Clinical Simulations Brochure 2024-2025

Clinical

Simulations

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THIS 2-VOLUME APPROACH gives your students experience in the key specialties they may not have in clinical.

Clinical Simulations for Nursing Education, 2nd Edition

Clinical Simulations for Nursing Education, 2nd Edition Patricia M. Dillon, PhD, RN Facilitator Volume Provides experience in key specialties

Patricia M. Dillon, PhD, RN Participant Volume Students’ passport to lab

51 structured case studies simulate the wide range of patient care challenges students will encounter in practice. These scenarios help them to develop the critical assessment, clinical-reasoning, and nursing skills they need to deliver safe and competent care—in a controlled, risk-free environment. Each realistic, patient-care simulation focuses on a defined clinical domain, critical knowledge and skills, levels of competency, evidenced-based practice guidelines, National Patient Safety Goals, and research-based design characteristics. § Integrates standards of practice including provider orders, evidence-based practice guidelines, general nursing practice, and references as well as preferred INACSL nomenclature. § Encompasses the full spectrum of clinical nursing practice domains, patient age levels, and cultural backgrounds at every level of health care—primary, acute, long-term, and palliative care. § Examines important topics in adult, pediatric, maternity, geriatric, emergency mental-health, and community nursing as well as nursing assessment and nursing fundamentals. § Bases scenarios on real-life patient care situations with decision points prompting students for an assessment, a response, and an action.

The Facilitator Volume provides all of the information found in the Participant Volume, the answers to the student exercises and two additional testing simulations, as well as everything you need to set up, administer and facilitate each simulation.

648 pages | Soft cover, spiral binding $524.95 (US) ISBN-13: 978-0-8036-6968-0

Instructor § eBook

§ Teaching Simulations § Testing Simulations § Appendix with standard forms

Receive the Facilitator Volume FREE when you adopt 20 or more copies of the Participant Volume. Limited 3 free copies per program.

496 pages | Soft cover, spiral binding $73.95 (US) ISBN-13: 978-0-8036-6969-7

QUESTIONS? Contact your F.A. Davis Educational Consultant at Hello@FADavis.com

Clinical simulation scenarios span the nursing curriculum!

Table of Contents

ASSESSMENT Respiratory Assessment Cardiac Assessment Abdominal Assessment/ Appendicitis Head-to-Toe Assessment

Complications of Cardiac Catheterization

Advanced

Beginner Beginner Beginner

Atypical Chest Pain

Intermediate to Advanced Intermediate to Advanced Intermediate

Subdural Hematoma/Alcohol Withdrawal

Spinal Cord Injury

Beginner

FUNDAMENTAL SKILLS Patient Safety/What’s Wrong with This Picture? Beginner

GERIATRIC NURSING Elder Abuse/Thoracic Trauma

Advanced

Admission and Care of a Client with Unstable Angina: Basic Assessment/Decision Making

Beginner

Syncopal Attack

Intermediate Intermediate

Dementia vs. Delirium

Care of the Patient with a Colostomy Postoperative Assessment Following Laparoscopic Choloecystectomy

Beginner Beginner

TRAUMA/EMERGENCY NURSING Placental Abruption

Advanced Advanced Advanced

Abdominal Pain

Beginner Beginner

Gunshot Wound

Aspiration Pneumonia

Stroke

Perioperative Care

Beginner to Intermediate

Adult Asthma

Intermediate

CRITICAL CARE NURSING Shock Advanced Acute Respiratory Distress Syndrome (ARDS) Advanced Hyperglycemic Hyperosmolar Nonketosis (HHNK) Advanced Diabetic Ketoacidosis (DKA) Advanced PSYCHIATRIC/MENTAL HEALTH NURSING Narcotic Overdose/Bipolar Disorder Intermediate Paranoid Schizophrenia Intermediate Lithium Overdose

MATERNAL/NEWBORN NURSING Postpartum Hemorrhage

Intermediate to Advanced

Immediate Newborn Assessment

Advanced

Dystocia

Intermediate Intermediate Intermediate to Advanced Intermediate to Advanced Intermediate Intermediate Intermediate Intermediate to Advanced Intermediate

