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CLINICAL: Maternal Newborn Clinical Simulation

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CLINICAL:  Maternal Newborn Clinical Simulation

 

Construct: Holism, Safety, Diversity and Culture

Macro concept: Family Care

Micro concepts: Professional Integrity, Physiological Integrity, Psychosocial Integrity

Curricular concepts: Care Competencies, Physiological Homeostasis & Regulation, Protection and Movement, Psychosocial Homeostasis & Regulation, and Coping, Stress, Adaptation

Exemplar: Therapeutic & Professional Communication, Quality & Safety, Teaching & Learning, Comfort

 

Purpose of Learning Activity: Care for patients in the in the maternal newborn setting.

PSLO #7 Practice holistic, evidence-based nursing care including diverse and underserved individuals, families, and communities.
Course Outcomes:  #6: Reflect on personal and professional actions based on a set of shared core nursing values.

#9: Provide safe, holistic client- centered nursing care in promoting health across the lifespan.

 

General Objectives:

  1. Based on a scenario in the maternal newborn setting, utilize group process to organize nursing assessments and interventions using a Clinical
  2. Utilize effective communication while communicating with a patient & support person(s) and members of the health care
  3. Demonstrate compliance to all universal competencies, ensuring safety.
  4. Demonstrate the application of psychomotor skills (focused assessments) for the efficient, safe, and compassionate delivery of patient care (competency 7j).
  5. Provide education based on assessment data.
  6. Safely administer interventions.
  7. Document on an electronic health record.

 

Specific Simulation Objectives:

Intrapartum:

  1. Identify a fetal monitoring strip that corresponds with adequate fetal oxygenation.
  2. Implement nursing interventions to promote fetal oxygenation.
  3. Provide emotional and physical support to a pregnant patient during delivery of the newborn and placenta.

 

Newborn:

  1. Perform a full assessment of the newborn following delivery, including an APGAR score.
  2. Implement nursing interventions for the newborn following delivery.

 

Postpartum:

  1. Promote maternal/newborn bonding and breastfeeding.
  2. Perform focused assessments (BUBBLE-HE) on the postpartum patient.
  3. Implement nursing interventions when caring for a postpartum patient.

 

Day of Simulation: 

  1. Students are to arrive professional in appearance including uniform, stethoscope, watch, and black pen.
  2. Students to bring the following information on medications: Oxytocin, Acetaminophen, Hydrocodone-Acetaminophen, phytonadione (Vitamin K), Erythromycin ointment.
  3. Pre-Briefing (60 minutes)
  4. Students will be divided into groups. Each group will be assigned a client to care for. Students will review the electronic medical record of their designated client and complete the Clinical Worksheet incorporating assessments and interventions they will do throughout their shift. Look up assessments, interventions, labs, and diagnostic tests that you are unfamiliar with.
  5. Students to review medications per the client’s MAR. Bring the following Medication Handouts or, as a group, you will complete the table below:
    1. Butorphanol
    2. D5 Lactated Ringers
  • Vitamin K injection
  1. Erythromycin ointment
  2. Acetaminophen
  3. Acetaminophen with oxycodone
  • Lactated Ringers with Pitocin
  • Colace
  1. Bisacodyl
  2. Globulin, Immune RhO (D)
  1. Groups will each respond to questions from the faculty on their client prior to the simulation.
  2. Simulation (30 minutes)
    1. Students will be divided into roles which will include nurses and observers.
    2. Observers will be expected to remain quiet during the simulation, allowing the nurses to critically think through the simulation.
    3. Students will then perform the simulation, including documentation.
  3. Debriefing (30 minutes)
    1. Students will provide feedback regarding their experience.
    2. Students will draft a review of a surprising idea that occurred to them during the simulation and the impact of the simulation on their future nursing career.
  4. Post-Debriefing:
  5. Confidentiality is required for all simulations to maintain integrity of the experience and respect for others.

 

Simulation Reflection Paper Rubric

Simulation Reflection is a tool which enables the individual enhance the further development of skills through the conscientious and strategic reflection of their experiences and knowledge.

Directions: Based on your simulation experience today, please comment on the following criteria in 250-300 words on a separate document then submit to the D2L Assignment Drop Box for this simulation.

Criteria 1 Point 0 Point
What was your most powerful learning moment? Why?

 

Comments on the simulation experience are insightful. Sentences are complete and include detail. Comments lack insight into the experience.

Makes little to no effort to include details. Sentences are not complete

What did you learn about yourself in this experience?

 

Comments on the simulation experience are insightful. Sentences are complete and include detail. Comments lack insight into the experience.

Makes little to no effort to include details. Sentences are not complete

How will you use what you learned in the future? Comments on the simulation experience are insightful. Sentences are complete and include detail. Comments lack insight into the experience.

Makes little to no effort to include details. Sentences are not complete

 

Maternal/NB Simulation Checklist
Simulation type: Health Promotion following Labor & Delivery
The Evaluation Checklist based on MANE Constructs      M= met expectations         U= unmet expectations
  Professional Development and Identity M U    
  Identification of self as a Student Nurse      
  Uses language/terms that follow accepted professional standards      
  Collaborative Practice (Communication) M U    
  Communicates verbally & non-verbally in professional manner to both the patient, family &/or co-nurse caregiver utilizing therapeutic & effective communication      
  Incorporates the teaching/learning principles as appropriate      
  Safety (Universal Competencies) M U    
  Sanitizes hands before direct contact with patient; uses Infection Control equipment      
  Verifies patient name/DOB initially      
  Protects the patient at all times, e.g., side rails raised when indicated; bed left in low position; call light in reach      
  Utilizes proper body mechanics throughout      
  Implements all Rights and 3 checks of medication administration, if applicable      
  Uses safe technique with all equipment, e.g., oxygen      
  Holism M U    
  Lifestyle patterns and habits that maintain healthy living are stressed, e.g., safety, social support, health practices, social, stress management, rest, exercise, etc.      
  Documentation/Informatics (EHR, information technology) M U    
  Documents orders, assessments & interventions in an expedient/efficient manner      
  Evidenced-Based Practice & Quality Improvement (Assessment, Interventions, Evaluation) M U    
  Performs assessments based on priorities   T         P       R         BP      O2 sat        Pain      
  Diversity and Culture M U    
  Utilizes effective approaches to meet the health and nursing needs of the

diverse intracultural variations of the patient and family, as applicable

     

