progressive Care Unit. Feel free to stop the
tape to listen/repeat sections of the report. You have charts on all four of your patients.
You will then proceed as you would on a regular day shift. The date today is January 16th,
2007 and it is 0700 when you get report.
You have a unit tech who helps with baths and patient ambulation only. You have a unit
secretary who can help you should you need to contact any one (nursing supervisor,
MD/NP, radiology, pharmacy, etc). Phone the unit secretary and she can page/get in
touch with those resources.
Again, remember, we are working in real time and you need to actually perform the skills
that are required.
Do you have any questions?
We will now play taped report.