Incorporating simulation into nursing curriculum, as we have seen, can be challenging. Catherine Recznik wanted to meet the challenge of creating a pediatric simulation for her nursing students. As an experienced instructor and simulation educator, Recznik knows the value of simulation in healthcare education.
Recznik’s first steps were to perform a needs analysis and assess her resources.
First of all, Recznik had to determine that creating a multi-patient pediatric simulation would benefit students. What were the advantages to pursuing this course? She came up with five answers:
- Increased learning is observed when students have the opportunity to apply learned content
- It is increasingly difficult to find pediatric clinical placements
- Some clinical sites do not allow students to pass medications
- While individual simulation case studies are useful, too many students were only able to observe, rather than participate
- Ongoing course revisions lead to implementation of additional active learning strategies
Franciscan University has a simulation lab that serves a very high volume of students. At the time of initial design, Recznik had up to four of the current manikins available (although she had to get creative with one). Due to demands on students’ time, scheduling a simulation outside of classroom time was unappealing. Additionally, Recznik realized she was unlikely to be able to recruit another faculty member for a one-hour, in-class time experience.
The pediatric course that Dr. Recznik teaches is at the junior level, and junior students in Franciscan’s nursing program do not yet have IV or phlebotomy skills. In each class, there are between 25 and 30 students. Dr. Recznik is the only instructor, and there are no extra lab personnel. The goals included that all students get hands-on time in the simulation (i.e. no observers), the existing lab setup would only need minimal changes, and the simulation would be able to be run in the last hour of a four-hour class.
Participating in the Simulation
I participated in the simulation when Dr. Recznik ran it at the Simulation Alliance of Pennsylvania, Ohio, and West Virginia (SimPOW) October meeting. I was in a team of six people, most of them instructors at other institutions. As a writer, I asked to be the group’s recorder because it was the only role for which I was qualified. (Even then, I needed some help getting definitions for PMH [past medical history] and WNL [within normal limits].)
The SimPOW meeting had about 30 attendees, so Dr. Recznik broke us into groups: four parent standardized participants (SPs), four pharmacist SPs, and “students.” Each student had a defined role: one to record information, one to assess and monitor the patient (this can be two people if the group is large enough); one to perform diagnostic tests; one to administer any ordered meds/IVs; one to assess the airway and deliver any breathing interventions such as nebulizer treatments.
Because there were four manikins available, each group was exposed to different disease states. In addition, each of the simulators was a different age and gender (6-month-old male, 7-year-old female, 14-year-old female, and 16-year-old male). Each of the simulations was a pediatric respiratory emergency, with the simulated parents giving information and answering questions. The parents were provided with a written intro and instructions regarding signs and symptoms, past medical history, allergies, etc.
Our “patient” was the 14-year-old female; her parent named her Amelia. The manikin was mid-fidelity with breath sounds and a pulse in the right arm. The instructors on my team all seemed engaged in the scenario, crisply assessing, asking for meds and test results, and following up on the X-ray and lab results.
I was not only impressed with my team, though. In a room with four hospital beds and 30 people, I expected things to be a little chaotic, but I didn’t get that impression at all. Each team performed admirably and efficiently. Perhaps things are different with younger students, but on the other hand, perhaps the simulation is designed and run that efficiently!
Dr. Recznik says she has learned the following by designing this multi-patient simulation:
- Revise, revise, revise
- Time everything
- Take notes (“Actually read your notes!” she says)
- Revise again!
The goal, she points out is to “maximize student learning.” The current simulations within the pediatrics course include respiratory distress, abdominal pain, diabetic ketoacidosis, and critical care with anaphylaxis, pneumonia, and dehydration – but she wants to design others as she learns more.
Catherine Recznik, PhD, RN, CEN, CPEN is an Associate Professor of Nursing at Franciscan University of Steubenville. As a full-time faculty member in the nursing department, she works in a variety of fields, including instructing the pediatrics course, functioning as a clinical instructor, and performing general faculty duties. She also designs, implements, and administrates simulation lab experiences for all levels of nursing education.
This article is from “Innovations in Multi-Patient Pediatric Simulation,” which Dr. Recznik presented at the October 19, 2019, SimPOW meeting at Franciscan University of Steubenville. Image by Jayme Maley, Pocket Nurse Marketing Manager. Dr. Recznik, left, prepares a patient and a parent SP for the upcoming simulation scenario.