F.A. DAVIS; Clinical Simulations

2022–2023

Clinical Simulations

FADavis.com

Clinical simulation scenarios

Follows INACSL Standards!

SATISFY UP TO 50%

of clinical requirements in your simulation lab —Study by National Council of State Boards of Nursing (NCSBN)

span the nursing curriculum!

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

Patricia M. Dillon, PhD, RN

Participant Volume

Facilitator Volume

Students’ passport to lab

Provides experience in key specialties

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.

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.

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.

$524.95 (US) ISBN-13: 978-0-8036-6968-0

§ 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.

648 pages | Soft cover, spiral binding | 2018

496 pages | Soft cover, spiral binding | 2018 $73.95 (US) ISBN-13: 978-0-8036-6969-7

Beginner Beginner Beginner

Instructor § eBook § Teaching Simulations § Testing Simulations § Appendix with standard forms

Immediate Newborn Assessment Dystocia Thermoregulation and Hypoglycemia Postoperative Cesarean Section Precipitous Delivery

Receive the Facilitator Volume FREE when you adopt 20 or more copies of the Participant Volume.

Limited 3 free copies per program.

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

Spleen Injury

Subdural Hematoma/Alcohol Withdrawal Spinal Cord Injury

Beginner Beginner

Elder Abuse/Thoracic Trauma Syncopal Attack Dementia vs. Delirium

Advanced Intermediate to Advanced Intermediate to Advanced Intermediate

GERIATRIC NURSING

Beginner Beginner Beginner Beginner Beginner to Intermediate

Advanced Intermediate Intermediate

TRAUMA/EMERGENCY NURSING Placental Abruption Gunshot Wound Stroke Adult Asthma

Advanced Advanced Advanced Intermediate

CRITICAL CARE NURSING Intermediate to Advanced Advanced Intermediate Intermediate Intermediate to Advanced Intermediate to Advanced

PEDIATRIC NURSING Pediatric Asthma Head Injury Fracture/Suspected Child Abuse Meningitis

Complications of Cardiac Catheterization Atypical Chest Pain

Beginner

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

Admission and Care of a Client with Unstable Angina: Basic Assessment/Decision Making Care of the Patient with a Colostomy Postoperative Assessment Following Laparoscopic Choloecystectomy Abdominal Pain Aspiration Pneumonia Perioperative Care

Postpartum Hemorrhage

QUESTIONS? 2

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

MATERNAL/NEWBORN NURSING

§ 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.

Table of Contents

Intermediate Intermediate Intermediate Intermediate to Advanced Intermediate

Shock Acute Respiratory Distress Syndrome (ARDS) Hyperglycemic Hyperosmolar Nonketosis (HHNK) Diabetic Ketoacidosis (DKA)

Advanced Advanced Advanced Advanced

PSYCHIATRIC/MENTAL HEALTH NURSING Narcotic Overdose/Bipolar Disorder Paranoid Schizophrenia Lithium Overdose

Intermediate Intermediate Intermediate to Advanced

COMMUNITY HEALTH NURSING Wound Care in Home Setting Unresponsive Patient at Home Assessment of School-Aged Child Intractable Pain

Intermediate Intermediate to Advanced Advanced Intermediate

ADULT HEALTH NURSING Intestinal Obstruction Postoperative Hip Pulseless Electrical Activity Uncontrolled Atrial Fibrillation Cardiopulmonary Arrest Cardiac Arrhythmia Rapid Response CHF/COPD

Beginner to Intermediate Intermediate Intermediate Advanced Advanced Advanced Intermediate

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

Intermediate Intermediate

3

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

THE SIMULATIONS IN...

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

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.

Care of the Patient with a Colostomy 31 This is the ticket to lab—identifying 1. Identify items and their purpose in the care of a patient with a colostomy. all of the prep work students must 7. Nursingto Problems/Diagnoses complete be fully prepared to Item Purpose Identify threeinpriority nursing problems/diagnoses. participate the simulation.

Note: Stethoscope Detect bowel sounds Only the Facilitator Version includes Colostomy equipment change appliance Assessment Priority Intervention Expected Patient To Which Interventions the answers!

Data Problem Outcome Could Be Delegated Clean gloves Not a sterile procedure

to Unlicensed

2-3

■

Fundamental Skills

STANDARD FORMS

Primary nurse Enterostomal nurse/wound ostomy continence nurse (WOCN).

