Pediatric Nurse Residency


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Pediatric Nurse Residency

  1. 1. Pediatric Competency DevelopmentPediatric Competency Development Bridget Mudge, RN, MS Judy Kertis RN BSN Pediatric Clinical Nurse Specialist
  2. 2. ObjectivesObjectives • Determine didactic content • Creating scenarios • Integrating core practice issues in to simulations • Evaluating performance
  3. 3. 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
  4. 4. OrientationOrientation 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)
  5. 5. 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
  6. 6. Simulation Additional UsesSimulation Additional Uses • Add National Safety Goals: Medication safety. Patient Identification. Clinical Alarms. Verbal Orders. Critical Labs.
  7. 7. PROGRAM COMPONENTS: Pediatric Nurse ResidencyPediatric Nurse Residency Web-based: Pediatric intensive-care course developed by Indiana University (
  8. 8. 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
  9. 9. 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.
  10. 10. 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.
  11. 11. 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.
  12. 12. COMPONENT OF PROGRAM:COMPONENT OF PROGRAM: DIDACTICDIDACTIC • Trauma Care. • PICU Specific: Ventilators, EKG monitoring, Defibrillator, IV Therapy, Vasoactive Medications, ICP, Hemodynamic Monitoring.
  13. 13. SIMULATIONS:SIMULATIONS: Simulation Development • Who, What? • Sample: • Airway Management. • RSV.
  14. 14. SimulationsSimulations • Seizures. • EEG Monitoring. • Responding to Medical Emergencies • Documentation • Admission • Trauma • Diabetes
  15. 15. 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
  16. 16. Simulation developmentSimulation development • RSV Review of standards and skills Isolation Room set up Nasal cannula application Patient Education
  17. 17. Simulation developmentSimulation development • Time out • SBAR • Team building
  18. 18. CHALLENGES:CHALLENGES: • Logistics: Ideal number of new grads. • Schedule: Presenters. Preceptors around fixed classes. • Securing lab and Sim Baby.
  19. 19. CHALLENGES:CHALLENGES: Simulation: • How complicated to make scenarios? • Scenarios consistent? • Ideal class size?
  20. 20. CHALLENGES:CHALLENGES: What is best done in simulation?What is best done in simulation? Responding to medical emergencies. Skin Care and Diabetic Education versus
  21. 21. EvaluationEvaluation • What are critical Clinical Behaviors? • Objective information • Experts evaluate • Final Simulation = Integration of skills • Pass / Fail
  22. 22. 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.
  23. 23. 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.
  24. 24. Pediatric ResidentsPediatric Residents Readiness for Practice Questionnaire Pediatric Residents (n=4) READY3READY2READY1 Mean 90 80 70
  25. 25. 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
  26. 26. CONCLUSIONS: • Utilizing a nurse residency program provides: Opportunities to become safe, competent caregivers.
  27. 27. 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.