Critical Care Skills Laboratory · ACADEMIC YEAR 2010 – 2011 FIRST SEMESTER Workshop / training...

College of Nursing

Critical Care Nursing

2011

Critical Care Skills Laboratory

Edited By

Dr. Radwa Hamdi

Assistant Professor of Critical Care

College of Nursing

University of Dammam

2011

UNIVERSITY OF DAMMAM

COLLEGE OF NURSING

MASTER PROGRAM

CRITICAL CARE NURSING

Critical Care skills Laboratory

Objectives

The critical care laboratory in the college of nursing is a fully equipped state-of-the-art

laboratory designed to recreate the atmosphere of the critical care unit, the latest in

laboratory and simulation technology such as high fidelity human patient simulators,

digitalized video, bedside computer charting, and electronic supply and static mannequins

are all included within the lab. The lab also provides a space for debriefing and reflective

thinking exercises that allow the students time to review their decisions and actions with

the instructor and their classmates.

Mission:

Preparing graduate nurses qualified for caring for critically ill patients according to the

universal standards of nursing practice.

Objectives:

Enhance learning using simulation technology and related resources.

Provide educational materials for students, faculty, and staff.

Provide hands-on learning experiences specific to critical care nursing course

objectives as directed by the nursing curriculum.

Provide a safe environment for students to practice critical care nursing skills

Bridge the gap between theoretical learning and clinical training

Encourage independent student learning opportunities

Integrate Clinical Simulation into critical care Nursing curriculum

Increase preparedness of nursing students before introduction to hospital training

Introduce physiology/ pharmacology/health assessment, etc. into cases critical care

students

Increase preparedness for dealing with high acuity and critical cases

Enhance communication skills

Demonstrate the value of team-work and collaboration


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Schedules


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University of Dammam

College of Nursing

Post Graduate Department

1431 – 1432

Master of Science in Critical Care Nursing

Time Table of Third Semester

Master Program

Critical Care Nursing

Date / Time 8-9 9-12 12-

12:30

12:30-2:30

Saturday

Clinical (Hospital) Prof. Dr. Fatma Mokabel A. Prof. Radwa H. Bakr

A.. Prof. Hanan El-Kefafy

A.. Prof. Omnia H. Salem

Pra

yer

Tim

e

Critical Care Medicine A. Prof. Radwa H. Bakr*

Sunday

Critical Care Surgery A. Prof. Radwa H. Bakr*

Monday

Clinical (Hospital)

Tuesday Critical Care Nursing II Prof. Dr. Fatma Mokabel*



Critical Care Nursing II Prof. Dr. Fatma Mokabel*



Wednesday

Seminars in Critical Care Nursing Prof. Dr. Fatma Mokabel


A.. Prof. Omnia H. Salem*

Seminars in Critical Care

Nursing Prof. Dr. Fatma Mokabel


A.. Prof. Omnia H. Salem* * Course Coordinator

Program Coordinator: Postgraduate Coordinator: College Dean:

Dr. Radwa Hamdi Prof. Dr. Fatma Mokabel Prof. Dr. Mohamed Hegazy

MASTER OF SCIENCE IN CRITICAL CARE NURSING


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LABORATORY ROTATION

THIRD SEMESTER

ACADEMIC YEAR 2010 - 2011

Date Activity Staff member

1st week

Saturday Examination of the

critically ill patient :

simulated clinical

experience

Dr. Radwa Hamdi

Sunday Vascular access

Dr. Radwa Hamdi

Monday Clinical skills revision

: ECG, ABG, XRAY,

redominstration and

screening

Dr. Radwa Hamdi

2nd

week

Saturday Assessment of the

trauma patient :

simulated clinical

experience

Dr. Omnia Hemeda

Sunday NGT insertion , gavage

, lavage , feeding

Dr. Omnia Hemeda

Monday Tracheal suctioning

Insertion of an

indwelling catheter

Dr. Omnia Hemeda

Program Coordinator Postgraduate Coordinator

Dr. Radwa Hamdi Prof. Dr. Fatma Mokabel

CRITICAL CARE II


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LABORATORY OCCUPANCY

ACADEMIC YEAR 2010-2011

Course Year Semes

ter

Number

of

students

Days

occupying

lab

Duration Description

Medical /

surgical

nursing

Third

Year

First

Semes

ter

88

Saturday and

Sunday

16 weeks Students will

practice procedures

and simulation as

part of their clinical

training

Fundament

als of

nursing

Secon

d

Year

First

semest

er

120

Tuesday and

Wednesday


practice procedures

and simulation as


training

Critical

care

nursing

Master

progra

m

Third

semest

er

3

Saturday ,

Sunday

Monday


practice procedures

and simulation as


training


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POSTGRADUATE COURSES

Course Simulated

clinical

experience

(SCE)

Objectives Duration Logistics

CRITICAL

CARE

NURSING

Care of the

patient who

develops

cardiopulmonary

resuscitation

ACLS protocols

- Recognizes and responds

appropriately to a crisis

situation

- Correctly identifies

cardiopulmonary arrest ,

calls for help and responds

to the code leader’s orders

for interventions

- Adheres to ACLS

protocols and algorithms

- Correctly administers

cardiovascular medications

- Correctly defibrillates the

patient using safety

precautions

- Documents interventions

and the patient’s response

Six

sessions

Critical

Care Lab

II

ADVANCED

HEALTH

ASSESSMENT

Assessment of

the

cardiovascular

system

Assessment of

the respiratory

system

- Correctly takes history

from simulated patient

- Inspects the chest and

identifies findings

- Palpates for excursion,

TVF, and pulsations

- Percuses the chest over

MCL and MAL, back

- Auscultates the chest

over MCL and MAL

-Identifies normal and

abnormal breath sounds

and adventitious sounds

and heart sounds and their

significance

- Documents findings

- Communicates effectively

with patient and team

members

Four

sessions

Critical

Care Lab

II


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Documents


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Laboratory Rotation

List of Procedures Cardiovascular system :

