WELCOME TO THE CLINICAL CENTER GRAND ROUNDS,
A WEEKLY SERIES OF EDUCATIONAL LECTURES FOR PHYSICIANS AND
HEALTH CARE PROFESSIONALS BROADCAST FROM THE CLINICAL
CENTER AT THE NATIONAL INSTITUTES OF HEALTH IN
BETHESDA, MD.
THE NIH CLINICAL CENTER IS THE WORLD'S LARGEST HOSPITAL TOTALLY
DEDICATED TO INVESTIGATIONAL RESEARCH AND LEADS THE GLOBAL
EFFORT IN TRAINING TODAY'S INVESTIGATORS AND DISCOVERING
TOMORROW'S CURES.
LEARN MORE BY VISITING US ONLINE AT HTTP://CLINICALCENTER.NIH.GOV
>> GOOD AFTERNOON.
WE INVITE TO YOU PROVIDE
FEEDBACK BY SCANNING THE QR CODE
AND FOR THOSE WANTING CME YOU'LL
PROVIDE A LINK AND THE USE THE
FEEDBACK FOR THE PRESENTATION
AND QUESTIONS FOR THE SPEAKERS
WILL BE TAKEN FOR THE
MICROPHONES IN THE AISLES.
ADDITIONALLY, VIDEOCAST VIEWERS
MAY SCROLL DOWN AND CLICK THE
LIVE FEEDBACK BUTTON LOCATE ON
THE VIDEOCAST WEBSITE.
QUESTIONS WILL BE ANSWERED AS
TIME PERMITS AT THE CONCLUSION
OF THE PRESENTATION.
TODAY WE'RE PROUD TO PRESENT OUR
ANNUAL GRAND ROUNDS SPONSOR THE
CLINICAL CENTER NURSING
DEPARTMENT TO RECOGNIZE NATIONAL
NURSES MONTH.
THE PRESENTATIONS WILL FOCUS ON
SIMULATION TRAINING AND NURSING
AND HONORED TO HAVE MAYBEL GOMEZ
MEJIA AND DR. JENNIFER JABARA
AND EUGENA BERGVALL.
DR. GOMEZ IS A GRADUATE FROM
COLOMBIA.
AFTER COMPLETING HER RESIDENCY
IN INTERNAL MEDICINE CARDIOLOGY
SHE BECAME AN INSTITUTIONAL
CARDIOLOGIST AND THEN HELD
POSITIONS OF INCREASIE IIE IING
RESPONSIBILITY IN THE CRITICAL
CARE DEPARTMENT.
SHE'S CURRENTLY EARNING A
MASTER'S DEGREE IN EPIDEMIOLOGY
WITH THE SCHOOL OF HYGIENE AND
TROP TROP -- TROPICAL MEDICINE
AND FOLLOWING HER FELLOWSHIP AT
HARVARD SHE JOINED AS A CLINICAL
SIMULATION FACILITATOR.
DR. GOMEZ DEVELOPED AND
IMPLEMENT THE STRATEGIC ROAD MAP
FOR THE CREATION OF A CLINICAL
CENTER WIDE SIMULATION PROGRAM.
STANDARDIZING AND IMPROVING
CAPABILITIES WITHIN THE CLINICAL
CENTER AND HAS LED A FACULTY IN
THE DEVELOPMENT AND EXECUTION OF
16 HIGH FIDELITY TRAINING
INITIATIVES WITH FOCUS ON
INTERPERSONAL COLLABORATION AND
COMMUNICATION AND HER ACADEMIC
INTEREST IS IN COLLECTIVE
INTELLIGENCE AND DEBRIEFING IN
HEALTH CARE.
OUR SECOND SPEAKER, DR. JENNIFER
JABARA IN THE NURSING
PROFESSIONAL DEVELOPMENT
PROGRAM.
LIEUTENANT COMMANDER IN THE
PUBLIC HEALTH SERVICE SHE EARNED
HER BACHELOR'S OF NURSING AT
PENNSYLVANIA AND WORKED IN END
OF LIFE PEDIATRIC CARE AND
FAMILIES AND CHALLENGED PR
PRACTITIONERS FOR END OF LIFE
PLANNING AND WAS IN NURSING AND
HEALTH CARE LEADERSHIP PROGRAM
AT VANDERBILT.
IN ADDITION TO HER ROLE AS A
NURSE EDUCATOR AND PART OF THE
SIMULATION TEAM AMONG
RESPONSIBILITIES INCLUDE THE
COORDINATOR OF THE FUNDAMENTALS
OF NURSING RESEARCH NURSING
CURRICULUM, THE GENOMICS AND
GENOMICS AND GENETICS EDUCATION
PORTFOLIO AND COORDINATING JS
EDUCATING PROGRAM.
AS A U.S. OFFICER SHE HAS
UTILIZED SIMULATION AND HER
EXPERTISE IN HEALTH CARE
SIMULATION PREPARING FELLOW
OFFICERS FOR DEMANDING ROLES IN
THE FACE OF EMERGING INFECTIOUS
DISEASES OR NATIONAL DISASTER.
SHE'S A PROFESSIONAL LEADERSHIP
FELLOW AND A GLOBAL HEALTH
GRADUATE IN THE PROGRAM.
THE THIRD SPEAKER IS
DR. BERGVALL NEUROSPECIALIST IN
THE NURSING DEPARTMENT.
SHE'S A DISTINGUISHED ADVANCED
PRACTICE NURSE AND TRIPLE BOARD
CERTIFIED AS A CLINICAL NURSE
SPECIALIST AND HOLDING SPECIALTY
CERTIFICATIONS FOR CRITICAL CARE
AND NEUROSCIENCE NURSING.
SHE EARNED HER BACHELOR'S OF
NURSING AT THE UNIVERSITY OF
COLORADO AND NURSING PRACTICE AT
THE MARYLAND BALTIMORE AND
COMPLETING A POST-DOCTORAL
PROGRAM AT THE OHIO STATE
UNIVERSITY.
AS LEADER IN HER FIELD,
DR. BERGVALL DEVELOPED THE
NURSING EDUCATION SERIES AND
CO-DIRECT THE EBPFULLOSHIP
PROGRAM AND PUBLISH THE EPILEPSY
CHAPTER IN THE NURSING CORE
CURRICULUM AND WAS A CORE
CONTRIBUTOR TO THE FIRST
CERTIFICATION PROGRAM FOR
SEIZURE AND EPILEPSY
PROFESSIONALS.
SHE BRINGS AN OVER TWO DECADES
OF EXPERIENCE IN CLINICAL
NEUROSCIENCE AND CRITICAL TRAUMA
NURSING WITH 17 YEARS AT THE
BEDSIDE IN ICU IN GERMANY.
SHE HAS PUBLISHED ON EBP AND
TECHNOLOGY INTEGRATION.
SHE'S AN ACTIVE MEMBER OF
MULTIPLE NATIONAL NURSING
ORGANIZATIONS AND SERVING ON
SEVERAL NATIONAL COMMITTEES AND
FOUND BOARD MEMBERS OF THE
AMERICAN ASSOCIATION OF --
MARYLAND ASSOCIATION OF CLINICAL
NURSE SPECIALISTS.
TITLE OF TODAY'S PRESENTATION A
TRANSFORMING NURSING EDUCATION
AND PREPAREDNESS IN SIMULATION.
PLEASE JOIN ME IN WELCOMING OUR
SPEAKERS, DR. GOMEZ, DR. JABARA
AND DR. BERGVALL.
THANK YOU.
>> THANK YOU, EVERYONE FOR
HAVING US TODAY.
IT'S A REAL PLEASURE TO BE HERE
CELEBRATING THE NIH CLINICAL
CENTER NURSING DEPARTMENT
ACHIEVEMENTS IN RECOGNITION OF
THE SIMULATION PROGRAM.
WE WOULD LIKE TO TAKE YOU TODAY
ON A JOURNEY ESPECIALLY THIS
BEAUTIFUL FRIENDSHIP BETWEEN
NURSING EDUCATION AND
SIMULATION.
SO I HAVE TO TAKE YOU BACK IN
TIME AND REVIEW THE HISTORY OF
SIMULATION AND NURSING EDUCATION
TO UNDERSTAND THE PAST, TO
UNDERSTAND THE PRESENT AND
PREPARE FOR THE FUTURE.
DR. JABARA WILL TALK ABOUT
SIMULATION IN THE CLINICAL
CENTER AND DR. BERGVALL WILL
SHOW YOU THE BEHIND THE SCENES
USING SIMULATION.
SO TO START, I WOULD LIKE TO ASK
YOU ALL A QUESTION.
SO PLEASE LOOK AT THIS LADY, USE
YOUR CELL PHONES, SCAN THIS C.R.
QR CODE AND LET US KNOW WHO DO
YOU THINK THIS LADY IS?
THE FIRST PATIENT AT BELLEVUE IN
NEW YORK OR AMERICA'S FIRST
TRAINED NURSE OR YOU GOT IT.
THE AUDIENCE SAYS THIS IS MS.
CHASE.
THAT'S CORRECT.
SHE WAS THE FIRST SIMULATION
USED IN 1911.
SHE WAS DEVELOPED WHEN THE
PRINCIPLE OF THE HOSPITAL HERE
IN THE PICTURE, THEY THOUGHT
MAYBE IF STUDENTS COULD PRACTICE
SKILLS ON SOME TYPE OF DOLL, AND
REACHED OUT TO A DOLL MAKER FROM
PAWTUCKET, RHODE ISLAND TO
DEVELOP THE SIMULATOR.
MS. CHASE BECAME POPULAR IN
NURSING EDUCATION AND USED UNTIL
THE EARLY '80s.
MS. CHASE WAS EXPENSIVE AND NOT
AFFORDABLE FOR MANY NURSING
SCHOOLS.
LIKE IN REAL LIFE, RIGHT?
SO NURSES BECAME VERY CREATIVE
AND IN 1914, A NURSE FROM NEW
YORK PUBLISHED IN THE AMERICAN
JOURNAL OF NURSING INSTRUCTIONS
ON HOW TO MAKE A HOMEMADE
HOSPITAL DOLL FOR $7.30.
SHE ALSO ADDED A PATH TO
PRACTICE HYPODERMIC INJECTIONS.
OF COURSE TECHNOLOGIES HAVE
EVOLVED OVER THE YEARS FROM MS.
