Clinical boot camp: an innovative simulation experience to prepare nursing students for obstetric and pediatric clinicals.
Obstetric and pediatric patients require unique specialized care not included in traditional adult health education. To prepare nursing students for clinical rotations beginning the second week of class, faculty developed an innovative one-day simulation seminar, the OB/PEDS Boot Camp, in which groups of students rotated through six stations of obstetric and pediatric simulation exercises. This article provides insight on the development and implementation of the OB/PEDS Boot Camp.
Obstetric--Pediatric--Clinical Simulation--Nursing Education
Nursing education focuses primarily on preparing students to care for the adult patient. However, obstetric and pediatric patients have unique needs requiring specialized care. In our nursing program, clinical rotations begin the second week of the semester, when students have not yet learned the complexities of caring for obstetric (OB) and pediatric (PEDS) patients. To provide students with a foundational knowledge of populations and prepare them for a more meaningful clinical experience, course faculty developed the OB/ PEDS Boot Camp, a one-day simulation seminar in which students become acquainted with assessment, terminology, medical devices, and equipment specific to obstetric and pediatric populations. Divided into groups, students rotated through three obstetric and three pediatric simulations.
Studies have demonstrated that simulation helps develop student knowledge and skills (Veltri, Rowe, Bell, Arwood, & Kindler, 2014) and increases confidence prior to entering the clinical setting (Hope, Garside, & Prescott, 2011). In a study by Partin, Payne, and Slemmons (2011), students found simulation enhanced learning and prepared them for clinical practice in a nonthreatening way.
No. 1, Nasogastric/Orogastic/Gastrostomy Tube
The focus of this station was the purpose of gastrostomy (G-tube), nasogastric (NG), and orogastric (OG) tubes and how the tubes differ. Equipment used for this station included the Special Needs Infant Medium Fidelity Simulator with tracheostomy, an infant stethoscope, and NG and OG tubing. Students were introduced to the simulator and the specific needs for each type of tubing. The instructor demonstrated tube insertion, placement check, suctioning, proper irrigation, and procedures for feedings.
Students were given opportunities to ask questions throughout the demonstration. To facilitate discussion, students selected prepared questions from a hat to answer as a group. After the discussion, all students practiced skills on the manikin with faculty assistance.
No. 2, Scoliosis/Pediatric Assessment/Unsafe Crib
Equipment required for the station included a crib, an infant stethoscope, a scoliometer, and Baby Vital Sim[TM], a medium-fidelity simulator with heart and lung sounds that simulated a 10- to 12-month-old infant. The scoliosis review included the importance of early screening, screening methods, treatment, and a review of the scoliometer. Faculty demonstrated how to assess for scoliosis and the correct use of the scoliometer. Students practiced using the scoliometer on each other with instructor assistance as needed.
To demonstrate a mock unsafe crib, a second function of this station, the crib was filled with items considered unsafe for the pediatric patient. Items included oxygen tubing, stuffed animals, a bloodstained sheet, an IV cord draped across the crib, a capped needle, a hanging stethoscope, and outdated hand sanitizer. Students were tasked with identifying physical and microbiological hazards, as well as child-friendly features.
To demonstrate proper assessment of children and infants, students completed a general head-to-toe physical assessment on Baby Vital Sim, with little assistance from the instructor. The assessment included use of pediatric blood pressure equipment and the verbalization of normal vital signs according to age group.
No. 3, Respiratory Assessment/Chest Physiotherapy/Pediatric CPR
This station also utilized Baby Vital Sim. The session included a discussion of specific signs, symptoms, assessment techniques, and normal respiratory variations in the pediatric population. Students listened to a variety of breath sounds on the manikin. Chest physiotherapy included indications, contraindications, and complications that may occur with this therapy. Proper techniques were demonstrated, and students practiced on a low-fidelity simulator and on one another.
All students who participated in the OB/PEDS Boot Camp were CPR certified. However, it was imperative they understand the proper technique for pediatric resuscitation. An overview of pediatric CPR included placement of the resuscitation bag valve mask, chest compression techniques and rate, and the role of the nursing students during CPR in the hospital setting. Students were provided an opportunity to demonstrate proper technique on low-fidelity resuscitation infant and child simulators. A green light appeared on the simulator if students were properly performing chest compressions; a red light indicated improper technique.
No. 1, Antepartum and Labor and Delivery
Most students had no previous experience with pregnant patients during foundational and adult health clinical rotations. The purpose of this station was to acquaint students with the antepartum and laboring patient. Equipment utilized included the high-fidelity NOELLE[R] Maternal and Neonatal Birthing manikin, along with maternal/fetal monitors, an empathy belly, and antenatal measuring tape.