Drawing blood from a vein

Insertion of an IV line

Assiting insertion of a central venous line

Central venous line care

CVP measurment

Drawing an arterial sample

Inserting an arterial line

Cardiopulmonary resuscitation

Defibrillation

Respiratory system:

Maintaining patent airway

Inserting an oropharyngeal airway

Bag valve mask ventilation

Suctioning the airway

ETT care

Tracheostomy care

Managing ventilator emergencies

Gastrointestinal and genitourinary:

Inserting a nasogastric tube

Feeding via NGT

Inserting a urinary catheter

Caring for a patient with an indwelling catheter


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STUDENT EVALUATION OF SIMULATED CLINICAL

EXPERIENCE

Do not

agree

Somewhat

agree

Strongly

agree

Not

applicable

The instructor prompts guided me I

thinking critically

I feel more confident in my ability to deal

with real patients

I developed better understandings of

drugs used in the simulated clinical

experience

I feel more prepared for decision making

My physical examination and assessment

skills have improved

I feel more able to predict what

pathophysiological changes may occur in

a real patient

The simulated clinical experience has

reinforced my theoretical knowledge

The simulated clinical experience has

challenged me to think and make

decisions

I have learned a great deal from

observing my colleagues

I have learned ways to improve my

communication skills with patients and

colleagues

Debriefing sessions and discussions

were valuable

Comments :

………………………………………………………………………………………………

…………………………………………................................................................................

………………………………………………………………………………………………

………………………………………………………….......................................................

……………………………………………………………………………………………….


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CLINICAL SIMULATION LABORATORIES

PHOTOGRAPHY RELEASE

I , ___________________________________ hereby agree to allow

___________________________________ to record or photograph my

performance in the clinical simulation lab , for use in simulation sessions for

teaching purposes or for use in educational materials , brochures, manuals

and presentations.

Date : _____________________________________________________

Name : ____________________________________________________

Signature : _________________________________________________


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Workshops and

training


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CRITICAL CARE (II) LABORATORY

SCHEDULED TRAINING ACTIVITIES

AND WORKSHOPS

ACADEMIC YEAR 2010 – 2011

FIRST SEMESTER

Workshop /

training

Date Instructor Location Duration

Pediatric ECS

(METI )

October 6TH

2010

Dr. Radwa

Hamdi

Critical

Care Lab

1 day

Virtual IV

Maintenance and

training

October 3rd

Dr. Ashraf Critical

Care Lab

1 day

SIMMAN 3G

Faculty training

workshop

October 11th

October 17th

Eng.

Abubakr

Critical

Care Lab

2 days

ECS Training

workshop

November

1st

Wael kossa Critical

Care Lab

Highfidelity

simulation

workshop

January 10-

11th

Organization is in progress


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High fidelity Simulation

Workshop

With :

Pedia Sim by METI®

INSTRUCTOR : DR. RADWA HAMDI

Participants :

Pediatric Nursing Academic Staff and Demonstrators

Duration:

One day

Timing:

Wednesday 6 0ct0ber 2010

Venue:

College of Nursing - Critical Care II Skill Lab


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Workshop Rationale:

This workshop is designed to acquaint pediatric nursing faculty with the

high fidelity simulator designed by METI ; Pediatric Emergency care

simulator (PEDIA SIM), as well as the educational modules of the Program

of Nursing Curriculum Integration (PNCI) , a four-semester guide which

provides simulated clinical experiences (SCE). That are integrated within the

nursing curriculum. Human patient simulation provides an innovate

learning environment where nursing students can practice clinical and

critical thinking skills without fear of harming a real person, the result is

increased self-confidence, and ultimately competence. Simulation offers

multiple opportunities for student training and clinical experience that help

overcome the limitations of clinical areas, However simulators are often

under- utilized due to insufficient staff training.

The aim of this workshop is to train pediatric Nursing academic staff on the

use of high fidelity simulators to prepare them for the use of simulation in

undergraduate and postgraduate student clinical training .

Workshop objectives:

As a result of successful completion of the workshop, participants will be

able to:

Identify the parts of the high fidelity simulator

Familiarize with simulator software and applications

Demonstrate how to operate the high fidelity simulator Familiarize

with educational modules of the Program of Nursing Curriculum

Integration (PNCI)

Demonstrate how to run a scenario on the high fidelity simulator


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Demonstrate how to write new scenarios by editing existing ones

Demonstrate how to create new scenarios

Demonstrate how to conduct a clinical simulation session

Demonstrate how to conduct a debriefing session


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High fidelity Simulation Workshop

Pedia Sim by METI®

Instructor : Dr. Radwa Hamdi

Program

Day : Time: Activity:

Tuesday

13/10/09

8.00-8.30: Identify the parts of the high

fidelity simulator

8.30-9.30: Familiarize with simulator software

and applications

Demonstrate how to operate the

high fidelity simulator

9.30-10.00: Familiarize with educational

modules of the Program of Nursing

Curriculum Integration (PNCI)

10.00 - 10.30: Practical application : how to run a

scenario on the high fidelity

simulator

10.30- 11.00 Writing new scenarios by editing

existing ones

Creating new scenarios

11.00 – 12.00

Practical application : conducting a

clinical simulation session

Demonstrate how to conduct a

debriefing session

12.30 – 1.30: Prayer break

1.30 – 2.00: Practical application :

Conducting a debriefing

session


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Simulation

Training

Workshop With :

