SLIPPS Sim

SLIPPS
Simulation Scenario 4
Emergency Assessment
Booklet
Scenario 4 Emergency Assessment by SLIPPs Project Team is licensed under

a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License. Based on a
work at https://www.slipps.eu/. Permissions beyond the scope of this license may be available
at https://www.slipps.eu/..
1
Contents
1. Good Practice – Emergency Assessment ............................................................................................ 3

2. Good Practice – Emergency Assessment (Student Guidelines) ........................................................ 13
3. Debriefing Sheet ............................................................................................................................... 15
4. SLIPPS feedback Sheet ...................................................................................................................... 17

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1. Good Practice – Emergency Assessment
SCENARIO GOOD PRACTICE: EMERGENCY/Primary Health Care Teacher template
Scenario 4 Emergency
Target group Advanced nursing and paramedic students: last semester and Large group Small group Assessment bySLIPPs Project Team is
medical students licensed under a Creative Commons
max 10 Attribution-NonCommercial-ShareAlike
OR 4.0 International License.
Based on a work
Multi-professional team from HCO at https://www.slipps.eu/..
Permissions beyond the scope of this
license may be available
at https://www.slipps.eu/.
Theme EMERGENCY/Primary Health Care --- Good practice. How to prevent hazard? IDEA IS, THAT STUDENTS FIND A WAY TO PREVENT HAZARD.
Expected Technical learning outcomes:

learning
outcomes 1. The students are able to do systematic examination of patient: primary assessment (A,B,C) and advanced patient assessment (A,B,C,D,E)
2. The students are able to evaluate status of the patient and make working diagnosis and start right treatment.
Scenario 4 Emergency Assessment by SLIPPs Project Team is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0
International License. Based on a work at https://www.slipps.eu/. Permissions beyond the scope of this license may be available
3
Non-technical learning outcome:
1. The students are able to communicate effectively (use of ISBAR (Identify, Situation, Background, Assessment, Recommendation), repeat back, give
clear instructions) with team and patient.
Based on Teaching / Instruction Literature
Standards of Best Practice: Simulation
This simulation is a part of studies: INACSL Standards of Best Practice: Simulation SM
Patient safety in Nursing Care Simulation Design
Emergency Nursing Care INACSL Standards Committee. Clinical simulation in nursing 2016.
Ministry of Social Affairs and Health. Patient and client safety strategy. 2017.
CRM key points. Rall & Gaba in Miller, Anesthesia, 6 th Edition. 2005
Variation and adaptation: learning from success in patient safety-oriented simulation training.
Dieckmann et all. 2017
Time frame Briefing: 15 min: Simulaton: Recommended time for this is Debriefing: max 45 min
15 – 20 min
 describe the structure of
simulation
 to get familiar with
simulator, environment,
medical devices
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Participants Student roles: Teacher roles: Any other roles:
participants: three nursing students: 1. triage, 2.nurse Facilitator/Defriefer: the leader of simulation Technical personnel who control simulation
I, 3. nurse II and doctor (=teacher) programming: is available, if there occurs any
technical problems
observers/peer learners: 6 Co-debriefer: programs vital functions to
patient monitor..
Standardised patient: one of students
Practical Tasks/to-do-list: Preparation of simulator / patient and Available equipment:

preparations environment:
- Before simulation The preparations that must be made for A&E equipment
- Order rooms/ facilitators simulator and room to be realistic in relation to
- Order technical and / or technical assistance the scenario: Supported documents: patient files, lab results, x-
from the skills center / facilitators rays, electrocardiograms
- Inform the students about the scenario well environment: A&E and equipment
ahead of time/ facilitators student-guideline Suitable clothes for participants, standardized
- Prepare the simulator and room/ facilitators Supported documents: patient files, lab results, patient and doctor
and technical personnel x-rays, electrocardiograms
- -Make sure that the students are familiar with
Makeup to standardised patient
the simulator/ facilitators
- -Clean up after completion of scenario/
participants, facilitators, technical personnel
Case Situation, when scenario begins:

