Capstone Simulation Experience Paper

S.P. should be up out of bed post-op day 1 and wearing TED hose continuously, as well as wearing SCDs overnight in bed. Constipation prevention should e achieved by administering scheduled doses of Colace. Proper nutrition should be encouraged to include plenty of protein to ensure proper wound healing and avoid development of pressure ulcers (Lewis, Dirksen, Heitkemper, Bucher, & Camera, 2011). S.P. should practice coughing and deep breathing throughout her hospital stay to avoid lung congestion and occurrence of pneumonia infection, educating the patient about smoking cessation assistance can be helpful as well.

1. As the clinic nurse, what routine information would you want to obtain from S.R.?

In every profession there are changes that propel how tasks are done; nursing is no stranger to this. One of the biggest changes that have come into nursing’s daily events is how report hand-offs are being done. Gone are the days of taped report that each off going nurse must tape about each patient and the oncoming nurse must listen to. Nurses are now being encouraged to move their report to the bedside, in front of the patient (Trossman, 2007). It is very important to know how this can affect the patient and even the nurse’s schedule. With every change, there are positives and negatives that can finalize the decision to keep or forego

Plan: The patient will be admitted, kept NPO, and an appendectomy will be performed by Dr. Rogers in the morning.

Currently at the hospital I work in does not require bedside reporting in high acuity areas such as the emergency department. The current practice is to first identify the nurse for the assignment you are relieving, which often times can be multiple nurses. This often leads to very brief exchange of patient information so that each nurse can get to the next person and start care or leave for the day. Due to the nature of an emergency department, patient population is extremely diverse yielding reports regarding patients of different ages, diagnoses, and acuity. Couple the diverse nature of clients with the brief interactions between nurses to communicate what is presumed important regarding patient care while attempting to maintain privacy all with the distractions of a busy nursing station and it is likely some piece of information may be missed or overlooked.

Verbal and nonverbal communications are essential components of nursing care. It is critical for patient care providers to ensure an accurate portrayal of the patient. The situation background assessment recommendation (SBAR) protocol is a technique that provides a structure for communication between patient care providers. SBAR was a tool designed to promote efficient care that ensures patient safety.

Staff reacted quickly and appropriately and when safe transferred the patient into the resuscitation area. I witnessed good communication between staff with the use of SBAR, giving structure to the information being provided by ambulance staff and by nurses to medical staff. Communication between staff and the patient promoted a good therapeutic relationship. Communication is vital in the nurse patient relationship to build trust and gain information (Webb, 2011).

According to the Wound, Ostomy, and Continence Nurses Society, (WOCN), before focusing on the ostomy care, the nurse should establish a relationship with the patient and their family. A comprehensive assessment should be performed that focuses on all aspects of the patient’s wellness; physical, psychosocial, cultural and spiritual. The nurse informs the patient about dietary needs, bathing/showering, and returning to work (Cronin, 2005). In doing so, the nurse gains the patient’s trust and confidence helping ease them throughout the intervention process. The assessment allows the nurse to fully recognize the patient not as another client needing a procedure but as a person who is going to have questions, concerns, and needs (WOCN, 2010).

Communication between nurses at report change is essential. The next nurse needs the most important information whether it is as Situation-Background-Assessment-Recommendation (SBAR) that the Institute for Healthcare Improvement (n.d.) outlines to use or in another form. The case of Rio Grande Regional Hospital Inc v. Villarreal discusses how one nurse breached the standard of care because the record reflects that from the time Hermes was given the double-edged razor until he died neither Nurse Bergado nor any other nurse checked to see how Hermes was doing in the bathroom” (Find Law for Legal Professionals, 2016). At Baylor Scott & White at All Saints, we have a policy that each patient is rounded on physically every hour.

The patient is a 45 year old man who had GI surgery 4 days ago.  He is NPO, has a nasogastric tube, and IV fluids of D51/2saline at 100 mL/hr.  The nursing physical assessment includes the following:  alert and oriented; fine crackles; capillary refill within normal limits; moving all extremities, complaining of abdominal pain, muscle aches, and "cottony" mouth; dry mucous membranes, bowel sounds hypoactive, last BM four days ago; skin turgor is poor; 200 mL of dark green substance has drained from NG tube in last 3 hours.  Voiding dark amber urine without difficulty.  Intake for last 24 hours is 2500mL.  Output is 2000mL including urine and NG drainage.  Febrile and diaphoretic; BP 130/80; pulse 88; urine specific gravity 1.035; serum

After notifying the physician of the history, labs, and assessment data further testing was ordered as well as a surgery consult, with the expected perforated bowel and sepsis prevention being the focus. After the subsequent testing confirmed perforated bowel, sepsis treatment was began and the patient

For my change, I would like to implement the use of SBAR sheets for shift report. For my Transition to Professional Practice course, I was at Butler Memorial Hospital. My preceptor’s name is Health Alter. She has been at Butler Memorial for about seven years. She is everything I expected from a preceptor. She is knowledgeable, kind, and willing to teach me everything I need to know, plus some. When I started at Butler Memorial, they were in the transition of changing to the onset of bedside reporting from shift to shift between nurses. I noticed that nurses were forgetting to relay information from nurse to nurse at the patient’s bedside, and were having to continue the patient’s report at the nurse’s station, which is not conducive to the ideal of bedside reporting. I went to Heather about what I was noticing, and she agreed. She said that she even noticed herself forgetting information while giving report, since sometimes there may be family in the room, or the patient is asking a lot of questions, etc.. So that evening, she had me give report to the oncoming nurses using the SBAR format. The oncoming nurses did not ask for any additional information and Heather said that using the SBAR format aided in giving a thorough report. It is important for all stakeholders, being the nurses and patients, to have and give accurate information about the patient’s care.

The base Capstone Simulation point score is generated as outlined below. You may access your Round and Cumulative score during Team Competition on the CapSim website at Reports →Analysis & Scoring →Analyst Report. This document outlines how the 10-item scoring method will be used. Your grade for the team or Individual Competitions will be simply your total points earned divided by the maximum points earned by a student or team (Individual or Team Competitions) in the same industry (simulation number). Large classes may have two industries organized in them.

I am familiar with SBAR report and am still using it in the hospital where I work. It is an efficient way of reporting about the patient during the change of shift, admission, transfer of the patient to other units or facilities and during emergency situations (Schroeder, 2011). This is a standardized tool to help nurses to communicate efficiently, focusing on the relevant information rather than going into the unwanted details. In any nursing unit as the staff has different levels of experience, some of them could provide a good report whereas others may not have the same skill to do it efficiently. This could lead to the omission of wanted details in the patient’s care planning and lead to a negative patient outcome (Schroeder, 2011). Using

Communication in a health care setting is vital for the continuation of care. The change-of-shift report is the approach nurses from one shift communicate and transfer information, liability and accountability to nurses on the next shift. Potter and Perry (2013) define the change-of-shift report also known as nursing hand-off as a method used by incoming and off going nurses to transfer information about the patients they will be caring for and or cared for. During this change of shift report, the off going nurse reviews information about the patients such as the patient’s condition, their medical history, their course of treatment to the incoming nurse and if they met their daily goals. This vital information helps the incoming nurse to continue with the plan of care for the patients and patient safety by avoiding setbacks and errors.