NOELLE was programmed to simulate various types of contractions, variations on fetal heart tones, and a birth. Students observed and discussed fetal heart rate and contraction monitoring, heard fetal heart tones with a Doppler, measured fundal height, and observed a simulated birth. In addition, students put on an "empathy belly" to experience the weight, posture, and balance issues faced by the antepartum patient. Faculty discussed the appropriate use of equipment, the labor and delivery process, and the nursing roles of assessment and intervention for the antepartum and intrapartum patient.
No. 2, Postpartum
The postpartum station utilized the medium-fidelity Nursing Annie (SimPad Capable) manikin to acquaint students with the assessment of the postpartum patient. Using the BUBBLE H acronym introduced students to assessment of breast, uterus, bladder, bowels, lochia, episiotomy/perineum, and hemorrhage. Assessment was demonstrated by faculty and included the assessment of size, shape, firmness, redness, and symmetry of breasts; fundal (uterus) height, placement, and firmness; maternal voiding (bladder); bowel sounds; along with lochia color, odor, and amount.
Lochia was demonstrated through the use of moulage. Examples of scant, light, moderate, and heavy lochia and blood clots were demonstrated on perineal pads, as well as coloring of rubra, serosa, and alba. Episiotomy and perineum assessment included tissue color, edema, ecchymosis, discharge, and approximation. Students were given opportunities to ask questions and participated in assessment techniques.
No. 3, Newborn Assessment, Apgar Scores, Swaddling
Some students had no experience with newborns or newborn care. Four substations comprised newborn assessment and care. The first was for Apgar scoring and used the high-fidelity infant manikin Newborn HAL[R] with heart and lung sounds. Faculty described Apgar scoring and manipulated Hal to mimic the five areas of assessment for scoring. Students recorded scores and then compared and discussed them with faculty. The importance of skin-to-skin contact with the mother was discussed, as well as the significance of feeding, glucose monitoring, and temperature assessment.
The second substation offered a demonstration of newborn reflexes. Students watched a YouTube video demonstrating common newborn reflexes and the differences between newborn and adult reflexes.
The third substation included manikin babies (some with congenital deformities) set up on tables with newborn assessment forms. Faculty reviewed the forms and discussed the assessment of newborns. Swaddling, dressing, and diapering were demonstrated, discussed and practiced. Diapers with the front scoop below the umbilical cord were demonstrated to emphasize the importance of keeping the cord dry and free from urine. In addition, students learned the proper and safe techniques for holding and passing a baby from one person to another.
The fourth substation utilized Nursing Baby VitalSim for assessing heart rate and respirations in the newborn. Experience has shown us that students have difficulty accurately counting heart and respiratory rates in infants. This station allowed students to practice on manikins and receive immediate feedback.
The primary goal of all experiences in the OB/PEDS Boot Camp was to give students a frame of reference for what they could see in their pediatric and obstetric clinical rotations. The experience did not prepare students to fully care for these patients; that preparation came through further content presented in the didactic portion of the class and in the clinical environment. However, the OB/PEDS Boot Camp allowed students to better understand the patients, procedures, and interventions they would see and experience throughout their clinical education with these specific patient populations.
We chose not to utilize the OB/PEDS Boot Camp during the summer and fall terms in 2015. However, we did complete a clinical orientation with some simulation experiences. We are currently conducting research regarding the benefits of Boot Camp and other simulation experiences conducted throughout the semester.
The authors are faculty in the Family, Community, and Health Systems Department at the University of Alabama at Birmingham School of Nursing. Connie Hogewood, MSN, RN, is an instructor. Tedra Smith, DNP, CRNP, CPNP-PC, is an assistant professor. Sherita Etheridge, MSN, CRNP, CPNP, is an instructor. Sylvia Britt, PhD, RN, is an assistant professor. For more information, contact Connie Hogewood at email@example.com.
Hope, A., Garside, J., & Prescott, S. (2011). Rethinking theory and practice: Pre-registration student nurse experiences of simulation teaching and learning in the acquisition of clinical skills in preparation for practice. Nurse Education Today, 3, 711-715. doi:10.1016/j.nedt.2010.12.011
Partin, J. L., Payne, T. A., & Slemmons, M. F. (2011). Students' perceptions of their learning experiences using high-fidelity simulation to teach concepts relative to obstetrics. Nursing Education Perspectives, 32(3), 186-188. doi:10.5480/1536-5026-32.3.186
Veltri, L. M., Rowe, J. M., Bell, K. J., Arwood, E. L., & Kindler, L. L. (2014). The maternal-newborn assessment study: Can simulation replicate the clinical learning experience in undergraduate nursing education? Journal of Obstetric, Gynecologic and Neonatal Nursing, 43(S1), S84. doi:10.1111/1552-6909.12442
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|Author:||Hogewood, Connie; Smith, Tedra; Etheridge, Sherita; Britt, Sylvia|
|Publication:||Nursing Education Perspectives|
|Date:||Nov 1, 2015|
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