| 1 - Telesimulation Name: Late Preterm Newborn (LPTNB) with Hypoglycemia Target Audience: Undergraduate nursing students from the 5th semester. |
| 2 - Main Learning Objective: To implement nursing care for late preterm newborns with neonatal hypoglycemia, emphasizing knowledge, leadership, and decision-making skills. |
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3 - Secondary Objectives:
• Perform vital signs assessment and physical examination.
• Identify risk factors for neonatal hypoglycemia.
• Early recognition of clinical signs of neonatal hypoglycemia associated with risk factors.
• Promptly request medical evaluation.
• Guide and execute steps of the neonatal hypoglycemia management protocol.
• Provide guidance to family members regarding the care provided.
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4 - Duration:
• 10 minutes for briefing.
• 10 minutes for the running phase.
• 30-40 minutes for teledebriefing.
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5 - Material and Human Resources:
• Communication application: Microsoft Teams®.
• Vital sign simulator: https://sourceforge.net/projects/vitalsignsim/.
• Two computers:
• Background image file: Neonatal inpatient unit.
• Image files for projection: Newborn in an incubator with hypotonia and baby being punctured.
• Audio file: Newborn crying.
• Video file: Newborn sucking maternal breast.
• Human resources: One operator, one facilitator, and three actors.
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6 - Guidance for Actors:
Doctor: The actor assigned to this role should thoroughly review the case. They will portray a physician in the Neonatal Inpatient Unit and, when prompted, request the necessary infusions as per the protocol.
Experienced Nurse (if necessary): If the participant fails to request blood glucose measurement or fails to identify hypoglycemia, the experienced nurse enters the scenario to offer assistance. They provide information but do not remain in the scene.
Child’s Mother: Simone, 19 years old. Following a cesarean delivery, she is admitted to the obstetric inpatient unit. She is distressed about being separated from her first daughter. The scenario requires her to seek help from the team, reporting that the baby appears very “soft.” This should challenge the participant in managing the case. If asked, important information to provide includes: “The baby is sleepy while breastfeeding, doesn’t latch well, and I’ve been breastfeeding every 3 hours.”
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| 7 - Participants: two nurses |
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8 - Pre-briefing:
• Announce the activity, stating that the scenario will focus on nursing care for late preterm infants.
• Provide the reading material in advance.
• Explain the steps involved in the telesimulation.
• Discuss the adaptation of expectations in the virtual environment.
• Present the resources that will be utilized (actors, software, images, videos, audios).
• Clarify the communication methods during the scene.
• Establish the fictional contract, confidentiality agreement, and the commitment to respect and empathize with colleagues.
• Describe the roles of the participants.
• Explain the role of observers and the use of the checklist during the scene.
• Distribute the papers to the participants as specified in item 7.
• Present the clinical case according to item 10.
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9 - Scenario Summary:
A 34-week and 4-day-old newborn from the Obstetric Center is admitted to the neonatal inpatient unit due to respiratory dysfunction and weight gain issues. The scene begins with the late preterm newborn in the incubator, accompanied by the mother. The mother informs the team that her daughter appears unwell, mentioning hypotonia and tremors. Participants are expected to promptly identify signs and symptoms of neonatal hypoglycemia, inform the medical team, and implement nursing care for the late preterm newborn with neonatal hypoglycemia, following the protocol and prescription.
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10 - Description of the Clinical Case:
The clinical case involves a female newborn named Ana Clara, with a gestational age of 34 weeks and 4 days. She was delivered via cesarean section, weighing 1900 g at birth. Ana Clara is classified as Small for Gestational Age and had APGAR scores of 6 and 8. After being born at the Obstetric Center, she was admitted to the neonatal intermediate care unit at CARE Hospital due to respiratory dysfunction, prematurity, and low birth weight. Currently, she is approaching 24 hours of life and weighs 1850 g. Ana Clara is kept in a heated incubator, receiving ambient air ventilation and has no venous access. She is on an oral diet of breastfeeding on demand, with her last feeding occurring 3 hours ago. She has not received any milk supplement, and her blood glucose level at 12 hours of life was measured at 71 mg/dl. Ana Clara’s mother, Simone, is also admitted to the obstetric inpatient unit and regularly comes to breastfeed her daughter. Upon arrival, Simone noticed that Ana Clara appeared unwell and requested assistance from the nursing team, mentioning that the baby felt “soft” and exhibited tremors. You have been called to manage this case.
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| 11- Running (Scene): |
| Time |
Monitor settings |
Operator actions |
Participants’ actions |
Clues |
| 0’ |
Initial state: RR:70mpm HR: 115 bpm AT: 36.6°C Sat: 89% |
-Shares monitor screen without data and image of the newborn in the incubator with hypotonia;
- When a participant mentions that he has measured vital signs, the data are released on the monitor;
- The physical examination data are informed by the facilitator, as requested by the participant.
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-Greet and introduce yourself to the mother;
-Collect more information about the patient;
-Performs the measurement of vital signs;
-Performs physical examination of the newborn.