Surgeon

Supporting ■

3.

Husband

1. Colostomy

Alteration in bowel functioning related to the colostomy

2. Colostomy

Potential for alteration in skin integrity related to creation of a stoma

3. Colostomy

Potential for altered body image related to the colostomy and loss Simulator Settings provide of bowel the information youfunction need to

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 ■ Intake and Output Record ■ Standardized Flow Sheet ■ MAR 26 Fundamental Skills

ROLES Participating ■

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

Care of the Patient with a Colostomy

FUNDAMENTALS LEVEL: Beginner

■

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

2

Fundamental Skills

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

Learning outcomes meet INACSL Standards of Best Practice: Simulation Outcomes and Objectives and are tied to each simulation so that your students Use SBAR when communicating with team members in 3. Demonstrate attention to standard precautions. Includes know exactly what infection they will learning. the care of a patient with a colostomy. hand washing, controlbe measures, and use of

■

SIMULATION Prerequisites

4

■ ■ ■ ■ ■

Acute medical-surgical nursing Anatomy and physiology Nutrition Ostomy care Fluid balance

Setting

Hospital room, Surgical Unit

Frame (timed)

Settings

Additional Findings

Participant Action/Correct

Participant Action/Incorrect

0–15 min

128/82

Stoma site with a colostomy appliance

Completes a bowel auscultation, identifying correct assessment

Identifies incorrect bowel sounds

Bowel 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 Copyright ©Care 2018 by F.A. Davis Company. All rights reserved.

Facilitator Role Check To Assessment/ Patient Event/ Cues/Time be Used by Participant Action Response Progression Facilitator as Correct Patient Check List Assessment Data

Not applicable Treatment

Administer medications and IV fluids as ordered Irrigate if ordered

■ Stomas are performed because of disease or trauma.

11 years. She requires teaching regarding her colostomy care.

■ An ileostomy may be performed for unresponsive or Nursing Management Mannekin with abdominal insert containing a stoma.

Ostomy complicated ulcerative colitis or suspected carcinoma.

Goal: Maintain fluid balance. appliance bag filled withorchocolate or butterscotch pudding ■ A colostomy may be performed for colon rectal ■ Monitor I & O cancer or to relieve an obstruction. to simulate stool.

■ Administer IV fluids For a comprehensive collection of recipes for simulator Risk Factors Goal: Prevent other postoperative complications. effects, see Merica, J. (2011).

Medical How to make ■ Monitor for signs of intestinal obstruction Risk factors vary according to the diseaseB. process resulting in moulage: your simulation come alive.

Philadelphia: F. A. Davis at technique www ■ Use aseptic the need for a stoma. Risk factors for colonrectal cancer .fadavis.com ■ Observe stoma appearance include: ■ Male Equipment ■ Middle aged

■

Environment and Simulator

■

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

■ ■ ■

ID band with name and birth date Copyright © 2018 by F.A. Davis Company. All rights reserved.

Telephone Mannequin or simulator Ostomy equipment (bag, face plate, paste, scissors, and measuring tool) Face cloths

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?

Copyright © 2018 by F.A. Davis Company. All rights reserved.

0–15 min

Copyright © 2018 by F.A. Davis Comp

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.

Current pain level

Simulator Settings

Diagnostic Tests

■

Response to morphine

Primary nurse

Assessment/ Participant Action Incorrect

Patient Event/ Response

Participant will Patient denies introduce self, pain and agrees identify patient to teaching by 2 means, and session explain the teaching plan and complete a pain assessment

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

Patient is overwhelmed, refusing the teaching and complains of pain

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

If a language barrier is not identified, patient and

Patient doesn’t understand directions

Family decides which family members can remain in the

Check

Comments Fundamental Skills

Pathophysiology

After reviewing the client background and nursing report, you

Patient and family

32

25

Ileoanal anstamosis: The large intestine is removed and the small intestine is inserted into the rectum and attached just above the anus.

Current diet plan Changing of the colostomy could be delegated to a caregiver or unlicensed personnel History following discharge

Data Requiring Follow-up

Risk for fluid volume deficit related to increased output through stoma.

■ Demonstrates self-care for independent living 5. Identify the appropriate interventions for a patient with Develop self-confidence in the care of a patient with a www.ihi.org/IHI/Topics/PatientSafety/SafetyGeneral/ ■ Makes6. dietary adjustments a colostomy. colostomy.

