week 7 simulation

Date:

Discipline:

Expected Simulation Run Time:

Location:

Sim Name:

Your Name: Target Learning Group:

Estimated Debriefing Time:

Guided Reflection Time:

2

© 2015, National League for Nursing. Adapted from Child, Sepples, Chambers (2007). Designing simulations for nursing education. In P.R. Jeffries (Ed.) Simulation in nursing education: From conceptualization to evaluation (p 42-58). Washington, DC: National League for Nursing.

This Simulation Design Template may be reproduced and used as a template for the purpose of adding content for specific simulations for non-commercial use as long as the NLN copyright statement is retained on the Template.  When used for this purpose, no specific permission is required from the NLN. 

Adapted from : © 2015, National League for Nursing. Adapted from Child, Sepples, Chambers (2007). Designing simulations for nursing education. In P.R. Jeffries (Ed.) Simulation in nursing education: From conceptualization to evaluation (p 42-58). Washington, DC: National League for Nursing.

Setting/Environment:

|_| ER

|_| Med-Surg

|_| Peds

|_| ICU

|_| OR / PACU

|_| Women’s Center

|_| Behavioral Health

|_| Home Health

|_| Pre-Hospital

|_| Other:

Simulator Manikin/s Needed:

Props:

Equipment Attached to Manikin:

|_| IV tubing with primary line

fluids running at |_| mL/hr

|_| Secondary IV line running at mL/hr

|_| IV pump

|_| Foley catheter |_|mL output

|_| PCA pump running

|_| IVPB with running at |_| mL/hr

|_| 02 |_|

|_| Monitor attached

|_| ID band

|_| Other:

Equipment Available in Room:

|_| Bedpan/Urinal

|_| Foley kit

|_| Straight Catheter Kit

|_| Incentive Spirometer

|_| Fluids

|_| IV start kit

|_| IV tubing

|_| IVPB Tubing

|_| IV Pump

|_| Feeding Pump

|_| Pressure Bag

|_| 02 delivery device (type)

|_| Crash cart with airway devices and

emergency medications

|_| Defibrillator/Pacer

|_| Suction

|_| Other:

Medications and Fluids: (see chart)

|_| IV Fluids

|_| Oral Meds

|_| IVPB

|_| IV Push

|_| IM or SC

Diagnostics Available: (see chart)

|_| Labs

|_| X-rays (Images)

|_| 12-Lead EKG

|_| Other:

Documentation Forms:

|_| Provider Orders

|_| Admit Orders

|_| Flow sheet

|_| Medication Administration Record

|_| Graphic Record

|_| Shift Assessment

|_| Triage Forms

|_| Code Record

|_| Anesthesia / PACU Record

|_| Standing (Protocol) Orders

|_| Transfer Orders

|_| Other:

Recommended Mode for Simulation:

(i.e. manual, programmed, etc.)

Student Information Needed Prior to Scenario:

|_| Has been oriented to simulator

|_| Understands guidelines /expectations for

scenario

|_| Has accomplished all pre-simulation

requirements

|_| All participants understand their assigned roles

|_| Has been given time frame expectations

|_| Other:

Roles/Guidelines for Roles:

|_| Primary Nurse

|_| Secondary Nurse

|_| Clinical Instructor

|_| Family Member #1

|_| Family Member #2

|_| Observer/s

|_| Recorder

|_| Physician/Advanced Practice Nurse

|_| Respiratory Therapy

|_| Anesthesia

|_| Pharmacy

|_| Lab

|_| Imaging

|_| Social Services

|_| Clergy

|_| Unlicensed Assistive Personnel

|_| Code Team

|_| Other:

Important Information Related to Roles:

Timing (approx.)

Manikin/SP Actions

Expected Interventions

May Use the Following Cues

0-5 min

Role member providing cue:

Cue:

5-10 min

Role member providing cue:

Cue:

10-15 min

Role member providing cue:

Cue:

15-20 min

Role member providing cue:

Cue: