Overview
This lesson provides a formative assessment of previously mastered concepts and skills. Students in the Health Science Internship Course or completing the Certified Patient Care Technician or Certified Nursing Assistant training programs should be proficient in analyzing a patient encounter as well as applying skills and knowledge to formulate a plan. Students will complete a pre-learning activity and pre-briefing before the simulation experience. A structured debriefing follows the simulation experience and serves as a formative assessment. This lesson will focus on standard and transmission-based precautions as well as communication skills.
Content Standards
CTE08.HS.HSI.1
CTE08.HS.HSI.9
Demonstrate therapeutic communication skills in the health care facility.
CTE08.HS.NAT.1
Demonstrate knowledge and skills related to communication, safety, infection control, resident rights, and independence with satisfactory performance prior to engaging in direct contact with residents.
CTE08.HS.PCT.6
Implement infection control guidelines including isolation techniques.
CTE08.HS.PCT.15
Simulate technical skills required for safe patient care as implemented by a Patient Care Technician.
CTE08.HS.PCT.49
Communicate professionally and appropriately through listening, speaking, reading, and writing.
Interdisciplinary Connections
Learning Objectives
Primary Learning Objectives
- Students will explain the concepts of standard and transmission-based precautions in relation to patient encounters and the prevention of disease transmission.
- Students will analyze a patient situation and demonstrate appropriate PPE use aligned with standard and transmission-based precaution guidelines in a simulated healthcare setting.
- Students will analyze a patient situation and recognize patient safety checkpoints according to facility guidelines in a simulated healthcare setting.
- Students will demonstrate appropriate communication techniques with the patient/family by using therapeutic communication guidelines in a simulated healthcare setting.
- Students will reflect on the simulation, evaluate the experience, connect knowledge gaps, and form conclusions.
Procedures/Activities
Procedures/Activities
Before/Pre-learning activity:
The students will complete a worksheet related to standard and transmission-based precautions. The worksheet will serve as a cognitive aid to facilitate discussion prior to the simulation pre-briefing and simulation experience. The completed worksheet should be presented to the instructor on the day of the simulation as their “admission ticket” to the experience. The Pre-Learning Activity Worksheet has been provided and should be revised to mirror the instructional style and language of the instructor. The instructor will use this worksheet as a template to guide the group discussion. Students will explain the concepts related to standard and transmission-based precautions. This discussion should be conducted in a way that does not reveal the critical actions the instructor will assess during the simulation experience. Students not completing the pre-learning activity should be given an alternate assignment and should not participate in the simulation experience.
During/Pre-briefing:
Once the group discussion is complete the instructor will begin the pre-briefing. A pre-briefing guide is attached and should serve as a “script” for the instructor to provide an orientation for the student.
The pre-briefing should be conducted in an area separate from where the simulation experience will take place.
Prior to the pre-briefing, the instructor should determine which students will be in the role of active participants and which students will observe.
(See pre-briefing guide, confidentiality/fiction contract)
Welcome: The welcome gives the student some expectation of what they will experience. At this point, all students should have their cell phones put away and in silent mode. The welcome set the tone for a safe learning environment so the student will feel comfortable enough to perform to the best of their ability.
Purpose of Simulation: The instructor will describe the objectives for the simulation and establish relevance for the student.
Confidentiality/Fiction Contract: The instructor will explain the contract and students will sign the contract. The instructor should keep the signed contract in their student files. Please remember if confidentiality is broken the simulation will not be valid for future students.
Interacting with the simulated environment: The instructor points out anything the student might need to know in order to have a meaningful experience. Describe the simulated space noting any limitations to realism and ask the learner to perform skills as they would in the real clinical environment. Remind students they are to function in their current role of a health science internship, CNA, or PCT student and they should not perform procedures outside their scope of practice.
Stem: Read the case stem and begin the simulation. An example stem is provided in the attachments.
Additional information: All students are expected to be engaged in the simulation experience and participate in the debriefing. Once the simulation begins the observers should not be a distraction and should be as unobtrusive as possible. Observation tools are provided in the attachments.
Simulation Experience:
During the simulation, the instructor serves as the simulated RN. The students arrive at the unit for their job shadowing experience and the RN gives a brief report on the patient. The students are asked to assess the patient's vital signs and attend to any immediate need the patient might have. The patient's family member is at the bedside. The students go to the patient room and note the isolation precautions. They determine the correct PPE to wear. (Critical action) The students enter the room and conduct related pre-procedure activities and note patient safety checkpoints. They should ID the patient, introduce themselves, explain the procedure, and note the alert bracelets or signage related to a PICC line. (Critical actions) The student proceeds to assess vital signs. When taking the patient's temperature it is discovered there are no probe covers for the thermometer. The student removes PPE and performs hand hygiene before leaving the room to retrieve more or stands at the inside edge of the isolation room opening and asks for assistance. (Critical action) During the blood pressure assessment, the student notes the PICC line, alert bracelet, or signage and uses the appropriate arm for the assessment. (Critical action) During the assessment of the respiratory rate, the patient or patient family member will not stop talking to the student. They are asking all manner of questions about the health science program, about the patient's vital signs, and when the doctor will be available. The student responds to the patient/family member appropriately in order to assess the respirations accurately. (Critical action) When the students are finished they should remove PPE and perform hand hygiene in the room. (Critical action) The students should note post-procedure guidelines and safety checkpoints such as placing the bed in the lowest position, verifying the patient’s understanding of using the call light, and placing all personal items within reach. (Critical action)
After/Debriefing:
During the debriefing, the students will reflect on the simulation experience. Students will evaluate actions and connect gaps in knowledge. The students will form conclusions and gather takeaways they will use in future practice.
