Transcript Pediatric Competency Development - Dartmouth

Pediatric Competency Development
Bridget Mudge, RN, MS Judy Kertis RN BSN
Pediatric Clinical Nurse Specialist
Objectives
• Determine didactic content
• Creating scenarios
• Integrating core practice issues in to
simulations
• Evaluating performance
OVERVIEW:
Pediatric Nurse Residency
• 4 components.
• 16-week program.
Didactic
Simulation
• Each week two (2) class days:
– Web-based learning.
– Didactic with experts to review
institutional specific.
– Followed by simulations.
• Two days of eight-hour clinical;
then progresses to 12 hours after 8
weeks.
Web Based
Clinical
Orientation
Content:
Clinical Orientation
Identify common patient diagnosis (e.g. Neuro,
Oncology, Resp distress: RSV)
Problem prone areas ( Medication delivery,
Isolation)
Skills or tasks ( Blood administration)
Orientation Content
Complex skills or infrequent skills ( Chest tubes)
High Risk: Sedation
Clinical Questions asked ( How do you evaluate
seizures)
New processes or skills
National patient safety goals
Feedback
Simulation Additional Uses
• Add National Safety Goals:
Medication safety.
Patient Identification.
Clinical Alarms.
Verbal Orders.
Critical Labs.
PROGRAM COMPONENTS:
Pediatric Nurse Residency
Web-based:
Pediatric intensive-care course developed by
Indiana University (http://original-oncourse.iu.edu).
WEB-BASED LEARNING MODULES:
PEDIATRIC CRITICAL CARE
Psychosocial
Respiratory
Cardiovascular
Multi-system
Hematology/Oncology
Renal/Endocrine
GI
Neurology
Comfort
Immunology
COMPONENT OF PROGRAM:
DIDACTIC
• Didactic with specialist/ unit experts:
• Respiratory: CF, Asthma, RSV.
• Pain Management: Assessment Tools, PCA,
Epidurals, Pain Free Program.
• Developmental Aspects: Chronic Illness,
Bereavement.
• Cardiac: CHF, Cardiac Cath Postoperative Care.
COMPONENT OF PROGRAM:
DIDACTIC
• Family-centered Care.
• Wound and Skin: Braden Q.
• Nutrition: Feeding Techniques, Formula,
GU Care.
• Responding to Medical Emergencies.
• Orthopedic Care.
• GI Care.
COMPONENT OF PROGRAM:
DIDACTIC
•
•
•
•
•
•
•
•
Diabetic Care: Management and Teaching.
Organ Donation.
Pre- and Post-Op Care.
Child Abuse.
Communication: SBAR.
Transfer and Discharge Planning.
IV Central Line Care.
Newborn.
COMPONENT OF PROGRAM:
DIDACTIC
• Trauma Care.
• PICU Specific:
Ventilators,
EKG monitoring, Defibrillator,
IV Therapy,
Vasoactive Medications,
ICP,
Hemodynamic Monitoring.
SIMULATIONS:
Simulation Development
• Who, What?
• Sample:
• Airway Management.
• RSV.
Simulations
• Seizures.
• EEG Monitoring.
• Responding to
Medical Emergencies
• Documentation
• Admission
• Trauma
• Diabetes
Simulation development
Diabetes:
• Who: Unit experts
• What:
Frequently asked questions of the expert
Chart review for orders
Review of standards of care for diabetes
Patient Education
Simulation development
• RSV
Review of standards and skills
Isolation
Room set up
Nasal cannula application
Patient Education
Simulation development
• Time out
• SBAR
• Team building
CHALLENGES:
• Logistics:
Ideal number of new grads.
• Schedule:
Presenters.
Preceptors around fixed classes.
• Securing lab and Sim Baby.
CHALLENGES:
Simulation:
• How complicated to make scenarios?
• Scenarios consistent?
• Ideal class size?
CHALLENGES:
What is best done in simulation?
Responding
to
medical
emergencies.
versus
Skin Care
and
Diabetic
Education
Evaluation
•
•
•
•
•
What are critical Clinical Behaviors?
Objective information
Experts evaluate
Final Simulation = Integration of skills
Pass / Fail
OUTCOMES:
• Increased proficiency and accuracy with
technical skills.
• Developed skills as team members.
• Developed relationships with the clinical
experts and learned to utilize a variety of
resources.
OUTCOMES:
• The simulations became a
place to learn about safety
and how errors can and do
occur.
• Experienced staff members
stated an increase in their
own knowledge by their
participation in the
didactic.
Pediatric Residents
Readiness for Practice Questionnaire
Pediatric Residents (n=4)
Mean
90
80
70
READY1
READY2
READY3
Global Scores for Pediatric Residents
baseline global conf
10
idence
baseline global comp
8
etence
baseline global read
6
iness
final global confide
4
nce
final global compete
nce
2
final global readine
0
ss
N=
4
4
4
4
July
GROUP
4
4
CONCLUSIONS:
• Utilizing a nurse residency program
provides:
Opportunities to become safe, competent
caregivers.
CONCLUSIONS:
• Receive immediate feedback on scenario
vignettes and quizzes to enhance individual
learning and review.
• Human patient simulation supports the
organizational initiatives related to patient
safety and addresses the unique needs of the
pediatric population.