Thermoregulation and Hypoglycemia Postoperative Cesarean Section

Precipitous Delivery

Intermediate to Advanced

PEDIATRIC NURSING Pediatric Asthma

COMMUNITY HEALTH NURSING Wound Care in Home Setting

Head Injury

Intermediate Intermediate to Advanced

Fracture/Suspected Child Abuse

Unresponsive Patient at Home

Meningitis

Assessment of School-Aged Child

Advanced

Spleen Injury

Intractable Pain

Intermediate

ADULT HEALTH NURSING Intestinal Obstruction

Beginner to Intermediate Intermediate Intermediate

FACILITATOR VOLUME ONLY

Postoperative Hip

TESTING Postoperative Complications: Pulmonary Embolism in the Intermediate Postoperative Total Hip Replacement Patient Blood Transfusion Reaction

Pulseless Electrical Activity Uncontrolled Atrial Fibrillation

Advanced Advanced Advanced

Intermediate

Cardiopulmonary Arrest

Cardiac Arrhythmia Rapid Response

Intermediate

CHF/COPD

Intermediate

THE SIMULATIONS IN... Clinical Simulations for Nursing Education

have been validated through their use in the NCSBN National Simulation Study and meet the current INACSL Standards of Best Practice: Simulation.

Don’t forget to take a look at the Table of Contents on page 3 to see how these 53 simulations span the curriculum.

Fundamental Skills 2

All of these Standard Forms , Patient Charts , and activities are included online.

2-3 Care of the Patient with a Colostomy

FUNDAMENTALS LEVEL: Beginner ROLES Participating ■ Primary nurse ■ Enterostomal nurse/wound ostomy continence nurse (WOCN). ■ Surgeon Supporting ■ Husband LEARNING OUTCOMES These outcomes were designed so that the Educator/Facilitator can select the learning objectives that best fit his or her needs for that simulation experience.The Facilitator may opt to select objectives based on the amount of time available to devote to the simulation experience. Cognitive The participant will be able to: 1. Describe signs and symptoms of a healthy stoma. 2. Correlate signs and symptoms of infection to the physiology of wound healing. 3. Identify factors in a patient’s history that increase the risk of colon cancer. 4. Identify factors in a patient’s current condition that increase the risk of complications with the colostomy. 5. Identify the appropriate interventions for a patient with a colostomy. 6. Differentiate the roles of team members in response to a patient with a colostomy. Psychomotor The participant will be able to: 1. Perform an appropriate assessment for a patient with a colostomy. 2. Initiate appropriate interventions including stoma assess- ment, cleansing the stoma, applying the appliance, and

STANDARD FORMS These templates are included in the Appendix which appears in the Participant Volume and also on DavisPlus. They can be used to make a simulated patient chart. ■ Interdisciplinary Progress Notes ■ Vital Sign and Pain Assessment Record

Learning outcomes meet INACSL Standards of Best Practice: Simulation Outcomes and Objectives and are tied to each simulation so that your students know exactly what they will be learning. 3. Demonstrate attention to standard precautions. Includes hand washing, infection control measures, and use of personal protective equipment (PPE) as needed. Leadership and Management/Delegation The participant will be able to: 27

■ Intake and Output Record ■ Standardized Flow Sheet ■ MAR

Fundamental Skills

25 ■ Continent ileostomy: A pouch is created inside the wall of the intestine.The pouch serves as a reservoir similar to the rectum.The pouch is emptied on a regular basis with a small tube. ■ Ileoanal anstamosis:The large intestine is removed and the small intestine is inserted into the rectum and attached just above the anus. Pathophysiology OVERVIEW OF THE PROBLEM Definition Colostomies and their care. Fecal diversion procedures create stomas, which may be temporary or permanent. Types of stomas include: ■ Temporary:The fecal stream is rerouted to allow the GI tract to heal or provide an outlet in obstruction. ■ Permanent:The intestine cannot be reconnected, often performed for cancer of the colon and/or rectum. 3. Use SBAR when communicating with team members in the care of a patient with a colostomy. 4. Practice Transparent Thinking (thinking out loud) to facilitate group problem solving. 5. Use Directed Communication (directing a message to specific individual) when delegating tasks. 6. Employ Closed-Loop Communication (acknowledgment of receipt of the message and status) to acknowledge communications from others. Safety The participant will be able to: Administer and maintain specific protecting interven- tions with attention to safety of the client and healthcare professional. 1. Demonstrate a safe environment with attention to haz- ards to healthcare providers, visitors, and the client. Includes body mechanics, tripping hazards, and equip- ment issues. 2. Demonstrate attention to national patient safety goals. Includes patient identification standards, effective communication among healthcare providers, and safe medication administration. 4. What does a normal stoma look like? Answer: Pink, red, moist, free of blood. Stomas are performed because of disease or trauma. ■ An ileostomy may be performed for unresponsive or complicated ulcerative colitis or suspected carcinoma. ■ A colostomy may be performed for colon or rectal cancer or to relieve an obstruction. Risk Factors Risk factors vary according to the disease process resulting in the need for a stoma. Risk factors for colonrectal cancer

