SECTION II: CURRICULUM INTEGRATION A. SCENARIO LEARNING OBJECTIVES Do What With What For What Demonstrate accurate/focused assessment A adult patient with known diagnosis of Type 1 diabetes To determine if symptoms are related to Type 1 diabetes to determine approach of care. Apply nursing knowledge to prioritize nursing care Assessment data acquired for focused assessment To prioritize nursing care Apply therapeutic communication skills A patient being discharged with a diagnosis of DKA To provide discharge teaching Demonstrate medication knowledge Diabetic patient with an increased temperature To administer using the medication “rights” B. Learning Outcome Assessment / Rubric Competency (based on “What For”) Demonstrated attributes align with required competency Demonstrated attributes need some improvement to align with required competency Demonstrated attributes need major improvement to align with required competency Understand diagnosis of Type 1 diabetes to determine approach of care 1) Identify signs & symptoms of glucose imbalance. 2) Perform accurate glucometer. 3) Knowledge of related lab values. 4) Completes a focused assessment. 1) Has difficulty recognizing signs & symptoms of glucose imbalance. 2) Has difficulty completing glucometer. 3) Has difficulty performing a focused assessment. 1) Does not recognize symptoms of glucose imbalance. 2) Fails to complete a glucometer. 3) Does not perform focused assessment. Apply assessment date to prioritize care 1) Appropriately organize interventions. 2) When identifying critical abnormal 1) Has difficulty prioritizing interventions to meet patient's needs. 1) Cannot prioritize interventions. 2) Does not recognize critical abnormal values.
implement appropriate interventions. 3) Recognizes when patient care is beyond scope of practice. 4) Defers information to appropriate care provider as required. 2) Delayed response to critical abnormal findings. 3) Delayed time to recognize care is beyond scope of practice. 4) Delayed timing in relating critical information to appropriate care provider. 3) Intervention places patient at increased risk for harm. 4) Does not recognize care is beyond of practice. 5) Does not relate critical information to appropriate care provider. Apply (communication) 1) Knowledge to understand the cause of patient’s current condition. 2) Communicate basic teaching to patient related to cause of symptoms exacerbation. 3) Identify potential barriers to maintain glycemic control. 4) Identify appropriate community resources appropriate for patient. 1) Has difficulty identifying cause of patient’s current condition. 2) Has difficulty communicating information to patient at an appropriate level. 3) Has difficulty identifying barriers specific to patient. 4) Is not aware of all appropriate resources. 1) Does not link symptoms to diabetes. 2) Does not communicate information to patient. 3) Does not ensure communication is at an appropriate patient level. 4) Does not identify barriers impacting patient adherence. 5) Does not refer to appropriate resources. 6) Is not aware of community resources. Demonstrate medication knowledge 1)Student is able to confidently and competently administer medications as per orders 1)Student has some difficulties with medication calculations and or administration of medication 1) Student does not recognize need for PRN meds, and cannot accurately calculate medication dosage as per orders and has difficulty with medication administration. C. PRE-SCENARIO LEARNER ACTIVITIES Prerequisite Competencies Knowledge Skills/ Attitudes Pathophysiology and Etiology, risk factor, clinical manifestations of diabetic ketoacidosis Lab values related to diabetic ketoacidosis/infection control/hand hygiene Diagnostic sampling Obtain accurate glucose reading/ understand indications for random sample versus fasting sample/ urine analysis (specific gravity, ketones, glucose, pH)
Case Flow / Triggers/ Scenario Development States Initiation of Scenario : Patient is received in bed in semi fowler’s position. Pt. IV in left arm was pulled out during the transfer. Pt. has slight decrease in LOC and is lethargic. Learners will receive transfer report from ED nurse. State / Patient Status Desired learner actions & triggers to move to next state Baseline 0900 (10-15 minutes) BP: 80/50 HR:130 RR: 26 SpO2: 96% (2L O2 via nasal prongs) SpO2 reads only when sensor is placed on patient finger Temp: 38.4oC Lungs sounds are clear Heart Sounds: sinus tachycardia, no mumur Bowel Sounds: normoactive Skin: flushed and dry Pain: diffuse abdominal pain 2/10 Operator Triggers: “I am not feeling very well” Patient is agitated, lethargic Bed is slightly damp from IV being pulled out “I feel like I might vomit” Learner Actions Conducts a complete head to toe assessment and measures vital signs. Recognizes abnormal findings. Prioritizes plan of care. Initiates and maintains therapeutic communication. Initiates patient centered care. Reviews admitting orders. Delegation of care. IV fluids initiated. Student reconnects cardiac monitor. Debriefing Points: Student /learner ability to perform a quick head to toe assessment Prioritization of care: how did student prioritize their care and was it appropriate for this patient? Was student/learner able to delegate care to complete tasks in timely manner Discuss Kussmaul breath sounds and clinical significance Review admitting and standing orders State / Patient Status Desired actions & triggers to move to next state
(20 minutes) Time laps 1 hour Slight improvement in patient status BP: 90/65 HR: 115 RR: 20 SpO2: 97% on 2L O2 nasal prongs Temp: 38.4oC without Tylenol given Temp: 37.8oC with Tylenol given Operator: Make improvements on mannequin if interventions are appropriate If Tylenol had been given on previous state decrease temp to 37.8oC Triggers: Have patient pull off nasal prongs stating "It is bothering my nose". Patient states: "What's going on?" Level of consciousness begins to improve. Learner Actions: Learners read through admitting orders. Learners reassess patient and vital signs. Students evaluate significant findings. Student prepares and Initiates continuous insulin infusion as per orders with assistance from the RN. Student recognizes scope of practice and need for the RN supervision Effective teaching and communication with patient. Student collects urine from collection bag for urinalysis. Glucometer testing. Debriefing Points: Learners recognize slight improvement in patient status with IV fluids. Nursing process and the need to reassessment. Discuss complexity of IV continuous insulin infusion. Teaching and communication skills. Discuss significant findings such as fruity breath, improvements in LOC. Discuss implications of fluid administration and signs of fluid overload. Look at lab values and what are the important lab values, what are the abnormal and what are the appropriate interventions. STATE / PATIENT STATUS DESIRED ACTIONS & TRIGGERS TO MOVE TO NEXT STATE 3. Final State (20 mins) (Time laps 4 hours) BP: 110/70 HR: 90 Operator: Make improvement on mannequin when Learner Actions: Recognize patient improvements Debriefing Points: Evaluation of simulation, student learning and student satisfaction