Running head: SCHOLARLY PRACTICUM SYNTHESIS
Scholarly Practicum Synthesis: High-Fidelity Simulation Teaching
Kathy Bowers
Ferris State University
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SCHOLARLY PRACTICUM SYNTHESIS
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Abstract
Orienting in a nurse educator role is a demanding and rewarding process to pursue. Working
with an experienced mentor, and using the National League of Nursing’s (NLN) core
competencies for reference are beneficial for guiding novice nursing educators through the
process. Utilizing the teaching-learning process new nursing educators may gain needed training
in the skills and high-fidelity simulator laboratory. A duo project of developing a high-fidelity
simulation scenario and a debriefing tool for educating students in the simulation laboratory was
completed during this practicum experience. The clinical practicum has provided an opportunity
to gain experience as a neophyte in the nursing faculty role.
Keywords: nursing students, high-fidelity simulation, practicum nurse educator
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Scholarly Practicum Synthesis
Nurses transitioning from an experienced clinical position to a novice educator role often
find it a daunting experience. Understanding the role of nurse educator is crucial for long term
success in a faculty position (Penn, Wilson, & Rosseter, 2008). The National League for Nursing
(NLN) has developed eight core competencies to follow as a guide for nursing faculty (NLN,
2007). By employing the NLN’s core proficiencies into teaching practice, novice nursing
educators can become competent in transitioning from beginner to an expert role. The purpose of
this practicum was to offer a student teaching role in the skills/high-fidelity simulation laboratory
at North Central Michigan College (NCMC). Utilization of Patricia Benner’s Novice to Expert
theory was the basis of the learning experience (Benner, 2001). Also by applying Joanne
Duffy’s Quality-Caring theoretical framework as an educational model, and working under the
supervision of an experienced preceptor, provided me guidance through the student practicum
experience (Duffy, 2009).
This paper discusses the practicum experience at NCMC as well as challenges and issues
related to the function of the role. The strategies and methods developed to address the concerns
and challenges encountered throughout the practicum will be discussed. Also, a description and
analysis in understanding practice and theory, a depiction of the clinical project, and evaluation
of the practicum with data, is included in this paper.
Practicum Experience
Preparing to become a novice nurse educator, possessing strong clinical skills is
significant but there is much more to being an effective nurse educator, than expert skills
(Tartavoulle, Manning, & Fowler, 2011).
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When transitioning from staff nurse to nurse educator it could be assumed to be an effortless
process but without formal training would be an unsuccessful enterprise (Cangelosi, Crocker, &
Sorrell, 2009). Conversion to a faculty role, the novice nurse educator should become capable of
identifying individual student learning styles and become familiar with their own teaching style
and the outcome it has on learner growth and socialization (Pettigrew, Dienger, & King, 2011).
In order to fulfill the practicum requirements for the Masters of Science Nursing (MSN)
degree at Ferris State University (FSU), over 300 student teaching hours in the simulation/skills
laboratory at North Central Michigan College (NCMC) was completed. With the guidance of an
experienced mentor, I was able to meet my objective of fulfilling four of the NLN’s core
competencies. To meet the objectives for my clinical practicum, implementing educational
strategies that incorporated evidence-based practice, developing curriculum design, and
providing experiences for students to develop critical thinking skills were utilized throughout the
experience (NLN, 2007). Attached in Appendix A is a copy of the practicum planning guide.
During the teaching practicum there were several challenges identified in the skills and highfidelity simulation laboratory. A few of the issues discovered were challenges in altering
assignments in the clinical setting, student professionalism, and student procrastination. Lastly,
another challenge that was identified was the lack of a formal debriefing tool used for postsimulation case experience.
Issues, Concerns, Challenges with Strategies
Flexibility in Clinical Assignments
The first challenge encountered was changing clinical assignments. One clinical group of
students was not allowed to go to an assigned clinical day at an extended care facility (ECF).
Information was given to my preceptor Mary Miles that one of the nursing home rotations would
SCHOLARLY PRACTICUM SYNTHESIS
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not be able to accept students due to an upper respiratory virus among clients and workers. It
was decided by the laboratory coordinator, clinical instructor, the dean of nursing, and my-self,
to bring the students to the high fidelity simulation lab for eight hours so that they would not lose
valuable clinical time. I was asked to develop two scenarios to be performed, and create charts
for each patient, that would meet learning objectives and outcomes for second year students.
The scenarios would be performed in the high-fidelity simulation laboratory on the student’s
clinical rotation day, and I was given three days to prepare. This happened two consecutive
weeks in a row and I was able to create separate scenarios each week for student learning and
socialization. High-fidelity simulation has been proven to be an effective substitute for
conventional clinical practice by way of higher test scores for students that participated in
simulation practice (Gates, Parr, & Hughen, 2012). I found the high fidelity simulation to be
beneficial learning for the students by gaining experience with physical assessment, medication
administration, and critical decision making skills. It was significant to see how each student fell
into their respective roles, and always an evolving leader emerged. We spent approximately
twenty minutes debriefing by verbalizing thoughts and observations. However, there was no
formal debriefing tool used so the students were asked to write their reflections in a journal.
