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A PORTFOLIO OF SIMULATION SCENARIOS

FOR NOVICE AND SENIOR NURSES

Written and compiled by Yukie Abe, RN, PhD

Japanese Nursing Association Publishing Company

Nurture in 1 Year! Spring series

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A list of scenarios (original page: v) Series Theme Skill level* Content of learning Learning by debriefing

Spring 1 Observation and identification of multiple patients; verification of their conditions and environments

Novice Greeting to the patients in the morning and verification of their conditions and environments after the reporting on 3 patients in charge (1 diabetes, 1 pneumonia, and 1 cholelithiasis) by night shift nurses on the previous day

Greeting to the patients; verification of their conditions and environments; objective, application, and criteria of oxygen therapy; and oxygen concentration, oxygen saturation, and arterial partial pressure of oxygen

Spring 2 Medical interview of an inpatient

Novice Collection of information from the patient who complained of shaking chills, had fever, and was then hospitalized

Grooming as nurses; systematic review; (speaking and hearing) attitudes during a medical interview; what are vital signs?; mechanism and nursing care of fever

Spring 3 Physical assessment of multiple patients by novice nurses

Novice Physical assessment of 3 patients (1 pneumonia, 1 prostatitis, and 1 diabetes)

Physical assessment (anatomy, physiology; method of medical examination) of respiration; mechanism of respiration

Spring 4 Physical assessment of multiple patients by advanced beginner nurses

Advanced beginner

Physical assessment of 4 patients (1 pneumonia, 1 diabetes, 1 prostatitis, and 1 immediately after laparoscopic cholecystectomy)

Physical assessment immediately after surgery; fluid volume required for adults and urine volume

Spring 5 Reporting by a novice nurse to a leader nurse

Competent Appropriate judgments and actions of the competent nurse as a leader after reporting, contact, and consultation by the novice nurse who performs the physical assessment of 3 patients

Classification of asthmatic paroxysms: mild to status asthmaticus; leadership

Summer 1 Physical assessment of multiple patients at night

Novice Physical assessment of a diabetic patient with symptoms of hypoglycemia, a patient waiting for surgery of cholelithiasis, and a patient with prostatitis-induced fever

Basic knowledge of diabetes; hypoglycemia; insulin therapy; basic knowledge of cholelithiasis

Summer 2 Rounding of multiple patients

Novice Rounding of a patient at the night of laparoscopic cholecystectomy and of a pneumonia patient on oxygen and instillation therapies

Fundamentals and characteristics of nocturnal nursing care; mental and physical characteristics of patients at night; management of postsurgical nursing care for abdominal drain

Summer 3 Physical assessment and nursing care of an abrupt change 1): Fall

Novice Physical assessment and nursing care of a patient who fell when tried to go to the restroom at night

Physical assessment and nursing care at the time of fall; observation of the fracture of the femoral neck

Summer 4 Reporting by a novice nurse to a leader nurse

Competent Physical assessment of 4 patients (1 pneumonia, 1 diabetes, 1 prostatitis, and 1 immediately after laparoscopic cholecystectomy)

Complications of diabetes; basic knowledge, as well as physical assessment and nursing care of myocardial infarction; and leadership

Summer 5 Reporting by a novice nurse to a leader nurse

Competent Appropriate judgments and actions of the competent nurse as a leader after reporting, contact, and consultation by the novice nurse who performs the physical assessment of 3 patients

Physical assessment and nursing care of the onset of severe cerebral infarction, as well as leadership

Autumn 1 Physical assessment in rooms for women

Novice Physical assessment of 4 patients (1 asthma, 1 arrhythmias, 1 anemia, and 1 appendicitis)

Knowledge of anemia; physical assessment of the cardiovascular system; basic knowledge of extrasystoles

Autumn 2 Physical assessment and nursing care of an abrupt change 2): Asphyxia

Novice Physical assessment and nursing care of a person who had asphyxia

Physical assessment and nursing care of asphyxia; back blows and Heimlich maneuver

*: Benner P. From novice to expert. Am J Nurse. 1982;82:402-7

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Continued Series Theme Skill level* Content of learning Learning by debriefing

Autumn 3 Physical assessment and nursing care of an abrupt change 3): Cerebral infarction

Novice An abrupt change of a patient at the time of nocturnal rounding. Physical assessment and nursing care of a patient with slurred speech and paralysis

Physical assessment and nursing care of the patient with suspected cerebral infarction

Autumn 4 Physical assessment and nursing care of an abrupt change 4): Asphyxia

Competent Appropriate judgments and actions of a competent nurse as a leader after reporting, contact, and consultation by a novice nurse who performs the physical assessment of a patient who had asphyxia

Application and assistance of intratracheal intubation; basic knowledge of blood gases; leadership at the time of an abrupt change

Autumn 5 Physical assessment and nursing care of an abrupt change 5): Supraventricular tachycardia

Advanced beginner

Physical assessment and nursing care of a patient who abruptly developed supraventricular tachycardia

Basic knowledge, as well as physical assessment and nursing care of supraventricular tachycardia

Winter 1 Physical assessment of 4 patients in rooms for men and women, as well as reporting

Novice Physical assessment and nursing care when 4 patients in charge are allocated in 2 separate rooms

Basic knowledge, as well as physical assessment and nursing care of hyperglycemia; basic knowledge of bronchial asthma: mild bronchial asthma

Winter 2 Physical assessment and nursing care of an abrupt change 6): Hematemesis

Novice Physical assessment and nursing care of an anemic patient with suspected gastrointestinal bleeding, who developed sudden hematemesis

Physical assessment and nursing care of hemorrhagic shock; classification of shocks

Winter 3 Physical assessment and nursing care of an abrupt change 7): Anaphylactic shock

Novice Physical assessment and nursing care of anaphylaxis at the first administration of antibiotics to a patient with prostatitis

Physical assessment and nursing care of anaphylactic shock; classification of allergies

Winter 4 Physical assessment and nursing care of an abrupt change 8): Postsurgical bleeding from the abdominal cavity drain

Advanced beginner

Physical assessment and nursing care of bleeding from the abdominal cavity drain at the night of laparoscopic cholecystectomy

Basic knowledge of cholecystectomy; abdominal drainage; hemorrhagic shock

Winter 5 Physical assessment and nursing care of an abrupt change 9): septic shock

Advanced beginner

Physical assessment and nursing care of condition changes immediately after the hospitalization of a patient who had prostatitis-induced fever

Observation, as well as physical assessment and nursing care of septic shock

*: Benner P. From novice to expert. Am J Nurse. 1982;82:402-7

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2. How to Use Scenarios (original pages: 8-9) Scenarios in simulation-based medical education (SBME) are not a simple set of scripts or plots but are an integrated and systematized battery of SBME programs which allow the effective simulation-based learning of the participants.

I prepared formatted scenarios in another book published previously to this portfolio of

simulations and scenarios⎯“Simulation-based nursing education: A workbook for the first steps.” (2013, Japanese Nursing Association Publishing Company). To my joy, there are instructors who are training novice nurses and who manifested their will to do so. In the course of supervising such instructors, I came to be aware of things that cannot be transmitted through formats that are filled with characters only.

For this reason, I prepared this book after a deep deliberation on the better presentation of scenarios that facilitate instructors, who are busy in routine nursing care, to train novice nurses.

This portfolio has the following features that help instructors perform the training. • Innovations

1. A total of eight patients, four males and four females, appear on the scene in this portfolio. In each scenario, these eight patients appear under different settings and conditions. Patients are presented in Chapter II. Read information carefully to get a handle on these eight patients.

2. By changing objectives, settings, and conditions of the same patients, scenarios allow the training of novice, advanced beginner, and competent nurses.

3. “Scenario design sheets” in the abovementioned workbook are shown in this portfolio as the slides of “Objectives,” “Patient presentation,” and “Themes” that instructors explain during briefing. Furthermore, the text uses speech balloons ( ) to explain the “real briefing points” of instructors.

