Pediatric Competency Development Bridget Mudge, RN, MS Judy Kertis RN BSN Pediatric Clinical Nurse Specialist

Objectives Determine didactic content Creating scenarios Integrating core practice issues in to simulations Evaluating performance

OVERVIEW: Pediatric 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.

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)

Complex skills or infrequent skills ( Chest tubes) Orientation 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 Uses Add National Safety Goals: Medication safety. Patient Identification. Clinical Alarms. Verbal Orders. Critical Labs.

PROGRAM COMPONENTS: Pediatric Nurse Residency Web-based: Pediatric intensive-care course developed by Indiana University (http://original-oncourse.iu.edu).

WEB-BASED LEARNING MODULES: PEDIATRIC CRITICAL CARE Psychosocial Renal/Endocrine Respiratory GI Cardiovascular Neurology Multi-system Comfort Hematology/Oncology Immunology

COMPONENT OF PROGRAM: DIDACTIC 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: DIDACTIC 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: DIDACTIC 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: DIDACTIC Trauma Care. PICU Specific: Ventilators, EKG monitoring, Defibrillator, IV Therapy, Vasoactive Medications, ICP, Hemodynamic Monitoring.

SIMULATIONS: Simulation Development Who, What? Sample: Airway Management. RSV.

Simulations Seizures. EEG Monitoring. Responding to Medical Emergencies Documentation Admission Trauma Diabetes

Simulation 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 development RSV Review of standards and skills Isolation Room set up Nasal cannula application Patient Education

Simulation development Time out SBAR Team building

Securing lab and Sim Baby. CHALLENGES: Logistics: Ideal number of new grads. Schedule: Presenters. Preceptors around fixed classes. Securing lab and Sim Baby.

How complicated to make scenarios? Scenarios consistent? CHALLENGES: Simulation: How complicated to make scenarios? Scenarios consistent? Ideal class size?

CHALLENGES: What is best done in simulation? Responding to medical emergencies. Skin Care and Diabetic Education versus

Evaluation What are critical Clinical Behaviors? Objective information Experts evaluate Final Simulation = Integration of skills Pass / Fail

Increased proficiency and accuracy with technical skills. 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 Residents

Global Scores for Pediatric Residents

Utilizing a nurse residency program provides: 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.