Simulation Design Template
Date: 2/3/09
Discipline: Nursing
Expected Simulation Run Time: 5-10min
Location: LRC
File Name: Mr. Burns Pain Simulation
Student Level: Freshmen
Guided Reflection Time: 15-20
Location for Reflection: LRC
Admission Date: 2/1/09Today’s Date: 2/3/09 Psychomotor Skills Required prior to
Brief Description of Patient:
simulation:
Name: Mr. Melvin Burns Gender: M Age: 63
Race: Caucasian
Weight: _70kg
Height: _180_cm
Religion: Protestant Major Support: Wife
Phone:
Allergies: NKA
Immunizations: Flu Vaccine 11/08
Attending Physician/Team: Dr. Vivian
Past Medical History: 3 days post R knee
replacement. Physical therapy daily
Students should have attended
"communication lecture" as well as
"comfort therapy lecture" in N111.
Basic understanding of empathy and using
therapeutic communication skills.
Basic understanding of non-pharmocologic
comfort measures for patients experiencing
pain.
Cognitive Activities Required prior to
Simulation: i.e. independent reading (R), video
History of Present illness: Surgery on 2/1/09
review (V), computer simulations (CS), lecture (L)
Social History: Lives with wife of 30 years
Lecture: Therapeutic Communication
Reading: "
"
Lecture: Comfort/Pain Therapy
Reading: "
"
Primary Medical Diagnosis:
Surgeries/Procedures & Dates: Total R knee 2/1/09
Video: Introductory Video to Mr. Burns
Simulation, 5 minutes in length.
Simulation Learning Objectives:
1. The student will be able to assess Mr. Burns' level of comfort using the nursing process.
2. The student will be able to provide nursing interventions to address the need for increased level of
comfort.
3. The Student will be able to formulate a nursing diagnosis and plan of care for Mr. Burns as a postreflection activity.
Quality and Safety
Education For Nurses
(Chose applicable QSEN
Competencies)
√ Patient-centered
Care:
Recognize the patient or
designee as the source of
control and full partner
in providing
compassionate and
coordinated care based
on respect for patient's
preferences, values, and
needs.
√ Teamwork and
Collaboration:
Function effectively
within nursing and
inter-professional
teams, fostering open
communication,
mutual respect, and
shared decisionmaking to achieve
patient care.
'QSEN Coordinated'
Student Learning Objectives for Simulation Experience
(KSA's)
Knowledge
1. Integrate understanding of multiple dimensions of patient-centered care:
Patient / family / community preferences, values; Coordination and
integration of care; Information, communication, and education; Physical
comfort and emotional support; Involvement of family and / or friends;
Transition and continuity
2. Examine how the safety, quality, and cost-effectiveness of healthcare can be
improved through the active involvement of patients and families
3. Describe strategies to empower patients and families in all aspects of the
health care process
4. Discuss principles of effective communication
5. Examine nursing roles in assuring coordination, integration, and continuity
of care
Skills
1. Provide patient centered care with sensitivity and respect
2. Assess presence and levels of pain as well as physical and emotional comfort
3. Engage patients and surrogates in active partnerships that promote health,
safety and well-being and self-care management
4. Communicate care provided and needed at each transition in care
Attitude
1. Respect and encourage individual expression of patient values, preferences
and expressed needs
2. Appreciate the role of the nurse in relief of all types and sources of pain and
suffering
3. Value active partnerships with patients or designated surrogates in planning,
implementation, and evaluation of care
4. Value continuous improvement of own communication and conflict
resolution skills
Knowledge
1. Recognize contributions of individuals and groups to help patients / family
achieve health goals
2. Discuss effective strategies for communicating and resolving conflict
3. Describe examples how team functioning impacts safety and quality of care
4. Identify barriers and facilitators of effective team functioning
5. Examine strategies for improving systems to support team functioning
Skills
1. Act with integrity, consistency, and respect for differing views
2. Assume the role of team member or team leader based on the situation
3. Integrate the contributions of others who play a role in helping patient /
family achieve goals
4. Solicit input from other team members to improve individual, as well as team
performance
5. Follow communication practices that minimize risks associated with handoffs
among providers and across transitions in care
Attitude
1. Respect the unique attributes that members bring to a team
2. Appreciate importance of intra- and inter-professional collaboration
3. Value teamwork and the different styles of communication used by patients,
families and health care providers
4. Appreciate the risks associated with patient information handoffs
Fidelity (choose all that apply to this simulation)
Student Information Needed Prior to
Scenario:
o Has been oriented to simulator
o Understands guidelines /expectations for
scenario
o Has accomplished all pre-simulation
requirements
o All participants understand their assigned
roles
o Has been given time frame expectations
Report students will receive before
simulation: Show introductory video, assign
roles, and distribute cue cards/lanyards.
