265CHAPTER 22

Preparing Prelicensure Nursing Students for Clinical Practice in Pediatric Acute Care Settings and Interprofessional In Situ Simulation

Maureen M. Ryan and Melissa Holland

A. IMPLEMENTATION OF SIMULATION-BASED PEDAGOGY IN YOUR INDIVIDUALIZED TEACHING AREA

Within the collaborative curriculum at the University of Victoria (UVic), pediatric theory is taught in the classroom and psychomotor skills laboratory and applied in a variety of community and inpatient settings in the first 2 years of the program. However, more than two thirds of the student population do not have the opportunity to practice “hands-on” nursing care in acute care pediatric units before entering clinical practice in their senior year. As nursing education continues to evolve, there is the ongoing question as to whose responsibility it is to support preparation for nursing within specialty areas—academia or practice (Campbell & Lloyd, 2005; Chua, Mackey, Ng, & Liaw, 2013; Rosser, 2015)?

A partnership was developed between the faculty at the School of Nursing, UVic, and the nurse leaders at the Island Health Authority (IH), Vancouver Island, British Columbia, to address a mutual concern—how to prepare senior nursing students for acute pediatric nursing care? In our setting, twice a year, our generalist pediatric unit at Victoria General receives prelicensure nursing students who have transitioned into semiindependent practice practicums; students work under direct supervision of a staff nurse, following the nurse’s shift pattern, and are assessed by a clinical instructor from the university who meets with them after each set of shifts to evaluate their progress.

Simulation pedagogy has been integrated into our pediatric clinical placements with low-fidelity simulation as a key tool for transitioning to this specialty area. High-fidelity simulation is then used as part of the evaluation process as the semester progresses, which sets the students up for successful participation in interprofessional simulation experiences that take place in situ within the pediatric and pediatric intensive care unit (PICU) settings at Victoria General Hospital (and described in Chapter 48). UVic School of Nursing created my (Maureen Ryan) faculty position clinical simulation coordinator responsible for instilling simulation pedagogy in the BSN curriculum. I (Maureen) am a certified trainer providing simulation training, support, and evaluation to a team of clinical instructors including Melissa Holland (coauthor) in the prelicensure program. In addition, simulation learning events in clinical practice are situated within the Canadian Association of Schools of Nursing (CASN; 2015) guidelines for 266simulation and clinical practice and meet the International Nursing Association for Clinical Simulation and Learning (INACSL) Standards of Best Practice: Simulation^SM from recommended design standards through to participant evaluation and professional integrity (INACSL, 2013/2016).

C. SPECIFIC OBJECTIVES, INTRODUCTION OF SCENARIO, AND RUNNING OF THE SCENARIO

Low-Fidelity Simulation—Orientation

Before entering practice on the pediatric in-patient units, there is an expectation of students’ self-directed review of introduced pediatric theory and skills in years 1 and 2 before participating in a low-fidelity simulation learning event for a “hands-on” review of pediatric nursing practice. We use a multipurpose clinical teaching space with a crib rolled in to facilitate a clinical setup. As much as possible, hospital pajamas, linens, and basic supplies are used to support familiarity with products used within the clinical setting, depending on the age and stage of different pediatric patients. Our orientation events focus on concepts that will require critical thinking to transfer knowledge from previous adult settings to the unique pediatric setting.

Learning Objectives

1.  To review senior nursing students’ psychomotor skills and family-centered care practices

2.  To orientate and ensure senior nursing students’ readiness for pediatric practices in a semi-independent role at IH

Each session commences with a review of the room setting, equipment, learning objectives, and participant expectations. We use formative assessment and corrective learning as emphasized during debrief.

Scenario

“You have been working with a 6-year-old patient with significant stomatitis, which has made it difficult for her to maintain adequate oral intake. She has no underlying comorbidities, and has been ordered an intravenous (IV) line to be started for maintenance fluids and antibiotics.”

The student describes the steps for preparation and communicates with the low-fidelity human patient simulator (LFHPS). The instructor gives a developmentally appropriate response, which usually would include a refusal by the patient, because of the unknowns or anticipated pain. The student needs to work through how to proceed (e.g., hands-on site assessment, limb positioning, therapeutic hold, and communication with a child) alongside consideration of what supports (resources or personnel) he or she may need to enable the best outcome for this patient, including having family members present at the bedside. As part of the debriefing, the instructor offers additional learning to enable best practices in pediatric nursing and policies shaping pediatric nursing at IH.

High-Fidelity Simulation—Midsemester Evaluation

Within the 6 weeks of their clinical practice, we evaluate prelicensure nursing via a series of six high-fidelity simulation experiences. Students are expected to review the scenario descriptions before attending the learning event, including recommended prebrief reading.

Learning Objectives

1.  To evaluate student’s ability to successfully demonstrate progress in meeting the leveled entry-to-practice competencies as outlined by the College of Registered Nurses British Columbia (CRNBC; 2015) and provide feedback on how to successfully meet those leveled competencies by the end of term

2.  To assess student readiness for interprofessional team practice following the National Interprofessional Competency Framework (Canadian Interprofessional Health Collaborative [CIHC], 2010) evidenced by demonstrated scope of practice and role identity alongside team communication in an urgent situation

Setting the Scene

These simulations are either run within our clinical simulation lab facilities or use mobile high-fidelity simulation equipment available within the pediatric clinical area. In the next section, we provide an example of one of six required simulation learning events. Exhibit 22.1 lists the required resources needed to run the scenario.

F. PRESENTATION OF COMPLETED TEMPLATE

Ideally, a technician or second instructor is available to assist in simulation progression by playing the role of the patient and operating the high-fidelity human patient simulator (HFHPS) via a progression chart outlined in Exhibit 22.2. The instructor is free to attend to the simulation progression and complete the Exhibit 22.3 assessment checklist. One student will play the role of the parent and is given the Exhibit 22.4 cue sheet. Before launching the learning event, the instructor reviews the equipment, setup, and learning objectives (INACSL, 2013/2016).

A reflective practice narrative on the scenario may be added as needed. The reflective practice narrative asks the student to reflect on the learning event from an experiential standpoint, and then locate the experience in the larger context of evidence-based practice with a view to shaping entry to practice competencies.

I. EXPERT RECOMMENDATIONS AND WORDS OF WISDOM

Moving from simple simulation to strategically introducing more complex situations, the student ultimately joins the interprofessional in situ simulation described in Chapter 48. This allows prelicensure students to apply their learning in a way that naturally engages them with their clinical environment. Several adaptations to our approach include the use of a pre- and posttest administered to assess student knowledge before simulation and following simulation to assess knowledge base and gain. We are currently implementing that strategy using the National Council Licensure Examination (NCLEX; newly introduced in Canada) and mapping student readiness for licensure examinations. Mentioned in our introduction is the challenge we have in accessing a pediatric acute care placement for all of our nursing students before licensure examinations. We plan to pilot a simulation laboratory experience offering the six scenarios to students who will not “practice” in the clinical area but may participate in the interprofessional simulations and have an opportunity for “hands-on” application of knowledge of pediatric nursing.

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