CHASE TO THE FIRST TO PRACTICE
RESUSCITATION SKILLS AND THE
FIRST COMPUTERIZED MANNEQUIN
USED FORRANCE -- FOR ANESTHESIA
AND I WANTED TO MENTION HERE
PATTY DUGER THE FIRST
STANDARDIZED PATIENT AND A
NEUROLOGIST TRAINED FOR A
PATIENT WITH MULTIPLE SCLEROSIS.
AT THE TIME IT WASN'T ACCEPTED
PEOPLE WERE MAD BUT AFTER A
COUPLE YEARS IT PROVED TO BE A
GREAT TOOL TO TEACH.
OF COURSE CHANGING NEEDS AND
SIMULATION BECOME AN ESSENTIAL
TOOL LED TO SOPHISTICATED
MANNEQUINS LIKE THE ONES YOU SEE
HERE WITH A VARIETY IN PATIENTS
LIKE WE HAVE NOW WE HAVE ADULT
AND GERIATRIC POPULATION AS
WELL.
BUT SIMULATION TECHNOLOGY HAS
EVOLVED IN RESPONSE TO CHANGES
IN NURSING EDUCATION.
AND NURSING EDUCATION HAS
CHANGED BECAUSE WE HAVE A HEALTH
ENVIRONMENT THAT IS CHANGING ALL
THE TIME.
OF COURSE NOW WE HAVE A NEW
CONTENT OF TEAM WORK WHERE WE
BRING WE ALL BRING SKILLS AND
KNOWLEDGE TO PERFORM WELL AND TO
HELP OUR PATIENTS.
SO LET'S START WITH THE NURSING
EDUCATION.
HERE WE HAVE LINDA RICHARDS, THE
FIRST TRAINING NURSE IN THE
UNITED STATES.
SHE ESTABLISHED A MODEL AT THE
BELLEVUE HOSPITAL.
IT BECAME THE PRIMARY MODEL OF
TRAINING NURSES FOR NEARLY A
CENTURY.
ESSENTIAL THEY TRAIN IN
THEORETICAL AND PRACTICAL SKILLS
AND IT PROVIDE THE NECESSARY
KNOWLEDGE SKILLS AND ATTITUDE TO
CARE FOR THE ILL.
THE FOCUS OF THE MODEL WAS
TECHNOLOGY SKILLS.
HISTORICALLY HEALTH CARE
PROVIDERS HAVE BEEN TRAINED BY
OBSERVING IN AND ASSISTING AND
FINALLY PERFORMING UNDER THE
SUPERVISION UNDER MORE
EXPERIENCED PRACTITIONERS AND
SEE ONE, DO ONE, TEACH ONE OR IF
THE LEARNERS HAD ACCUMULATED
ENOUGH TIME OR EXPOSURE TO A
PARTICULAR SKILL.
THIS MODEL PROVED TO BE LIKE NOT
PERFECT FOR MANY REASONS.
SO WERE LEARNERS READY FOR
INDEPENDENT PRACTICE?
OF COURSE WE COULD PROVE THAT
ACCUMULATED HOURS OF CLINICAL
EXPERIENCE DO NOT TRANSLATE TO
COMPETENCE.
THAT'S NUMBER ONE.
NUMBER TWO, TECHNOLOGY SKILLS
ARE VERY IMPORTANT BUT WE ALSO
NIECE NON TECHNICAL SKILLS.
THE OTHER IS LEARNERS FINISH
TRAINING ONE INCOMPLETE LEARNING
CURVE.
THE REASON BECAUSE WE DIDN'T
HAVE ENOUGH CASES TO PRACTICE
DIFFICULT CASES.
AND THE LAST ONE THE LACK OF
OPPORTUNITY TO DEVELOP
INTERPROFESSIONAL TEAM WORK
SKILLS.
SO AFTER FINISHING THE TRAINING,
THESE EXPERTS OR PROFESSIONALS
NEEDED TO GO INTO THIS NEW WORLD
WITH THE TRANSITION FROM
TRAINING TO EXPERT.
PERCEPTION OF UNPREPAREDNESS
BECAUSE SKILLS LIKE MANAGEMENT
AND LEADERSHIP WITH HIGHER
DEGREES OF ANXIETY, STRESS AND
BURNOUT AND DIMINISHED JOB
SATISFACTION.
SO SIMULATION CREATED A SAFE
ENVIRONMENT WHERE THE LEARNERS
COULD PRACTICE UNTIL THEY COULD
EXCEL THOSE SKILLS.
IN OTHER WORDS, JUST DELIBERATE
PRACTICE, SYSTEMATIC PRACTICE TO
IMPROVE SKILLS.
THIS IS NOT ONLY FOR NEW
LEARNERS.
IT ALSO ALLI LILLI LILLI LILLLL
LEARNERS WELL TRAINED AND WE CAN
IMPROVE THE SKILLS WE ALREADY
HAVE.
IN OTHER WORDS, WE WENT FROM
EACH ONE TO SEE ONE, DO ONE,
SIMULATE MANY, SEE ONE, DO ONE,
TEACH ONE.
SO YOU KNOW THE FLORENCE
NIGHTINGALE ADVOCATED FOR NURSES
TO CONTINUE LEARNING BY URGING
THEM TO REMAIN CURRENT AND
COMPETENT IN THEIR NURSING
PRACTICE.
SO THAT MEANS WE HAD HIGHER
STANDARDS OF PREPARATION TO
PRACTICE AND NURSES NEEDED TO BE
READY FOR MORE COMPLEX ROLES
LIKE LEADERSHIP, PATIENT SAFETY,
RESEARCH AND EDUCATION.
AND WE DEVELOPED TWO NEW
CONCEPTS IN NURSING EDUCATION,
THE NURSE EDUCATOR ROLE AND
PROFESSIONAL DEVELOPMENT IN THE
EARLY '50s.
THE SECOND IS THE INCREASING
COMPLEXITY IN THE HEALTH SYSTEM
EVOLVING REGULATORY REQUIREMENTS
INCREASING FOCUS ON IMPROVING
PATIENT SAFETY.
LED US TO ACKNOWLEDGE THE HUMAN
ERROR, WHY?
BECAUSE WE ARE HUMANS AND
FALLIBLE.
THERE ARE MANY WAYS TO REPORT
ACTIONS WE CAN TAKE TO MITIGATE
THOSE HUMAN ERRORS.
SO WHAT HAPPENED IN HISTORY?
HERE WE HAVE DR. PEARCE WHO
URGED FOR ONGOING PATIENT SAFETY
SUSTAIN RESEARCH, TRAINING AND
DAILY APPLICATION IN THE
WORKPLACE.
THEN WE HAVE THE PUBLICATION OF
THE TO ERROR IS HUMAN FROM THE
INSTITUTE OF MEDICINE AND WHAT
WAS PUBLISHED FOR THE AGENCY OF
AND QUALITY IN COLLABORATION
WITH THE U.S. DEPARTMENT OF
DEFENSE.
THERE'S OTHER CONCEPTS IN HEALTH
CARE WE HAVE ADOPTED FROM OTHER
FIELD LIKE FOR EXAMPLE THE HIGH
RELIABILITY ORGANIZATIONS
REPAIRED -- PREPARED TO DEAL
WITH UNEXPECTED SITUATIONS.
THIS NEW ENVIRONMENT, NURSES ARE
REQUIRED TO RESPOND TO DIFFERENT
TYPES OF DEMANDS.
PATIENT CARE DEMANDS AND ALSO
HEALTH SYSTEM DEMANDS.
SO THEY NEED TO BE SUPER
FLEXIBLE WHICH ADDS MORE
COMPLEXITY TO THE NURSING WORK
WHICH IS ALREADY VERY COMPLEX.
IT REQUIRES PHYSICAL,
ORGANIZATIONAL AND COGNITIVE
WORK AND NURSE HAVE A UNIQUE
PERSPECTIVE.
THEY CONTRIBUTE WITH CARE,
KNOWLEDGE, EXPERTISE, VALUES OF
CARING AND COLLABORATION AND THE
NURSES HAVE ADOPTED CHANGED AND
DEVELOPED AND CONTINUED CHANGES
IN HEALTH CARE.
THE NURSES TRANSFORMED THE WORK
ENVIRONMENT TO MEET THE
SIGNIFICANT DEMANDS IN HEALTH
CARE, IN THE QUEST FOR
EXCELLENCE.
WHEN I WAS PREPARING THESE
PRESENTATIONS, I FOUND THIS IS
WHAT NURSE DOES.
THEY'RE PATIENT ADVOCATES,
NAVIGATOR AND COORDINATOR AND
WHEN A PATIENT IS GETTING INTO
TROUBLE UNTIL THE PATIENT'S
NEEDS HAVE BEEN MET.
WHAT A BEAUTIFUL CONCEPT THE
NURSES BRING.
THAT IS THE ELEMENT I WANT TO
PREVIEW TODAY THE TEAM WORK AND
COLLABORATION.
THIS IS A CLINICAL TEAM TAKING
CARE OF A PATIENT.
THEY HAVE A COMMON GOAL.
THEY WANT TO KEEP THE PATIENTS
SAFE AND AVOID COMPLICATIONS.
ALL OF THEM ARE WELL TRAINED AND
HAVE THE BEST INTENTIONS AND
THERE'S MANY ELEMENT ELEMENTS
THAT CONTRIBUTE TO A GROUP
PERFORMANCE.
EACH TEAM MEMBER HAS A PRIORITY.
IF A MEDICAL ERROR WAS MADE
DURING THIS PROCESS, IT WAS NOT
DISCUSSIBLE.
THAT'S THE REASON WE NEEDED AN
EVOLUTION IN TERMS OF HOW TO
WORK AS A TEAM AND WE COULD
DEMONSTRATE THAT COLLABORATIVE
PRACTICE AND INTERPROFESSIONAL
EDUCATION ACTUALLY HAS AN IMPACT
ON A TEAM'S PERFORMANCE AND
PATIENT'S SAFETY AND EFFECTIVE
TEAM WORK BEHAVIOR MUST BE
LEARNED AND IMPLEMENTED THROUGH
TRAINING AND PRACTICE AND I CO
GAC AGAIN TO THE CONCEPT OF WE
HAVE TAKEN FROM OTHER FIELDS
LIKE THIS ONE, HOW TO TEACH
SMART PEOPLE HOW TO LEARN.
WE HAVE WELL TRAINED CLINICIANS
HERE BUT WE ALWAYS HAVE A
ROUTINE.