(Please see the debriefing guide and use it as a script to guide the experience) Debriefing should take place in an area away from the simulated space.
Reactions Phase:
Go around the room and ask each student to express their initial reaction to the experience in one word. This reaction should focus on emotions rather than actions.
Facts of the Case:
Present to the students a summary or recap of the simulation experience. This regains the focus of the student.
Preview:
Describe the time frame in which the debriefing will take place and state the objectives the students will focus on during the debriefing. (See debriefing guide for example)
- Objective 1: The student will demonstrate appropriate PPE use following standard precautions and transmission-based guidelines.
- Plus/Delta- What worked well, what would you like to do differently next time?
- Advocacy/Inquiry- I saw, I’m concerned that, what are your thoughts.
- Advocacy/Coaching- State what you saw, following up with “In my experience…. “
- Objective 2: The student will recognize patient safety checkpoints and respond appropriately.
- Plus/Delta- What worked well, what would you like to do differently next time?
- Advocacy/Inquiry- I saw, I’m concerned that, what are your thoughts.
- Advocacy/Coaching- State what you saw, following up with “In my experience…. “
- Objective 3: The student will communicate with the patient/family appropriately.
- Plus/Delta- What worked well, what would you like to do differently next time?
- Advocacy/Inquiry- I saw, I’m concerned that, what are your thoughts?
- Advocacy/Coaching- State what you saw, following up with “In my experience…. “
Summary/Wrap Up:
Each student will state one thing they learned and will take with them into their future practice.
Additional Information:
It is important that the student observers make their statements about the simulation experience from a global perspective. They should not call out the active participant by name and state what they did wrong. This will not protect the psychological safety of the students.
Learning Activity (Before)
Learning Activity (During)
Learning Activity (After)
Assessment Strategies
Assessment Strategies
Objective 1: Formative assessment using group discussion to determine if the learner can explain the concepts of standard and transmission-based precautions in relation to patient encounters and the prevention of disease transmission.
Objectives 2-4: Formative assessment using a checklist of critical actions and observation tools.
Critical actions:
-
- The student dons appropriate PPE.
- The student identifies the patient and themselves and explains the procedure.
- The student notes the PICC line, limb alert bracelet, or signage and performs the blood pressure assessment on the appropriate arm.
- The student removes PPE and performs hand hygiene before leaving the patient's room to retrieve more thermometer probe covers or the student stands within the isolation room doorway and asks for assistance.
- The student respectfully asks the patient or family member to remain quiet during the assessment of respiratory rate, respectfully, and appropriately. The student should not tell the patient/family member they are counting respirations.
- The student performs post-procedure guidelines and notes patient safety checkpoints by placing the bed in the lowest position, verifying the patient’s understanding of using the call light, and placing all personal items within reach.
- Hand hygiene is performed appropriately.
Additional Information:
These critical actions should be used to guide your debriefing. You may note knowledge gaps unrelated to the stated objectives. It is important to focus on the stated objectives so the student will not be overwhelmed and the cognitive load will not be too great.
Objective 5: Formative assessment using debriefing techniques of plus/delta, advocacy coaching, and advocacy inquiry.
Rubrics
- For Hand Hygiene rubric consider using http://hosa.org/guidelines competitions guidelines → Health Professions Events → Nursing Assistant → Handwashing
- For Donning & Removing Transmission-Based Isolation Garments consider using http://hosa.org/guidelines competitions guidelines → Health Professions Events → Physical Therapy → Donning & Removing Transmission-Based Isolation Garments
- You can also use rubrics from a preferred credentialing agency.
Acceleration and Intervention
Approximate Duration
Total Duration
61 to 90 Minutes
Background and Preparation
Background/Preparation
Students should have mastered content knowledge related to standard and transmission-based precautions. They should be able to apply the appropriate personal protective equipment based on the disease and isolation signage. Students should be able to complete all patient safety checkpoints and procedures including identification of the patient and recognizing patient alert bracelets. Vital sign assessment, donning/doffing PPE, pre and post patient care procedure guidelines, and communication skills should be validated by return demonstration prior to this lesson. This entire lesson serves as a formative assessment of the application of previously mastered content and skills.
Instructors should have basic knowledge of simulation. The instructional design process for this lesson is developed using the INACSL Standards of Best Practice: SimulationSM. It is recommended that facilitators of this simulation be familiar with the INACSL standards, especially facilitation and debriefing.
Materials and Resources
Materials and Resources
INACSL Standards of Best Practice: SimulationSM
Simulation Planning Guides, Student Observation Form, Fiction and Confidentiality Contract
- Simulated patient/family member - elderly volunteers from the local community if available
- Hospital bed
- All PPE related to Standard and Transmission-Based Precautions: gloves, gown, procedure mask
- Signage related to isolation: Contact
- Electronic vital sign machine or manual equipment for vital sign assessment
- Hospital gown and patient ID/alert bracelets (pink limb alert)
- Student observation forms
- Pre-briefing, debriefing guides, fiction and confidentiality contracts
- The dress and grooming of learners should model the professional dress code required by healthcare facilities. (Scrubs, close toe shoes, hair up, etc)
Rubrics
- For Hand Hygiene rubric consider using http://hosa.org/guidelines competitions guidelines → Health Professions Events → Nursing Assistant → Handwashing
- For Donning & Removing Transmission-Based Isolation Garments consider using http://hosa.org/guidelines competitions guidelines → Health Professions Events → Physical Therapy → Donning & Removing Transmission-Based Isolation Garments
- You can also use rubrics from a preferred credentialing agency.
Technology Resources Needed
Computer/device
