High fidelity clinical simulation scenarios are usually an impactful and potential career altering educational event. More often than not an incredibly high amount of resources in numerous ways are required both in preparation and also delivery of this style of healthcare simulation scenarios. This article by Erin Carn-Bennett, MSN, RN will explore three suggested high fidelity pediatric clinical simulation scenarios that includes the scenario stem and also considerations for stages of scenario and delivery.
Importance and Place of High Fidelity
High fidelity clinical simulation scenarios involve advanced patient manikins that are life-like to assist with clinical simulation participant buy-in within the scenario. High fidelity clinical simulation scenarios can also involve simulated persons or a hybrid style of clinical simulation which may include a combination of both simulated person and wearable simulators. However, as this article relates to pediatric high fidelity clinical simulation there will be references primarily to use of high fidelity manikins in this article.
High fidelity healthcare simulation is incredibly valuable to the learner due to the closeness in nature to a real life event. Through the process of experiential learning, clinical simulation participants are often able to translate lessons from the clinical simulation scenario to improve patient care at the bedside in the future. This is the ultimate goal of all healthcare simulation experiences, however high fidelity simulation has the opportunity to have the largest impact in this way.
Clinical simulation participants will become frustrated if the fidelity does not make sense for the case in the scenario or is inaccurate. The stakes are high in high fidelity clinical simulation but the pay off long term in regards to return on investment is also high. Preparation and attention to detail is crucial. Ensure expertise is sought in revision of the clinical simulation scenario and use details from real cases that are deidentified and with an appropriate space from their presentation to the service as much as possible. Participants’ psychological safety should always be at the forefront and clinical simulation should not be used as a punitive measure for high performance teams.
Debrief Methodologies for High Fidelity Clinical Simulation
There are many debrief methodologies that can be utilized in a high fidelity style of clinical simulation. Find the methodology that works for the organization where clinical simulation is to take place. Clear and psychologically safe debrief particularly in high fidelity clinical simulation is critically important for clinical simulation participants.
Teamwork principles in action and the challenges around them are complex yet crucial to unpack and hone teamwork for future real life events after the high fidelity scenario. Often faculty members can be trained in a number of different debrief methodologies and there is use in a clear plan of what debrief methodology will be used in the clinical simulation. This should be decided early in the course plan phase with consensus. The most important intention is to deliver psychologically safe clinical simulation.
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Scenario One: Pediatric Head Injury
A pediatric head injury clinical simulation scenario with low GCS presents any emergency or critical care team with complex conundrums for clinical consideration. Ensure that the mechanism of injury is enough to peak the interest of the team such as a fall from a significant height. Observations of the patient should include a low heart rate, widened pulse pressures and irregular breaths in line with a cushings triad presentation. A blown pupil on the manikin can also enhance fidelity as well as bandages and blood for moulage.
This scenario stem could also be written for a ward based pediatric patient who had been admitted for observation and then decompensated with an intracranial bleed that requires emergent intervention. Low oxygen saturations alongside the altered GCS and groaning in pain will add pressure in a number of ways to the participants.
The expected outcomes from the clinical scenario include the administration of osmotic agents to manage intracranial pressure, pain management, neuroprotective cares, airway protection via intubation, preparation for safe transport for radiology and trauma assessments. Ideally plan to make the patient critical enough that intubation is required pre transport to radiology.
Scenario Two: Pediatric Sepsis
The second suggested pediatric scenario for high fidelity clinical simulation is a septic patient that requires IV fluid Resuscitation, IV antibiotics, inotropes and probable intubation. Base learning outcomes of this clinical simulation on the local organizations sepsis policy. Scenarios that require a lot of IV fluid delivery are often very fast paced and task overloaded particularly from a nurse team perspective. Scenario stems can be based on a patient with pneumonia, oncology history or a joint infection. This scenario could be altered to suit most pediatric clinical environments.
Ensure that the patient’s observations present urgency to the team in the high fidelity clinical simulation. Tachycardia, high fever, low blood pressure, altered GCS and a delayed central refill time should alert the team of the urgency to treat sepsis in this patient. If the team of this high fidelity clinical simulation are quick to resuscitate the pediatric patient with IV fluids and antibiotics then drop the patient’s oxygen saturations and add in complex airway management requirements and push the participants to intubate and consider potential issues around this such as the patient being high risk for a PEA arrest.
Scenario Three: Pediatric Massive Transfusion
The third pediatric clinical simulation scenario is a multisystem trauma that is hemodynamically unstable and requires the massive transfusion protocol or equivalent (organization dependant) to be activated and actioned. For a multisystem trauma clinical simulation competing priorities ideas include: blood administration, secure airway prioritization and operation room transfer timing. This case would ideally be completed in the emergency room.
For this patient a significant mechanism of injury should be included in the scenario stem such as presentation of an unrestrained passenger in a motor vehicle accident or equivalent. Complex clinical simulation scenario cases such as this one ideally use the story stem, radiology and blood results which have been de identified from a real case. If details are used from a real case ensure that enough time has passed since the real life case as to not retraumatise any staff involved in the real case.
A balance of emotional intelligence around this and also dedication to get details correct is critical for a clinical simulation with high fidelity to this level. Ensure that moulage is planned for, is accurate to the case stem and to a high standard to assist with participant buy in to the educational experience. This case will often have a rich discussion in debrief around complexity of blood administration process in the pediatric complex trauma patient.
This article has explored three clinical simulation scenarios for a pediatric patient in a high fidelity environment. These case stems and scenario bases can be adapted and altered to the pediatric placement of preference. High fidelity simulation can be incredibly high in resources for both preparation and delivery. However, the depth and breadth of learning for participants involved in these clinical simulation experiences will be impactful potentially for their entire careers.