A patient arrives in the first aid room at primary health care unit during morning shift and tells the nurses about a sensation in their chest and their poor
condition. The patient is not in any pain. The patient has been advised to come to primary care`s first aid room by the primary health care centre, where
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the patient had previously been waiting to see a doctor. The patient had not been examined in the primary health care center. He was just made to sit
and wait for a doctor. The patient has a history of alcohol abuse and a week-long bender had ended just last night.
Briefing Participants Peer learners/ observers
The preparation takes place in a simulation room The observers will sit in their own room and
together with the facilitators. It is important that the look at the simulation that is transmitted
players have familiarized themselves with the digitally. Facilitator controls sound and image
simulator before the simulation starts transfer. It is important that it is emphasized
to the observers that it is not allowed to tape
The participants are briefed in: (it could be also or record the sequence
before this phase)
- case and learning outcomes
- equipment
- estimated duration
- debriefing
- distribution of roles
- any audio / image transfer
When recording audio / video, the participants

must give permission with signature
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During the FACILITATORS ROLES
simulation
1. Facilitator/Debriefer: the leader of simulation
2. Co-debriefer: doctor (=teacher):

A doctor does not dare to make a decision to start thrombolysis.
Technical personnel who control simulation programming: programs vital functions to patient monitor: expected physiological changes:
Breathing:
Airway: open
Rate of breathing: 20/ min, shortness of breath
Breath sound: clear, symmetric
Work of breathing: normal
Oxygen saturation: 97%
Circulation:
Rate of hearth beat: 112 / min
Blood pressure: 170/105
Periphery: palm cool
ECG: ST elevation
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Other:
GCS= Glasqow coma scale 15
B-gluc: 7,0
VAS, visual analog scale (pain) 0
Weight / length: n. 63 kg /n. 165cm
Temperature: 37 ° C
OPERATOR ROLE Here you can remove this heading if there is no operator in this scenario
Expected observations and actions from the Response Operator: Current input for dialogue:
participants:
introduce themselves to patient Response Operator: Current input for dialogue:
identify patient Here is presented the role the operator should Prompts: ISBAR (Identify, Situation, Background,
play in relation to the participants' progress Assessment, Recommendation)
ABC
Here you will also find current programming of Primary assessment: ABC (Airway, Breathing,
ABCDE + treatment simulator(manikin)  look at During the Circulation)
contact doctor simulation
Advanced patient assessment: ABCDE (Airway,
Breathing, Circulation, Disability, Expose)
ISBAR
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STANDARDISED PATIENT:
Expected observations and actions from the Response standardized patient: Current input for dialogue:
participants
Treatment: for example Arrives in the first aid room at
primary health care unit during morning
1. ABCDE shift and tells the nurses about a sensation

2. ECG
3. Oxygen in their chest, poor condition.
4. Iv-line: hydration
The patient is not in any pain.
5. Moving patient to central hospital
6. Thrombolysis The patient has been advised to come to
7. Soothing/calming. Telling patient,
primary care`s first aid room by the primary
what you are doing.
health care centre, where the patient had
previously been waiting to see a doctor. The

patient had not been examined in the primary
health care center.
He was just made to sit and wait for a doctor.
The patient has a history of alcohol abuse and