WHO IS CONSIDERED THE FATHER OF
THE ORGANIZATIONAL LEARNING SAID
THAT TO KEEP SMART PEOPLE WE
NEED TO GO FROM SINGLE LEARNING
WHERE YOU IDENTIFY A PROBLEM TO
FIX A PROBLEM TO DOUBLE LOOP
LEARNING WHERE YOU IDENTIFY THE
PROBLEM AND REFLECT ON YOUR
ACTIONS TO SOLVE THE PROBLEM.
HERE'S IT'S COLLECTIVE
INTELLIGENCE THE ABILITY OF A
GROUP TO ACHIEVE MORE
INTELLIGENT OUTCOMES THROUGH
COLLABORATION EMERGES WHEN
PEOPLE WORK TOGETHER OFTEN WITH
THE HELP OF TECHNOLOGY TO SOLVE
COMPLEX PROBLEMS.
SO THIS IS SIMILAR TO WHAT WE DO
EVERY DAY WE USE TECHNOLOGY AND
HAVE TO SOLVE COMPLEX PROBLEMS.
HOW CAN WE APPLY THIS CONCEPT TO
THE HEALTH CARE ENVIRONMENT?
IT'S EASY.
WE USE AVAILABLE EXPERTISE,
KNOWLEDGE AND SKILLS FOR MORE
EFFECTIVE DECISION MAKING,
PROBLEM SOLVING AND TASK
EXECUTION SO THE TEAM DOES ITS
COLLECTIVE BEST FOR THE PATIENT.
HERE IN THE PICTURE, YOU CAN SEE
A CLINICAL TEAM PRACTICING WITH
SIMULATION AND YOU CAN SEE HERE
THE TEAM LEADER WE HAVE TWO ICU
NURSES, THE NURSE PRACTITIONER
AND THE SPECIALIST IS SOME WOULD
BEHIND AND THE ANESTHESIOLOGIST
AND AFTER THAT HAVING A
CONVERSATION WHERE EVERY TEAM
MEMBER BRINGS VALUE TO THE
DISCUSSION WITH RESPECT AND
EXCHANGE OF KNOWLEDGE AND
PRODUCTIVE CONVERSATION.
SO WHY SIMULATION IN AN
ENVIRONMENT LIKE THE NIH
CLINICAL CENTER?
IT'S NOT ONLY A TOOL TO SUSTAIN
OR IMPROVE PERFORMANCE IT HAS
SIMULATION THAT FOCUSES ON
QUALITY, SAFETY AND SYSTEMS.
WE CAN DEVELOP AND TEST WORD
PROCESSES USING SIMULATION AND
SOP AND SAFETY AND QUALITY
ISSUES AND ENHANCE TEAM AND
SYSTEM RESILIENCE.
HERE WE HAVE THREE EXAMPLES.
THREE DIFFERENT TEAMS USING
SIMULATION TO PRACTICE THE
RESPONSE.
AT THE BLOOD BANK, AT 1
SOUTHWEST AND IN RAID YOLLY --
RADIOLOGY AND HERE WE HAVE OUR
MANNEQUIN VISITING THE ROOM IN
THE THIRD FLOOR NEXT TO THE ICU
JUST TO SEE HOW EMERGENCY
RESPONSE WORKS IN THAT SPACE.
SO THE FUTURE OF SIMULATION FOR
NURSING PROFESSIONAL DEVELOPMENT
NEEDS TO EVOLVE AS WELL.
RIGHT NOW THE CURRENT SIMULATION
PRIORITIES ARE IN EDUCATION AND
TRAINING ASSESSMENT AND METRICS,
IMPROVEMENT AND CULTURE CHANGE.
BUT WE NEED TO MOVE INTO FUTURE
RESEARCH PRIORITIES LIKE WE NEED
TO MEASURE THE IMPACT ON PATIENT
AND LEARNING OUTCOMES, THE COST
EFFECTIVENESS AND RETURN ON
INVESTMENT OF TRAINING PROGRAMS,
SUSTAINABILITY SIMULATION
EFFORTS AND EMPLOYEE WELLNESS.
SO IF I DIDN'T CONVINCE YOU YET
I WOULD LIKE YOU TO THINK OF ONE
NON-PROFESSIONAL EXPERIENCE IN
YOUR LIFE WHERE YOU HAVE ONE
OPPORTUNITY TO DO EVERYTHING
PERFECTLY.
YOU KNEW EVERYTHING IN THEORY
BUT IT WAS FAILED JUST THINK
ABOUT THAT.
I KNOW.
REAL LIFE HAPPENS.
SO SIMULATION IS NOT GOING FIX
EVERY PROBLEM IN HEALTH CARE BUT
CAN HELP US TO BE PREPARED FOR
UNEXPECTED EVENTS.
I'M SURE THIS GENTLEMAN CHECKED
THE FORECAST, KNEW THE SPEECH
AND ALL THE THINGS BUT HE DIDN'T
PRACTICE OR REHEARSE THIS
ACCIDENT.
SO THINK OF THIS AND I'LL LET
DR. JABARA CONTINUE WITH THIS
JOURNEY.
>> ALL RIGHT, THANK YOU, AND
THANK YOU ALL FOR THE
OPPORTUNITY TO KICK OFF NURSES
MONTH TOGETHER.
AS I LOOK AROUND THE ROOM I SEE
MANY FAMILIAR FACES AND MANY MA
THAT HAVE BEEN PART OF THE
INITIATIVES IN THE NEXT SEGMENT
WHERE WE'LL FOCUS ON THE
PARTNERSHIP OR RELATIONSHIP
BETWEEN THE CLINICAL CENTER
NURSING DEPARTMENT AND THE NIH
CLINICAL CENTER SIMULATION
PROGRAM.
ABOUT FIVE AND A HALF YEARS AGO
WE CAME TOGETHER AND STARTED TO
EXPLORE HOW TO EXPAND SIMULATION
AT THE CLINICAL CENTER.
THERE WAS A ROBUST PROGRAM FOR
CRITICAL CARE AND WE WANTED TO
HAVE AN OPPORTUNITY TO EXPAND
THAT AND INCLUDE OTHERS O IN THE
INTERPROFESSIONAL ENVIRONMENT
AND THROUGHOUT THAT WE DEVELOPED
THIS DEFINITION OF OUR ENHANCED
SIMULATION CENTER.
THUS IS PUBLISH -- THIS IS
PUBLISHED IN THE CLINICAL CENTER
WHERE WE ARE COMMITTED TO
PREVENTING LAPSES AND ERRORS
BEFORE WHERE PROBLEM AND I AM
PROVING CAPABILITIES.
OUR OPERATIONS INVOLVE HIGH RISK
AND LOW VOLUME PROCEDURE THOUGH
TRAINING PROGRAMS HAVE BEEN USED
BY THE CRITICAL CARE AND NURSING
DEPARTMENT THE SIMULATION
CAPABILITIES NEED TO BE
COORDINATED.
ALSO, WE NEED TO ADD TRAINING
FOR CONTINGENCIES IN PEDIATRIC
PATIENTS TO THE CURRENT
SIMULATION CAPABILITIES AS SOON
AS POSSIBLE.
THE CURRENT SIMULATION
LABORATORY IS INADEQUATE AND A
NEW LOCATION WILL BE IDENTIFIED
AND RESOURCED AND THIS SETS THE
STAGE FOR WHAT WE'VE DONE.
WE RECOGNIZED WE HAD A LOT OF
TALENT AND SOME RESOURCES AND
DID THROUGH THE USE OF OUR
EXPERTISE WERE ABLE TO DO A
REALLY ROBUST EVALUATION OF WHAT
WE ALREADY HAD WITHIN THE
CLINICAL CENTER AND WHAT
OPPORTUNITIES WE HAD FOR
MATERIAL RESOURCES AS WELL AS
PERSONNEL WE ADDED A STIMULATION
TECHNICIAN TO OUR TEAM.
WE'VE HAD A COUPLE DIFFERENT OHS
AND PROUD TO SHARE WHERE WE'RE
AT THE PROGRAM VISION IS TO
ADVANCE PATIENT CARE AT THE
CLINICAL CENTER WITH STATE OF
THE ART STIMULATION IN THE
CONTINUUM FOR TRAINING AND
CLINICAL AND ADMINISTRATIVE
PROFESSIONALS.
MANY IN THE ROOM ENGAGED IN THE
CLINICAL SIMULATIONS.
WHAT MAKES US UNIQUE HOW WE DO
IT AT THE CLINICAL CENTER IS THE
RECOGNITION FOR MANY PATIENTS
MANY OF OUR PROTOCOLS WE MAY BE
DOING THINGS FOR THE FIRST TIME.
WE PRIDE OURSELVES WITH OUR
FIRST IN HUMAN SCIENCE AND HAVE
TO FIND UNIQUE WAYS TO PREPARE
AND SIMULATION SETS US UP FOR
SUCCESS TO COME TOGETHER AS AN
INTERPROFESSIONAL TEAM AND
PRACTICE PRIOR TO THOSE PATIENTS
COMING TO THE CLINICAL CENTER
WE'LL HIGHLIGHT A COUPLE
EXPERIENCES FOR YOU.
OUR MISSION IS WORDY BUT WE AIM
TO DEVELOP AND ESTABLISH AND
SUSTAIN ONE COORDINATED CENTER
AND PROGRAM FOR SIMULATION AND
TRAINING TO SUPPORT PROFESSIONAL
DEVELOPMENT OF THE CLINICAL
CENTER STAFF BY DELIVERING STATE
OF THE ART STIMULATION WE
COMMITTED TO AND IMPROVE SYSTEMS
AND TEAM PERFORMANCE AND SUPPORT
A SAFER ENVIRONMENT ENHANCING
PATIENT OUTCOMES ACROSS THE
HEALTH SYSTEM.
WHEN YOU READ THAT MISSION I
HOPE AS YOU SEE THE WORK WE DO
WE CONTINUALLY REFLECT BACK ON
THE MISSION STATEMENT FOR WHAT
ARE THE PRIORITIES AND WHERE WE
ARE WE SPENDING TIME AND ENERGY
AS A TEAM.
YOU'RE SEEING MOST OF OUR TEAM
THROUGHOUT TODAY AND CERTAINLY
WE ARE COMMITTED TO THIS MISSION
OF MAKING SURE IS THAT THIS IS
AN INTERPROFESSIONAL PROGRAM
WHERE WE'RE REACHING ALL ENDS OF
THE CLINICAL CENTER.
