| PREVIOUS COMPONENTS OF THE SCENARIO |
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1 - Theme:
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CARE FOR PATIENTS WITH CHEST PAIN. |
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2 - Prior knowledge of the learner:
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With theoretical content (lecture classes through slides and theoretical direction based on current references) and practice, through practical training, which can be repeated as many times as necessary. To approach the methodology, the group will have the opportunity to participate in a realistic simulation scenario in a room with 1 volunteer and the other participants as observers of the scene. |
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3 - Learning objectives:
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To develop technical and non-technical competences and skills among students for the care of patients with chest pain. |
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4 - Theoretical foundation:
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ACLS, 2013/2020 AHA, 2015/2020 BRUNNER & SUDDARTH, 2015. GRUPO BRASILEIRO DE CLASSIFICAÇÃO DE RISCO, 2018 SOCIEDADE BRASILEIRA DE CARDIOLOGIA, 2015 |
| PREPARATION OF THE SCENARIO |
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5 - Scenario fidelity:
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Hybrid scenarios of clinical simulation using mixed technologies, and a simulated patient (actors and mannequins without interaction), in addition to monitor and ECG simulators without real-time interaction. |
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6 - Are the clinical cases consistent? (Description of the cases to the participant and the instructor)
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CLINICAL CASE 1- SCREENING: Patient P.K, 42 years old, male, was admitted to the hospital emergency room with chest pain radiating to the left arm. On physical examination, he has dyspnea, nausea, and cool, clammy skin. Also, he is accompanied by a family member, who reports that the patient experienced strong emotion. The nursing technician has already checked the vital signs. You are the professional (nurse/doctor) in charge of this unit and will coordinate the flow of this patient care. Initial vital signs: At screening (BP: 90x50 mmHg, HR: 126 bpm, SpO2: 91%, RR: 23 rpm). Conduct data collection objectively, based on the acronym SAMPLE. Classify the urgency of care according to the Manchester protocol. Transfer the patient's case to the sector that will be responsible for continuing the care. CLINICAL CASE 2 - EMERGENCY CARE: Patient P.F, 43 years old, was admitted to the hospital emergency room with chest pain, in addition to nausea, dizziness and dyspnea. After screening, the patient was classified as an orange priority and sent to his sector to receive immediate first care. The patient is monitored for evaluation of continuous vital signs. You are the professional in charge of the emergency unit, you will coordinate care and assign functions to others if necessary. The following are present in the scene: the patient, the companion and a nursing technician. Vital signs - (Visible on the monitor): (BP: 70 x 50 mmHg, HR: 132 bpm, SpO2: 89%, AxT:35.7ºC). Start care as recommended for patients with chest pain. Depending on the care priorities, you can assign to the nursing technician the procedures that he/she can perform. Perform 12-lead ECG correctly. |
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7 - Characterization of the actors and instructions on the performance:
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Plain clothes, expression of pain on the face, hand on the chest, is agitated and bewildered. You are a middle-aged man, plainly dressed, with a complaint of chest pain and shortness of breath. Shows agitation, anxiety, reports constant increase in pain. Unable to answer questions asked by the nursing staff. Companion: Patient's relative, simple clothing. Provides information about the patient, saying: “he is hypertensive, diabetic and has experienced strong emotion just now” She is anxious and worried about the situation. Nursing technician - scenario 1: Stands beside the wheelchair and takes the chair to the patient, if requested by the participant that the patient be taken in the wheelchair. Nursing technician - scenario 2: He is present in the scenario and introduces himself right at the beginning, saying: - Hello! I'm the nursing technician on duty, I'm here to help with whatever it takes! He is calm and proactive, ready to carry out the actions that are delegated by the nurse (oxygen and venous access).NOTE: If assigned to perform the ECG, the actor must say that he does not know how to perform the procedure. Tip: If the participant is not paying attention to the monitor, the actor asks if the participant has already looked at the vital signs and if everything is fine. |
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8 - Human resources:
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Target Audience: Academics and/or health professionals who sign up for the activity and have been exposed to the theoretical and practical content programmed to carry out the activity. Facilitator: researchers, professionals trained to carry out educational intervention in Universities and Hospitals. Actors: People trained to play the role of patient, companion and Nursing Technician. |