Tools/SBARTechniqueforCommunicationASituational functions well 6. Differentiate the roles of team members in response■toOstomy a BriefingModel.htm ■ Adjusts to alterations in bowel elimination patterns patient with a colostomy.

Communication ■ Personal or family history of polyps or cancer OVERVIEW OF THE PROBLEM Wound, Ostomy, and Continence Nurses Society. Basic ■ Ulcerative colitis REVIEW The QUESTIONS Definition participant will be able to: Psychomotor ostomy skin care. Retrieved from http://www.wocn.org/ ■ High-fat low-fiber diet 1.

Communicate effectively with healthcare team members care.

1. What are the key nursing interventions for theColostomies care of a and their?page=BasicOstomySkinCare The participant will be able to: ■ Gardner’s syndrome (autosomal dominant disease, in the care of a patient with a colostomy.Fecal diversion procedures create stomas, which may be a colostomy?

1. Perform an appropriate assessment for a patient with a patient with familial adenomatous polyposis) temporary or permanent.

Communicate patient and family inTopics to Review Prior to the Simulation Answer:2.Stoma assessment,effectively bowel care,with pain the management, and colostomy.

Assessment the carecare. of a patient with a colostomy. Types of stomas■ include: teaching colostomy Medical/surgical nursing 2. Initiate appropriate interventions including stoma assess■ Temporary: The fecal stream is rerouted to allow the GI Subjective 2. What are the complications of a colostomy?

Ostomy care in obstruction. ment, cleansing the stoma, applying the appliance, and tract to heal or ■provide an outlet ■ Assess client response to stoma and stoma care Answer: Bleeding at the stoma site, skin irritation and breakSkin and abdominal assessment ■ Permanent: The■intestine cannot be reconnected, often down, stoma infection, constipation and obstruction, stoma ■ Colon cancer Objective performed for cancer of the colon and/or rectum. retraction.

■ Continent ileostomy: A pouch is created inside the wall ■ Nutrition ■ Observe appearance of stoma—should be pink, moist 3. What electrolyte imbalances or conditions wouldofyou the intestine.■The pouch serves as a reservoir similar to Fluid balance ■ Monitor for signs of bowel obstruction observe in a patient who has had a colostomy? the rectum. The pouch is emptied on a regular basis with ■ Check skin around stoma for signs of breakdown ■

Surgical date TheType of appliance Encourage patient patient will Typefeelings. of implement new to express procedure Acknowledge feelcoping patterns and verbalize ings and encourage patient to ask acceptance of 4. Initial Focused Assessment questions appearance

are ready to assess your client’s current status. Under each catpreprogram your high-fidelity Other Nursing Diagnoses egory, identify how you would target your assessment and what manikin according to each you would ■ Altered health maintenance related to knowledge of ostomy care.expect to find for the patient with a colostomy. scene/frame in the simulation.

■ Fear related to medical condition requiring stoma.

4. Practice Transparent Thinking (thinking out loud) to personal protective equipment (PPE) as needed. facilitate group problem solving. of the Patienttowith a Leadership Colostomy and Management/Delegation 27 5. Use Directed CommunicationCare (directing a message teaching self-care management for a patient withindividual) a LEARNING OUTCOMES The participant will be able to: specific when delegating tasks.

1.

Identify tasks that can be legally, ethically, and safely colostomy.

6.

Employ Closed-Loop Communication (acknowledgment These outcomes were designed so that the Educator/Facilitator Goal: Initiate ostomy care.

4.message What does a normal stoma look like? delegated to unlicensed assistive personnel (UAP) or 3. Work collaboratively as part of the healthcare teamofinthe of receipt and status) to acknowledge can select the learning objectives that best fit his or her needs Answer: Pink, red, moist, free of blood.

■ Prevent skin breakdown licensed practical nurse (LPN) in the care of a patient the care of a patient with a colostomy. communications from others. for that simulation experience.The Facilitator may opt to select with a colostomy.

■ Change appliance appropriately 5. What are the parts of a colostomy appliance? objectives based on the amount of time available to devote to Safety Affective 2.

Identify and prioritize patient’s needs in the care of a Answer: Face plate, bag/pouch, and clip (if applicable).

■ Use deodorizing drops the simulation experience.

The participant will be able to: colostomy.

The participant will be able to: Goal: Promote psychological comfort.

