469CHAPTER 40
Cardiovascular Resuscitation: Code Simulation for Health Care Students
A. IMPLEMENTATION OF SIMULATION-BASED PEDAGOGY IN YOUR INDIVIDUALIZED TEACHING AREA
The interprofessional simulation in this chapter is ideal for nursing students in prelicensure baccalaureate, RN-to-BSN students, or graduate programs. It serves pharmacy, respiratory, or medical students and is appropriate for a professional development activity for health care professionals responding to cardiac emergencies. St. John’s College of Nursing in Springfield, Illinois, offers this simulation in the baccalaureate program to medical–surgical students during their penultimate semester in the program, after completion of two other medical–surgical courses spiraled in difficulty. The experience is near midterm so that the students can use their acquired knowledge and skills throughout the semester. Interprofessional students include year-three pharmacy students with year-two respiratory care students.
After earlier simulations it became apparent that realism and interprofessional skills, such as teamwork and communication, can be improved on by adding interprofessional students. With the complexity of care that surrounds hospitalized patients, the interprofessional team now often responds to cardiac or respiratory arrests, and these first responders need to be proficient in both basic life support (BLS) and advanced cardiovascular life support (ACLS). When students are prebriefed by faculty and come prepared, having studied assigned algorithms, much learning can be accomplished in the resuscitation simulations. Resuscitation situations for new graduates may be stressful as they often have limited opportunities to practice these skills in the clinical area before graduation. This simulation-based pedagogy allows evidence-based practice in a faculty-supported environment where students can gain confidence and learn from their actions, as well as by observing interprofessional peers.
B. EDUCATIONAL MATERIALS AVAILABLE IN YOUR TEACHING AREA AND RELATED TO YOUR SPECIALTY
St. John’s Health Sciences Library and Educational Technology Department is available on campus with student-friendly hours, expert library staff, and many online and printed resources related to ACLS. In preparation for the simulation, nursing students complete a classroom review of basic cardiac rhythms. Then, nursing faculty and students discuss 2 to 3 hours of theory content specifically reviewing the American Heart Association (AHA; 2015) guidelines for cardiac resuscitation and hold a practice code simulation early in the semester. Respiratory care 470students complete the ACLS provider course before this interprofessional education (IPE) and have additional prereading about cardiovascular resuscitation. Pharmacy students complete prereading, discuss resuscitation with their faculty for 1 hour, view interprofessional videos on BLS and ACLS, and then practice mini scenarios in class. The pocket-sized AHA (2015) Handbook of Emergency Cardiovascular Care for Healthcare Providers is organized in a quick-reference format and translates current science to practice. In the 2015 edition, pages 1 to 72 will be most helpful in preparing for cardiovascular resuscitation (AHA, 2015).
The AHA publishes several resources for advanced cardiac care that contain current ACLS guidelines, available through the Channing Bete Company site at http://aha.channing-bete.com. Another resource, the 2015 AHA Guidelines Update for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Part 1: Executive Summary provides an overview of the science derived from a recent comprehensive review by the International Liaison Committee on Resuscitation (ILCOR). The full report is available online at http://circ.ahajournals.org/content/132/18_suppl_2/S313 and discusses current practice evidence (AHA, 2015). An online option for AHA BLS and ACLS courses is available for health care practitioners who desire this method of learning.
In 2011, the Interprofessional Education Collaborative (IPEC) Expert Panel (2011) published Core Competencies for Interprofessional Collaborative Practice that directed competencies in four domains, including (a) values/ethics for interprofessional practice, (b) roles/responsibilities, (c) interprofessional communication, and (d) teams and teamwork. With these expectations, a continued need exists to develop and evaluate innovative IPE methods and to disseminate the results (IPEC, 2011).
St. John’s simulation laboratory has high-fidelity human patient simulators (HFHPS) from Laerdal, including an infant and a SimMan 3G that has features such as medication recognition, sweating, and cyanosis, and also some low-fidelity HPSs and static manikins. Interprofessional faculty plan the simulation experience with the lab coordinator, who assists with updating scenarios, technological strategies, realism, and provides picture labels of the resuscitation medications.