Used as a teaching tool, simulation promotes clinical skills, interpersonal relationships, and
competencies in critical thinking, psychomotor, and affective learning skills (Dillon, Noble, &
Kaplan, 2009). According to Yildirim & Ozkahraman (2011), the practice of nursing
necessitates "creative, personalized solutions to unpredictable client circumstances'' (p. 176) and
the needs of student were met by the objectives and outcomes despite the need to alter a clinical
situation. The students were offered an alternative environment to practice critical events in an
organized and safe area that facilitates student confidence (Decker, Sportsman, Puetz, & Billings,
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2008). In designing student simulation scenarios NLN’s Competency III-Use Assessment and
Evaluation Strategies by providing timely feedback in debriefing, and Competency IVParticipate in Curriculum Design and Evaluation of Program Outcomes by developing scenarios
for student learning were met (NLN, 2007).
Student Professionalism
The second challenge was a lack of student professionalism at the college during a
clinical rotation day that was changed to a clinical simulation mock practice. The first week the
ECF clinical instructor told the students they could wear street clothing in to the simulation lab
practice. It was identified that some of the students were just a little too lackadaisical when
dressed in jeans, sweatshirts, and hats. Many of the students did not come prepared and forgot to
bring their stethoscopes, pen lights, and scissors. The following week, the students were asked
to come in full uniform, prepared with the equipment they would need in a real clinical scenario.
I noticed that when in uniform, the students seemed to act in a more professional manner. When
in uniform the students role-played with a serious attitude, and there was less verbalizing over
the patient.
Nursing uniforms increase pride and confidence and in turn create enhanced performance
in clinical practice by student nurses (Shaw & Timmons, 2010). The profession of nursing is
immersed in tradition. It is essential for educators to act as role models and teach students to
preserve a reverence for nursing history (Shaw & Timmons, 2010). The nursing department
maintains the required student uniforms professional but modern, due to multi-generational and
increased male gender in the student population. Therefore, it was decided by the nursing faculty
and the lab coordinator that for future simulation scenarios students will be mandated to wear
full uniform to the simulation lab. As role models for nursing students educators need to
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maintain a neat and professional appearance in the classroom as well as in the clinical areas.
Nursing instructors wear dress attire with professional lab coats in the clinical sites.
Student Procrastination
Another issue that was discovered was student procrastination with practice time in the
skills lab. Often, the students waited until the last minute or late on a Friday to come in to the
lab for practicing skills. The students must sign in and out using name, date, and time, when
utilizing the lab this helps the coordinator track student activity. Many of the students did not
come to practice, prior to test out skill sessions. Procrastination is a common problem for
college students and has been associated with fear of failure, poor study behavior, rejection from
peers, and distress with test taking, while others use it as a motivational tool (Chow, 2011).
Occasionally, procrastination can be a great motivator for those who use the last minute
technique to inspire them into completing an assignment. Therefore, it is vital to recognize high
risk students and assist them with interventions to prevent procrastination such as enhanced
study habits, tutors, time management, and coping mechanisms for test taking (Chow, 2011). An
email was sent to the clinical instructors with the names of students who were not coming in to
practice skills before the testing out period. After talking with the skills lab coordinator to devise
strategies, the students were offered extended lab hours. The lab was opened up one extra
evening per week, to help those students who had work commitments and would benefit from
expanded lab times. In addition, students were encouraged to come in with a partner to practice
with so that they could assist each other with the competencies. The domains of learning include
cognitive, psychomotor, and affective domains (Billings & Halstead, 2012). With advances in
technology nurse educators are challenged to find new innovative methods of assessment and
evaluation in each domain. Cognitive learning may be evaluated by electronic testing, while
SCHOLARLY PRACTICUM SYNTHESIS
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psychomotor can be evaluated through skills and simulation. Evaluation of affective domains
identifies performance levels as each student develops and gains experience (Billings &
Halstead, 2012). The lab coordinator preceptor decided to allow the students to videotape each
other, which is usually reserved for test out, so that they could reflect on their performance.
Students often overestimate their performance and there can be contradictions between student
and educator over technical steps. Consequently, videotaping the student is an important
teaching strategy for monitoring each sequence of the skill presentation (Watt, Rush & White,
2009). Since the lab coordinator is present and the clinical instructor is not in the lab for testing
the video can be saved and watched by the clinical instructor at a later date. This gives the
clinical instructor additional knowledge as to how their students are performing. In applying
these strategies the NLN’s Competency II- Facilitate Learner Development and Socialization by
nurturing cognitive, affective and psychomotor growth of the students was met (NLN, 2007).
Application of Knowledge from Practice, Theory, and Research
Teaching Transition
During my practicum I was able to utilize my past nursing clinical experiences and expert
skills to educate students in the skills and high-fidelity simulation laboratory. It was realized
early on that being a clinical expert helps in the academic setting, conversely there was much
more to learn as a novice educator. Therefore, with the guidance of an expert preceptor and
using the NLN core competencies and nursing theoretical frameworks of Patricia Benner’s
Novice to Expert and Joanne Duffy’s Quality Caring Theory the transition process began.