 

 

 

 

 

 

 

 

APGAR Scoring (1 & 5 minutes post-delivery)
Sign/Score 0 1 2  
Appearance Blue/pale Body pink, extremities blue Pink  
Pulse Rate None < 100 >100  
Grimace None Grimace Cries  
Activity Limp Some Active  
Respiration Absent Slow/irregular Strong cry  
Total Score  
A score of 7 or above indicates a newborn who is in good health.

A score below 7 indicates a newborn who may need more immediate medical attention.

 

 

LATCH Score
Sign/Score 0 1 2  
L (Latch) Too sleepy or reluctant Repeated attempts to latch or suck; hold nipple in mouth stimulate to suck Grasps breast; lips flanged; tongue down; rhythmic sucking  
A (Audible Swallowing) None A few with stimulation Spontaneous & intermittent; spontaneous & frequent  
T (Type of Nipple) Inverted Flat Everts after stimulation  
C (Comfort) Engorged; severe discomfort; cracked; bleeding Filling; red; mild-moderate discomfort Soft; non-tender  
H (Hold) Full assist (staff holds infant to breast) Minimal assist (staff may initiate & mother takes over) No assist (mother able to position & hold infant)  
Total Score  
The total score ranges from 0 to 10; the higher the score, the more the chances of successful breastfeeding.

A LATCH score of 0–3 is regarded as poor, 4–7 as moderate, and 8–10 as good.

 

 

 

 

Google Images.com

 

 

https://www.fresno.ucsf.edu/pediatrics/downloads/edinburghscale.pdf

 

 

Clinical Worksheet
Student Nurse:                                                                                                               
Diagnoses: KWIPES with 1-Min. Safety Check

Tubes & Lines

· Oxygen (nares, O2 source, flow rate. Order rate)

· Feeding tube (source, label, irrigation set-up clean & dated)

· Abdominal tubes (site, dressing dated)

· Tracheostomy (suction catheters & extra trach tube readily available; sterile water & dressing dated)

· Foley (tubing dependent without loops, drainage bag below level of bladder)

· IVs (site inspection; tubing and correct solution)

 

Environment

Side rails, if necessary, bed in low position; call light in reach, pathway free of obstacles; assistive devices in reach, bedside tray & other items in reach)

Allergies:
Code Status:     Full          DNR            DNI                  POLST on file:   Y     N            Precautions:  Safety    Isolation           Fall Risk:  Y      N
Activity:   Ad lib    with 1        EZ Lift      Hoyer Lift          Gait aide:   Cane        Walker        Standby        WC           Repositioning:     Y      N
Diet:     NPO         Clear        Full         Soft        Regular        Other:                                   Daily Weight:     Y      N      Prior Weight:
Bath:    Partial      AM Cares      Bed Bath
Tubes & Drains:
Inter-Professional Team:
Organize your day by writing these tasks into the 0700-1300 schedule below (may use more than 1 time):

__ KWIPES      __ HTT         __ Accu-check        __ Hygiene/moisturize __ Tube check                      __ Labs/Imaging           __ROM              __Document

__ Goals          __ Weight   __ Fall Risk              __ Linen change             __ Meal/Hydration              __Therapy                     __CDB                 __ SBAR

__ VS/Pain      __ I/O          __ Braden Scale     __ Wound check             __ Ambulate or reposition __Check new orders   __Ankle pumps  __ Break

  0700 0800 0900 1000 1100 1200 1300
Assessments

 

 

 

 

 

 

           
Medications (scheduled meds and prn’s given)

 

 

 

 

 

 

           
Treatments

 

 

 

             
Oncoming Shift Report

 

Off-going Shift Report (ISBARR)

 

 

 

 

Drug Name Medications
  Pharmacological Action:

Therapeutic Use:

Medication Administration:

Contraindications/Interactions:

Complications:

Nursing Assessments/Interventions:

Evaluation of Medication Effectiveness:

Client Education:

  Pharmacological Action:

Therapeutic Use:

Medication Administration:

Contraindications/Interactions:

Complications:

Nursing Assessments/Interventions:

Evaluation of Medication Effectiveness:

Client Education:

  Pharmacological Action:

Therapeutic Use:

Medication Administration:

Contraindications/Interactions:

Complications:

Nursing Assessments/Interventions:

Evaluation of Medication Effectiveness:

Client Education:

  Pharmacological Action:

Therapeutic Use:

Medication Administration:

Contraindications/Interactions:

Complications:

Nursing Assessments/Interventions:

Evaluation of Medication Effectiveness:

Client Education:

  Pharmacological Action:

Therapeutic Use:

Medication Administration:

Contraindications/Interactions:

Complications:

Nursing Assessments/Interventions:

Evaluation of Medication Effectiveness:

Client Education:

 

 

 

Name Assessments/Interventions
   

 

 

 

 

 

 

 

 

 

 
 

 

 

 

 

 
 

 

 

 

 

 
   

 

 

 

 

 

 

 

 

 

 
 

 

 

 

 

 
 

 

 

 

 

 

 

 

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