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9 - Material resources:
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Structural Composition: Table, chairs, hospital bed stretcher with identification badge, screen, sink, infectious and non-infectious waste, emergency room identification, medical gas alarm panel, IV pole, wheelchair, complete blood pressure and ECG monitor, ECG machine. Materials needed for the participant's performance: Surgical gloves, cotton, gauze pad, alcohol, electrically conductive gel, material for oxygen therapy (fluidizer connected to oxygen and O2 catheter), central venous tray- IV support. Separate materials: Needles, syringes, disposable diaper, disposable kit for trichotomy, stethoscope, axillary thermometer, device for measuring blood pressure, pulse oximetry, macromolecule nebulization. |
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10 - Reason for admission
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Chest pain that can radiate to left arm and dyspnea. |
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11 - Vital parameters:
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Initial vital signs: At screening (BP: 90x50 mmHg, HR: 126 bpm, SpO2: 91%, FR: 23 rpm). Vital signs-at the emergency room: (BP: 70 x 50 mmHg, HR: 132 bpm, SpO2: 89%, AxT: 35.7ºC). Visible on the monitor. |
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12 - Expected interventions:
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It is expected that the participant - In scenario 1: Perform the screening objectively, based on guidance contained in the SAMPLE history; Carry out the correct risk classification, according to Manchester; Perform a complete and consistent handover. - In scenario 2: Recognize the hemodynamically unstable patient; Evaluate and carry out interventions as recommended; Assign functions to the nursing team, such as venous access with a large-bore catheter, blood collection; Perform the ECG, interpret it or call the doctor within 10 min and record the care. |
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13 - Outcomes expected:
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Acquisition of skills and competencies in the initial emergency care of patients with chest pain. Aimed at technical and communication skills with the patient and family, in addition to the team. |
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14 - Scenario complexity:
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Low and medium fidelity clinical simulation scenario. |
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15 - Physical space:
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Practical laboratories (educational or health institutions) or In Situ are recommended. |
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16 - Estimated time for the scenario:
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Total of 10 to 15 minutes to carry out the 2 scenarios. For each individual scenario, 5-7 minutes. |
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17 - Validation of the scenario:
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After the judges' evaluation and suggestions, adjustments will be made, and then pilot testing of the scenarios will be conducted. |
| FINAL SCENARIO of COMPONENTS |
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18 - Development of the scenario:
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Scenario 1: - Anamnesis: Hypertensive, diabetic, without allergies. - Risk classification - code orange-Patient sent to rest. Scenario 2: - Physical examination: Initial assessment with ABCDE approach. -Evolution: Patient is admitted to the emergency service complaining of chest pain. In the emergency room, patient vital signs are monitored, signs of instability are noticed.After the initial contact with the patient, the student must identify the severity of the situation and perform the ECG within the appropriate time in the OSCE station. - Critical scenario factor: A patient with hypotension, dyspnea and tachycardia with low oxygen saturation, needs O² support. - Clues: the nursing technician and the patient’s companion will provide information to the participant according to their questioning. |
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19 - Simulation assessment:
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It will be done through a checklist of tasks based on the Objective Structured Clinical Examination (OSCE). |
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20 - Debriefing:
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Conducting the reflection and analysis debriefing: moment of feedback with review of care together with the student, through the evaluation checklist, evaluating strengths, weaknesses and improvements.Occurs after the simulated scenario. The estimated duration of the session is 30 minutes. |
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21 - Application of the Safety and Satisfaction scale
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Application of the scale to students to assess their satisfaction with learning through simulation. |
