1. Scenario Writing 101 Cheryl Feken Dixon RN MS
Assistant Professor of Nursing
Clinical Simulation Coordinator
Tulsa Community College

2. Goal of the Session
Describe resources available for identifying simulations applicable to the facility or educational needs
Discuss resources that facilitate the process for simulation writing
Identify tools needed for simulation writing
Develop a simulation

3. Resources Risk Management Team
Joint Commission (National Patient Safety Goals)
IOM
Hospital Education Department
Malpractice cases/Nurse Lawyers
Risk Management Teams are hospital-wide programs for the prevention, monitoring, and control of areas of potential liability exposure (patient and employees)
Your institutions RM team can be a wealth of ideas for near misses or common errors. The literature has already told us that those simulations that have been created based on true life events have more meaning to the learner
Joint Commission – resouce
Hospital Education Departments have a wealth of information. Individuals in the education department may be very aware of needs. Unit managers may identify learning needs for seasoned staff nurses as well as new graduates.
Malpractices cases and Nurse Lawyers also provide resources.

4. Resources for Simulation Ideas
Assess for unit needs or course needs
Essential experiences needed
Psychomotor skills
Education
Theory content
Case studies
Clinical experiences
Care plans
Journal articles
often include history, symptoms, lab values etc
Essential experiences –
High risk low opportunity - chest pain, poisoning in children, drug overdose etc.
Hospital units with a new or changed protocols

5. Resources to Guide the Process
International Association for Clinical Simulation Learning (INACSL)
Society for Simulation in Health Care
Simulation Innovative Resource Center (SIRC)
INACSL – mission statement is to promote and provide the development and advancement of clinical simulation and learning resource centers. This includes helping with collaboration, networking, mentoring etc
SSIR is a multi-disciplinary, multi-specialty, international society. Individuals from various arenas participate in this organization such as nursing, allied health paramedical personnel, physicians and industry to name a few
SIRC is an online e-learning site where individuals (states nursing faculty) can learn how to develop and integrate simulation into their particular environment. It provides 9 courses including designing and developing simulations, integrating concepts, debriefing and others 

6. Resources to Guide the Process
University of Miami
Laerdal
Meti
University of Miami – provides training & certification
Laerdal and Meti both have sites which provide resources. Meti does have an annual conference as well as a forum. Laerdal provides regional Simulation User Network meetings and has a forum as well.

7. Designing the Scenario
Determine Purpose
Knowledge acquisition/skills proficiency/critical thinking evaluation
Determine environment
Flow of the simulation
Participants
Type of manikin
Operation mode of manikin
Equipment requirements
Peer review/Revisions
Purpose – acquisition, evaluation
Environment – Acute, chronic, home health, long term care
Flow of simulation – what happens first, next desired performance, specific completion criteria, risks, complications, failure criteria
Participants – identify the roles, don’t put the participants in roles outside their own. Don’t make the nurse assume the role of a physician or respiratory therapist
Mode – on the fly or preprogrammed
Equipment – fidelity is paramount
Peer Review – have someone else review for content
Revisions – may want to make a few changes after the first time, but discourage changing them frequently.

8. Essential Assessment/Diagnosis Essential for developing
Identify what the participant needs to know
Essential for developing
Tool – writing the simulation
Determine outcomes/learning objectives
Level the experience appropriate for the participant
Evaluate participant’s current skill sets
Evaluate participant’s critical thinking
(Novice/Advanced Beginner/Competent/Proficient/Expert)
Assessment/Diagnosis – what are the participants struggling with on their unit. What new requirements are needed to be proficient in their job.
Plan – starting point
Specify the requisite skills participant needs to complete the simulation experience

9. Plan
Have to have a plan. Speaking from experience

10. Tool – writing simulation
Why use a tool
Organize thoughts
Outcome objectives & cognitive skills
Identify needs – for the mannequin, props for the room etc
Guide the set up
Guide the participant preparation
Scenario Planning Tool
Simulation in Nursing Education From Conceptualization to Evaluation
INACSL list-serve
Simulation User Network
A tool helps the writer stay focused; Leveled appropriately for the participant; what props are needed for the mannequin, props for the room etc.
Using the same format whom ever the participants are is beneficial since it helps to maintain some consistency, makes setting up easier - especially if the same individual is setting a variety of simulations for various education or professional groups.

11. Tool available from Laerdal

12. Identify Outcomes/Objectives
What do you want the participant to gain from this experience?
Leveled appropriately
Right mannequin
Right equipment
Recognize and manage post-operative complications
Administer blood products utilizing hospital protocol
Before you can begin writing you have to know what it is you want the participant (nurse, student, etc) to gain from this learning experience. Level the simulation appropriately. Simulations that are too difficult result in poor outcomes and negative experiences. Use the right kind of simulation mannequin.
Level 4: Plan may be to make sure students are safe with skills they have learned in previous semesters.
Correlate assessment data including vital signs and lab values
Recognize and manage symptoms of hypoxia.
Recognize and manage complications associated with hypoxia
Implement interventions to promote oxygenation

13. Cognitive Skills
What knowledge does the participant need to bring to this simulation experience?
Care of post-op client
Pain management
Pharmacologic and non-pharmacologic
What knowledge does the participant need to bring to this simulation experience?
Care of the client experiencing altered oxygenation, sterile technique, oxygen therapy, therapeutic communication

14. Critical Components Adequate preparation
Demeanor of the individual running the simulation the simulation
Debriefing at the conclusion of the experience

15. Getting Started

16. Writing and Programming a Scenario
Live Demonstration

17. Picking the Right Manikin for the Job

18. Vital Sim Capabilities
Variety of sounds with volume settings 0-9
Heart sounds - 8
normal, systolic & diastolic murmur, aortic stenosis, Austin flint murmur, friction rub, mitral valve prolapse,
Heart Rhythm – 24
Breath sound- 8
L and/or R lung
normal, course & fine crackles, pleural rub, pneumonia, rhonchi, stridor, wheezes, no sounds)
Heart Sounds: normal, systolic & diastolic murmur, aortic stenosis, Austin flint murmur, friction rub, mitral valve prolapse,
HR: SR w/Unifocal PVC’s, couplet PVC’s, multifocal PVC’s, VT very course, course, medium, fine to very fine, heart block 1st degree, 2nd degree type 1, 2nd degree type 2, 3rd degree

19. Vital Sim Capabilities
Bowel sounds - 4
Fetal heart sounds
Vocal sounds - 7
Breathing rate 0-60 in increments of 2
BP - increments of 2
IV therapy
Wound sets
Bowel sounds: normal, hyper, hypo, borborygmus, no BS,
Vocal sounds: cough, moan, vomit, SOB, scream, yes, no

20. Vital Sim Capabilities
Wounds
Secretions

21. Vital Sim Capabilities
Broken Bones
Ostomy

22. Vital Sim Capabilities
PEG Feedings
Head Injury

23. High Fidelity SimMan G3 SimMan istan MetiMan
SimMan
istan
MetiMan

24. References
Bremner, M., Aduddell, K, Bennett, D. VanGeest, J. The use of human patient simulators: best practices with Novice nursing students. Nurse Educator. 2006; 31(4):
Jeffries, R. A framework for designing implementing, and evaluating simulations used in teaching strategies in nursing. Nursing Education Perspectives ; 26(2):
Lamontagne, C., McColgan, J., Fugiel, L., Woshinsky, D., Hanrahan, R. Clinical simulation in nursing education. 2008; 4(1)
Seropian, M., Brown, K., Gavilanes, J., Driggers, B. An approach to simulation program development. Journal of Nursing Education ; 43(4) :