NRP 6 th Edition…Teaching the Course. Major problems with current NRP teaching methods - A “perfect” score does not help the learner. We often learn best.

NRP 6th Edition…Teaching the Course

Major problems with current NRP teaching methods - A “perfect” score does not help the learner. We often learn best from our mistakes. Simulation allows us to push learners to

fail in difficult situations and learn from these failures.

Failure should happen during training, NOT patient care

Instructor Requirements Each instructor watches the NRP Instructor

DVD and completes the post-test by January 1, 2012.

Beginning January 1, 2013, every instructor takes the online exam in the 2 years prior to renewal, at no cost.

Teach, or co-teach, 2 courses in 2 years

NRP Course Basics Lessons 1-4 and 9, minimum Everyone can practice and perform every

skill. NRP does not certify competence or change

legal scope of practice. Provider status is “renewed” every 2 years

NRP Course Revisions No separate provider and renewal courses Minimal lecture and no slides Students self-study the textbook and/or

DVD Students take the online exam prior to class

No more hard copy tests after Dec 31, 2011 Instructor:learner ratio = 1:3-4 learners

If your card “expires”??? The institution decides the employee’s fate

Provider Course Components Performance Skills Station for practice

Choose all or select skills based on student expertise

Integrated Skills Station for evaluation Required

Simulation and Debriefing for learning Required

Structuring of renewals - The one-person, quick check is an

inefficient use of instructor time and interferes with simulation and debriefing.

The “solo” NRP skills check-off The learner should be aware of his/her

expiration date and plan accordingly. Providing “solo” NRP skills check-offs is

NOT the instructor’s responsibility and IS NOT how we will conduct NRP skills check-offs at Cape Fear Valley.

Performance Skills Stations Reinforces cognitive learning

This is where you may choose to quiz the learner’s knowledge.

The learner practices or reviews hands-on skills with an instructor

When the learner feels confident in his/her skills, the instructor gives a short scenario that begins with the Equipment Checklist.

There is no scoring or grading. The Performance Checklist is used as a reference.

Simulation & Debriefing Now a requirement of the Provider Course Provides a safe setting for integration of

cognitive and technical skills, team communication, and patient safety

Confidentiality is essential for participation No one fails simulation and debriefing, but

this is where the learning happens!

The Art of Simulation

What’s wrong with how we have been doing things? We have fallen into the trap of “feeding”

too much information to learners With the loss of reality, we have a

tendency to let learners talk their way through scenarios

Are we doing them a favor by continuing this method? NO

Why simulation???? The more objective clues that we can

provide to learners, the more realistic the practice can be.

Hi-fidelity simulation requires… $$$ for purchase and maintenance Space for secure storage Staff who know how to run and maintain

the equipment Technical knowledge for problem-solving

Low-tech simulation methods…. moulage… Spray blood – make your own with red

fingerpaint, blue dishwashing liquid, baby oil

Meconium – pureed baby food Vernix – Eucerin with potato flakes Create the illusion, but don’t overdo it CLEAN UP!!!

How are WE going to do it??? Moulage…. Low-tech Video

How are WE going to do it??? Reorganized NRP teaching kits Moulage…no, but….

Red cloth = blood Green cloth = meconium Spray with water for wetness

If available, we will use a vacant warmer Simulated equipment panel – Simply NRP

How are WE going to do it??? Physiologic signs

Breathing, crying Tone HR – metronome O2 saturation

Preparing for effective simulation Supplies and equipment Physiologic feedback Team member orientation and role

designation Confidentiality Instructions and expectations

Supplies and Equipment Learners need to find the equipment and

handle it Learners perform the equipment check

using the Quick Pre-Resuscitation Checklist This will cue learners to be sure that they

have essential items.

Physiologic Feedback How will learners know the HR or if the

baby is breathing? We have to familiarize learners with how

we will be giving this information Information is not revealed until the learner

performs the appropriate assessment action and/or asks for the information

Team Member Orientation and Role Designation Let learners get to know each other Learners should wear visible nametags

with their designated role Important especially if filling a role outside

their normal Remind learners that acting in a role different

than their everyday role does not authorize them to perform skills outside their scope of practice in real life

Confidentiality – The Vegas Rule… Learners have the right to confidentiality and

confidence that scenarios will not be held against them in a punitive way

All events are confidential Protects the learner Protects the confidentiality of the scenario for use in

future classes

The events of simulation and debriefing are NOT part of the learner’s performance evaluation

Confidentiality – The Vegas Rule… Consent for filming If the exercise is filmed, the tape is erased at the

end of the course, unless the learner has given written permission for its additional use

Instructions and Expectations Learners need to know the “rules of the game”. Mistakes are acceptable!