Care of the Patient with a Colostomy

teaching self-care management for a patient with a colostomy. 3. Work collaboratively as part of the healthcare team in the care of a patient with a colostomy. Affective The participant will be able to: 1. Reflect upon performance in the care of a patient with a colostomy. 2. Express personal feelings in delivering care to a patient with a colostomy. 3. Discuss feelings related to working as a member of a team in the care of a patient with a colostomy. 4. Identify factors that worked well during the simulation of care of a patient with a colostomy. 5. Identify factors that needed improvement during the simulation of care of a patient with a colostomy. 6. Develop self-confidence in the care of a patient with a colostomy. Communication The participant will be able to: 1. Communicate effectively with healthcare team members in the care of a patient with a colostomy. 2. Communicate effectively with the patient and family in the care of a patient with a colostomy.

1. Identify tasks that can be legally, ethically, and safely delegated to unlicensed assistive personnel (UAP) or licensed practical nurse (LPN) in the care of a patient with a colostomy. 2. Identify and prioritize patient’s needs in the care of a colostomy. Teaching and Learning The participant will be able to: 1. Demonstrate to the patient how to change the colostomy appliance. 2. Describe the signs and symptoms of a functional colostomy to the patient. 3. Include the family in the teaching session with the patient’s consent. 4. Evaluate the teaching session and assess the patient’s knowledge. ■ Personal or family history of polyps or cancer ■ Ulcerative colitis ■ High-fat low-fiber diet ■ Gardner’s syndrome (autosomal dominant disease, familial adenomatous polyposis) Assessment Subjective ■ Assess client response to stoma and stoma care Objective ■ Observe appearance of stoma—should be pink, moist ■ Monitor for signs of bowel obstruction ■ Check skin around stoma for signs of breakdown Diagnostic Tests Not applicable Treatment ■ Administer medications and IV fluids as ordered ■ Irrigate if ordered Nursing Management Goal: Maintain fluid balance. ■ Monitor I & O ■ Administer IV fluids Goal: Prevent other postoperative complications. ■ Monitor for signs of intestinal obstruction ■ Use aseptic technique ■ Observe stoma appearance

Goal: Initiate ostomy care. ■ Prevent skin breakdown ■ Change appliance appropriately ■ Use deodorizing drops Goal: Promote psychological comfort. ■ Support patient and family ■ Assess grieving process Goal: Initiate Health teaching. ■ Self-care management ■ Diet adjustments ■ Signs of complications ■ Community referral and follow-up care Evaluation/Outcome Criteria ■ Demonstrates self-care for independent living ■ Makes dietary adjustments ■ Ostomy functions well ■ Adjusts to alterations in bowel elimination patterns REVIEW QUESTIONS 1. What are the key nursing interventions for the care of a patient with a colostomy? Answer: Stoma assessment, bowel care, pain management, and teaching colostomy care. 2. What are the complications of a colostomy? Answer: Bleeding at the stoma site, skin irritation and break- down, stoma infection, constipation and obstruction, stoma retraction. 3. What electrolyte imbalances or conditions would you observe in a patient who has had a colostomy? Answer: Hypokalemia, dehydration, constipation, and diarrhea.

5. What are the parts of a colostomy appliance? Answer: Face plate, bag/pouch, and clip (if applicable). Related Evidence-Based Practice Guidelines National Guideline Clearinghouse. Practice parameters for rectal cancer. Retrieved from https://www.guideline .gov/summaries/summary/46238/practice-parameters- for-the-management-of-rectal-cancer-revised?q=colon+ cancer+colostomy National Patient Safety Goals. Retrieved from https://www .jointcommission.org/standards_information/npsgs.aspx SBAR Technique for Communication: A situational briefing model. The Institute for Healthcare. Retrieved from http:// www.ihi.org/IHI/Topics/PatientSafety/SafetyGeneral/ Tools/SBARTechniqueforCommunicationASituational BriefingModel.htm Wound, Ostomy, and Continence Nurses Society. Basic ostomy skin care. Retrieved from http://www.wocn.org/ ?page=BasicOstomySkinCare Topics to Review Prior to the Simulation ■ Medical/surgical nursing ■ Ostomy care ■ Skin and abdominal assessment ■ Colon cancer ■ Nutrition ■ Fluid balance

Your students have all the key background information they need to prepare for the simulation and review questions that check their understanding. Students will see the questions. You will have the answers.

Copyright © 2018 by F.A. Davis Company. All rights reserved. .fadavis.com Equipment ■ ID band with name and birth date ■ Telephone ■ Mannequin or simulator ■ Ostomy equipment (bag, face plate, paste, scissors, and measuring tool) ■ Face cloths 11 years. She requires teaching regarding her colostomy care. Mannekin with abdominal insert containing a stoma. Ostomy appliance bag filled with chocolate or butterscotch pudding to simulate stool. For a comprehensive collection of recipes for simulator effects, see Merica, B. J. (2011). Medical moulage: How to make your simulation come alive. Philadelphia: F. A. Davis at www

SIMULATION Prerequisites ■ Acute medical-surgical nursing ■ Anatomy and physiology ■ Nutrition ■ Ostomy care ■ Fluid balance Setting Hospital room, Surgical Unit Environment and Simulator

We help you set the scene for your simulation—from the patient’s background information to the specific equipment and meds you need to have on hand.

include: ■ Male ■ Middle aged

Mrs. Jones is a 42-year-old woman who was diagnosed with colon cancer. She has undergone a resection of her large bowel and required a permanent colostomy. It is postop day 4. She is married and has four children, aged 4 to

Nursing Report You arrive on the unit at 0700 and have been assigned Mrs. Jones. She will require colostomy care teaching and her appliance needs to be changed. She has requested morphine

2 mg IV twice in the last 12 hr. Her husband and children are present in the room. She met with the enterostomal therapist yesterday and feels well enough to begin independent care of her colostomy.

Simulation Prep Assignments

Care of the Patient with a Colostomy

This is the ticket to lab —identifying all of the prep work students must complete to be fully prepared to participate in the simulation. Note: Only the Facilitator Version includes the answers! Assessment Priority Problem Data

1. Identify items and their purpose in the care of a patient with a colostomy.

7. Nursing Problems/Diagnoses Identify three priority nursing problems/diagnoses.

Item

Purpose

Stethoscope

Detect bowel sounds To change appliance Not a sterile procedure Could Be Delegated to Unlicensed Personnel?

Colostomy equipment

Intervention

Expected Patient Which Interventions

Outcome

Clean gloves

2. Identify team members and their specific roles in the care of a patient with a colostomy.

1. Colostomy

Alteration in bowel functioning related to the colostomy Potential for alteration in skin integrity related to creation of a stoma Potential for altered body image related to the colosto- my and loss

Team Member Primary nurse Teach patient about a healthy balanced diet. Monitor for signs and symptoms of constipation or diarrhea Assess for chemical/ mechanical, bacterial, fungal, and thermal irritants Type of procedure Encourage patient to express feelings. Acknowledge feel- ings and encourage patient to ask questions from Report

Patient will have regular bowel move-

Role

Teach and change colostomy appliance Resource for patients with colostomies

WOCN or enterostomal nurse

ments prior to discharge

Family members

Support

Physician/surgeon

Treatment plan

2. Colostomy

Patient will achieve/ maintain skin integrity

3. Relevant Data Exercise: Fill in the columns below. Relevant Data Relevant Data from

Sources for Missing Data

Data Requiring

Other Sources

Data Missing

Follow-up

Response to morphine Current pain level

Surgical date Type of appliance

Current diet plan Patient and family

3. Colostomy

The patient will implement new coping patterns

Changing of the colostomy could be delegated to a caregiver or unli- censed personnel following discharge

and verbalize acceptance of appearance

of bowel function Simulator Settings provide the information you need to preprogram your high-fidelity manikin according to each scene/frame in the simulation.

4. Initial Focused Assessment After reviewing the client background and nursing report, you are ready to assess your client’s current status. Under each cat- egory, identify how you would target your assessment and what you would expect to find for the patient with a colostomy.