Benner’s premise is that through the learning course the student goes through five stages of
competency novice, advanced beginner, competent, proficient, and expert (Benner, 2001). As a
SCHOLARLY PRACTICUM SYNTHESIS
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novice the goal is to progress through these stages and with time and experience achieve expert
skill as a nursing instructor.
Skills Lab Teaching
Being a novice at anything is always a difficult process. Thinking back to entering
nursing school many years ago as a student, it was a frightening and intimidating experience. A
novice is someone who has no experience in the circumstance that they are assuming (Stuart,
2008). Nursing skills are critical learning experiences that all nursing students must perform
and pass in the skills laboratory before performing in the clinical setting (Billings & Halstead,
2012). Having previous experience with adjunct teaching, in the clinical hospital setting I
would consider myself proficient in that position. However, this is my first time teaching in the
skills laboratory and I would be considered an apprentice in this area of academia. Going in to
the skills lab proved to be a smooth transition because of my strong personal clinical skills.
However, knowing that some of my nursing skills were not up to par I reviewed the skills that
students would be performing throughout the semester. During this practicum, teaching nursing
students various clinical skills such as intravenous (IV) and foley catheter insertions, priming IV
and intravenous piggy back (IVPB) tubing, tracheotomy care, suctioning, and administering
medications by all routes, enabled me to foster learning. Also, a new diabetic skills station was
taught by crafting an instruction module on insulin injections, insulin pumps, and insulin
infusions. Handouts and skills check off sheets were provided for review before performing
student test out. As preparation for graduating from the MSN program becomes closer there is
some apprehension about being qualified to be a nurse educator. Learning and applying aspects
of the NLN core competencies helps the novice educator advance through Benner’s five stages,
gaining compulsory experience in the role of nurse educator.
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Simulation Lab Teaching
By creating activities for student learning, it is essential to assign structured activities.
Simulation laboratory teaching is an example of a structured teaching activity and takes an
enormous amount of work to develop and complete (Billings & Halstead, 2012). In the highfidelity simulation lab, scenarios were developed and carried out educating students while in the
role of lead educator. I performed in the role as the facilitator for the simulation case experiences
and debriefing discussions. In structured activity the rationale, goals, and objectives need to be
unambiguous and succinct for student learning (Billings & Halstead, 2012).
Starting simulation instruction there are three basic steps that should be included with
every scenario (Rose, Courey, Ball, Bowler, & Thompson, 2012). The first stage is a brief
overview of the case presented to the students, to provide them the opportunity for preparation of
the scenario. The second step is to carry out the intra- simulation of the actual scenario. This
provides an opportunity for the students to perform the nursing process, and complete the
interventions and outcomes outlined for the simulation. The final and most important phase is
the debriefing reflection phase once the simulation is carried out with instructors present for
questions and feedback (Rose, et. al, 2012)
I have incorporated Duffy’s theory in my teaching philosophy with students in the
simulation lab. Duffy’s Quality-Caring Theory Model is a middle range nursing theory that
identifies the nursing role as a unique partner of the healthcare team (Peterson & Bredow, 2008).
Caring and nurturing relationships are at the core of the nursing profession and caring for ones’
self, patients, families, colleagues, and community are the foundation of the theory (Duffy,
2009). I instructed the students on the importance of caring for themselves, balancing work with
home life so that they do not experience burn out hastily in their practice. Equally, I try to instill
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that each patient is at the core of nursing care and that learning to become a patient advocate is a
key element of the nursing profession. This theory of caring was also adapted into the simulation
lab teaching as students carried out scenarios, they were encouraged to provide a caring
atmosphere for the patient, family and the entire healthcare team (Duffy,2009).
Duffy’s theory model consists of eight carative factors, including shared problemsolving, thoughtful reassurance, respect, encouraging behavior, and appreciation of distinctive
meaning, healing environment, attachment needs, and basic human needs (Duffy, 2009). All
aspects of the caring factors are essential for students to embrace and employ in their clinical
nursing practice. Students should be able provide compassionate and individualized care to
patients, families, and offer mutual respect to peers. Therefore, through introduction and
application of this middle range theory students are encouraged to make the most of the eight
carative factors throughout their clinical practice. Shared problem solving in the simulation lab
helps students to become more confident in real life situations where they will be more prepared
to recognize changes in a patient’s condition (Neill & Wotton, 2011).
Description Analysis of Clinical Project
High-Fidelity Simulation Scenario
It was determined by my preceptor that there was a need for a diabetic ketoacidosis
(DKA) simulation scenario for the college high-fidelity simulation laboratory. Therefore, I was
asked to create the scenario as my project for this practicum. Originally, I had planned to create
a debriefing tool for the project and frankly I had no idea where to start developing a simulation
scenario. In creating the DKA scenario, the focus was on meeting the first NLN CompetencyFacilitate Learning and the fourth Competency- Participate in Curriculum Design and Evaluation
of Program Outcomes (NLN, 2007).
