Pediatric Competency DevelopmentPediatric Competency Development

Bridget Mudge, RN, MS Judy Kertis RN BSN

Pediatric Clinical Nurse Specialist

ObjectivesObjectives

• Determine didactic content

• Creating scenarios

• Integrating core practice issues in to simulations

• Evaluating performance

OVERVIEW:OVERVIEW:Pediatric Nurse ResidencyPediatric 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.

Didactic

Simulation Web Based

Clinical

Didactic

Simulation Web Based

Clinical

Orientation 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)

Orientation ContentOrientation 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 UsesSimulation Additional Uses

• Add National Safety Goals:

Medication safety.

Patient Identification.

Clinical Alarms.

Verbal Orders.

Critical Labs.

PROGRAM COMPONENTS:Pediatric Nurse ResidencyPediatric Nurse Residency

Web-based: Pediatric intensive-care course developed by

Indiana University (http://original-oncourse.iu.edu).

WEB-BASED LEARNING MODULES:WEB-BASED LEARNING MODULES:PEDIATRIC CRITICAL CAREPEDIATRIC CRITICAL CARE

Psychosocial Renal/Endocrine

Respiratory GI

Cardiovascular Neurology

Multi-system Comfort

Hematology/Oncology Immunology

COMPONENT OF PROGRAM:COMPONENT OF PROGRAM:DIDACTICDIDACTIC

• 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:COMPONENT OF PROGRAM:DIDACTICDIDACTIC

• 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:COMPONENT OF PROGRAM:DIDACTICDIDACTIC

• 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:COMPONENT OF PROGRAM:DIDACTICDIDACTIC

• Trauma Care.

• PICU Specific:

Ventilators,

EKG monitoring, Defibrillator,

IV Therapy,

Vasoactive Medications,

ICP,

Hemodynamic Monitoring.

SIMULATIONS:SIMULATIONS:

Simulation Development

• Who, What?

• Sample:

• Airway Management.

• RSV.

SimulationsSimulations

• Seizures.• EEG Monitoring.• Responding to

Medical Emergencies • Documentation• Admission• Trauma• Diabetes

Simulation developmentSimulation 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 developmentSimulation development

• RSVReview of standards and skills

Isolation

Room set up

Nasal cannula application

Patient Education

Simulation developmentSimulation development

• Time out

• SBAR

• Team building

CHALLENGES:CHALLENGES:

• Logistics:Ideal number of new grads.

• Schedule:Presenters.

Preceptors around fixed classes.

• Securing lab and Sim Baby.

CHALLENGES:CHALLENGES:

Simulation:

• How complicated to make scenarios?

• Scenarios consistent?

• Ideal class size?

CHALLENGES:CHALLENGES:

What is best done in simulation?What is best done in simulation?

Responding

to

medical

emergencies.

Skin Care and

Diabetic Education

versus

EvaluationEvaluation

• What are critical Clinical Behaviors?

• Objective information

• Experts evaluate

• Final Simulation = Integration of skills

• Pass / Fail

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 ResidentsPediatric Residents

Readiness for Practice Questionnaire

Pediatric Residents (n=4)

READY3READY2READY1

Me

an

90

80

70

Global Scores for Pediatric Residents

444444N =

GROUP

July

10

8

6

4

2

0

baseline global conf

idence

baseline global comp

etence

baseline global read

iness

final global confide

nce

final global compete

nce

final global readine

ss

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.