Time: Approximately 5-10 minutes
References, Evidence-Based Practice Guidelines, Protocols, or Algorithms used for this
scenario: (site source, author, year, and page)
NCLEX Test Plan Category (bolded areas are included in the simulation)
Safe, Effective Care Environment
Management of Care
o Advanced Directives
Clients Rights
Collaboration
o Advocacy
Confidentiality
Delegation
o Case Management
Establishing Priorities
Informed Consent
o Legal rights and responsibilities
Performance Improvement
Referrals
o Staff Education
Resource management
Supervision
Safety and Infection Control
o Accident Prevention
Disaster Planning
Error Prevention
o Emergency Response Plan
Handling Hazardous and Infectious Materials
o Injury Prevention
Medical and Surgical Asepsis
Security Plan
o Reporting of Incident Event
Safe Use of Equipment
Restraints
o Standard / Transmission Based Precautions
Health Promotion and Maintenance
o
o
o
o
o
o
Aging Process
Developmental Stages
Expected Body Image Changes
Health and Wellness
High Risk Behaviors
Lifestyle choices
Ante/Intra/Postpartum and Newborn Care
Disease Prevention
Family Planning
Family Systems
Growth and Develop
Health Promotion
Health Screening
Human Sexuality
Immunizations
Self Care
Physical Assessment
Psychosocial Integrity
o
o
o
o
o
o
o
Abuse / Neglect
Chemical Dependency
End of Life
Mental Health Concepts
Religious and Spiritual Influences
Situational Role Changes
Therapeutic Environment
Behavioral Interventions
Coping Mechanisms
Family Dynamics
Psychopathology
Sensory / Perceptual Alterations
Therapeutic Communications
Unexpected Body Image Changes
Crisis Intervention
Cultural Diversity
Grief and Loss
Stress Management
Support Systems
Physiologic Integrity
Basic Care and Comfort
o Alternative and Complimentary Therapies
Assistive Devices
o Elimination
Mobility / Immobility
Rest and Sleep
o Non-Pharmacologic Comfort
Palliative / Comfort Care
Personal Hygiene
o Nutrition and Oral Hydration
Pharmacological and Parenteral Therapies
o Adverse Effects/Contraindications and Side Effects
Dosage Calculation
o Blood and Blood Products
Central Venous Access Device
Intravenous Therapy
o Expected Outcomes / Effects
Medication Administration
Parenteral Fluids
o Pharmacologic Interactions
Pharmacologic Pain Management
TPN
Reduction of Risk Potential
o Diagnostic Tests
Laboratory Values
Vital Signs
o Monitoring Conscious Sedation
Potential for Alteration in Body Systems
o Potential for Complications from Surgical Procedures and Health Alterations
o System Specific Assessment
Therapeutic Procedures
Physiologic Adaptation
o Alteration in Body Systems
Fluid and Electrolyte Imbalances
Hemodynamics
o Illness Management
Infectious Diseases
Medical Emergencies
o Unexpected Response to Therapies Radiation Therapy
Pathophysiology
Timing
Scenario Progression Outline
Manikin Actions
Expected Interventions
(approximate)
2 minutes
Poor position in bed, wound
bandaged, moaning and
groaning. Asking "Can I
have something for this
pain?"
2 minutes
2 minutes
Wife interacts with Mr.
Burns and begins demanding
the student nurses do
something for his pain.