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Description and Analysis
High-fidelity patient simulation laboratories have been established to develop critical
thinking skills and provide a safe environment for nursing student education (Wayne & Lotz,
2013). In order to begin the process, I felt it was important to have formal training on the highfidelity simulator from the manufacturer, the Laerdal Company, to be able to manage a project of
this magnitude. By attending this eight hour class it helped me to understand the complexity of
high-fidelity simulator operations and how to successfully connect the DKA scenario for the
project. I also viewed several training videos on the high-fidelity simulator the first week of the
practicum experience. The main focus for the first NLN competency was to help students
develop critical thinking and analytical reasoning skills. The scenario had to be aimed at
adapting to the curriculum of the college. In creating a scenario that was tailored to the student’s
needs, the objectives needed to be uniform with the course syllabus (Durham & Alden, 2008).
After I began writing the simulation scenario it was decided by the class room faculty, that I
should make a duo learning simulation by incorporating a psychology component. Therefore,
the course syllabus for NUR 150 Health Issues and Concepts and NUR 170 Holistic Health
Concepts had to be reviewed to meet the expectation of mutually consistent goals and objectives
for student learning.
As the scenario began to take form, the situation was shaped into a patient with type 1
diabetes mellitus who had a previous below knee amputation (BKA). The patient lived alone,
had been extremely depressed, and subsequently stopped taking life saving exogenous insulin in
an attempt to end his life. Often, in chronic illnesses there may be an element of depression that
goes undiagnosed by healthcare professionals (Katon, 2008). Therefore, I had to research
depression in people with diabetes in order to provide evidence based nursing practice for the
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simulation scenario. The fact that this was a suicide attempt is not inclusive in the title of the
scenario so it was expected that the students would be able to recognize through assessment,
evaluation, and communication with the patient.
It was planned that once the DKA simulation scenario case was completed there would be
a two day simulation experience carried out by students. The simulation was carried out in two
sessions with two rooms running simultaneously. The first simulation was from 8-10 a.m. and
the second from 10-12p.m. with five students, each assigned a role. Therefore, 40 students
performed the simulation case experience over a two day period. Once the scenario was
completed the post simulation debriefing discussion was to be carried out and students were to
complete a debriefing tool evaluation. Attached in Appendix B is a copy of the DKA simulation
scenario.
Evaluation of Project
The college was not using a formal debriefing tool therefore I created a tool during the
practicum experience to evaluate the simulation experience for my DKA case scenario.
Therefore, with evaluation of teaching and learning in mind I focused on meeting the objective
for the third NLN Competency-Use Assessment and Evaluation strategies (NLN, 2007).
Debriefing is an integral part of the simulation experience because it evaluates student
learning objectives and outcomes (Neill & Wotton, 2011). The method applied, consisted of
gathering, analyzing, and summarizing (GAS) and was used to develop a meaningful discussion
that allowed the students to identify and reflect on performance (Levine, DeMaria, Schwartz &
Sims, 2013). It was crucial for student learning, that as the facilitator I used questions with cues
to enhance critical reflection, and provided constructive feedback immediately after the
simulation experience (Levine et al., 2013). The debriefing tool Appendix C, evaluates learning
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outcomes and collecting and interpreting the data from the debriefing tool provided feedback to
faculty for improvements in the teaching-learning method for future semesters (Neill & Wotton,
2011). It was decided that student names were optional so that the students would not be
intimidated in reporting truthfully and making comments on the evaluation tool.
The student evaluations were extremely positive in reflecting that the simulation practice
was a valuable method for teaching strategies and learning outcomes. For every evaluation the
students scored a 1 or 2 either agree or strongly agree. None scored either a do not agree or not
applicable on any of the questions in the debriefing tool in the student evaluations Appendix D.
Many of the students verbalized during the debriefing discussion that they would have benefitted
from having more simulation case experiences earlier in the semester. Several of the evaluations
had written comments on them. The students also reported during the debriefing session, that
they liked having assigned roles for the activity as it created less confusion about their respective
responsibilities. Due to the request by students to have simulations earlier in the semester, to
help them feel more confident in the clinical setting, it was decided that next year the college
would have simulations started prior to ECF and hospital clinical rotations.
Evaluation of Clinical Practicum
There are several examples of evaluations of this clinical practicum. First, my preceptor
offered verbal feedback and assessment of my teaching throughout the course of the practicum
experience. I was given positive and constructive feedback in my teaching performance for the
skills and simulation lab. Mary also provided me ongoing feedback as I developed the
simulation scenario and the debriefing tool. This offered me the opportunity to improve on
certain aspects of my teaching presentation. The mentor-student relationship should be based on
open dialogue and respect in an ethical manner (Billings & Halstead, 2012). Mary was
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extremely open to my suggestions and guided me in a respectful approach throughout the
scholarly practicum student teaching process. By continually meeting and reviewing the goals
and objectives set up throughout the semester, Mary was able to help keep me on track in
meeting those goals and objectives. In encountering each challenge she was able to help me
brainstorm and develop strategies for resolving the issues almost immediately.
Second, evaluation for my teaching performance by my preceptor and the students helped
me to learn from my limitations and enhance growth and maturity in the role of nurse educator.