SimMan 3G ®

Instructor : Eng . Abubakr -- BETA COMPANY

Participants : College of Nursing Academic Staff and

Demonstrators

Duration:

One day

Timing:

Monday October 11th

2010 , to be repeated Sunday 17th

Oct

Venue:

College of Nursing - Critical Care I Simulation Laboratory


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2010

Workshop Rationale:

This workshop is designed to acquaint nursing faculty with the most recent

high fidelity simulator designed by SIMMAN ; SIMMAN 3G. Human

patient simulation provides an innovate learning environment where nursing

students can practice clinical and critical thinking skills without fear of

harming a real person, the result is increased self-confidence, and ultimately

competence. Simulation offers multiple opportunities for student training

and clinical experience that help overcome the limitations of clinical areas,

However simulators are often under- utilized due to insufficient staff

training. The aim of this workshop is to acquaint Nursing academic staff on

the use of SIMMAN 3G high to prepare them for the use of simulation in

undergraduate and postgraduate student clinical training .

Workshop objectives:

As a result of successful completion of the workshop, participants will be

able to:

Identify the parts of the high fidelity simulator

Familiarize with simulator software and applications

Demonstrate how to operate the high fidelity simulator

Familiarize with educational modules

Demonstrate how to run a scenario on the high fidelity simulator


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Demonstrate how to write new scenarios by editing existing ones

Demonstrate how to create new scenarios

Demonstrate how to conduct a clinical simulation session

Program

Day : Time: Activity:

Monday

11/10/2010

8.00-8.30: Identify the parts of the high

fidelity simulator SIMMAN 3G

8.30-9.30: Familiarize with simulator software

and applications

Demonstrate how to operate the

high fidelity simulator

9.30-10.00: Familiarize with educational

modules

10.00 - 10.30: Practical application : how to run a

scenario on the high fidelity

simulator

10.30- 11.00 Writing new scenarios by editing

existing ones

Creating new scenarios

11.00 – 12.00

Practical application : conducting a

clinical simulation session


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Training Workshop

Evaluation Form

12.30 – 1.30:

Prayer break

1.30 – 2.00: Practical application :

conducting a clinical

simulation session


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Please provide feedback regarding the

training session that you attended. Your

opinion is valuable to us and will guide

us in planning future training

workshops .

Workshop:

………………………………………………………………………

……………………………………..

Instructor :

………………………………………………………………………

…………………………………….

Please check the box corresponding to the degree to which you believe the training

workshop achieved its goals:

Excellent Good Fair Poor N/A

Objectives for the workshop were met

Questions were answered to my

satisfaction

I better understand the components of

the simulator

I better understand how to operate the

simulator

I better understand how to run a

simulation scenario

I received guidance on how to use

simulation in my course

I better understand how I can

integrate simulation into my

curriculum

I am better prepared to assume the

role of facilitator in a simulation

setting

I am better prepared to make the

simulator and its environment more

realistic

I better understand the importance of


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debriefing

I feel confident in my ability to use the

simulator with my student

Comments :

………………………………………………………………………………

………………………………………………………………………………

………………………………………………………………………………

High fidelity Simulation

Workshop

With :

PEDIASIM EMERGENCY CARE

SIMULATOR®

Instructor : Dr. RADWA HAMDI

Date : October 6 th 2010

Attendance

Serial Name Signature 1. DR. AWATEF ALSAYED

2. DR. LAYLA YOUNIS

3. DR. HODA NAFEA

4. DR. AFKAR RAGAB

5. DR. AHLAM

6. DR. THANAA ALHANAFY

7. DR. ABEER ALI

8.

9.


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10.

11.

12.

13.

14.

15.


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Checklists


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INTRAVENOUS CATHETER INSERTION

STUDENT’S NAME:…………………………………… STUDENT’S NUMBER: …………………………………………

Grade : …………………………………………………………………………………………………………………………..

Date of evaluation: ………………………………………………………………………………………………………….

Clinical supervisor: …………………………………………………………………………………………………………..

PROCEDURE CHECKLIST S US N/A COMMENTS

1 Explains the procedure and obtains consent.

2 Observes universal precautions

3 Applies local anesthetic

4 Places tourniquet above the intended site and palpates the vein.

5 Cleanses skin and fixes vein

6 Inserts catheter, bevel up, parallel to the vein at a 30 degree angle to the skin.

7 Advances into the vein.

8 Decreases angle when flashback occurs.

9 Advances 0.5 then retracts needle from catheter.

10 Advances catheter until port is flush with the skin.

11 Occludes the distal end of the catheter and connects IV tubing

12 Checks flow through catheter.

13 Secures the catheter


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UNIVERSAL PRECAUTIONS FOR INVASIVE PROCEDURE


Grade : …………………………………………………………………………………………………………………………..



Procedure checklist S US N/A Comment

1 Checks Patient identity

2 Checks relevant documents

3 Obtains informed consent

4 Marks procedure site

5 Positions patient correctly

6 Displays Images and results properly

7 Prepares blood products, implants, devices, or special equipment

8 Administers required antibiotics or fluids

9 Observes safety precautions based on history and medications


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ARTERIAL LINE INSERTION ( Radial artery )


Grade : …………………………………………………………………………………………………………………………..

Date of evaluation: ………………………… Clinical supervisor: ………………………………..


1 Explains procedure and obtains consent.

2 Observes universal precautions.

3 Positions limb for arterial cannulation: supinates the arm and dorsiflexes the wrist

4 Follows aseptic technique

5 Palpates the artery.

6 Infiltrates the insertion site with 1% lidocaine.

7 Uses Catheter-over-needle technique: Inserts needle and catheter at a 20- to 40-degree angle to the skin. When a flash of blood appears in the hub, drops angle to near 0 degrees and advances about 1 mm. Slides the catheter off the needle into the artery. Puts pressure on the artery and removes the needle from the catheter.

8 Connects the catheter to the transduction system and observes arterial waveform and pressure.

9 Secures the catheter with sterile dressing and tape.


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SUCTIONING A PATIENT WITH AN ENDOCTRACHEAL TUBE (ETT)


Grade : …………………………………………………………………………………………………………………………..




1 Explains the procedure to the patient.

2 Observes aseptic technique

3 Opens sterile gloves and suction catheter.

4 Places clean Latex glove on non-dominate hand.

5 Monitors oxygen saturation during procedure.

6 Pre-oxygenates patient with AMBU bag on a 100% O2 for 2 minutes

7 Turns on suctioning equipment with suction tubing and places near head of patient.

8 Places sterile gloves on dominate hand and connects suction catheter to suction tubing.

9 Using aseptic technique, passes suction catheter , while occluded , through ET tube until patient coughs.

10 Applies suction and withdraws suction catheter with a rotating motion at 5 second intervals.

11 Ventillates patient with ambu bag using 100% oxygen

12 Cleans out patient oropharyngeal airway with suction catheter .

13 Discards suction catheter

14 Rinses suction tubing with water.

15 Monitors patients breathing and oxygen saturation.

16 Notes amount, colour and consistency of tracheal aspiration


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SUCTIONING A PATIENT WITH A TRACHEOSTOMY TUBE


Grade : …………………………………………………………………………………………………………………………..

Date of evaluation: …………………………… Clinical supervisor: ………………………………………..


1 Explains the procedure to the patient.

2 Observes aseptic technique

3 Opens sterile gloves and suction catheter.

4 Places clean Latex glove on non-dominate hand.

5 Monitors oxygen saturation during procedure.

6 Pre-oxygenates patient with AMBU bag on a 100% O2 for 2 minutes

7 Turns on suctioning equipment with and places near head of patient.

8 Places sterile glove on dominate hand and connects suction catheter to suction tubing.

9 Using aseptic technique, passes suction catheter through connector down into tracheal tube entering the patients upper airway until patient coughs.

10 Applies suctioning while withdrawing suction catheter with a rotating motion at 5 second intervals.

11 Ventilates patient with AMBU bag on a 100% 02

12 Clean out patient oral pharyngeal airway with either suction catheter

13 Discards suction catheter

14 Rinse suction tubing with water.

15 Monitors patients breathing and oxygen saturation.

16 Notes amount, colour and consistency of tracheal aspiration


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DRAWING AN ARTERIAL SAMPLE (radial artery)


Grade : …………………………………………………………………………………………………………………………..

Date of evaluation: ………………………….. Clinical supervisor: ….……………………………….


1 Explains the procedure to the patient

2 Observes universal precautions for invasive procedures

3 Applies local anesthesic if appropriate

4 Prepares skin with antiseptic solution

5 Uses sterile technique.

6 Performs modified Allen test.

7 Positions patient supine and extends wrist to 30 to 45 degrees.

8 Palpates artery distal to the radial styloid

9 Holds the syringe like a dart with the lumen of the needle facing the flow of blood.

10 Enters the skin at a 45-degree angle, at a point 2 to 3 cm proximal to the volar wrist crease.

11 Slowly advances the needle toward the point of maximal arterial impulse.

12 Allows blood to fill the syringe.

13 Collects sample then withdraws the needle.

14 Expels air bubbles in the syringe,caps and labels.


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BAG MASK VENTILATION


Grade : …………………………………………………………………………………………………………………………..




1 Provides O2 supplementation and monitoring


3 Opens the patient's airway with head-tilt or

jaw-thrust.

4 Chooses a proper size face mask and connects to

oxygen

5 One-handed technique: (C E )

Holds the mask with the thumb and forefinger

in a "C" shape and hold the jaw with the other

fingers (E )

6 Two-handed technique: Places thumb and of one hand on one side of the mask and places other hand similarly on the other side of the mask. Uses remaining fingers to pull the mandible into the mask

7 Uses correct sized bag to ventilate: 250 mL for neonates, 500 mL for pediatric , 1000 to 1500 mL for adults


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BASIC AIRWAY MANAGEMENT


Grade : …………………………………………………………………………………………………………………………..




1 Uses universal precautions.

2 Head-tilt chin-lift maneuver : Applies downward pressure on the forehead and uses fingers to lift mandible.

3 Jaw-thrust maneuver : Places heels of hands on sides of the patient's head and grasps angles of mandible with fingers and push jaw anteriorly.

4 Oropharyngeal airway (OPA) insertion : Selects correct size OPA (from mouth to the angle of the mandible).

5 Inserts OPA inverted, then rotates 180 degrees at the posterior pharynx.

6 Nasopharyngeal airway (NPA) insertion : Selects correct size NPA (from tip of nose to angle of mandible).

7 Lubricates NPA and inserts along floor of the nasal cavity.

8 Bag-valve mask ventilation : Opens airway, then applies mask using either one- or two-handed technique ventilates at rate of 10 to 12 breaths per minute, at a tidal volume of 8 to 10 mL/kg.


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DRAWING BLOOD FROM A VEIN


Grade : …………………………………………………………………………………………………………………………..




1 Explains procedure and obtains consent.


3 Positions the patient supine and places all supplies within reach.

4 Places tourniquet 5 to 10 cm proximal to selected venipuncture site.

5 Cleanses overlying skin with antiseptic solution.

6 Applies traction distal to the vein.

7 Holds butterfly needle with bevel facing upward.

8 Inserts needle into vessel and observes for flash of blood.

9 Inserts vacuum tube into the vacuette tube and collects sample.

10 Releases tourniquet and removes needle.


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VENTILATOR EMERGENCY



1 Problems Associated With Mechanical Ventilator: Detach patient from ventilator and manually ventilate patient using Laerdal Silicone Resuscitator (attached to endotracheal tube) and high flow oxygen.