DR
WE HAVE 16 ACTIVE SIMULATION
PROGRAMS IN THE MIX AND WE HAD
AN OPPORTUNITY TO PARTNER WITH
THE OFFICE OF QUALITY AND SAFETY
THROUGH INITIATIVES SPECIFICALLY
SOME MAY HAVE PARTICIPATED IN
QUALITY AND WEEKS WHERE WE'RE
COMMITTED TO BRINGING FOLKS
TOGETHER IN THE SIMULATION
CENTER TO REALLY HIGHLIGHT SOME
OF THE OPPORTUNITIES THAT
ENHANCE PATIENT SAFETY AND WE'RE
JUST GETTING STARTED.
HOW DOES THAT REFLECT THE
CLINICAL CENTER NURSING
DEPARTMENT MISSION AS YOU LOOK
AT THE NURSING GRAND ROUNDS?
THOSE WHO JOINED FOR THE 9:00
A.M. CALL WE WILL GIVE A SHOUT
OUT REFLECTING ON THE MISSION
AND VISION.
THE MISSION IS TO IMPROVE HUMAN
HEALTH BY SUPPORTING CUTTING
EDGE RESEARCH AND PROVIDING
EVIDENCE-BASED NURSE CARING TO A
DIVERSE POPULATION OF PATIENTS
AND FAMILIES.
OUR VISION, TO BE THE PREMIER
NURSING DEPARTMENT WHERE THE
WORLD'S BEST CLINICAL RESEARCH
NURSES PROVIDE EXPERT PATIENT
CARE, GENERATE NEW KNOWLEDGE AND
DEVELOP INNOVATIVE PRACTICES TO
IMPROVE PATIENT OUTCOMES.
WE THINK WE HAVE A SEAT AT THE
TABLE IN SIMULATION AS WE TALK
ABOUT CREATING THE WORLD'S BEST
RESEARCH TO PROVIDE THE EXPERT
PATIENT CARE AND WE FEEL WE HAVE
THE OPPORTUNITY TO EMPOWER AND
GIVE THE GREAT CARE.
SO SIMULATION IN NURSING
PROFESSIONAL DEVELOPMENT.
IN THE NURSING DEPARTMENT IN
COLLABORATION WITH THE SIM
PROGRAM WE CONTINUE TO FIND WAYS
TO USE SIMULATION TO ANTICIPATE
AND PREPARE.
WHEN WE FIRST STARTED TALKING
ABOUT HOW WE WERE GOING TO USE
SIMULATION AND ENGAGE PEOPLE
ACROSS THE NIH ENTERPRISE, ONE
OF THE THINGS WE RECOGNIZED WAS
HIGH RISK, LOW VOLUME
POPULATION.
HOW DO WE MAKE SURE THAT WHEN
PATIENTS ARE COMING HERE AND
WE'RE GOING TO BE PROVIDING CARE
WE'VE NEVER DONE BEFORE WE HAVE
THE OPPORTUNITY TO BE PREPARED
AND TO BRING THE TEAM TOGETHER
TO REALLY TALK ABOUT ALL THOSE
WHAT-IF SCENARIOS.
AS A CLINICAL NURSE THAT WAS
OFTEN ONE OF THE STRESSORS WHEN
WE THINK ABOUT THE REALITY THAT
RESEARCH DONE IN THE LAB WE CAN
ANTICIPATE CERTAIN THINGS AND
THE ABILITY TO PRACTICE IT IN
THE LAB AND THEN HAVE THE
POWERFUL DEBRIEFING WHERE WE
COME TOGETHER AND SAY BUT WHAT
ABOUT THIS OR WHAT WOULD YOU DO
HERE, WHAT WERE YOU THINKING
WHEN YOU DID X, Y AND Z.
THE POWER IN THE DEBRIEFING.
AS WE TALK ABOUT THE MODEL I
WANT TO HIGHLIGHT IT'S NOT JUST
THE ACTIVITY THAT HAPPENS AS OUR
NURSES AND INTERPROFESSIONAL
TEAMS ENGAGE WITH THE MANNEQUINS
BUT THE RICHNESS ON THE FRONT
END AND THE DEBRIEFING WHERE WE
DIVE INTO WHAT WENT WELL AND
WHAT OPPORTUNITIES THERE ARE NOT
JUST FOR THE CLINICAL PRACTICE
BUT AS MENTIONED THE PIECES
AROUND SYSTEMS.
SOMETIMES WE LOOK AT THE
ENVIRONMENT AND SAY ARE THERE
OTHER TOOLS THAT WE NEED OR O
OTHER RESOURCES?
SOMETIMES IT LOOKS LIKE
SIMULATION SEVERAL TIMES OVER
UNTIL WE FEEL LIKE WE'VE GOTTEN
IT RIGHT AND PREPARED FROM A
RESOURCE AND PERSONNEL
PERSPECTIVE.
THE ADVANTAGES OF UTILIZING
SIMULATION FOR NURSING EDUCATION
IS THE OPPORTUNITY TO PRACTICE
HIGH RISK-LOW VOLUMES.
IT CAN BE REPRODUCED AN
MANIPULATE.
WE CAN TAKE SOMETHING AND HAVE
PLAN A THIS IS WHAT HAPPENED AND
THEN TURN AROUND AND WORK MAGIC
WITH THE SIMULATION TECHNICIAN
TO MAKE IT A DIFFERENT OUTCOME
IN HOW WOULD YOU RESPOND?
WE HAVE A SAFE SPACE TO MAKE
MISTAKES AND LEARN FROM THEM.
WHAT BETTER PLACE TO HAVE
SOMETHING GO WRONG THAN WITH ONE
OF THESE SIMULATORS RATHER THAN
A PATIENT.
THERE'S A GREAT T-SHIRT WE SEE
AT SIMULATION CONFERENCES THAT
SAYS DON'T WORRY, I PRACTICED ON
A MANNEQUIN.
THERE'S AN AN INCREASED COMFORT
WHEN YOU'VE DONE THAT BEFORE.
ONE OF OUR GREATEST SUCCESSES
HAS BEEN WHEN WE'VE HAD THE
OPPORTUNITY TO PREPARE A TEAM
FOR A NEW POPULATION OR A
PATIENT EXPERIENCE THAT MAYBE
THEY HAVEN'T HAD THE OPPORTUNITY
TO WORK THROUGH IN A WHILE.
WE BRING THEM IN THE SIM LAB OR
GO TO THE UNIT AND PROVIDE THAT
CARE AND STAFF WILL COME BACK
WEEKS LATER AND SAY I HAD A
PATIENT WHERE THAT HAPPENED AND
I FELT MORE PREPARED BECAUSE OF
THE EXPERIENCE WE HAD.
THAT INTERPROFESSIONAL
ENGAGEMENT IF YOU'RE CLINICAL
EDUCATOR IS ENGAGED IN YOUR
INITIATIVE CAN BE TRICKY TO GET
INTERPROFESSIONAL COLLEAGUES
INVOLVED.
ONE ADVANTAGE OF SIMULATION IS
HAVE TIMES WHERE WE SAY OUR
SUCCESSFUL PROGRAM WE HAVE A
HABITUAL SIMULATION EVERY
FRIDAY.
WE KNOW THAT GROUP OF FOLKS WILL
COME TOGETHER AND WE DON'T JUST
HAVE NURSES OR PHYSICIANS, WE
HAVE ANESTHESIA AND RESPIRATORY
THERAPY AND NURSES FROM FLOOR
AND ICU.
IT'S THE INTERPROFESSIONAL
ENGAGEMENT WHERE YOU GET THE
BENEFIT AND RICHNESS OF THE
EXPERIENCE IN THE ROOM AS WELL
AS THE VARIOUS PERSPECTIVES.
WHEN WE LOOK AT THE LEARNING
MODEL HOW DOES IT REFLECT IN
SIMULATION?
IT'S THE CONCRETE EXPERIENCE.
WE DO SKILLS MANAGEMENT AND HAVE
A NUMBER OF PIECES OF EQUIPMENT
WE CALL SKILL TRAINERS FOR
SPECIFIC TASK.
SOME HAVE HAD THE JOY OF GOING
THROUGH THE NIH CLINICAL CENTER
WORKSHOP WE HAVE TASK TRAINERS
FOR THAT OR REFLECT ON THE WORK
AROUND THE CARE IN THE LAST YEAR
THAT'S A SIMULATION EXPERIENCE
WHERE YOU'RE DOING A HARD SKILL
AND PRACTICE IT SEVERAL TIMES
AND START TO EMBED THAT SKILL.
BUT WE WANT TO TAKE IT A STEP
FURTHER WITH SIMULATION AND
REFLECTIVE OBSERVATION.
I MENTIONED THE RICHNESS OF THE
DEBRIEFING AND HOW POWERFUL IT
CAN BE TO HEAR FROM YOUR PEERS
WHEN YOU SAID OR DID THIS, THIS
IS WHAT I WAS THINKING OR WHEN
YOU'RE ABLE TO LOOK BACK AT AN
EMERGENCY RESPONSE SIMULATION
AND SAY, I FOUND MYSELF SORT OF
DRIFTING TO THE BACK OF THE
GROUP RATHER THAN ENGAGING.
THROUGH THE DEBRIEFING WE CAN
HAVE CONVERSATION TO EMPOWER
THAT PERSON BUT ABOUT WHAT WERE
YOU THINKING WHEN YOU WERE
STEPPING BACK IN THE CORNER.
DID YOU FEEL LIKE YOUR VOICE
COULD BE HEARD IN THE MIDST OF
THAT EMERGENCY RESPONSE?
THERE'S RICHNESS WITH THAT AND
BUILDING ON THE LEARNING.
ABSTRACT CONCEPTUALIZATION AS WE
HAVE THE DEBRIEFING AND WALKWAY,
ONE EXCITING THING IS REPLICATE
THE SAME SCENARIO WITH INCREASED
COMPLEXITY AND SEE HOW THEY
APPLY THE KNOWLEDGE.
WE HAVE GROUPS WHERE WE WORK ON
PROFESSIONAL DEVELOPMENT AND
LEADERSHIP DEVELOPMENT WITHIN
TEAMS.
TO BE ABLE TO SEE THOSE
INDIVIDUALS COME BACK TIME AND
TIME AGAIN AND SEE THE BUILDING
BLOCKS STARTING TO CLICK.
AND ACTIVE EXPERIMENTATION.
WE HAVE THE ABILITY ON A DIME WE
CAN SHIFT TO SIMULATION IF WE
WANT TO.
MANY WE DO SCRIPT OUT AHEAD OF
TIME IN A VERY METHODICAL WAY
BUT WE HAVE THE ABILITY THROUGH
SIMULATION TO SAY THAT ISN'T
WHERE WE THOUGHT IT'D GO BUT SEE
WHERE IT GOES FROM A LEARNING
PERSPECTIVE.