Many nursing faculty are afraid of the new technology available in nursing education today and
it takes skill to master it (Axley, 2008). Although I was intimidated in the beginning, by delving
into learning and utilizing the simulator during my practicum experience allowed me to increase
confidence and enhanced my ability to use the high-fidelity simulator. Evaluation of my
performance in the simulation and skills laboratory will be provided in Appendix D and it
offered me desired feedback for moving forward as a novice nurse educator.
Last, self evaluation provides an opportunity to reflect on my own learning and
subsequent growth through the process of teaching. Attached in Appendix F will be a self
evaluation of my scholarly practicum teaching performance. I also maintained a journal that
encompassed teaching in the skills/ high-fidelity simulation laboratory, development and
performance of the DKA simulation case scenario, and development and performance of the
debriefing tool discussion; from beginning to end.
Conclusion
The scholarly practicum experience afforded me the opportunity to explore the role of a
nurse educator teaching 1st and 2nd year nursing students. I experienced some frustration and a
number of issues during the process but learned strategies, with the help of my preceptor, to
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successfully meet my goals and objectives for learning. The evaluation process gave me the
opportunity to improve my teaching skills as I move forward in pursuing further opportunities in
a nursing faculty role. I found engaging with and teaching the students a beneficial and
rewarding experience. I am also grateful for the chance to network and develop relationships
with faculty in the academic arena.
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References
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Gates, M., Parr, M., & Hughen, M.(2012).Enhancing nursing knowledge using high-fidelity
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Appendix A- Practicum Proposal Planning Guide
Goals
Goal 1:
Gain development in
the nurse educator
advanced specialty role
by utilizing NLN’s
Competency 1Facilitate learning.
Spring/2014
Objectives
Activities
Timeline/Complete
by:
1.1
Identify and start to
implement teaching
and learning
approaches in the
skills/simulation lab
for NCMC students
January 2014
semester.
1.1a.
Review nursing
January 15th 2014
program mission and
student handbook for
the nursing program
1.1b
Research teaching and February 1, 2014
learning strategies
incorporating
cognitive,
psychomotor and
affective domains.
1.1c
Research innovative
February 25, 2014
learning environments
to develop critical
thinking skills by
utilizing role playing
& simulation
scenarios.
1.1d
Complete and carry
out critical thinking
scenarios for each
week of SIM class
with debriefing
sessions at the end of
class each day.
1.1e
Meet with preceptor
January 15- May 6
during course of
practicum for
guidance and
feedback
SCHOLARLY PRACTICUM SYNTHESIS
Goal 2
To meet core
competency 2 Facilitate
learner development
and socialization.
2.1
Identify objectives to
promote student
learning.
2.2
Identify individual
diverse student
learning styles.
Goal 3
To meet the
competency of the third
core competency of
Use Assessment and
Evaluation Strategies
3.1
Identify education
module assessments,
evaluation tools and
debriefing philosophy
and evaluation tool.
21
2.1a
Encourage student
participation and
collaboration by role
playing.
2.2b
Create learning
atmosphere conducive
to socialization and
reflection by using
journaling.
3.1a
Research literature on
assessments and
evaluation
applications.
3.1b
Provide constructive
and timely feedback
to students
3.1c
Provide an evaluation
tool for students and
preceptor to evaluate
my teaching.
3.1d
Develop a debriefing
evaluation tool for
student’s simulation
experience.
March 5, 2014.
March 12, 2014
March 25th, 2014
March 30, 2014.
April 1-5, 2014
April 10,2014
SCHOLARLY PRACTICUM SYNTHESIS
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Appendix B-DKA Simulation Scenario
Burt McReynolds-Diabetic Ketoacidosis-BKA
Burt McReynolds
Age: 53 years
Weight: 70.0 kg
Base: Stan D. Ardman II
Overview
Synopsis
The learner is caring for a 53 year old who is divorced and lives alone in an apartment on the
second floor He has no insurance and has been seeing the local federally qualified health clinic
for management of his Type 1 diabetes mellitus. He attempts to manage but has trouble
remembering to monitor his blood sugar 4 times a day and admits to missing insulin doses at
times. His neighbor had not seen Burt in a few days so he called Burt’s daughter who had a key
to the apartment. Upon entering the apartment they found him lying on the floor unresponsive so
EMS was called. When EMS arrived the blood sugar reading was 550 so they gave 12 units of
regular insulin and transported to the emergency department of the local hospital.
The SCE prepares the student for the following items of the NCLEX-RN test format:
NCLEX_RN Test Plan:
X Safe and Effective patient care
X Management of patient care
X Health promotion and maintenance of patient
X Psychosocial integrity of patient
X Physiological integrity of patient
X Basic care and comfort of patient
X Pharmacological therapies
X Reduction of patient risk potential
X Physiological adaptations of patient
______________________________________________________________________________
Background
Patient History
Past Medical History: Diagnosed with Type 1 diabetes mellitus at the age of 13, hyperlipidemia
Past Surgical History: Right below knee amputation 2yrs ago
Allergies: No known drug allergies
Medications: Insulin glargine 40 units at bedtime, aspart insulin 1 unit for every 15gms carbs ac
tid, aspart insulin per sliding scale before meals and at bedtime 0-12 units, Lipitor 20mg daily
Code Status: Full code
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Social/Family History: Married at age 20. His wife helped him with a proper diet, exercise and
blood glucose level monitoring. At age 50, his wife divorced him and he moved into an
apartment and after his BKA went on full disability.