2 If the patient is "easy" to manually ventilate and settles once removed from the ventilator - the ventilator has been identified as the primary source of the ventilator emergency.

3 While one nurse manually ventilates the patient, a second skilled nurse inspects the ventilator and attends performance check (as per manufacturer's guidelines).

4 If the problem cannot be identified and rectified, the ventilator is replaced with another.

5 The malfunctioning ventilator is sent to biomedical engineering for review.

6 Problems Associated With The Endotracheal Tube: -If the patient is "easy" to manually ventilate but an audible air leak is present, check cuff pressure with manometer.

7 If the leak persists or is unsealable, check tube position / length and air entry. Reinsert tube to correct length.

8 Check for absence of cuff leak and equal air entry.

9 Document event.

10 If the patient is "difficult" to ventilate, attempt to pass suction catheter.

11 If the suction catheter cannot be passed further than 5 cm - verify that the patient is not biting on the tube. Insert oropharyngeal airway and attempt to suction patient again. If difficulty persists: proceed.

12 If the suction catheter cannot be passed further than 10-15 cm:

13 Position patient's head / neck in a position of neutral alignment and attempt to suction patient again.


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Grade : …………………………………………………………………………………………………………………………..



14 If difficulty persists: proceed. If the suction catheter cannot be passed further than the tip of the endotracheal tube: Deflate cuff. Pass suction catheter. - Reinflate cuff to pressure of 15 to 25 cm H2O. Attempt to pass suction catheter again.

15 If passage of catheter is impossible and ventilation is absent: remove tube.

16 Call for assistance of ICU physician immediately.

17 Manually ventilate patient using Laerdal Silicone Resuscitator and appropriately sized mask.

18 -Prepare for reintubation.


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TRACHEOSTOMY DRESSING


Grade : …………………………………………………………………………………………………………………………..

Date of evaluation: …………………………Clinical supervisor: …………………………………………………………


1 Explains procedure to patient

2 Aseptically prepares equipment

3 Prepares dressing pack at bedside

4 Suctions patient

5 Removes old dressings and ties

6 Swabs around tracheal stoma with normal saline

7 Folds sterile gauze squares in half and place on under each wing of tracheostomy tube.

8 Attaches cotton tape to tracheostomy tube by passing doubled cotton tape up through opening then threading loose ends up through loop.

9 Passes two long portions of cotton tape behind patients head.

10 Ties long end to short leaving a two finger space between patient and tie tapes.

11 Measures cuff pressure


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SET UP AND INSERTION OF CENTRAL VENOUS CATHETER


EQUIPMENT:

Surgical Mask (Physician and Nurse) Sterile gown and gloves

1 large trolley drape ,1 large patient drape

1 fenestrated drape , Basic dressing pack

Chlorhexidine1 x 5ml syringe

1 x 10ml syringe 1 x 23g needle

1 x 19g needle 10mls 1% Plain Lignocaine

5 - 10mls Heparinised Saline 50 units in 5ml 2/0 Black Silk on straight cutting needle

Stitch cutter

Hansipore dressing or Gauze dressing and Micropore tape

Central Venous Catheter as requested. (Add extra 5ml syringe for single lumen catheter).

PROCEDURE CHECKLIST S US N/A Comment

STANDARDS:

1 The procedure will be performed under the strictest aseptic conditions.

2 The procedure will be explained to the patient and written consent will be obtained by the Medical Officer.

3 Universal precautions will be maintained throughout the procedure and in the clean up phase following the procedure.

4 Patient safety will be maintained throughout the procedure.

OUTCOMES

5 The catheter will be located in Superior Vena Cava.

6 The risk of infection will be minimised.

7 The patient will feel safe and secure during the procedure.

8 There will be a defined clinical benefit for the patient from the performance of the procedure.


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Grade : …………………………………………………………………………………………………………………………..


9 The attendant risks involved in the performance of, and subsequent to the procedure will be monitored and managed within defined protocols

SPECIAL

CONSIDERATIONS

10 Resuscitation trolley should be readily accessible.

11 Patient bed should be able to be tilted in the Trendelenberg position.

12 The insertion site e.g. jugular or subclavian area, should be exposed and clear of clothing, ECG dots, wires and jewellery.

I.V Lines and infusion pumps should be primed with the prescribed fluid and ready for connection.

The audible QRS tone on the monitor should be turned on during the procedure.

Chest X-Ray to be taken and reviewed by a medical practitioner as soon as practicable post insertion of a subclavian line.

NURSES ROLE:

Remains with the patient throughout the procedure

Prepares the patient, removing clothing, exposing the site area, repositioning ECG dots/wires.

Positions the patient in the Trendelenberg position.

Opens packs and sets up for procedure.

13 Observes Cardiac Monitor during insertion of the guidewire/catheter.


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CRITICAL CARE NURSING Clinical supervisor: …………………………………………………………………………………………………………..

SET UP AND INSERTION ENDOTRACHEAL TUBE


EQUIPMENT: Oxygen Suction 10ml syringe attached to buffered artery forcep Laryngoscope Magills forceps Lubricant (H20 solution or L.A.) 1m white tape Scissors Geudel airway Laerdal resuscitation and mask Yankeur sucker Drugs as ordered Stethoscope Leucoplast tape Procedure checklist

S US N/A Comment

1 STANDARDS: * Emergency intubation to be undertaken by the medical officer skilled in this procedure.

2 Persons warranting E.I. must have a registered nurse in constant attendance.

3 IV access made available.

4 Cricoid pressure to be applied prior to intubation and removed only after cuff inflation.

5 Cuff inflated to 200mmHg and no more than 30mmHg.

6 Positioning of the ETT is verified by observing chest movement.

7 - Auscultation of the chest and stomach.

