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Pediatric Competency DevelopmentPediatric Competency Development
Bridget Mudge, RN, MS Judy Kertis RN BSN
Pediatric Clinical Nurse Specialist
ObjectivesObjectives
• Determine didactic content
• Creating scenarios
• Integrating core practice issues in to simulations
• Evaluating performance
OVERVIEW:OVERVIEW:Pediatric Nurse ResidencyPediatric Nurse Residency
• 4 components.
• 16-week program.
• 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.
Didactic
Simulation Web Based
Clinical
Didactic
Simulation Web Based
Clinical
Orientation 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 ContentOrientation 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 UsesSimulation Additional Uses
• Add National Safety Goals:
Medication safety.
Patient Identification.
Clinical Alarms.
Verbal Orders.
Critical Labs.
PROGRAM COMPONENTS:Pediatric Nurse ResidencyPediatric Nurse Residency
Web-based: Pediatric intensive-care course developed by
Indiana University (http://original-oncourse.iu.edu).
WEB-BASED LEARNING MODULES:WEB-BASED LEARNING MODULES:PEDIATRIC CRITICAL CAREPEDIATRIC CRITICAL CARE
Psychosocial Renal/Endocrine
Respiratory GI
Cardiovascular Neurology
Multi-system Comfort
Hematology/Oncology Immunology
COMPONENT OF PROGRAM:COMPONENT OF PROGRAM:DIDACTICDIDACTIC
• 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:COMPONENT OF PROGRAM:DIDACTICDIDACTIC
• 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:COMPONENT OF PROGRAM:DIDACTICDIDACTIC
• 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:COMPONENT OF PROGRAM:DIDACTICDIDACTIC
• Trauma Care.
• PICU Specific:
Ventilators,
EKG monitoring, Defibrillator,
IV Therapy,
Vasoactive Medications,
ICP,
Hemodynamic Monitoring.
SIMULATIONS:SIMULATIONS:
Simulation Development
• Who, What?
• Sample:
• Airway Management.
• RSV.
SimulationsSimulations
• Seizures.• EEG Monitoring.• Responding to
Medical Emergencies • Documentation• Admission• Trauma• Diabetes
Simulation developmentSimulation 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 developmentSimulation development
• RSVReview of standards and skills
Isolation
Room set up
Nasal cannula application
Patient Education
Simulation developmentSimulation development
• Time out
• SBAR
• Team building
CHALLENGES:CHALLENGES:
• Logistics:Ideal number of new grads.
• Schedule:Presenters.
Preceptors around fixed classes.
• Securing lab and Sim Baby.
CHALLENGES:CHALLENGES:
Simulation:
• How complicated to make scenarios?
• Scenarios consistent?
• Ideal class size?
CHALLENGES:CHALLENGES:
What is best done in simulation?What is best done in simulation?
Responding
to
medical
emergencies.
Skin Care and
Diabetic Education
versus
EvaluationEvaluation
• 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 ResidentsPediatric Residents
Readiness for Practice Questionnaire
Pediatric Residents (n=4)
READY3READY2READY1
Me
an
90
80
70
Global Scores for Pediatric Residents
444444N =
GROUP
July
10
8
6
4
2
0
baseline global conf
idence
baseline global comp
etence
baseline global read
iness
final global confide
nce
final global compete
nce
final global readine
ss
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.