WE HAVE THE ABILITY TO ACTIVELY
EXPERIMENT.
ANOTHER POWERFUL WAY TO USE
SIMULATION IS SET UP A SCENARIO
AND GO THROUGH AND EVERY ONCE IN
A WHILE IT'S HARD AND DOESN'T GO
AS WELL AS EVERYONE WOULD LIKE
AND WE HAVE THE ABILITY TO SAY
TIME-OUT LET'S HAVE A MINI
DEBRIEF AND WHY IT FEELS
COMPLICATE AND RESTART.
WE DON'T GET THAT OPPORTUNITY
WITH PATIENTS.
WHEN SOMETHING GOES WRONG WE'VE
HAD A BAD DAY AND THEY HAVE A
BAD DAY AND WE CAN MANIPULATE
THE SCENARIO IN SIMULATION TO
SUPPORT LEARNING IN WHAT WAY THE
ACTIVE PARTICIPANTS CAN BE
SUPPORTED.
ONE OF OUR PILLARS IS THE
INTERNATIONAL ASSOCIATION OF
NURSING SIMULATION AND WE AN
ELEVATE THIS AND THEY'VE DONE
WORK ON SIMULATION SPECIFIC TO
NURSING BUT WITH A VESTED
INTEREST IN THE NATIONAL NURSING
ASSOCIATION FOR CLINICAL
SIMULATION AND LEARNING AND THIS
IS PART OF A QUALITY SIMULATION
AND WE TRY TO MIRROR OUR WORK
FROM THIS.
THE GOAL IS PROFESSIONAL
DEVELOPMENT, THERE IS DEDICATED
ATTENTION TO SIMULATION DESIGN.
WE LIKE TO HIGHLIGHT THIS FOR
FOLKS.
SOMETIMES WHEN PEOPLE THINK OF
SIMULATION THEY THINK ABOUT WHEN
THEY GO FOR THEIR CPR CARD EVERY
COUPLE YEARS AND YOU'RE DOING
COMPRESSIONS ON THE MANNEQUIN
AND I KNOW FOR MYSELF IT'S BEEN
A MINUTE SINCE I WAS IN NURSING
SCHOOL AND IT FELT LIKE A PROP
THAN WE WERE ENGAGE WITH THEM.
NOW WE'RE THOUGHTFUL ABOUT THE
SIMULATION DESIGN AND THAT CAN
TAKE TIME AND A PROCESS WHERE WE
WORK WITH STAKEHOLDERS AND TRY
TO UNDERSTAND WHAT ARE THE
LEARNING OBJECTIVES AND HOW DOES
THIS RELATE TO THE CLINICAL
PRACTICE THAT YOU'RE TRYING TO
INFLUENCE AND HOW CAN WE SUPPORT
YOUR TEAM THROUGH OUR SIMULATION
DESIGN AND MAKE SURE WE HAVE
SHARED S.
WE WANT TO HAVE THOSE OUTCOMES
AND OBJECTIVES CLEARLY DEFINE.
WE DON'T LIKE TO WALK AWAY FROM
A SIMULATION SAYING THAT WENT
WELL AND WE FEEL GOOD ABOUT IT.
WE SAY THESE INTEREST THE IT
THINGS WE WANTED TO ACCOMPLISH
AND CAN WE SAY WE HAVE AND
THAT'S A SUCCESS TO US.
WE DO A PREBRIEFING.
WE TALKED ABOUT THE DEBRIEFING
AND LIKE TO BRING LEARNERS IN
THE ROOM AND SHARE WHAT TO
ANTICIPATE AND THERE'S SOMETIMES
SURPRISES IN SIMULATION BUT WE
CREATE THE SAFE SPACE FOR
LEARNING.
WE ESTABLISH THIS IS A LEARNING
ENVIRONMENT AND WE OFTEN SAY
IT'S VEGAS RULES, WHAT HAPPENS
HERE, STAYS HERE IT'S A SAFE
SPACE WHERE WE ACKNOWLEDGE
EVERYONE COMING TO THE TABLE IS
AN EXPERT IN THEIR FIELD.
WE'RE ALL IN THIS ROOM SEASONED
CLINICIANS WHO BRING A GREAT
DEAL OF EXPERTS AND TALENT AND
ACKNOWLEDGE THAT BUT THIS IS A
LEARNING OPPORTUNITY SO WE'RE
GOING ENGAGE OURSELVES WITH THIS
HIGH FIDELITY SIMULATION AND
ACKNOWLEDGE MANNEQUINS HAVE SOME
LIMITATIONS AND WORK THROUGH THE
SIMULATION.
FACILITATION.
WE TYPICALLY HAVE A NUMBER FROM
THE TEAM PRESENT TO HELP ENSURE
IT GOES WELL.
ON THE DAYS WE DEFINE SIMULATION
AS SHOWING UP WITH A MANNEQUIN
AND LET'S SEE WHAT HAPPENS.
WE HAVE A COORDINATED
FACILITATION PLAN.
THE DEBRIEFING, WE TALKED A
LITTLE BIT ABOUT.
THAT IS THE OPPORTUNITY TO
REFLECT ON THE EXPERIENCE AND
MAKE SURE THAT EVERYONE LEAVES
FEELING GOOD ABOUT IT AND WE
HAVE SOME DIRECTION OF HOW WE
CAN IMPROVE FUTURE SIMULATION
AND THE IMPACT ON PATIENT CARE.
AND PARTICIPANT EVALUATION IS AN
EXPECTATION.
EVERYONE WHO COMES IN TO THE
SIMULATION HAS THE OPPORTUNITY
TO FILL A QUICK SURVEY TO GIVE
US FEEDBACK ON HOW THINGS WENT
AND WHAT ARE AREAS FOR
IMPROVEMENT AND GIVES US
OPPORTUNITY TO HAVE METRICS WE
CAN SPEAK TO.
ONE THING WE'RE EXPLORING IS HOW
CAN WE ENGAGE WITH FOLKS A
COUPLE MONTHS LATER AFTER SOME
OF OUR TRAININGS TO GATHER SOME
SUSTAINABILITY AND HOW LONG
THINGS LAST THEREAFTER.
SO HERE WE TALK ABOUT
INTERPROFESSIONAL EDUCATION.
TODAY WE'RE HERE TO TALK ABOUT
NURSING GRAND ROUNDS BUT WE
CAN'T TALK ABOUT THE SUCCESS OF
NURSING SIMULATION WITHOUT
ACKNOWLEDGING THE
INTERPROFESSIONAL PIECE.
WE FIND IT IMPORTANT TO ENGAGE
THIS WAY WHENEVER POSSIBLE.
WE'LL DO SIMULATION WHERE'S IT'S
POPULATION BASED OR SKILLS
TRAINING BUT FOR THE MOST PART
IF YOU COME TO THE CLINICAL
CENTER SIMULATION PROGRAM AND
SAY I'M INTERESTED IN DOING
SIMULATION ON X, Y AND Z WE'LL
SEE WHO ARE THE PEOPLE TO CARE
FOR THE PATIENT AND WHO ELSE
WOULD ENGAGE THROUGH THE
PROTOCOL TO GET A FEEL FOR WHAT
EVENTS MAY BE PART OF THAT
PATIENT'S JOURNEY TO ENGAGE AS
MANY AS POSSIBLE TO GET THE
BENEFIT OF THE INTERPROFESSIONAL
EDUCATION PIECE.
IN 2010 IF USED DESCRIBED WHEN
TWO OR MORE PROFESSIONALS LEARN
FROM AND WITH ONE ANOTHER FOR
EFFECTIVE COLLABORATION AND
IMPROVE HEALTH OUTCOMES.
THE COMPETENCY DOMAINS VALUES
AND ETHICS, ROLES AND
RESPONSIBILITIES FOR
COLLABORATIVE PRACTICE AND TEAM
WORK.
DR. GOMEZ TALKED ABOUT THE TEAM
WORK AND SOME CAN TALK ABOUT THE
RICHNESS OF THE DEBRIEFING AND
BETTER UNDERSTANDING OF ONE
ANOTHER IN WHAT WE BRING TO OUR
DAILY CLINICAL PRACTICE.
SO FACTORS THAT FACILITATE OUR
HIGH QUALITY PROFESSIONAL
DEVELOPMENT, IT'S IMMEDIATE AND
SAFE FEEDBACK.
UNLIKE WHEN WE WERE ALL BACK IN
NURSING OR MEDICAL SCHOOL AND
WAITED TO HEAR FEEDBACK YOU HEAR
FEEDBACK IMMEDIATELY IN A
SUPPORTIVE ENVIRONMENT.
IT'S NEVER PUNITIVE.
THE VAST MAJORITY IS TEAM
BUILDING INTERPROFESSIONAL
LEARNING.
THE REPETITIVE PRACTICE.
SOMETIMES ABOUT WHAT WE'LL FOCUS
ON STARTING IT AND HIT A HARD
SPOT AND PAUSE AND REPEAT IT.
OTHER TIMES IT'S SUCCESSFUL BUT
WE KNOW THERE'S A BIG CHALLENGE
COMING AND NEW PATIENT
POPULATION OR INTENSE PROTOCOL.
WE'RE GOING DO THAT SEVERAL
TIMES OVER EVEN WHEN IT WORKS
WELL THE FIRST TIME WE WANT TO
MAKE SURE IT WORKS WELL THE
SIXTH TIME.
IT'S A CONTROLLED ENVIRONMENT.
WE CAN MAKE SURE WHAT THE
VARIABLES ARE FOR OUR
PARTICIPANTS.
WE DON'T HAVE TO WORRY THE CALL
BELLS ARE GOING OFF NEXT DOOR,
DIFFERENT THINGS.
WE CAN MAKE SURE THEY HAVE THE
RICHNESS OF THE LEARNING THE
OBJECTIVES WERE AHEAD OF TIME
AND PROVIDES THE OPPORTUNITY FOR
APPLICATION, CRITICAL THINK AND
IS THE INTERPROFESSIONAL
COLLABORATION WHERE WE'RE ABLE
TO GET THE RICHNESS OF THE
PATIENT EXPERIENCE WHILE BEING
IN A CONTROLLED ENVIRONMENT.
I'M EXCITED TO SHARE A COUPLE OF
OUR SUCCESSFUL STORIES AND THEN
TURN IT OVER TO ONE OF OUR
ROBUST PROGRAMS.