a week-long bender had ended just last night.
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After 5 minutes the patient will start to be short
of breath.
Patients`script: abuse of alcohol
Debriefing: Descriptive phase: Analyzing phase: Take home message:
WHAT HAS TO BE First thank participants and remind of zero tolerance Analyzing phase: Summary of lessons learnt
DEBRIEFED? on rude comments
FACLITITATORS During this phase, students will reflect on and During this phase, students will identify what they
SHOULD DECIDE • The roles of facilitators: The debriefer and co- analyze the actual simulation. Knowledge, learned from the simulation, how this knowledge
debriefer attitudes, assessments and interaction are can be further used and what they may learn more
IT BEFORE
• Remind: aims of debriefing, confidentiality, discussed in relation to learning outcomes. about. Questions that you can ask students in this
DEBRIEFING.
present the structure of debriefing Questions that you can ask students in this phase may be wise to have written here.
FACILITATORS Descriptive phase:
CAN TAKE phase may be wise to have written here
MAXIMUM 2-3 During this phase of the debriefing, students will
MIN TO DECIDE describe what actually happened during the actual
THIS. simulation. The purpose is to create a common
• Thank participants and remind about
understanding of the course of events.
confidentiality
The participants must first express themselves and
then any observers and standardized patient.
This should not be an evaluation of the participants.
Questions that you can ask students in this phase may

be wise to have written here
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Reflection Debriefing is focused on the individual case, here is room for more points related to the whole scenario:
WHAT HAS TO BE DEBRIEFED BASED ON LEARNING OUTCOMES/AIMS? FACLITITATORS SHOULD DECIDE IT BEFORE DEBRIEFING. FACILITATORS
CAN TAKE MAXIMUM 2-3 MIN TO DECIDE THIS.
For example:
Questions about predefined learning objectives?
Questions about learning as a team: communication?
Evaluation Here is a presentation of how it is intended to evaluate the simulation teaching plan:
• Any suggestions to develop this scenario?

– Participants? –Observers? –Other facilitators?
• What did facilitators learn?
PREPARING/DEVELOPMENT OF THE SCENARIO
Scenario Designers: Date of design: Modified by: Date for change:
Arja Sara-aho and Stina Ekman February 2019 Date last modified: 26.2.2019/ Arja Sara-aho
COMMENTS
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COMMENTS
Here are present current comments ahead of the scenario, such as logistics around the scenario
Here are also current comments following the scenario, such as evaluation results and improvement potential
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2. Good Practice – Emergency Assessment (Student Guidelines)
GOOD PRACTICE, EMERGENCY SCENARIO, STUDENT GUIDELINES
Target group: Advanced nursing and paramedic students: last semester and medical
students
This scenario in part of studies:
 Patient safety in nursing care

 Emergency nursing care
How to study for a simulation:
- ISBAR (Identify, Situation, Background, Assessment, Recommendation)

- CRM (crew resource management) = non-techical skills (leadership, decision
making, communication, team work)
- primary assessment (A,B,C = Airway, Breathing, Circulation)
- advanced patient assessment (A,B,C,D,E = Airway, Breathing, Circulation, Disability, Expose)
- Variation and adaptation: learning from success in patient safety-oriented simulation training.
Dieckmann et all. 2017
How to get ready for simulation-scenario-day:

Students
- have suitable clothes

- be there at time, those who are late cannot take part in simulation
Simulation scenario-day:
- always remember confidentiality

- be active
- support other learners
- no rude comments
- participants: after scenario: no communication at the end of the scenario until
everyone is ready for debriefing

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Observer-guideline:
- follow the scenario

- observation tool for observers:
- Observers concentrate to all preterminated learning objectives
-
o The students are able to do systematic examination of patient
o The students are able to evaluate status of the patient and make working diagnosis
and start right treatment.
o The students are able to communicate effectively
Remember, simulation is a good opportunity to learn in safe

environment.
Do perform simulation case as good as if this is a real nursing
situation.

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3. Debriefing Sheet
Structured and guided reflection based on “3D Model of Debriefing”:
o Defusing: to allow learners to “vent” emotions. To recap and clarify what happened
during the scenario. To conduct a needs analysis of objectives important to the learner.
o Discovering: to analyse and evaluate performance through reflection. To discover
mental models or rationale for specific behaviours through inquiry. To identify
gaps/matches between exiting and targeted mental models.
o Deepening: to apply lessons from simulations and make connections to clinical
practice.
o Summary: to review what was learned throughout the session.
Zigmont JJ, Kappus LJ, Sudikoff SN. (2011) The 3D Model of Debriefing: Defusing, Discovering, and
Deepening.
Seminars in Perinatology 35:52-58
Key questions
Descriptive phase:
1. How are you feeling now?
2. What were the positive actions? What went well?
3. Have you ever been in the same situation?
Analyzing phase:
4. What do you want to improve?
5. Would you do something differently?
6. Which implication this scenario could have on clinical practice?
Take home message:
7. What did you learn from this scenario?

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Please remember at the end: Tell participants, that they can leave their roles now and remind
them it is important to keep scenarios confidential so as not to influence the future learning
opportunities of other learners/students.

16
4. SLIPPS feedback Sheet
Simulation Scenario facilitator

Thank you for Using the SLIPPs scenarios and resource pack.
We value feedback to enable us to continually update and improve our resources.
Can you complete this short evaluation form and send it to contact@slipps.eu
Question Response
What went well in the classroom?
What did not go so well?
What do you think we could do to improve

our resources?
What were the students overall thoughts?
What did the students think could be

improved?
Many thanks

17

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Scenario 4 Emergency Assessment by SLIPPs Project Team is licensed under

1. Good Practice – Emergency Assessment ............................................................................................ 3

Scenario 4 Emergency Assessment by SLIPPs Project Team is licensed under

SCENARIO GOOD PRACTICE: EMERGENCY/Primary Health Care Teacher template

Expected Technical learning outcomes:

Based on Teaching / Instruction Literature

Standards of Best Practice: Simulation

This simulation is a part of studies: INACSL Standards of Best Practice: Simulation SM

Patient safety in Nursing Care Simulation Design

Practical Tasks/to-do-list: Preparation of simulator / patient and Available equipment:

Case Situation, when scenario begins:

Briefing Participants Peer learners/ observers

- case and learning outcomes

- any audio / image transfer

When recording audio / video, the participants

1. Facilitator/Debriefer: the leader of simulation

2. Co-debriefer: doctor (=teacher):

Rate of breathing: 20/ min, shortness of breath

Breath sound: clear, symmetric

Work of breathing: normal

Oxygen saturation: 97%

Rate of hearth beat: 112 / min

Blood pressure: 170/105

Periphery: palm cool

GCS= Glasqow coma scale 15

VAS, visual analog scale (pain) 0

Weight / length: n. 63 kg /n. 165cm

introduce themselves to patient Response Operator: Current input for dialogue:

Treatment: for example Arrives in the first aid room at

primary health care unit during morning

1. ABCDE shift and tells the nurses about a sensation

previously been waiting to see a doctor. The

He was just made to sit and wait for a doctor.

The patient has a history of alcohol abuse and

Patients`script: abuse of alcohol

Debriefing: Descriptive phase: Analyzing phase: Take home message:

This should not be an evaluation of the participants.

Questions that you can ask students in this phase may

Questions about predefined learning objectives?

Questions about learning as a team: communication?

• Any suggestions to develop this scenario?

PREPARING/DEVELOPMENT OF THE SCENARIO

Scenario Designers: Date of design: Modified by: Date for change:

GOOD PRACTICE, EMERGENCY SCENARIO, STUDENT GUIDELINES

This scenario in part of studies:

 Patient safety in nursing care

How to study for a simulation:

- ISBAR (Identify, Situation, Background, Assessment, Recommendation)

How to get ready for simulation-scenario-day:

- have suitable clothes

- always remember confidentiality

Scenario 4 Emergency Assessment by SLIPPs Project Team is licensed under

- follow the scenario

- Observers concentrate to all preterminated learning objectives

Remember, simulation is a good opportunity to learn in safe

Scenario 4 Emergency Assessment by SLIPPs Project Team is licensed under

Structured and guided reflection based on “3D Model of Debriefing”:

Scenario 4 Emergency Assessment by SLIPPs Project Team is licensed under

Scenario 4 Emergency Assessment by SLIPPs Project Team is licensed under

Simulation Scenario facilitator

We value feedback to enable us to continually update and improve our resources.

What did not go so well?