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The mother reports that the daughter is very “soft” and with tremors. |
| 2 min |
RR: 70mpm HR: 115 bpm AT: 36.6°C Sat: 89% |
- The result of the blood glucose measurement is provided verbally by the facilitator (19mg/dl); |
-Requests blood glucose measurement by tape;
-Identifies hypoglycemia
-Requests urgent medical evaluation;
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-If the participants do not request the blood glucose dosage.
-The most experienced nurse actress enters the scene.
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| 4 min |
RR: 70mpm
HR: 110 bpm
AT: 36.6°C
Sat: 88%
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- Decreases HR to 110 and Saturation to 88%;
-Shares image of punctured newborn and with infusion pump.
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- Identifies clinical deterioration.
- Performs venipuncture.
- Administers a bolus of 10% glucose solution using a infusion pump.
- Installs a continuous infusion of 10% glucose solution.
- Performs blood glucose measurement using a tape after 30 minutes.
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-Doctor enters the scene and requests information, venipuncture and infusions. |
| 6 min |
RR: 50mpm
HR: 130 bpm
AT: 36.6°C
Sat: 96%
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-Facilitator verbally informs that 30 minutes have passed;
-Verbally inform the blood glucose result (75mg/dl)
- Change signals according to time settings 6’;
-Releases newborn crying sound;
- Share video of newborn sucking maternal breast.
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-Performs blood glucose measurement and measurement of vital signs;
-Guides the team on glycemic control at 1 hour, 2 hours and 4 hours until glycemic stability;
- Place the newborn to suck the maternal breast or offer milk formula if the mother is not available;
-Instructs the mother on the importance of breastfeeding;
-Requests consultation on breastfeeding.
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-Mother says: “What a relief that Ana is crying. It must be getting better If the participant does not put the baby to breastfeed, the mother asks if it is possible, as she seems to be hungry. Question if you’re doing it right. |
| End of scenario |
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12- Teledebriefing:
Following the conclusion of the scenario, gather all participants, observers, and actors for the debriefing session. Direct the following questions to the participants: How did you feel during the scenario? Can you provide a chronological account of what unfolded in this specific scene? What characteristics are commonly found in late preterm newborns (LPNBs) that were evident in Ana Clara, the newborn in this case? Did Ana Clara possess any risk factors for hypoglycemia? If so, which ones? What symptoms of hypoglycemia did she exhibit? Why was the situation considered urgent? What are the risks associated with hypoglycemia in newborns? According to the protocol, what actions were taken? How important is post-event care? What nursing interventions are necessary for preventing hypoglycemia? What is the relationship between breastfeeding and hypoglycemia? How might LPNB characteristics impact breastfeeding? Was there any behavior missing during the scenario? Is there anything you would have done differently? For the observers, is there anything you would like to add that hasn’t been mentioned by the participants? If you were in an acting role, what would you have done differently? What lessons have been learned from this scenario? Are there any additional areas of knowledge that could be beneficial in this context? Finally, ask the actors: How did you feel portraying the role of [actor/actress role] in this situation? As a concluding question, what was the main takeaway from this experience?
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| 13- Summary of the Activity by the Instructor: Review the objectives of the telesimulation, referring to items 2 and 3 of the script, and discuss with the larger group whether they were achieved. |
| Item 14- Observer Checklist
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Expected actions |
D |
ND |
PD |
| Communication |
He greeted the family member (the mother) and introduced himself before seeking assistance from the nursing team. He gathered additional information about the patient and urgently requested a medical evaluation. He provided guidance to the family members regarding the nursing care being provided and emphasized the importance of breastfeeding on demand. He discussed the option of using milk from the milk bank if the newborn is drowsy. |
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| Clinical information |
Next, he proceeded to measure vital signs and conduct a physical examination of the newborn |
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| Identifying signs and symptoms of neonatal hypoglycemia |
He addressed the complaint of hypotonia and attended to the concerns of tremors. He analyzed the previous blood glucose results obtained at 2, 4, 6, and 12 hours. He requested a blood glucose measurement at 24 hours of life and identified clinical deterioration based on the following findings: oxygen saturation (Sat) - 89%, respiratory rate (RR) - 70 breaths per minute, heart rate (HR) - 115 beats per minute, and axillary temperature (AT) - 36.6ºC. By evaluating the blood glucose measurement using a tape, he confirmed the presence of hypoglycemia (Result=19mg/dl). |
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| Management of neonatal hypoglycemia |
To address the hypoglycemia, he performed a venipuncture and administered a 3 ml push of 10% glucose solution as per the medical prescription. He provided guidance to nursing technicians on glycemic control at 1 hour, 2 hours, and 4 hours. He initiated a continuous infusion of glucose solution using an infusion pump for 24 hours. He performed a blood glucose measurement 30 minutes after administering the glucose push. He encouraged the newborn to suckle at the maternal breast or offered milk formula if the mother was unavailable. He sought advice on breastfeeding. |
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