8 Chest x-ray (reviewed by medical officer).

9 ETT sizes ranging from 2.5mm to 9.5mm. Selection appropriate to patient size.


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Grade : …………………………………………………………………………………………………………………………..



10 Necessary drugs are prescribed and administered at medical officers request.

OUTCOMES:

Patient airway available with means to maximise respiratory function.

PROCEDURE:

1. Excess secretions/foreign bodies removed from oropharynx prior to procedure.

2. Excess secretions/foreign bodies removed from oropharynx prior to procedure.

3 Excess secretions/foreign bodies removed from oropharynx prior to procedure.

4 Patient pre-oxygenated with 100% oxygen. Patient placed in supine position with adequate access to the head. Drugs prepared and available close to IV access. Manual of mechanical ventialtion comenced when ETT in situ. Record size of ETT and placement at the lips. Observe and record respiratory observations.


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CENTRAL VENOUS CATHETER CHANGE

STUDENT NAME :………………………………….. STUDENT NUMBER; ……………………………………………….

Grade : …………………………………………………………………………………………………………………………..


Clinical supervisor: ………………………………………………………………………………………………………….


1 Explains the procedure and obtains consent.


3 Prepares dressing pack at bedside prior to positioning patient.

4 Hangs new IV solution and places new new administration set ( protecting distal end from contamination by placing distal end on open dressing pack).

5 Primes IV line with appropriate solution

6 Stops infusion pump and clamps IV line, with roller clamp on CVC lumen extension being changed

7 Clamps off line of CVC pigtail being changed with slide clamp.

8 Places new IV administration set and IV solution into Infusion Pump.

9 Places CVC pigtail and IV line on sterile towel from dressing pack and allows solution to dry

10 Starts Infusion Pump and allow fluid to run into sterile field of dressing pack.

11 Connect new IV line too CVC pigtail and removes slide clamp from CVC pigtail.

12 Label IV administration set with time and date of change.


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simulation


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Laboratory Rotation

Simulated Clinical Experience

Objectives

During their laboratory rotation critical care master students will be exposed

to several simulated clinical experiences tailored to mimic situations to

which they will be exposed in the ICU environment , this will provide an

opportunity for students to practice skills and interventions in a safe risk free

environment as well as implement teamwork leadership, and communication

skills.

The simulated clinical cal experience will be followed by a debriefing

session during which strengths and areas for improvement will be discussed

with the instructor. As a result of each simulated clinical experience students

will be expected to:

Integrate theoretical knowledge to practice

Utilize evidence base, critical thinking and the nursing process as

afrme work for nursing care

Determine the priorities for nursing utilizing individualized plans of

care

Evaluate the effectiveness of therapeutic interventions implemented

Document nursing and medical interventions

Implement best nursing practices for the simulated patient

Apply interdisciplinary collaboration

Communicate effectively with healthcare providers regarding patient

progress


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Integration of simulation in

Critical Care Nursing curriculum

Human patient simulation is one such strategy to address the multiple issues

faced in teaching critical care nursing today. Patient simulation allows teach

multiple objectives while brings learning alive in a multidimensional

environment, and increases the confidence of the learner, which leads to

competence. This is of particular importance for nurses who will be working

in a high acuity environment where skill and self confidence are of utmost

importance .

The Program for Nursing Curriculum Integration (PNCI) by METI provides

an answer to assist faculty with this transition and make more efficient use

of their time as they embark on the use of patient simulation to facilitate

learning and to assess competency.

Areas of practice

Critical Care Nursing:

Selected topics of the critical care curriculum will be chosen to be taught

using human patient simulation in an effort to bridge the gap between theory

and knowledge while enhancing skill, knowledge and self confidence.

The following is a list of the critical care topics included in the program of

nursing curriculum integration , the high lighted items are presently being

used in postgraduate teaching

Assessment of the cardiovascular system


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Assessment of the respiratory system

Traumatic Brain Injury

RSV Bronchiolitis

Meningitis

Fluid and Electrolyte Imbalance

Cystic Fibrosis

Chronic Heart Failure and COPD

Bioterrorism

End-of-Life Care

Sickle Cell Crisis

Chronic Osteomyelitis on Home Antibiotic Therapy

Acquired Immune Deficiency Syndrome

Cardiac Rehabilitation

Dementia and UTI

Intentional Overdose of a Hypnotic

Cardiopulmonary Arrest

DIC

Acute respiratory distress syndrome

Mechanical ventilation

Acute Coronary Syndrome and AMI

COPD Exacerbation with Respiratory Failure

Postoperative Pulmonary Embolism

Closed Head Injury with Increasing ICP

Multiple Patient Care Management


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ROADMAP FOR INTEGRATION

PROGRAM OF NURSING CURRICULUM INTEGRATION

Simulated clinical experience


Concept

Simulated clinical experience

Changes in Vital Signs in Relation to

Critically Ill Patients

Interventions and Treatment of

Abnormal Vital Signs in Life

Threatening Disorders: ECG, Pulse

Oximetry, Arterial Lines, Respiratory

and Temp. Monitoring

Acute heart failure exacerbation

Basic dysrhythmias recognition and

management

Suctioning; Endotracheal Tubes,

Artificial Airways

Oxygen Delivery Systems;