SO WHEN WE LOOK AT THE NURSING
DEPARTMENT AND SOME OF OUR
SUCCESSES IN SIMULATION THOUGH
THERE ARE MANY, THERE'S A COUPLE
SHINING STARS WE WANTED TO SHARE
TODAY.
ONE THE EMERGENT CARE OF THE GM1
GENE THERAPY PROTOCOL.
THIS WAS AN OPPORTUNITY TO
PREPARE FOR A NEW POPULATION.
A RECOGNITION OF NEW PATIENTS,
NEW SYSTEMS COMING INTO THE
CLINICAL CENTER.
WE DID THIS ON REPEAT SEVERAL
TIMES OVER.
WE HAD THE ABILITY TO OFFER THE
SIMULATION WITH THE
COLLABORATION WITH THE 1
NORTHWEST TEAM.
WE WERE ABLE TO BE EMBEDDED
WITHIN THE UNIT MAKING IT MORE
CONVENIENT HOPEFULLY FOR STAFF
AND ASSESS FROM A SYSTEMS WHAT
RESOURCES WERE AVAILABLE ON THE
UNIT AND WHAT PERHAPS WE WOULD
NEED TO BE FULLY PREPARED.
THIS WAS ONE OF OUR SUCCESSES
WHERE AFTER SEVERAL TIMES OVER
AND SOME WENT WELL AND SOME WE
HAD SOME CHALLENGES WE WORKED
THROUGH.
WE CONTINUED TO PRACTICE UNTIL
IT BECAME EASIER AND KNEW WE HAD
THOSE RESOURCES LINED UP FOR THE
PARTICIPANTS AND THIS WAS ONE OF
THOSE SUCCESS STORIES WHERE ONCE
THE PATIENT POPULATION CAME TO
THE CLINICAL CENTER WE HEARD
FROM MULTIPLE PARTICIPANTS THEY
FELT BETTER PREPARED ONCE THOSE
PATIENTS ARRIVED.
THAT'S PROBABLY THE BIGGEST
COMPLIMENT OUR PROGRAM COULD
HAVE IN REFLECTION THAT
SIMULATION IMPACTS OUR ABILITY
TO PREPARE FOR PATIENT CARE.
OUR PEDIATRIC BRIDGE TO PRACTICE
WITH OUR CNS TRISH TODD IS A
COMBINATION OF DIDACTIC AND
SIMULATION.
THIS WORK HAS BEEN DONE IN
COLLABORATION WITH THE PEDIATRIC
PROGRAM OF CARE IN THE INTENSIVE
CARE UNIT OVER THE PAST SEVERAL
YEARS AND OVER THE PAST FEW
YEARS WE'VE INCLUDED SIMULATION
AS PART OF THE EXPERIENCE.
THESE INDIVIDUALS RECEIVE A
COUPLE DAYS OF DIDACTIC LECTURE
AND HANDS-ON SKILLS TRAINING AND
CULMINATE WITH THE SIMULATION OF
THE DIDACTIC INFORMATION THEY'VE
RECEIVED OVER THE COURSE OF THE
TIME TOGETHER.
YOU CAN SEE PICTURES OF OUR
FACULTY AND STUDENTS FOR THE
PROGRAM.
AND AGAIN THIS IS ONE WHERE
WE'RE EXCITED AND HAVE DONE POST
VACCINA
EVALUATIONS AND SURVEYS AND
FOLLOWING OVER THE YEAR TO
HOPEFULLY SHOW METRICS OF THE
SUCCESS OF THIS PROGRAM BECAUSE
YOU KNOW WE ALL FEEL IT IN OUR
HEART BUT WANT TO MAKE SURE
WE'RE ABLE TO SHARE AND
DISSEMINATE THAT IN A POWERFUL
WAY MOVING FORWARD.
OUR MSS EDUCATION SERIES, THE
SERVICE HAS EDUCATION DAYS YEAR
AFTER YEAR AND HAVE AN
INCREDIBLE COLLABORATION WITH
THEIR EDUCATION TEAM AND
PLANNING FOR A ROBUST DAY OF
DIDACTIC INFORMATION AND SKILLS
TRAINING AND LAST YEAR WAS THE
FIRST YEAR THEY CAME TO US AND
SAID WE WANT TO DO A FORMAL
SIMULATION PROGRAM.
UNDER THE DIRECTION OF MARY
MEYERS AND HER TEAM WE DEVELOPED
A STIMULATION REFLECTIVE OF A
DIFFICULT PATIENT EXPERIENCE
THEY'RE TEAM EXPERIENCED AND
ENCOUNTERED.
THEY SHARED ALL OF THE
CHALLENGES, WORKING THROUGH THE
PATIENT SCENARIO AND SOME
DIFFICULTY FOR STAFF AFTERWARDS
WHERE THEY WERE PROCESSING WHAT
HAD HAPPENED ON THE UNIT.
WE TOOK ALL THAT INFORMATION AND
MODEL IT INTO A CLINICAL
SCENARIO THAT WAS OBVIOUSLY NOT
100% WHAT THEY EXPERIENCED BUT
HAD SOME OF THOSE ELEMENTS WHICH
GAVE US A POWERFUL WAY TO
DEBRIEF AND GET TO SOME OF THOSE
EMOTIONAL PIECES SOME STAFF WERE
HANGING ON TO AND SHARE THAT IN
A SAFE SUPPORTIVE ENVIRONMENT OF
THEIR PEERS WHERE WE COULD LEARN
FROM THAT EXPERIENCE AND
HOPEFULLY BE PREPARED FOR THE
NEXT PATIENT.
WITH THAT I'M EXCITED TO SHARE
ONE OF OUR OTHER SUCCESSES,
DR. BERGVALL WILL SHARE THE
NEUROSCIENCE 1.0 SERIES.
>> I HAD THE PLEASURE OF
BRINGING THIS HOME.
FIGURATIVELY AND LITERALLY BRING
IT TO THE CLINICAL CENTER AND
WANTED TO SHARE THE EXPERIENCE
WITH YOU.
IT'S SUPER EXCITING AND WAS AU
TEAM EFFORT AND IT WAS A NEW
APPROACH AND IF ANYBODY
UNDERSTANDS YOU HAVE TO THINK
OUTSIDE THE BOX ESPECIALLY HERE
AT THE CLINICAL CENTER.
SO WHAT I'D LIKE TO SAY IS I
LIKE TO BRING THE HEART AND
BRAIN TOGETHER.
I ALWAYS HAVE I LIKE TO BRING HE
HEART AND BRAIN TOGETHER BECAUSE
I THINK THE BRAIN'S MORE
IMPORTANT.
DR. GOMEZ THINKS THE HEART'S
MORE IMPORTANT SO WE COME
TOGETHER AND WE WANT TO ADVANCE
NEUROLOGICAL ASSESSMENT.
AT THE CLINICAL CENTER WE WANTED
TO BRING THE MEANING BEHIND THE
NEUROLOGICAL ASSESSMENT AND
CONNECT THE CRITICAL THINKING
TRANSLATE TO BEDSIDE AND
INTEGRATE THE NEUROLOGICAL
EMERGENCIES.
THIS IS INTERESTING BECAUSE WE
HAD STAKEHOLDERS AND OUR NURSING
EXECUTIVE AND CLINICAL CENTER
EXECUTIVE TEAM SUPPORTED THIS
MISSION.
WE DO PROTOCOLS AND CREATE A
COMMON GROUND OR COLLECTIVE
INTELLIGENCE AS DR. GOMEZ SAID
AND SHARE THE SAME MENTAL MODEL.
WE WANTED TO UNDERSTAND AND
SPEAK THE SAME LANGUAGE FROM
NURSING TO PROVIDERS AND TO DO
THAT WE WANTED TO MAKE SURE THAT
WE HAD SOMETHING MEANINGFUL.
AND OVER ALL WE WANTED TO KEEP
IT SIMPLE.
ONE OF THE THINGS I LIKE TO SAY
IS KEEP IT SIMPLE AND AS A
BEDSIDE NURSE FOR A VERY LONG
TIME ONE OF MY POST POPULAR
SAYING TO SAY IS I DON'T HAVE
TIME FOR THAT.
SO EVERYBODY CAN SAY, I DON'T
HAVE TIME FOR THAT.
I HAVE TO INTEGRATE WHATEVER I'M
GOING TO BE DOING INTO MY DAILY
CARE BECAUSE I REALLY DON'T HAVE
TIME TO DO MORE EDUCATION OR
TRAINING.
SO THAT TRUST WAS IMPORTANT TO
FIGURE OUT WHAT TO DO NEXT.
THIS LED ME TO A QUOTE WHEN I
START THE THISSOUS -- THIS OUT
THAT RESONATED.
NIL I FORGET AND TEACH ME I
REMEMBER AND INVOLVE ME AND I
LEARN.
I'M ABOUT GIVING FISHING POLES
AND NOT FISH.
I WANTED TO MAKE A LONG LASTING
IMPACT AND I EMBRACE THE THEORY
AND THOUGHT PROCESS BEHIND
SIMULATION BUT IT'S NEW FOR
NURSING.
WHY DON'T WE USE THE
NEUROEDUCATION SERIES TO SEE HOW
IT WILL WORK OUT?
THIS WAS ROBUST.
LOOK AT THE TIME LINE.
I LIKE TO SEE THE SUCCESS.
BETWEEN SUMMERS OF 2020 AND 2022
WE EXPERIENCED MANY DRY RUNS.
WHO HERE LOVE NEURO?
I KNOW YOU'LL ALL RACE -- RAISE
YOUR HAND AND AS WELL.
IT HAS A STIGMA.
DOES EVERYBODY HAVE A BRAIN AND
SPINAL CORD?
I HOPE SO.
IT'S VITAL TO OUR DAILY PRACTICE
AS NURSES AND PRACTITIONERS.
WHEN WE LOOK AT THE MILESTONE
AND PHASES WE WENT THROUGH THE
INITIAL CALL TO ACTION WAS IN
SUMMER OF 2020.
NOT A GREAT TIME TO INITIATE A
PROGRAM.
I DON'T KNOW.
THERE WAS SOMETHING GOING ON
ABOUT THAT TIME.
I'M NOT SURE WHAT IT WAS BUT
PRETTY WE GOT THROUGH IT.
WE LAD TO RETHINK AND WITH
DR. GOMEZ WE DID TRIAL RUNS AND
SOME SUCCESS AND SOME FAILS.
WE WANTED TO DEVELOP SOMETHING
THAT WAS MEANINGFUL AND NEW.
WE WENT FROM THE BASEMENT OF
FAES AND DR. GOMEZ WAS CARRYING
A MANNEQUIN WHICH WAS HEAVY AND
WE WERE TRYING TO GET IT TO WORK
BUT TIME WASN'T ON OUR SIDE.