History Are there any questions you need to ask the patient or family to obtain additional relevant data? ■ Do they require an interpreter for the teaching session? ■ Are they able to pay for the supplies? ■ What is the client’s normal diet?

Other Nursing Diagnoses ■ Altered health maintenance related to knowledge of ostomy care. ■ Fear related to medical condition requiring stoma. ■ Risk for fluid volume deficit related to increased output through stoma.

Simulator Settings

Frame (timed)

Settings

Additional Findings Participant Action/Correct Participant Action/Incorrect

Completes a bowel auscultation, identifying correct assessment

128/82 Bowel

Stoma site with a colostomy appliance

Identifies incorrect bowel sounds

0–15 min

sounds— can be hypo, hyper, or normal

It’s easy to find the simulation script —these steps will always appear in landscape format and include facilitator cues, timing, correct participant actions and other possible responses.

Scene 1: Health Teaching—Colostomy Care Facilitator Role Check To

Assessment/

Patient Event/

Check Assessment/

Patient Event/

Comments

Cues/Time Progression

be Used by

Participant Action

Response

Participant

Facilitator as Correct

Patient

Action

Response

Check List

Assessment Data Patient denies pain and agrees to teaching session

Incorrect

Participant will introduce self, identify patient by 2 means, and

If participant just brings supplies to bed side and doesn’t ask permission or explain his/her actions, then stop the sce- nario. Also a pain assessment

Patient is over- whelmed, refusing the teach- ing and complains of pain

0–15 min Primary nurse

explain the teaching plan and complete a pain assessment

must be included

Participant then asks the patient if she wants all her family members present. The nurse should

Family decides which family members can remain in the room

If a language barrier is not identified, patient and family under-

Patient

doesn’t understand directions

Auscultate for bowel sounds Ensures continued peristalsis Observe family and patient for nonverbal behaviors. Ask patient and family if they have any questions Determines level of understanding of the procedure

Positive bowel sounds

Patient verbalizes understanding of procedure

Family and patient may have unan- swered ques- tions

Patient

may be unable to independ- ently care for the colostomy

Clinical Pause 1. Should a client with a colostomy have a shower? Answer:Yes, the client may have a shower with or without the appliance. However, the client should avoid direct pressure on the stoma site and the skin needs to be dried thoroughly. If a pouch is worn, it may need to be reapplied because adhesion is decreased. 2. What types of nonverbal behaviors would indicate that the family and client were ready to learn about the colostomy? Answer: If the family or client looks at the stoma and ask questions, they are probably ready to learn. If they are apprehensive and cannot look at the site, they may need further counseling.

Care of the Patient with a Colostomy Debriefing questions are available online and cover the core topics that should be included in every debrief.

Every scene or frame in every simulation is followed by simulation- specific Clinical Pause questions that allow you to pace the simulation, check students’ understanding, and refocus as necessary.

Clinical Pause 1 As a nurse, what could you do if the client and family refuse to look at the stoma?

Answer: Obtain information about ostomy support groups, refer the client and family to other volunteer agencies, or contact the WOCN at the hospital.

Debriefing/Guided Reflection Facilitator, refer to the debriefing/guided reflection ques- tions located the Appendix which appears in the Participant Volume and also on DavisPlus. References Deglin, J. H., & Vallerand, A. H. (2017). Davis’s drug guide for nurses (15th ed.). Philadelphia: F. A. Davis. Dillon, P. (2007). Nursing health assessment: A critical thinking and case studies approach (2nd ed.). Philadelphia: F. A. Davis. Erikson, E. H. (1950). Childhood and society . NewYork: Norton. .

Hoffman, J., & Sullivan, N. (2017). Medical-surgical nursing: Making connections to practice. Philadelphia: F.A. Davis. Lagerquist, S. L. (2012). Davis’s NCLEX-RN success. (3rd ed.). Philadelphia: F. A. Davis. Lutz, C. A., Mazur, E. E., & Litch, N. A. (2015). Nutrition and diet therapy (6th ed.). Philadelphia: F. A. Davis. Treas, L. S., &Wilkinson, J. M. (2017). Basic nursing (2nd ed.). Philadelphia: F. A. Davis. Van Leeuwen, A. M., & Bladh, M. L. (2017). Davis’s comprehensive handbook of laboratory and diagnostic tests with nursing implications (4th ed.). Philadelphia: F.A. Davis.

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