Your students have all the key background Related Evidence-Based Practice Guidelines anda maintain specific protecting interven1. patient Reflectand upon performance in the care of Administer a patient with Cognitive Teaching and Learning ■ Support family tions with attention to safety of the client and information healthcarePractice parameters National Guideline Clearinghouse. forbe able they need to prepare for the colostomy.

■ Assess grieving process The participant will to: The participant will be able to: professional. rectal cancer. Retrieved from https://www.guideline 2. Express to a patient 1. Demonstrate to the patient how to change the colostomy Healthpersonal teaching.feelings in delivering1.care 1. Describe signs and symptoms of a healthy stoma. Goal: Initiate Demonstrate a safe environment with attentionsimulation to hazand review questions that check .gov/summaries/summary/46238/practice-parameterswith a colostomy. appliance. ards to healthcare providers, visitors, and the client.

2. Correlate signs and symptoms of infection to the ■ Self-care management for-the-management-of-rectal-cancer-revised?q=colon+ 2.

Describe the signs and symptoms of a functional their understanding.

Students will see the 3.

Discuss feelings related to working as a member of a Includes body mechanics, tripping hazards, and equip■ Diet adjustments physiology of wound healing. colostomy to the patient. cancer+colostomy team in the care of a patient with a colostomy. ment issues.

3. Identify factors in a patient’s history that increase the■ Signs of complications questions.

You will have the answers.

3.

Include the family in the teaching session with the National toPatient Safety Goals. from https://www 2. the Demonstrate national patient safetyRetrieved goals.

4. Identify factors workedcare well during simulationattention ■ Community referral and that follow-up risk of colon cancer. patient’s consent. standards, effective .jointcommission.org/standards_information/npsgs.aspx of care of a patient with a colostomy. Includes patient identification 4. Identify factors in a patient’s current condition that 4. Evaluate the teaching session and assess the patient’s communication among healthcare providers, and safe Evaluation/Outcome Criteria SBAR Technique for Communication: A situational briefing 5. Identify factors that needed improvement during the increase the risk of complications with the colostomy. knowledge. medication administration. simulation of care of a patient with a colostomy. model.The Institute for Healthcare. Retrieved from http://

Copyright © 2018 by F.A.Answer: Davis Company.

All rights reserved.

Hypokalemia, dehydration, constipation, and diarrhea. a small tube.

Teach patient about Patient will Team Member Role have regular a healthy balanced Primary nurse Teach and change colostomy appliance diet. Monitor for bowel moveWOCN or enterostomal nurse Resource for patients with colostomies signs and symptoms ments prior of constipation or to discharge Family members Support diarrhea Physician/surgeon Treatment plan Assess for chemical/ Patient will mechanical, achieve/ bacterial, fungal, Data Exercise: maintain skin 3. Relevant Fill in the columns below. integrity and thermal Relevant Data from Sources for irritantsRelevant Data from Report Other Sources Data Missing Missing Data

5

Auscultate for bowel sounds

Recipes for realistic clinical experiences!

Positive bowel sounds

Ensures continued peristalsis Observe family and patient for nonverbal behaviors.

Ask patient and family if they have any questions

Patient verbalizes understanding of procedure

Family and patient may have unanswered questions

Medical Moulage How to Make Your Simulations Come Alive Bobbie J. Merica,

Owner of Moulage Concepts & Simulation Coordinator/Technologist, Yuba Community College District, Marysville, CA

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.

Heighten realism in your simulations and live drills!

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.

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

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

Facilitator, refer to the debriefing/guided reflection questions 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. New York: Norton.

Care of thequestions Patient with 37 Debriefing area Colostomy available online and cover the core topics that should be included in every debrief.

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

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.

SAFE FOR PEOPLE & SIMULATORS! 696 pages 1,300 full-color illustrations Hard cover | 2012

Create over 300 reusable, non-staining special effects for your clinical simulations and live drills. Simple recipes and over 1,200 full-color illustrations provide step-by-step how-to’s using readily available ingredients.

Mix, mold, and paint your way to creating a dehiscence suture

$182.95 (US) ISBN-13: 978-0-8036-2499-3

35

Debriefing/Guided Reflection

Care of the Patient with a Colostomy

Copyright © 2018 by F.A. Davis Company. All rights reserved.

Determines level of understanding of the procedure

Patient may be unable to independently care for the colostomy

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