4. This portfolio illustrates “Patient’s conditions” that were described in “Simulation outlines” of the abovementioned workbook, thus making this book easier for use when instructors have a meeting and when a person playing the role of a “simulated patient (voice)” and a nurse assuming the role of an “operator” practice or gear up for a scenario.

• Procedures to use

1. First, instructors are encouraged, all together, to read the entire scenario that they liked. 2. A scenario should be selected in full consideration of the readiness of learners. Depending on

the actual professional skills of learners, instructors can modify the objectives, patient information, themes, prior learning, and others.

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3. When an objective or theme was modified, “Patient’s conditions,” outline sheets (“Objectives-appropriate movements that are expected for learners” and “Intervention of facilitators and points to keep in mind”), and debriefing guide sheets need to be reviewed.

4. This portfolio lists debriefing points in “Debriefing guide sheets” and describes basic knowledge to have in each scenario. Instructors can use them to verify their knowledge during briefing.

5. There is no inconvenience in replacing the listed items with those that can be obtained at each medical institution and in switching the listed items that cannot be obtained to “Items available,” “What done,” and others. Unreasonable costs should be avoided to develop long-lasting simulation-based nursing education (SBNE).

6. Setup also should be devised in response to the settings at each medical institution. In an institution where laboratories or training rooms are not constructed, there is no inconvenience in using rooms available, e.g., spare rooms and conference rooms.

7. Once having an understanding about the contents of the entire scenario, instructors should never fail to determine their roles and should share a mutual comprehension about their roles. Furthermore, the facilitator and the debriefer should further the preparation for the α test*1 or β test*2 in order that all instructors comprehend the scenario (“Objectives”), outline sheets (“Objectives-appropriate movements that are expected for learners”), and “Debriefing guide” (What and to what level instructors expect learners to learn). I presume it quite difficult for all instructors to gather together in actual clinical settings. Nevertheless, instructors are encouraged to forgather on the day of or before training to perform at least the α test without fail.

8. Instructors should debrief their skills as facilitators and debriefers after each scenario was performed.

*1: The α test is a test run of the scenario to be performed among instructors. *2: The β test is a test run of the scenario to be performed by using nurses with qualifications that

are better than or equivalent to those of subject nurses.

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(Original page: 13) Patient’s full name

Taro Akiayama Date of birth: June 10, 191□ Age: 98 yrs Gender: male

Duration of admission mm/dd/yyyy to mm/dd/yyyy

Occupation Ex-farmer Blood type B/RH+ Insurance type: NHI Infection None Allergy Medication (none); meals (none); others (none) Diagnosis: Pneumonia and dehydration Chief complaints at admission:

Fever, cough, sputum, and respiratory distress Anamnesis Hypertension and dyslipidemia Amlodipine, oral, 2.5 mg once a day in the morning 7 years ago: Right putaminal hemorrhage and left-sided hemiparesis

History of present illness: The patient had cough and sputum since 1 week earlier and waited and saw at home. However, he had a fever of 38 degrees Celsius since last night, presented an intense cough, choked strongly at the time of food intake, had difficulty in food intake and drinking. Therefore, he saw a doctor, was diagnosed with pneumonia based on the results from hematology and chest x-ray and was then admitted to the hospital for treatment purposes. Conditions at home: Sometimes chokes during meals. Examinations at admission: Hematology, urinalysis, sputum culture, and chest x-ray

Family history, family composition, and key person Key person: Yudai Akiyama (eldest son)