Mechanical Ventilation

Acute Respiratory Distress/ Failure

Secondary to Trauma,

Post-Anesthesia and pneumonia

Glasgow Coma Scale; Trauma Patient

Gunshot wound

Herniation syndrom

Motor vehicle collision with abdominal

injuryy and internal bleeding and

hypovolemic shock

ICP monitoring , arterial lines ,

pulmonary artery cathters

Pulmonary artery catheter

Cardiac pacemakers Syncope Secondary to Bradycardia

Requiring Transthoracic Pacing Prior to

the Insertion of a Permanent Pacemaker

Inclusion of pertinent pharmacology

in critical care

Antidysrhythmic Agents

Thrombolytic Agents; Vasopressors;

Blood products

Cardiopulmonary arrest

Brain attack with thrombolytic therapy

Adult Drug Overdose and Poisoning

Neurologically Compromised Patient

Intentional Overdose of a Hypnotic

Cocaine Overdose with Cardiac Arrest

Spinal cord injured patient with

neurogenic shock

Ventilator Dependent Patients

Postoperative pulmonary embolism


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Debriefing guide

Simulation: ……………………………………………………………….

Instructor : ………………………………………………………...……..

Objectives :

Enhance learning through reflection

Self evaluate knowledge and abilities

Assess of teamwork and communication skills

Enhance critical thinking and problem solving

Process of debriefing :

Explore personal reactions

Assess and analyse interventions

Discuss prioritization of care

Discuss communication and collaboration

Discuss safety

Review documentation

Link to clinical and real world

Video playback

Review what went well and what did not

Identify areas for improvement

Evaluate simulated clinical experience


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Case 1:

History: Mrs Gamela is a 29 year old Saudi woman

She is 7m pregnant

Complains of dizziness, palpitations and easy fatigability

also complains of being out of breath

(gets breathless on doing light housework)

The condition started about 1 month ago but has markedly

worsened over the last two days

The condition worsens by effort and improves when she lies

down

She sleeps on two pillows

This is her first pregnancy she is on irregular antenatal care

The patient also complains of indigestion, heart burn and

constipation

Past history : Received monthly shots for one year when about 12 does not

know for what

Tonsillectomy at age 13

no DM , HTN

No allergies

medication : only takes vitamins prescribed by her

obstetrician

Family History Mother is diabetic

Father and mother are first cousins


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Case 4:

Mr Amar is a 87 year old Saudi man who lives in a nursing home

his wife died 1 year ago, he has two children who live abroad and

call him once a week

The patient experiences shortness of breath and palpitation when

he gets up from bed to go to the bathroom this has been going on

ever since his last surgery, he sleeps sitting up in bed and feels

more dyspnic when he lies down

Over the last two weeks the patient has lost 4 pounds

Past history: DM type II of 20 years duration

The patient had two CABG surgeries one of three vessels ten years

ago and the second of four vessels 3 months ago.

His current medications include: (The patient does not know the name of the drugs but has them

with him)

Metformin 1000mg X 2

Furosimide X 2

Lisinopril X1

Nadolol X 3

Digoxin X 1 except Friday

Family history: DM, HTN , heart disease

two of his brothers died of a heart attack


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Case 2:

Noora is a 45 year old Saudi female she is married and has four

children

The patient complains of abdominal pain and diarrhea for the last

couple of days, diarrhea (8/ day) with nausea but no vomiting she

reports that this has happened since she had eaten a meal at a local

restaurant

she also reports feeling frequently as if her heart is missing a beat

The patient also complains of tingling and numbness in the fingers

of her right hand that is increased by cold weather this has been

going on for the last few years

The patient is obese and is diabetic on insulin for the last 15 years

Past history: Hysterectomy 2 years ago, for bleeding

Arthritis for the last 5 years

Her current medications include: Insulin

Prednisolone tablets x 1 for arthritis

Family history: DM (mother)

HTN (mother)

2 of her children havesickle cell disease


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Case 3:

SAID is a 27 year old Egyptian male who works in a ceramic

factory he is married and has two children

the patient complains of severe fatigue and weakness that has been

going on for the last month, two days ago the patient experienced

two attacks of fainting from which he recovered by lying down, the

patient also complains of palpitations

the patient has had bronchial asthma for the last 6 years but

recently his attacks were exacerbated by dusty weather

Past history: The patient has a history of scarlet fever at the age of 10

He recalls having several attacks of arthritis during his childhood

He was dispensed from military service for having a bad heart

His current medications include: Simbicort inhaler x3 or as needed

Family history: Irrelevant


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CRITICAL CARE NURSING Simulated clinical experience:

care of the patient who develops respiratory

failure

Description of the activity:

Students will be exposed to a simulated clinical experience involving a 26 year old

patient who develops ARDS and progressive respiratory failure following exposure to a

motor vehicle accident causing bilateral lung contusions. One student will assume the

role of nurse in charge while the others will as observers and the roles will be reversed

subsequently .Students will be expected to :

Perform initial assessment

Evaluate data and document findings

Assess surgical wounds, drains

Assist healthcare provider in endotracheal intubation

Check ventilator settings

Evaluate effecyiveness of ventilator settings

Monitor pumps and infusions and check for patency

Assess vitals , ABG and xray and report to healthcare provider

Administer oral care

Do cuff pressure checks

Document assessment, interventions and response to treatment

The objectives of this simulated clinical experience are:

Identify the pathophysiology and causes of ARDS

Perform assessment of the critically ill patient

Prioritize interventions for a mevchanically ventilated patient

Describe the nursing management of a person to be weaned from mechanical

ventillation

Discuss the modes of ventilator settings for a mechanically ventilated patient


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SIMULATED CLINICAL EXPERIENCE OBSERVATION SHEET

Simulation: …………………………………………………………………………………………………………………………………..…

Student name: ………………………………………………………………………………………………………….. ………………………

Appropriate nursing

intervention

Areas for improvement

Assessment :