He has been following up at the federally qualified health clinic for management of diabetes but
has missed several appointments.
______________________________________________________________________________
Handoff Report
The learner is to assess and stabilize patient for admission to the ICU
The report should follow the SBAR format and include:
Situation:
The patient was found unconscious in his apartment with a blood sugar of 550. He has been
living alone and after his wife divorced him he became depressed and has had trouble
remembering to check blood sugars and take insulin. He has been going the federally qualified
health clinic because he has no insurance, but has missed several appointments. His daughter
states that he has not been eating well and that her father may have missed some insulin doses.
She reports he has been very depressed and last time she visited he appeared to have poor
hygiene but she could not get him to go to the doctor. She stated that he told her he “just did not
want to live like this anymore.”
______________________________________________________________________________
Assessment
Vital Signs: HR 120, BP 110/60, RR 30 and rapid with fruity smell, SpO2 98% on 3L NC,
Temperature 37C
General Appearance: Clothing is old, worn and does not fit well. Appears older than stated age
Cardiovascular: Sinus rhythm
Respiratory: Breath sounds clear
GI: Normal bowel sounds
GU: Incontinent of urine
Extremities: Full range of motion in all four extremities
Skin: Pale, cool, and poor turgor. Mucous membranes dry
Neurological: Semi conscious pupils equal and reactive to light bilaterally
Labs: Blood glucose 530
Fall Risk: High-risk for falls
Pain: Moans with painful stimulation
______________________________________________________________________________
Initial Providers Orders:
Start IV fluid 0.9NS @ 15mL/kg/hr for 2 hours, then run at 7.5/kg/hr.
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Start 2nd IV Humulin Regular Insulin infusion at 2units hr
Give 20 units aspart (novolog) now x1.
Monitor blood sugars q 15 mins and vital signs every 30mins.
NPO
Monitor I &O if no void in 6 hours, foley catheter insertion
Neurological checks every 1 hr.
Labs Chem. Panel, CBC, Phosphorus, serum ketones & ABG stat
EKG and chest X-ray stat
Transfer patient to ICU after IV infusion, subcutaneous insulin and labs and x-rays
completed
__________________________________________________________________________
Preparation
Learning Objectives
Student will demonstrate knowledge of the nursing process in planning and caring for patients
with diabetes.
Student will demonstrate knowledge of integrating evidence based practice research into clinical
practice to provide safe care for patients with health alterations.
Student will demonstrate use of appropriate technology to gather information regarding the
patient’s disease process, and plan and document interventions.
Student will demonstrate therapeutic communication skills through verbal and non-verbal means
with patient and family.
Student will demonstrate recognition of the distinction between moderate depression and major
depression disorder
This SCE addresses the following QSEN Competencies;
X Patient-Centered Care
X Team Work and Collaboration
X Evidence-Based Practice
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Quality Improvement
Safety
Informatics
EHR
Learning Performance Measures
Essential Performance Measures for the SCE:
Reviews patient’s medical record
Performs hand hygiene before and after patient contact
Demonstrates appropriate use of personal protective equipment
Introduces self to patient
Verifies patient identity with two identifiers
Conducts basic environmental safety assessment and maintains safety measures
Uses therapeutic communication to establish rapport and reduce patient anxiety
Provides developmentally appropriate education
Evaluates effectiveness of education
Documents all findings, interventions and patient responses
Preparation Questions
Describe the difference between type 1 and type 2 diabetes mellitus.
Why is the recognition and treatment of acute changes in blood sugar levels important?
Identify chronic complications of diabetes mellitus.
What risk factors are associated with diabetes mellitus?
Outline a teaching plan for a patient with type 1 diabetes mellitus.
What is the cardinal rule of insulin administration?
Why is it best to take blood sugar readings in pairs (before and after administration of insulin)?
What laboratory values indicate a patient has diabetes mellitus?
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Why is a patient with diabetes mellitus at risk for developing neuropathies, macro-vascular and
microvascular diseases?
What is carbohydrate counting and why is it the preferred diet regimen for patients with
diabetes?
Why is depression a psychological component in diabetes?
What is the role of the nurse for a patient with suicidal ideation or attempt?
______________________________________________________________________________
Equipment & Supplies
Medication Supplies
Alcohol wipes
Distilled water 10mL vials (2) labeled
Aspart insulin
Human insulin regular
Miscellaneous
Patient chart with appropriate forms and order sheets
Patient identification band
Stethoscope
BP cuff adapted for use with simulator
Non-sterile gloves (1 box)
Sharps container
Audio and video recording devices
Glucometer
Glucometer test strips
Jar of cotton balls
Jar of tongue depressors
Flash light
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Notes
Facilitator Notes
This SCE was created with the patient Burt McReynolds and only this patient can be used.