C. SPECIFIC OBJECTIVES FOR SIMULATION USAGE WITHIN A SPECIFIC COURSE AND THE OVERALL PROGRAM
1. Demonstrate the ability to efficiently care for a client requiring cardiovascular resuscitation.
2. Demonstrate the ability to effectively communicate with other health care professionals during emergency situations.
3. Apply teamwork competencies in a collaborative simulation activity to foster interprofessional team skills necessary to provide patient-centered care.
4. Collaborate with interprofessional partner(s) to promote safe medication administration.
5. Reflect on both individual and team performance improvement.
D. INTRODUCTION OF SCENARIO
Setting the Scene
This simulation represents one of the 12 different scenarios used for the experience with the high-fidelity Laerdal SimMan 3G.
Objectives
Objectives for the experience are listed earlier. In addition, this scenario provides opportunity for students to safely practice key elements from the National Council Licensure Examination for Registered 471Nurses test plan (NCLEX-RN®) published in 2015 by the National Council of State Boards of Nursing (NCSBN). Categories and subcategories addressed in the simulation include:
Safe and effective care environment: Management of care (advance directives, advocacy, collaboration with interdisciplinary team, continuity of care, delegation, establishing priorities, ethical practice), Safety and infection control (accident/error/injury prevention, emergency response plan, error prevention, safe use of equipment/standard precautions); Health promotion and maintenance: Techniques of physical assessment; Psychosocial integrity: Coping mechanisms, support systems, therapeutic communication, therapeutic environment; Physiological integrity: Basic care and comfort, Pharmacological and parenteral therapies (adverse effects/contraindications/side effects/interactions, dosage calculation, expected action/outcomes, medical administration, parenteral/intravenous [IV] therapies), Reduction of risk potential (changes/abnormalities in vital signs, diagnostic tests, potential for complications of diagnostic tests/treatments/procedures, system specific assessments), Physiological adaptation (hemodynamics, fluid and electrolyte imbalances, illness management, medical emergencies, pathophysiology, unexpected response to therapies).
The landmark report by the Institute of Medicine (IOM) of the National Academies, The Future of Nursing: Leading Change, Advancing Health, recommends interprofessional collaboration through joint classroom and clinical education opportunities (IOM, 2010). This interprofessional simulation supports Essential VI: Interprofessional Communication and Collaboration for Improving Patient Health Outcomes from The Essentials of Baccalaureate Education for Professional Nursing Practice published by the American Association of Colleges of Nursing (AACN; 2008). Essential VI further states communication and collaboration among health care professionals are critical to delivering high quality and safe patient care (AACN, 2008).
Technology Used
An HFHPS, cardiac monitor, and defibrillator are used. Audiovisual equipment allowed observation from a nearby room that also had a flip chart with scenario information and patient assessment data printed at the front of the room.
Description of Participants
Interprofessional students rotate using the given scenario along with other scenarios that facilitate learning by both participation and observation on audiovisual screen projection in a nearby room. Student participants rotate to different roles within the simulation, ones that they have not done previously. The nursing students maintain roles of code leader as this aligns with practice in our clinical settings. If students are not participating, they are observing. Roles include airway/respiration management, chest compressions, medication administration, cardioversion/defibrillation/pacer, recorder, safety observers, an experienced nurse portrays a family member. Alternating roles allows practice and understanding of each role while facilitating teamwork and communication. Before the scenario, each student is given a card that highlights important role functions. Cards are rotated to the later students as they move to the subsequent role and list pointers such as:
Team leader: Coordinate everyone. Watch patient, monitor, and staff; collaborate with staff asking for confirmation about completed interventions if not communicated by team members.
Recorder: Note age, assessment information, cardiopulmonary resuscitation (CPR) starts and stops, medication, cardioversion and defibrillations settings and clearing.
Defibrillation/cardioversion: Do not delay if defibrillation is needed. Defibrillation uses no “synch.”
Medication administration: Open syringe from the bottom; flip yellow caps and screw together; check all medication rights, including right medication for the right patient assessment and algorithm.
Airway and respirations: Perform 30 compressions and two respirations until the advanced airway is inserted; then, deliver 1 breath every 6 seconds. If a pulse returns, check to see whether the patient is breathing. Remove oxygen from the immediate area of defibrillations/cardioversions for fire safety.
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