The best learning may come from an error. The goal of simulation and debriefing is NOT

perfection….it is learning. Laughing and joking are not acceptable during

resuscitation…so, they are not acceptable during simulation!

The instructors NEVER trick the learners (ie. sabotaging the scenario)

Instructions and Expectations Learners need to think out loud.

Helps other team members and instructor know what they are thinking and why

Helps to promote a common “mental model” Learners need to actually perform the actions,

NOT simply say they are doing or would do something The exception to the rule is administration of fluid

and epinephrine. Draw up the med first. Then expel on bed linen and simulate administration.

Instructions and Expectations Everyone participates during a simulation. Team members may help each other in any

way that is plausible to the scenario. Communication and teamwork are

encouraged and expected! The instructor, NOT the learner, indicates

when the scenario has ended. “The scenario is over. Let’s debrief.”

Instructor Roles

What do I do as an instructor? It is difficult for one instructor to do

everything during a scenario. Instructor #1 – watch the scenario and

responses and give the physiologic cues Instructor #2 – video, take notes about

what happens and plan for debriefing Set video recorder on tri-pod

Conducting a scenario Learners benefit from participation in more

than one scenario. Once learners know the ground rules, begin

with a simple scenario. Then, progress to more complex scenarios that push learners outside their comfort zones.

Conducting a scenarioPreparation for the actual scenario Prepare the manikin with the appropriate

visual cues. Define instructor roles. Read the scenario. Allow learners to ask about relevant

perinatal history. Gestational age, fluid color, etc.

Conducting a scenario Allow learners to –

Designate roles – assign leaders and tasks Check supplies and equipment Ask additional questions if needed

Announce when the scenario has begun. Depending on the complexity of the

scenario, other “players” may be used to provide cues and enhance reality.

Conducting a scenario Once the scenario begins, stay out of the way as

much as possible. For complex scenarios, be prepared to answer

questions about information like confirmation of endotracheal tube placement and other resuscitation indicators.

DO NOT give hints or additional information beyond what learners must ask to assess the effects of their actions!

Conducting a scenario Allow learners to take the scenario down

the path they choose without interruption, coaching, or feedback.

Preparing for the debriefing Use the Scenario Template form to take notes.

Check off the interventions performed as they happen. Note unexpected occurrences. Pay attention to which behavioral objectives were met

and how that occurred. Video helps…the camera doesn’t lie!

Note which segments hold key information. Note the learners who are especially dominant or

submissive. This can effect the debriefing strategies you use.

Managing the unexpected Unexpected things can happen during a scenario

(ie. equipment dropped, med error, mental model not shared).

If this is an event that can happen in real life, learners should solve the problem.

If the scenario continues for a long time and drifts far off-track, the instructor may need to assess the need to end the scenario and debrief without successfully resuscitating the baby.

Managing the unexpected When a scenario problem or need for

redirection occurs, the instructor can send in a “confederate” to play a certain role for a specific purpose.

The “confederate” is not one of the learners participating in the scenario.

Examples of using a “confederate” A learner cannot stop giggling. So, the

instructor sends in the “baby’s grandfather” to remedy the situation by saying – “I’m this baby’s grandfather, and I’d like to know what is so funny. This looks like a pretty serious situation to me.”

Examples of using a “confederate” Some scenarios can be very complicated

and involve may players with a planned script. It is appropriate to have the “confederate” play a set role.

Ending a scenario End the scenario with an objective

statement like – “That ends your scenario. Let’s debrief now.”

The instructor does not end a scenario with a judgmental statement like – “That was great”. OR “Well, okay. We have a lot to talk about.”

Ending a scenario Is it okay for a scenario to end with the

baby’s death? Yes, if that is part of the learning objectives

or if there is an egregious error. NEVER to “punish” the resuscitation team

for errors made during the scenario.

Debriefing

Debriefing is the most challenging new skill for NRP instructors We’ve been taught to lecture and give feedback. New role is direction of a team-centered

discussion by asking open-ended questions. The learners will discover for themselves what

went well, what needs improvement, and how NRP Behavioral Skills impact the outcome.

Give input at the end of the discussion. Summary of main points, next steps,

acknowledgement of good efforts

Ready, Set, Go…. Review “Ready, Set, Go Instructor Prep

Sheet” and “Simulation Preparation, Tips, and Sample Debriefing Questions”

References Kattwinkel, J., Perlman, J.M., Aziz, K., Colby, C., et. al.

(2010). Special Report - Neonatal Resuscitation: 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Pediatrics, 126(5), e1400-e1413.

Zaichkin, J. (Editor). (2011). Neonatal Resuscitation: Instructor Manual. American Academy of Pediatrics.