The physiological values documented indicate appropriate and timely interventions. Differences
will be encountered when care is not appropriate or timely. The facilitator should not click "Run"
until ready to start the SCE.
Students should perform an appropriate physical exam. The facilitator or patient should verbalize
the physical findings the students are seeking but not enabled by the simulator (such as pain on
palpation).
The facilitator should use the microphone and/or preprogrammed vocal or audio sounds to
respond to the learners' questions, if present on your simulator.
______________________________________________________________________________
Where appropriate, do not provide information unless specifically asked by the student. In
addition, ancillary results (e.g., ECG, chest x-ray, labs) should not be provided until the students
request them.
For the patient: Dress the simulator in tattered, worn, ill-fitting clothing appropriate for the
weather
Place the simulator in a laying position
Simulation personnel should role- play the following:
Transferring nurse
Make up a patient chart with the appropriate written order forms, medical administration record,
diagnostic results, etc. for students to use. The chart should include the patient identification
information.
Begin the simulation with a transferring nurse (simulation personnel) offering verbal handoff
using SBAR.
Have the student’s role-play inter-professional communication with simulation personnel role
playing back communication for the simulator.
Highlight the importance of data organization and comprehensiveness when communicating.
Debriefing and reflection after the scenario are crucial. When possible view a video of the
scenario afterward for instructional and debriefing purposes.
______________________________________________________________________________
Debriefing Points
The facilitator will begin by introducing the process of debriefing:
Introduction: Discuss faculty role as a facilitator, expectations, confidentiality, safe-environment.
Personal Reactions: Allow student to display emotions, explore student's reactions
Discussion of Events: Analyze events of the SCE, using video tape if available
Summary: Appraise what went well and what did not, identify areas for improvement and
evaluate the experience using a debriefing tool
Questions to be asked during debriefing:
What was the practice experience like for you?
What occurred and why?
What action took place and was it valuable?
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Teaching Q & A
What is the rule of insulin administration?
How would the nurse assess the patient's willingness to learn?
What is the patient's level of education?
What is the patient’s socioeconomic and psychological level?
What are the barriers to learning?
What are the patient’s physical capabilities?
How to identify community resources?
What priorities should be included in this patient's discharge teaching?
How to recognize the signs and symptoms and management of hypoglycemia and
hyperglycemia?
When should nurse contact healthcare provider?
How to monitor blood glucose levels?
Proper administration of medications using 5 rights
What are sick day guidelines?
What possible referrals would be ordered for this patient?
Social services
Dietitian
Diabetic nurse educator
Local community resources
Community case nurse manager
28
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References
Butler, M. K., Kaiser, M., Johnson, J., Besse, J., & Horswell, R. (2010).Diabetes mellitus disease
management in a safety net hospital system: Translating evidence into practice.
Population Health Management, 13(6), 319-324. doi:10.1089/pop.2009.0078
DeFronzo, R. A., Stonehouse, A. H., Han, J., & Wintle, M. E. (2010).Relationship of baseline
HbA1cand efficacy of current glucose-lowering therapies: A meta-analysis of
randomized clinical trials. Diabetic Medicine, 27(3), 309-317. doi:10.1111/j.14645491.2010.02941.x
Edelman, C.L., & Mandle, C.L.(2010). Health promotion throughout the life span (7th ed.). St.
Louis, MO: Mosby Elsevier.
Forehand, M. (2010).Bloom's taxonomy: Emerging perspectives on learning, teaching, and
technology .Department of Educational Psychology and Instructional Technology,
University of Georgia.
Retrievedfromhttp://projects.coe.uga.edu/epltt/index.php?title=Bloom%27s_Taxonomy
Giger, J.N., & Davidhizar, R.E. (2008) Transcultural nursing: Assessment and intervention (5th
ed.). St.Louis, MO: Mosby Elsevier.
Johnson-Russell, J. (2010).Facilitated debriefing In W.M. Nehring & F.R. Lashely (Eds.), High
fidelity patient simulation in nursing education, pp. 369-385. Sudbury, MA: Jones and
Bartlett.
Lewis, S.L., Dirkse, S.R., Heitkemper, M.M., & Bucher, L. (2011).Medical-surgical nursing:
Assessment and management of clinical problems (8th ed.). St. Louis, MO: Elsevier
Mosby.
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Melnyk, B.M., & Fineout-Overholt, E.(2010). Evidence-based practice in nursing & healthcare:
A guide to best practice (2nd ed.). Philadelphia, PA: Lippincott Williams & Wilkins
National Council of State Boards of Nursing.(2010).2010 NCLEX-RN test plan. Retrieved from
https://www.ncsbn.org/2010_NCLEX_RN_Testplan.pdf
Quality and Safety Education for Nurses.(2011).Quality and safety competencies. Retrieved
February 19, 2014, from http://www.qsen.org/competencies.php
The Joint Commission.(2014).National patient safety goals. Retrieved February 19, 2014 from
http://www.jointcommission.org/standards_information/npsgs.aspx
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Appendix C- Debriefing Tool: Simulation Case Experience (SCE)
Date: ___________
Course: _________________
Instructor: ________________________
Name (Optional):______________
Please rate the statements below on the scale. Mark N/A if there is no experience.
