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NRP 6th Edition…Teaching the Course
Major problems with current NRP teaching methods - A “perfect” score does not help the learner. We often learn best from our mistakes. Simulation allows us to push learners to
fail in difficult situations and learn from these failures.
Failure should happen during training, NOT patient care
Instructor Requirements Each instructor watches the NRP Instructor
DVD and completes the post-test by January 1, 2012.
Beginning January 1, 2013, every instructor takes the online exam in the 2 years prior to renewal, at no cost.
Teach, or co-teach, 2 courses in 2 years
NRP Course Basics Lessons 1-4 and 9, minimum Everyone can practice and perform every
skill. NRP does not certify competence or change
legal scope of practice. Provider status is “renewed” every 2 years
NRP Course Revisions No separate provider and renewal courses Minimal lecture and no slides Students self-study the textbook and/or
DVD Students take the online exam prior to class
No more hard copy tests after Dec 31, 2011 Instructor:learner ratio = 1:3-4 learners
If your card “expires”??? The institution decides the employee’s fate
Provider Course Components Performance Skills Station for practice
Choose all or select skills based on student expertise
Integrated Skills Station for evaluation Required
Simulation and Debriefing for learning Required
Structuring of renewals - The one-person, quick check is an
inefficient use of instructor time and interferes with simulation and debriefing.
The “solo” NRP skills check-off The learner should be aware of his/her
expiration date and plan accordingly. Providing “solo” NRP skills check-offs is
NOT the instructor’s responsibility and IS NOT how we will conduct NRP skills check-offs at Cape Fear Valley.
Performance Skills Stations Reinforces cognitive learning
This is where you may choose to quiz the learner’s knowledge.
The learner practices or reviews hands-on skills with an instructor
When the learner feels confident in his/her skills, the instructor gives a short scenario that begins with the Equipment Checklist.
There is no scoring or grading. The Performance Checklist is used as a reference.
Simulation & Debriefing Now a requirement of the Provider Course Provides a safe setting for integration of
cognitive and technical skills, team communication, and patient safety
Confidentiality is essential for participation No one fails simulation and debriefing, but
this is where the learning happens!
The Art of Simulation
What’s wrong with how we have been doing things? We have fallen into the trap of “feeding”
too much information to learners With the loss of reality, we have a
tendency to let learners talk their way through scenarios
Are we doing them a favor by continuing this method? NO
Why simulation???? The more objective clues that we can
provide to learners, the more realistic the practice can be.
Hi-fidelity simulation requires… $$$ for purchase and maintenance Space for secure storage Staff who know how to run and maintain
the equipment Technical knowledge for problem-solving
Low-tech simulation methods…. moulage… Spray blood – make your own with red
fingerpaint, blue dishwashing liquid, baby oil
Meconium – pureed baby food Vernix – Eucerin with potato flakes Create the illusion, but don’t overdo it CLEAN UP!!!
How are WE going to do it??? Moulage…. Low-tech Video
How are WE going to do it??? Reorganized NRP teaching kits Moulage…no, but….
Red cloth = blood Green cloth = meconium Spray with water for wetness
If available, we will use a vacant warmer Simulated equipment panel – Simply NRP
How are WE going to do it??? Physiologic signs
Breathing, crying Tone HR – metronome O2 saturation
Preparing for effective simulation Supplies and equipment Physiologic feedback Team member orientation and role
designation Confidentiality Instructions and expectations
Supplies and Equipment Learners need to find the equipment and
handle it Learners perform the equipment check
using the Quick Pre-Resuscitation Checklist This will cue learners to be sure that they
have essential items.
Physiologic Feedback How will learners know the HR or if the
baby is breathing? We have to familiarize learners with how
we will be giving this information Information is not revealed until the learner
performs the appropriate assessment action and/or asks for the information
Team Member Orientation and Role Designation Let learners get to know each other Learners should wear visible nametags
with their designated role Important especially if filling a role outside
their normal Remind learners that acting in a role different
than their everyday role does not authorize them to perform skills outside their scope of practice in real life
Confidentiality – The Vegas Rule… Learners have the right to confidentiality and
confidence that scenarios will not be held against them in a punitive way
All events are confidential Protects the learner Protects the confidentiality of the scenario for use in
future classes
The events of simulation and debriefing are NOT part of the learner’s performance evaluation
Confidentiality – The Vegas Rule… Consent for filming If the exercise is filmed, the tape is erased at the
end of the course, unless the learner has given written permission for its additional use
Instructions and Expectations Learners need to know the “rules of the game”. Mistakes are acceptable!