Proper equipment used

Systematic approach

Appropriate techniques

Identifies significance of findings

Management:

Evaluates data and document findings

Administers appropriate patient care

Assist healthcare provider in procedures when indicated

Checks ventilator settings

Evaluates effecyiveness of ventilator settings

Monitor pumps and infusions and check for patency

Assesses vitals , ABG and XRAY and report to healthcare provider

Documents interventions and response to treatment

Team work and Communication :

Communicates effectively with patient

Uses verbal and non verbal communication

Communicates effectively with family members

Uses terms appropriate to patients background and level of education

Collaborates appropriately with colleagues and healthcare team


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Simulated clinical experience observation sheet:

Simulation: assessment of the respiratory system

Student name: …………………………………………………………………………………………………………...

Appropriate nursing intervention Areas for improvement

Assessment :


Systematic approach



Communication :

Communicates effectively with

patient

Uses verbal and non verbal

communication


family members

Uses terms appropriate to

patients background and level of

education


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Simulated clinical experience observation sheet:

Simulation: assessment of the cardiovascular system

Student name: …………………………………………………………………………………………………………...

Appropriate nursing intervention Areas for improvement

Assessment :


Systematic approach



Communication :


patient

Uses verbal and non verbal

communication


family members

Uses terms appropriate to

patients background and level of

education


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STUDENT EVALUATION OF SIMULATED CLINICAL EXPERIENCE Do not

agree

Somewhat agree Strongly agree Not applicable

The instructor prompts guided me I thinking critically

I feel more confident in my ability to deal with real patients

I developed better understandings of drugs used in the simulated clinical

experience

I feel more prepared for decision making

My physical examination and assessment skills have improved

I feel more able to predict what pathophysiological changes may occur in a

real patient

The simulated clinical experience has reinforced my theoretical knowledge

The simulated clinical experience has challenged me to think and make

decisions

I have learned agreat deal from observing my collegues

I have learned ways to imprive my communication skills

Debriefing sessions and discussions were valuable

Comments :

…………………………………………………………………………………………………………………………………………..........................

…………………………………………………………………………………………………………………………………………………………...

……………………………………………………………………………………………………………………………………………………………

……………………………………………………………………………………………………………………………………………………………


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Inventories


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ITEM # CABINET # EQUIPMENT / SUPPLIES QTTY. REMARKS

A. SIMULATOR/MANIKIN

1 ECS include the ff: 2006

Full-scale adult patient simulator: 1

BP cuff 1

SPO2 probe 1

Ambu Bag 1 New one on 3/10/2009

Screen monitor 1

11dr METI Laptop 1 SN: ECS849 METI

PCU Regulator 1

Regulator CO2 1

Compressor 1

2 6dr/7dr Central venous cannulation model 2

3 12dr Tracheostomy care simulator 2

4 7 dr Chester chest 1

5 10dr AED Little Anne 1 0

6 10dr Arterial Puncture arm 2

7 Virtual IV 1 2/12/2007; SN: 32070539-C

8 Pedia Sim METI manikin w/ bed 1 13/10/08

Screen Monitor 1 13/10/08

Compressor 1 13/10/08

PCU regulator 1 13/10/08


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METI vision, LCD & CPU 1 13/10/08

9 AED Little Anne Training System 1 11/09/2008

10 Electronic weighing scale with stand 1 19/08/2009

11 Crash Cart 1 19/08/2009

12 Suction apparatus with accessories 1 19/08/2009

13 Littmann Stethescope 3 19/08/2009

14 Laryngoscope with accessories 1 19/08/2009

15 Medication Trolley 1 19/08/2009

B. ELECTRONICS

1 Eiki EIP-200 Data Show w/ RC 1 24/02/08; 40119

2 Team Board 1 2006

3 Sony Bravia Plasma TV w/ RC 1

4 Dell LCD monitor w/ mouse & keyboard 2 2006; 2007

5 Dell CPU Optiplex 2 2006 SN: j28kb2j; 2007 SN: 6FNJFD1

6 IP Fast Dome Camera 1 2006

7 ip Primax Canon printer 1 Feb, '07; w/ CD & manual; w/ Dr. Fatma 27/10/08

8 Pressure infusor 1 from Pedia lab #1

9 11dr Amplifier 1 from Funda

10 SMARTSIGNS Compact Patient Monitor 1 from MS lab

11 Accutorr Plus (Datascope) 1

12 Terumo-Infusion Pump 1 old from KFHU;

13 12 dr Portable suction machine 1


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14 14dr Omron Fat Loss Monitor

14 LG DVD player 1 01/07/2009

15 LG VCR player 1 31/12/08

C. FURNITURES

1 Computer table 2 2006; 1 from comp lab

2 Multipurpose cart 1 w/ 4 drawers

3 Multipurpose cart 1 w/ 7 drawers and holders

4 Conference table 1 2006

5 Swivel chairs 21

6 Manual Bed w/ mattress 1 from Funda lab; to MS lab

7 Bedside table 1 from Funda lab

8 Filling trolley 2 29/10/07; 01/11/08 from classroom

D. OTHERS

1 Bed cover blue 2 11/11/2007; 1 from Funda 01/11/08

2 Bed sheet blue 7 6 2007; 2 old; 1 to MS lab

3 Pillow case 2 11/11/2007

4 Gown blue 1 11/11/2007

5 Bath towel white 2 11/11/2007

6 Face towel white 2 11/11/2007

7 IV stand 2 new 1 placed on 19/08/2009

8 Nursing Education Modules 5

9 Wall Painting 2 2006


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Reviewed 2010


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