Wife continues to be
demanding and very
emotional...Mr. Burns
continues to complain of
pain.
Student nurses should
begin to assess Mr. Burns
pain. Have him rate his pain
on a scale of 1-10, identify the
location and quality of pain.
Remind Mr. Burns he is not
due for his Tylenol #3 yet.
Should take his vital signs
Students should assess the site,
offer to elevate the R knee,
change his position, ask about
what activities may help to
keep his mind off the pain
(music, TV, playing cards).
May use the
following Cues:
Role member
providing cue: TA
Cue: Is there a way
we can assess his
pain?
Role member
providing cue: TA
Cue: Should we
assess the site?
Are there any
activities that would
provide distraction?
Role member
providing cue: TA
The student nurses should
look to alter his environment:
dim the lights, provide
privacy, and some quiet time.
Cue: Should we ask
Perhaps ask Mrs. Burns to
Mrs. Burns to leave?
"take a break" and "leave Mr.
Burns rest.
Debriefing / Guided Reflection Questions Utilizing QSEN Competencies:
(Adopted from the NLN Debriefing/Guided Reflection QSEN Overview for Laerdal Simulations, Volume II))
General opening questions frequently used to start the debriefing session:
Can someone give me a summary of the experience?
How did the experience feel?
What problems were identified?
What went well?
Patient-Centered Care:
Definition: recognize the patient or designee as the source of control and full partner in providing
compassionate and coordinated care based on respect for the patient’s preferences, values, and needs.
Describe how you involved family members in the patient care being provided.
How did the patient describe his/her symptoms?
What have you learned from this patient?
Describe your assessment of this patient’s physical pain. Was this thorough? Did you miss anything?
Did you assess emotional pain/suffering? Why or why not?
Was the patient’s expression of pain impacted by culture/ethnicity?
What intervention did you apply for the patient’s pain? Was it effective? How do you know this?
How did you feel that you managed to “share decision making” with your patient?
Describe your communication with your patient. Appropriate boundaries? Therapeutic? Mutual respect?
Describe the level of “caring” that was demonstrated in your communication with your patient.
How did you handle the conflict between patient’s rights and organizational responsibility for patient care?
Discuss the level of empowerment you felt your patient exhibited. What did you do to facilitate empowerment?
How was your patient informed?
How was consent provided for procedures?
Did you feel that the patient received coordinated, continuous care during a transition of care? Why or why not?
Teamwork and Collaboration:
Definition: function effectively within nursing and inter-professional teams, fostering open communication,
mutual respect, and shared decision-making to achieve quality patient care.
Describe your personal strengths and limitations as a team member.
Did you identify a leader in the clinical simulation experience?
Can you describe who the leader was?
Why do you think this person became a leader?
Describe the scope of practice of all participants in the scenario.
Did you feel that everyone functioned within the scope of practice? Why or why not?
Describe who you called for help.
What lead up to this request for help?
Describe your collaborative efforts.
Describe your utilization of resources available.
Were roles clear?
Was communication closed loop and clear? How do you know this?
Were all the contributions acknowledged and respected?
Was there a conflict? Was the conflict resolved? How?
Describe “systems” that support effective teamwork and ineffective teamwork.
Debriefing/Guided Reflection Overview
General wrap-up questions frequently used to close the debriefing session:
What will you take away from this experience?
What would you do differently next time?
What discoveries have you made?
What did you learn about yourself?
Complexity – Simple to Complex
Suggestions for changing the complexity of this scenario to adapt to different levels of
learners:
Have participants repeat the simulation, selecting different roles the second time.
Have Mr. Burns develop shortness of breath or chest pain for a sophomore level/med/surg experience.
Include a heart monitor and have him develop Atrial Fibrillation.
Evaluation Log & Checklist of Competencies in Simulation Experience:
Simulation Topic:
Date of Experience:
Level of Student:
# of Students Participating:
Faculty Person Coordinating:
LRC Person Coordinating:
TAs Participating:
QSEN Competencies ID
○ Patient Centered Care
Attained
○Y ○ N
○ Teamwork /Collaboration ○Y ○ N
Appropriateness/Barriers/Areas for Improvement
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