The best learning may come from an error. The goal of simulation and debriefing is NOT
perfection….it is learning. Laughing and joking are not acceptable during
resuscitation…so, they are not acceptable during simulation!
The instructors NEVER trick the learners (ie. sabotaging the scenario)
Instructions and Expectations Learners need to think out loud.
Helps other team members and instructor know what they are thinking and why
Helps to promote a common “mental model” Learners need to actually perform the actions,
NOT simply say they are doing or would do something The exception to the rule is administration of fluid
and epinephrine. Draw up the med first. Then expel on bed linen and simulate administration.
Instructions and Expectations Everyone participates during a simulation. Team members may help each other in any
way that is plausible to the scenario. Communication and teamwork are
encouraged and expected! The instructor, NOT the learner, indicates
when the scenario has ended. “The scenario is over. Let’s debrief.”
Instructor Roles
What do I do as an instructor? It is difficult for one instructor to do
everything during a scenario. Instructor #1 – watch the scenario and
responses and give the physiologic cues Instructor #2 – video, take notes about
what happens and plan for debriefing Set video recorder on tri-pod
Conducting a scenario Learners benefit from participation in more
than one scenario. Once learners know the ground rules, begin
with a simple scenario. Then, progress to more complex scenarios that push learners outside their comfort zones.
Conducting a scenarioPreparation for the actual scenario Prepare the manikin with the appropriate
visual cues. Define instructor roles. Read the scenario. Allow learners to ask about relevant
perinatal history. Gestational age, fluid color, etc.
Conducting a scenario Allow learners to –
Designate roles – assign leaders and tasks Check supplies and equipment Ask additional questions if needed
Announce when the scenario has begun. Depending on the complexity of the
scenario, other “players” may be used to provide cues and enhance reality.
Conducting a scenario Once the scenario begins, stay out of the way as
much as possible. For complex scenarios, be prepared to answer
questions about information like confirmation of endotracheal tube placement and other resuscitation indicators.
DO NOT give hints or additional information beyond what learners must ask to assess the effects of their actions!
Conducting a scenario Allow learners to take the scenario down
the path they choose without interruption, coaching, or feedback.
Preparing for the debriefing Use the Scenario Template form to take notes.
Check off the interventions performed as they happen. Note unexpected occurrences. Pay attention to which behavioral objectives were met
and how that occurred. Video helps…the camera doesn’t lie!
Note which segments hold key information. Note the learners who are especially dominant or
submissive. This can effect the debriefing strategies you use.
Managing the unexpected Unexpected things can happen during a scenario
(ie. equipment dropped, med error, mental model not shared).
If this is an event that can happen in real life, learners should solve the problem.
If the scenario continues for a long time and drifts far off-track, the instructor may need to assess the need to end the scenario and debrief without successfully resuscitating the baby.
Managing the unexpected When a scenario problem or need for
redirection occurs, the instructor can send in a “confederate” to play a certain role for a specific purpose.
The “confederate” is not one of the learners participating in the scenario.
Examples of using a “confederate” A learner cannot stop giggling. So, the
instructor sends in the “baby’s grandfather” to remedy the situation by saying – “I’m this baby’s grandfather, and I’d like to know what is so funny. This looks like a pretty serious situation to me.”
Examples of using a “confederate” Some scenarios can be very complicated
and involve may players with a planned script. It is appropriate to have the “confederate” play a set role.
Ending a scenario End the scenario with an objective
statement like – “That ends your scenario. Let’s debrief now.”
The instructor does not end a scenario with a judgmental statement like – “That was great”. OR “Well, okay. We have a lot to talk about.”
Ending a scenario Is it okay for a scenario to end with the
baby’s death? Yes, if that is part of the learning objectives
or if there is an egregious error. NEVER to “punish” the resuscitation team
for errors made during the scenario.
Debriefing
Debriefing is the most challenging new skill for NRP instructors We’ve been taught to lecture and give feedback. New role is direction of a team-centered
discussion by asking open-ended questions. The learners will discover for themselves what
went well, what needs improvement, and how NRP Behavioral Skills impact the outcome.
Give input at the end of the discussion. Summary of main points, next steps,
acknowledgement of good efforts
Ready, Set, Go…. Review “Ready, Set, Go Instructor Prep
Sheet” and “Simulation Preparation, Tips, and Sample Debriefing Questions”
References Kattwinkel, J., Perlman, J.M., Aziz, K., Colby, C., et. al.
(2010). Special Report - Neonatal Resuscitation: 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Pediatrics, 126(5), e1400-e1413.
Zaichkin, J. (Editor). (2011). Neonatal Resuscitation: Instructor Manual. American Academy of Pediatrics.