Do
Not
Agree
Agree
Strongly Not
Applicable
Agree
The debriefing questions helped me to critically think
0
1
2
N/A
I feel more confident in making decisions
0
1
2
N/A
I gained better understanding of the pathophysiology
of conditions in the SCE
0
1
2
N/A
I feel I will be more prepared to recognize changes in
my real patient’s condition
0
1
2
N/A
I feel my assessment skills improved with the SCE
0
1
2
N/A
I feel I have improved my medication administration
skills
0
1
2
N/A
I learned from my active role as well as observing
peers throughout the SCE
0
1
2
N/A
Debriefing and discussion with the team were
valuable
0
1
2
N/A
Performing the SCE helped me to better understand
the classroom content
0
1
2
N/A
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Appendix D- Student Evaluations
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Appendix E-Preceptor Evaluation
43
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Appendix F-Self Evaluation
Objectives
Met
Facilitates
Learning:
1.Engages in
teaching and
learning strategies
incorporating
cognitive,
psychomotor and
affective domains in
the skills lab
1a. Effective use of
Critical thinking
scenarios in
Simulation Lab.
Facilitates
Socialization and
Learner
Development:
2. Encourage
student participation
and collaboration by
engaging students in
role play.
2a. Effectively uses
journaling for
reflective
X
Use Assessment
and Evaluation
Strategies:
3. Provides
constructive and
timely feedback to
students.
X
Not Met
Comments
I was able to
engage students
in learning in
various domains
of learning.
Stimulated
critical thinking
by questions and
cues.
X
Carried out
several
simulation
experiences for
students
engaging them
in role-play for
effective
learning.
Even though
students used
journaling I was
not able to read
them.
I provided the
students with
real-time
feedback and
constructive
communication.
SCHOLARLY PRACTICUM SYNTHESIS
Participates in
Curriculum Design
and Evaluation of
Outcomes:
3. a. Provides a
student and
preceptor evaluation
tool for assessment
of teaching.
3. b. Develops a
high-fidelity
simulation scenario
meeting the goals
and objectives for
NUR 150 & NUR
170
3. c. Develops a
debriefing tool for
evaluation of
simulation teachinglearning experience
successfully.
X
46
Evaluations
performed in the
skills lab.
I developed a
DKA highfidelity
simulation
scenario and a
debriefing tool
for evaluation.
I completed over 300 hours of student teaching at NCMC from January-May.2014. I feel I have
grown from this experience and had the pleasure of working with a wonderful group of students
and faculty at NCMC. This experience will help me in my future aspiration of becoming a full
time faculty nurse educator.
Kathy Bowers
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Bibliography
Butler, M. K., Kaiser, M., Johnson, J., Besse, J., & Horswell, R. (2010).Diabetes mellitus disease
management in a safety net hospital system: Translating evidence into practice.
Population Health Management, 13(6), 319-324. doi:10.1089/pop.2009.0078
DeFronzo, R. A., Stonehouse, A. H., Han, J., & Wintle, M. E. (2010).Relationship of baseline
HbA1cand efficacy of current glucose-lowering therapies: A meta-analysis of
randomized clinical trials. Diabetic Medicine, 27(3), 309-317. doi:10.1111/j.14645491.2010.02941.x
Edelman, C.L., & Mandle, C.L.(2010). Health promotion throughout the life span (7th ed.). St.
Louis, MO: Mosby Elsevier.
Forehand, M. (2010).Bloom's taxonomy: Emerging perspectives on learning, teaching, and
technology .Department of Educational Psychology and Instructional Technology,
University of Georgia.
Retrievedfromhttp://projects.coe.uga.edu/epltt/index.php?title=Bloom%27s_Taxonomy
Giger, J.N., & Davidhizar, R.E. (2008) Transcultural nursing: Assessment and intervention (5th
ed.). St.Louis, MO: Mosby Elsevier.
Guillaume, A. (2011).Developing high-fidelity health care simulation scenarios: A guide for
educators and professionals. Journal of Simulation and Gaming, 42 (1), 9-26.
Neill, M., &Wotton, K.(2011). High fidelity simulation debriefing in nursing education: A
literature review. Clinical Simulation in Nursing, 7 (5), e168-e181.
Pettigrew, A., Dienger, M., & King, M. (2011). Nursing students today: Who are they and what
are their learning preferences? Journal of Professional Nursing, 27(4), 227-236.
doi:10.1016/j.profnurs.2011.03.007.
SCHOLARLY PRACTICUM SYNTHESIS
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Quality and Safety Education for Nurses.(2011).Quality and safety competencies, Retrieved
February19, 2014 from http://www.qsen.org/competencies.php.
Su, W., & Osisek, P.(2011). The revised Bloom’s Taxonomy: Implications for educating
nurses. Journal of Continuing Education for Nurses,42(7) 321-7.
doi:10.3928/0022012420110621- 05.
The Joint Commission.(2014).National patient safety goal, Retrieved February 19, 2014 from
http://www.jointcommission.org/standards_information/npsgs.aspx.