Height: 165 cm; body weight: 57 kg [Status of ADL] Standing motion: Can stand for several minutes in a place where there is a handhold. Transfer motion: Assisted. Movement motion: Operates by himself an indoor- and outdoor wheelchair. Excretion motion: Has ambiguous desires to void and defecate (totally assisted); Wears underpants for training; Uses a diaper at night; Defecates once every 2 days (takes two 2-mg tablets of sennoside before bedtime); Urinates 6 times during day twice at night. Eating motion: Can eat by himself with a spoon. Bathing motion: Totally assisted with use of a shower chair. Gowning motion: Totally assisted Grooming activity: Can wash his face and brush his teeth when prepared. [Presence or absence of physical impairments] Visual disturbance: Presbyopia; uses auxiliaries (glasses when reading only) Auditory impairment: hearing loss of the left ear; Does not use an auxiliary (can get it when transmitted with a loud clear voice) Language disturbance: Mild difficulty in articulation Communication: Capable. Gait disorder: Left-sided hemiparesis; uses a wheel chair. Swallowing difficulty: Chokes slightly; uses upper and lower false teeth.

Mental, social, and economic backgrounds Disease and admission: Comments of spouse and elderly son: We are worry about his recovery because of his advanced age. We are concerned although he has perked in some way to date. We wish him to come alive because his grandchild will marriage next month. Income source: Pension managed by his spouse Dwelling environments: A two-story building (two-family dwelling) The husband and wife live on the first floor of a barrier-free renovated house. The family of the eldest son live on the second floor. Status of welfare service utilization: Care level: 3 Day care: three visits per week Rented welfare equipment: a wheelchair and a bed Explanations from the attending physician and comprehension about the disease and treatment Attending physician: Aspiration pneumonia and dehydration are probable based on symptoms and on the results from hematology and chest x-ray. I will perform instillation therapy and a course of antibiotics to treat pneumonia. Furthermore, I will also start oxygen therapy because of a hypoxic condition. Family: We are concerned about him because of his advanced age and wish to receive immediate contact if any change occurred. We desire him to come alive and recover. We have fear about a fall because he had fallen in the previous admission. We will accompany him if necessary. Therapeutic plan

Admitted to the hospital for the treatment of aspiration pneumonia Treatment: Pharmacotherapy by instillation and with antibiotics Oxygen therapy Rehabilitation therapy (respiratory rehabilitation) Examinations: Hematology Chest x-ray

Basic information Full name Taro Akiyama Age 98 Gender Male

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(Original page 14)

Vital signs on the 3rd hospital day

Blood pressure: 140/68 mmHg Body temperature: 36.8°C

Pulse rate: 78 beats/min, regular SpO2: 96% (oxygen flow rate: 3 L/min

via nasal cannula) Respiratory rate: 24 breaths/min

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Table 3-2 Debriefing guide sheet (original page: 98) Aim Debriefing point

(1) To be able to get a handle on the conditions of multiple patients

Q 1: Discuss the greatest problem of each patient as identified based on records, and then summarize them. A1: Mr. Akiyama: Respiratory condition (type, posture, respiratory rate, SpO2) Mr. Fuji: Symptoms of hypoglycemia and meals volume Mr. Onaka: Abdominal symptoms; Does he adhere to the prohibition of eating and drinking?; Does he have any symptoms of cold or fever?

(2) To be able to perform the physical assessment of each patient

Q 2: Discuss how can you get a grip on the first impression of all patients in the room. A 2: Mr. Akiyama had respiratory distress. Mr. Yamashiro is getting recovered. Mr. Fuji read newspapers and appears not to be hypoglycemic. Q 3: Explain vital signs. A 3: See 3-1-1 Basic knowledge to have: A 1 (details are described on the original page 100) Q 4: How did you assess the consciousness level of Mr. Akiyama? What anatomical part is responsible for the control of consciousness? What assessment scales are used to assess consciousness level? In which patients did you measure pulse rate and blood pressures? What are the physiologic functions of the cardiovascular system? What physiologic functions do pulse rate and blood pressures have? Indicate their reference values. What other aspects did you assess when you palpated the radial artery? A 4: See 3-1-2 Basic knowledge to have: A 2- A 5 (details are described on the original pages 100-101). Note) Questions 5-9 in the original book are truncated in this sample document.

This sample document is downloadable at the following website:

http://jnapcdc.com/sim/abe