WE HAD TO RETHINK IT.
THEN WE HAD TO FIGURE OUT WHAT
WE WERE GOING TO TEACH.
WELL, AGAIN, EVERYBODY SAY I
DON'T THERE TIME TO DO THAT OR A
30 MINUTE NEURAL ASSESSMENT.
SO WHAT WE WERE GOING TO TEACH?
IN FALL OF 2021, IN THE MIDST OF
COVID TIMES WE WERE ABLE TO HAVE
AN APPROVED ONLINE COURSE TO
LAUNCH FIRST AND THEN THE IN
PERSON SESSIONS WHEN IT WAS SAFE
TO DO SO.
SO I'M GOING TO TAKE YOU THROUGH
THAT STORY AND JOURNEY.
IT'S REALLY EXCITING.
FIRST LET'S TALK ABOUT THE
COMMON GROUND.
SO WHEN WE TALK ABOUT THE COMMON
GROUND, IT'S LIKE WHY ARE WE
DOING THIS?
I THINK ABOUT THAT SHARED MENTAL
MODEL AND WE ALL WANT TO WORK IN
A VACUUM.
I'M AN ONCOLOGY NURSE AND
ONCOLOGIST AND NEURAL NURSE AND
ICU NURSE.
WE ALL HAVE A BRAIN AND SPINAL
CORD AND SO LET'S USE THEM AND
HEART OF COURSE.
WE STRIVE TO SPEAK THE SAME
CLINICAL LANGUAGE.
WE BELIEVE BY COLLABORATING AND
SUPPORTING EACH OTHER WE CAN
PROVIDE THE BEST EVIDENCE-BASED
PRACTICE CARE FOR OUR CLINICAL
RESEARCH CENTERS AT THE NIH
CLINICAL CENTER AND RECOGNIZE
NEUROLOGICAL EMERGENCY.
SEE THAT RECOGNITION OF THOSE
OVER AND OVER AGAIN BECAUSE THAT
IS WHAT WAS IMPORTANT AND THE
SHARE MENTAL MODEL THE
COLLECTIVE INTELLIGENCE.
NO MATTER WHERE WE'RE COMING
FR
FROM, WE NEED TO SPEAK THE SAME
LANGUAGE AND DO THE SHARED
MENTAL MODEL.
INITIALLY, WE WERE LOOKING AT
WHAT WAS GOING ON HERE.
SO AS PART OF EVIDENCE-BASED
PRACTICE WE LET THE EVIDENCE
GUIDE US TO THE ANSWERS.
WHAT IS GOING ON IN THE
LITERATURE AND GOING ON HERE.
WE WERE AS UNIQUE AS WE THOUGHT
WE WERE.
FOR A NON-NEUROLOGICAL
POPULATIONS THE MOST COMMON
PRIMARY DIAGNOSIS WERE ONCOLOGY
PATIENTS.
THAT'S NOT PRIZE SURPRISING AND
WE SAW SOLID TUMORS AND
LYMPHOMAS AND WHAT WE SAW FOR
CONSULTS WAS STROKE LIKE AND
SEIZURE LIKE SYSTEMS AND ACUTE
DECLINE AND ACUTE STATUS AND
WE'VE SEEN THAT IN OUR
PRAGMATICS.
-- PRACTICE.
WHEN I LOOK AT NURSING
DOCUMENTATION, WHAT WAS LACK ON
THE ACCURACY?
IT WAS CONFUSING TO LOOK AT THE
DOCUMENTATION ITSELF AND LOOK AT
THE ASSESSMENT IN ITS ENTIRETY
AS FROM THE NEURAL PERSPECTIVE
OUTSIDE THE NEUROLOGICAL UNIT.
WE THEN DO NOT USE THE NIH
STROKE SKILL.
I KNOW THAT'S SHOCK BUT I DON'T
HAVE A SCALE TO LOOK AT THE
PRACTS.
WHAT WAS MISSING IS SENSORY,
VISUAL FIELDS AND INACCURATE
PUPIL CHECKS, PARAMETERS, WHOLE
MISSING PARAMETERS IN
DOCUMENTATION LIKE SEIZURES,
GAIT AND NO BASELINE
NEUROLOGICAL ASSESSMENTS A LOT
OF TIMES.
AND NOW THAT IS NOT DIFFERENT
FROM WHAT WE SEE IN THE OUTSIDE
POPULATION.
TO TAKE THE SUMMARY OF THE CLIN
ISSUES I WANTED TO PUT THEM IN
FOUR DOMAINS TO THINK ABOUT THE
SO WHAT.
SO I FOUND OUT WHAT WE'RE
MISSING.
I FOUND OUT WHAT WAS IN THE
LITERATURE AND WHAT STRATEGIES
I'M GOING LOOK AND ONE GOAL BY
DEVELOPING THE NEURAL EDUCATION
SERIES?
WELL, OBVIOUSLY THE TRIGGER AT
THE BEGINNING, IMPROVED
NEUROLOGICAL NURSING DOCUMENT
AND IMPROVE THE COMPETENCY AND
JUDGMENT WITH NEUROLOGICAL
ASSESSMENT.
THESE WERE VERY IMPORTANT AS THE
FOUNDATION AND STRUCTURE AS A
LOOK AT THE CLINICAL ISSUES.
SO YOU SAW A LOT OF THEORY AND I
KNOW PEOPLE LOVE THEORY -- MAYBE
NOT.
THAT MAKES PEOPLE A LITTLE DIZZY
BUT IT'S A GREAT THEORY AND MY
MENTORS MENTIONED TO ME WHEN I
CAN LINK THEORY AND SCIENCE YOU
HAVE MAGIC.
SO THIS IS THE TANNER CLINICAL
JUDGMENT MODEL DEVELOPED BY
TANNER AND WROTE AN ARTICLE THAT
SAID THINK LIKE A NURSE.
NOW, THINKING LIKE A NURSE IS
INTERESTING BECAUSE IN NURSING
WHEN IS DIFFERENT THAN MEDICINE
IS WE LOOK AT SYMPTOMS AND
PATTERN RECOGNITION AN NOTIFY
WHEN WE NEED TO ESCALATE CARE.
SO WE LOOK AT ALL THESE
ASSESSMENTS AND DESCRIBE THINGS
TO THE ENDTH DEGREE AND WHAT I
DID OR WE DID WAS LOOKED AT
NOTICE AND WHAT DO WE NOTICE
WHEN WE ASSESS?
AND HOW DO WE INTERPRET THIS?
WHAT DO WE THINK OF?
HOW DO WE UNDERSTAND?
WHAT IS INTUITIVE AND WHAT IS
OUR EXPERIENCE ALLOWED AND HOW
TO RESPOND.
AGAIN, I DON'T HAVE TIME FOR
THIS AND KEEPING IT SIMPLE, WHAT
ARE THE TWO THINGS I CAN DO.
DO I ACT OR NOT ACT?
AND AS NURSES, WE'RE ALWAYS AT
THE BEDSIDE.
SO THAT'S EXACTLY WHAT WE DO.
DO WE ACT AND CALL OUR
PROVIDERS?
DO WE GIVE MEDICATIONS.
WHAT IS THE INTERVENTION.
AS NURSES AND NOT WITHIN OUR
SCOPE OF PRACTICE DO WE
DIAGNOSE.
WE NEED TO IDENTIFY WHAT IS
EMERGENT AND HOW TO ESCALATE.
THEN, WE COME BACK AND WE
RECOGNIZE FINDINGS AND CAN
REFLECT ON THE ACTION.
DO YOU SEE HOW THIS CAN REALLY
INTEGRATE ITSELF INTO
SIMULATION?
SO THIS ACTUALLY BROUGHT TO WHAT
AM I GOING TEACH?
NO ONE HAS TIME TO DO A FULL
NEURAL ASSESSMENT.
A NEUROLOGIST WILL SAY IT TAKES
30 MINUTES AND THE EXPERTISE OF
THAT.
I'M NOT ASKING ANYBODY TO PULL
OUT THEIR TRAINING FORKS OR
REFLEX HAMMERS.
BUT THOSE AWAY.
NEED A PEN AND HERE WE GO.
WE DID PRELIMINARY VALIDATION ON
THE NEUROLOGICAL PRECISION AID
TOOL.
WHAT'S IT'S NOT IS AN ALGORITHM.
IT'S A GUIDE TO HELP YOU GO
TOWARDS THE NEXT CLINICAL
DECISION.
AS YOU CAN SEE, HERE YOU HAVE
TEST, CONNECT AND RESPOND WHICH
COINCIDES WITH NOTICE, RECOGNIZE
AND ACTION.
SO HOW WE DO THIS IS WE TAKE THE
FOUR MAJOR NEURO DOMAINS WE'RE
OFTEN MISSING BECAUSE PEOPLE
DIDN'T UNDERSTAND IN GENERAL
WHAT WAS INCLUDED IN A
NEUROLOGICAL ASSESSMENT.
YOU NEEDED ALL THESE TO BE
INCLUDED IN NEUROLOGICAL
ASSESSMENT WITHIN THE LITERATURE
AND THE EVIDENCE WE FOUND WHAT
WILL LEAD YOU TO EMERGENCY AND
WE SIMPLIFIED IT BY MAKING THE
ACTIONS BINARY.
IT'S EITHER YES OR NO.
WILL IT LEAD YOU TO A CAUTION
WHERE YOU'LL HAVE A HIGHER ALERT
RESPONSE OR COMPLETE RED FLAG?
THIS ALLOWED US TO DEMYSTIFY THE
NEURO ASSESSMENT AND HAVE A
TANGIBLE TOOL AND COINED IT THE
HIGH YIELD NEURAL ASSESSMENT.
MOVING ALONG, WE'RE GOING TWO
PHASE 3 OUR MILESTONE.
SO WE HAVE -- WE KNOW WHAT WE'RE
TESTING, CHECK, AND NOW WE HAVE
TO TEACH IT.
HOW ARE WE GOING DO THAT?
EVERYBODY LIKES TO SAY
EDUCATION, EDUCATION, EDUCATION.
WE AN ISSUE, WE NEED TO TRAIN.
WE HAVE AN ISSUE, WE NEED TO
TRAIN.
AND YOU NEED TO HAVE MEANING
BEHIND IT AND ONCE AGAIN
CREATING THEORY BEHIND OUR
INTERVENTION WE ADDED THE
KNOWLEDGE SKILL ATTITUDE.
KNOWLEDGE BY INCLUDING THE
FOUR-HOUR ONLINE MODULE HELPED
BY INCLUDING CONTINUING
EDUCATION CREDITS.
NEXT WAS DEMONSTRATING THE
SKILLS AND REPEATING THIRD WAS
HOW TO CHANGE THE ATTITUDE OR
RESPONSE TO IT.
IT WAS A BEAUTIFUL THING FOR
NOTED.
PEOPLE THOUGHT NURSES KNEW HOW
TO DO AN ASSESSMENT.
AND SOMETHING AS SIMPLE AND
BASIC AS NEUROLOGICAL ASSESSMENT
WAS NOT DONE THE SAME WAY.
OR WASN'T DONE AT ALL.
SO HOW DID WE DO?
YOU GUYS READY?
I'M EXCITED.
THIS IS JUST A DISCLOSURE THIS
WAS ALL ANONYMOUS AND OUR
STRATEGY TO PROVE EFFECTIVENESS
WAS DONE ON THE THREE METRICS.
MY MENTORS HELPED ME IDENTIFY
WHAT TO MEASURE.
WE'RE LOOKING AT BRAIN CODES AND
INTERMEDIATE CONSULTS AND ADD
SERVICE EVENTS PRE AND POST
KNOWLEDGE AND THE EFFECTS MUCH
THE EDUCATION TRAINING.
WE HAD OUR NURSING INTRAMURAL
SCIENCE AND PRIOR TO AUDITING
THE DOCUMENTATION.
WE AUDIT A LOT OF CHARTS.
WE HAD TO LOOK AT WHAT WE WERE
GOING TO BE DOCUMENTING.
WHAT WOULD LEAD TO NEUROLOGICAL
EMERGENCIES AND WHAT WE WERE
GOING TO AUDIT.
SOME COMPONENTS WERE IN THE
MIDDLE AND WE DIDN'T HAVE AN
EXACT MEASUREMENT.
PAINSTAKINGLY I HAD TO GO
THROUGH ALL THE DOCUMENTATION TO
SEE WHAT WAS IMPROVEMENT.
I DID THIS TO ELIMINATE BIAS BY
CREATING A RUBRIC.
HERE IS A QUICK SNAPSHOT OF PRE
AND POST NEURAL EDUCATION
SERIES.
THE FIRST PART OF IT WAS THE
FOURTH QUARTER.
WE DIDN'T HAVE THAT MUCH DATA
THERE BUT HAD A NUMBER OF BRAIN
CODES AND YOU CAN SEE IT
DECREASED.
I CAN'T TELL YOU IF THAT WAS
BETTER OR WORSE.
YOU CAN ARGUE EITHER WAY.
THE NUMBER OF REQUIRED HE IS
SC
CALATION OF CARE AND --
ESCALATION OF CARE AND ABSENCE
OF BASELINE, EVERYBODY DID A
BASELINE ASSESSMENT I NOTED ON
MY DOCUMENTATION AND ALL BRAIN
CODES.
NURSING DOCUMENTATION MEASURED
BY 12 INDICATORS AT 100% OF THE
CRITERIA DONE BY THE RUBRIC.
AND NOW THE ACTUAL SIMULATION
COURSE.
NOW, 80% OF STAFF SUCCESSFULLY
COMPLETED THE EDUCATION PROGRAM
BY MARCH 2023.
THAT WAS BASED ON THE NUMBER
WHEN WE STARTED THE PROGRAM AND
NUMBER OF NURSES.
SO WE HAD A GREAT OUTPUT.
RESULTS FROM THE IN PERSON
SKILLS AND SIMULATION WAS ALSO
FANTASTIC.
WE HAD 100% COMPLIANCE OF PEOPLE
LOOKING AT COMPLETING THE
SIMULATION AND GIVING RESULTS.
APPROXIMATELY 362 NURSES
COMPLETED THE EXPERIENCE.
AND OVER 99% STATED THAT THE
EXPERIENCE WAS EXCELLENT.
THEY STRONGLY AGREED POSITIVELY
AND OVER ALL GAVE A POSITIVE
IMPACT AND IMPACTED THEIR
CLINICAL PRACTICE.
WHAT WAS MEANINGFUL WAS THE
THEMATIC ANALYSIS.
THE MAJORITY OF RESPONSES
INCLUDED RESPONSES AND FEEDBACK
AND SOME OF THE COMMENTS WERE
WELL DONE, LOVED, EXCELLENT,
ENJOYABLE.
THE PRIMARY POPULATION WAS
ONCOLOGY.
WHAT WAS MORE MEANINGFUL THEY
RECOGNIZED WAS THAT NURSES WOULD
STOP ME AND STAY I LOVE THAT
COURSE.
OR THEY WOULD SEND E-MAILS
SAYING I CAUGHT SOMETHING EARLY.
THAT WAS IMPACTFUL.
WE CAN'T ALWAYS MEASURE THAT
BECAUSE THAT'S WITH OUR HEART,
RIGHT, BUT IT WAS MORE IMPACTFUL
EVERY DAY WHEN PEOPLE WANTED TO
TAKE THAT CLASS.
UNFORTUNATELY, FORTUNATELY IT
WAS OFTEN OVERBOOKED BECAUSE WE
DIDN'T HAVE AS MANY SPACES
AVAILABLE HOWEVER PEOPLE WERE
ABLE TO ENJOY THE EXPERIENCE.
WHAT DID WE LEARN?
QUALITY TAKES TIME.
THOUGH WE WERE SUCCESSFUL.
I'M SURPRISED WE WERE ABLE TO DO
THIS FOR THREE YEARS IN THE
MIDST OF COVID.
TO RELY ON SUBJECT MATTER
EXPERTS AND CREATE STRUCTURE.
IT'S HARD AND SHOULD NOT BE
TAKEN LIGHTLY.
WHEN I SEE DEBRIEFING DONE ON A
WHIM IT'S DANGEROUS IN A WAY
BECAUSE WE'RE ASKING PEOPLE TO
BE SENSITIVE AND WE HAVE TO
PROVIDE THE SAFE ENVIRONMENT.
THE WAY WE TALK AN WAY WE
EXPERIENCE SOME REALLY
HIGH-LEVEL SITUATIONS IS
IMPORTANT.
SIMULATION IS NOT JUST
EDUCATION, AND I LEARNED THAT
FROM OUR ORIGINAL DIRECTOR.
SHE REALLY WAS ABLE TO HONE THAT
IN AND BRING IN THAT EDUCATION
PIECE AND HELP THAT OUT AND
REALLY HELP LINK THAT SIMULATION
WITH DR. GOMEZ AND LATER
DR. JABARA.
INTERDISCIPLINARY COLLABORATIVE
IS EFFECTIVE.
EVERYBODY HAS A DIFFERENT POINT
OF VIEW.
EVERYBODY HE SEES THINGS
DIFFERENTLY.
SHE MIGHT LOOK AT THE HEART
RATE, I'M GOING TO LOOK AT THE
NEURO ASSESSMENT BECAUSE THAT'S
WHAT I'M COMFORTABLE WITH.
UNDERSTANDING THE CONCEPT WAS
IMPORTANT AS WE DEBRIEFED AND
LOOKED AT THE PROGRAM.
SO OUR FUTURE, WE'RE GOING TO
CONTINUE TO MONITOR METRICS
BECAUSE WE LOVE TO AUDIT CHARTS.
THAT'S SARCASM BY THE WAY.
INTERDISCIPLINARY NEURO
SIMULATION.
WE'LL TRY DO MORE AND MORE
PRIORITIZE TO THE POPULATIONS
AND INCREASED BRIEF NEURO
ASSESSMENT DOCUMENTATION WHICH
IS A BARRIER TO E.H.R. IN
GENERAL FOR EVERY ORGANIZATION.
THAT'S WHAT WE WERE GOING TO DO
TO HAVE ACTUAL REPORTS.
SO I'D LIKE TO GIVE SPECIAL
THANKS TO THESE PEOPLE WHO
HELPED.
AND ALL THESE PEOPLE THAT HELPED
US DEBRIEF.
HERE'S OUR CONTACT INFORMATION.
AND OUR LOVELY PICTURES.
IF YOU WANT TO CONTACT US FOR
ANY TIME PLEASE MAKE SURE IT'S
SIMULATION AND THANK YOU TO ALL
THE NIH CLINICAL CENTER AND
NURSING DEPARTMENT AND THE NIH
CLINICAL CENTER SIMULATION TEAM
AND STAKEHOLDERS AND THE
PARTICIPANTS WHO INSPIRE OUR
WORK AND WERE THERE TO BE THE
GUINEA PIGS SOMETIMES OF WHAT WE
WERE TRYING TO DO AND
ACCOMPLISH.
QUESTIONS?
>> I WANT TO WRAP UP AND THANK
FOUR EXCELLENT SPEAKERS.
GREAT TRENGS PRESENTATIONS AND
LIKE ANY GOOD PRESENTATION EN
GENDERS US TO CREATE NOR
QUESTIONS AND BE REFLECTIVE AND
SEE WHAT OPPORTUNITIES ARE.
THANK YOU FOR TAKING US THROUGH
THE JOURNEY AND THE HISTORY OF
THE PRACTICE AND IMPACT FOR
SIMULATION AND WE'RE OUT OF TIME
SO I INVITE YOU TO COME DOWN AND
SPEAK TO SPEAKERS AND FOR THOSE
ON VIDEOCAST WE WILL FORWARD
YOUR QUESTIONS TO THE SPEAKERS.
I WANT TO SAY THANK YOU FOR WHAT
YOU'RE DOING AND FOR WHAT YOU DO
EVER DAY.
-- EVERY DAY.
11 YEARS AGO AND 10 MONTHS OR 11
YEARS AGO THIS MONTH, EXCUSE ME,
I FOUND MYSELF ON THE WRONG SIDE
OF THE BED RAIL AND WITH IT I
THINK WE HEAR EVERY DAY WHAT
NURSES DO BUT I THINK THAT MY
OWN JOURNEY WAS THAT NURSES
ALLOW A PERSON TO MAINTAIN THEIR
HUMAN DIGNITY AND OFTEN WHAT IS
OFTEN THE MOST UNDIGNIFIED YOU
CAN FIND YOURSELF IN.
FOR THAT I WANT TO SAY THANK YOU
FOR WHAT YOU DO EVERY DAY AND I
HOPE THIS PRODUCTIVE AND
ENRICHING NURSES GRAND ROUND. 1783 01:08:27,970 THANK YOU VERY MUCH.