“Get Connected”: Integrating Telehealth Triage in a Prelicensure Medical Simulation – Healio

31August 2020

Knowing OutcomesAt the completion of the obstetric telehealth simulation, the learner will be able to:1.

Interact successfully with customer and peers making use of audio-visual innovations.

Translate pertinent risk factors and findings.

Create a plan of care based upon evaluation findings.

Background: Client C.D.DOB: 4/17/2000 Client is 10 days postpartum: Client called the workplace and has actually left a voice message that she is experiencing pain in her ideal breast. She is also having troubles with breastfeeding and feeling a bit beat. She is requesting a telehealth service. Surgical History: 2 vaginal shipments (2019, 2020); wisdom teeth extraction (2018) G2P2: 4/9/2019: vaginal shipment: 35 weeks, epidural, birth weight 2359 grams (5.2 pounds.); 4/17/2020: vaginal shipment: 39 weeks; vacuum helped, epidural, birth weight 4445 grams (9.8 lbs.). Mentor Materials: Postpartum Depression (PPD) Edinburg Postnatal Depression Scale Calculation Tool, health record, Telehealth Triage Nurses Notes/Documentation kind Didactic Content: Mastitis, Postpartum Hemorrhage (PPH), Postpartum Anxiety Pre-BriefingAddress any technology problems. Describe telehealth triage simulation procedure, expectations, and discovering results. Evaluation the customers background info and health record. Orientate to the simulation laboratory. Each student nurse was motivated to speak and communicate as the main nurse. There is just one role. Students can connect to the instructor with making use of the CHAT videoconferencing function. Review didactic topics related to postpartum telehealth. Didactic Topics: Didactic Discussion Material: SCHOLAR Triage(see Telehealth Triage Documentation Form) SCHOLAR acronym to gather subjective data and document findings=Signs, Qualities, History: Onset and period, Area, Aggravating or Associated Factors, Relieving Aspects. Collecting subjective data/review of systems and a basic survey/objective information that can be examined throughout a telehealth video conference. Telehealth Privacy and Privacy Issues Consent Type “Non-public facing” videoconference innovation Nurses note/Documentation Form/Date/Time/ Findings Effective Interaction Recognize self. Use of understanding statements: “Inform me more”, “I understand”, “What happened next”, “I’m sorry you aren’t feeling well.” Active listening. Making use of SBAR interaction. Mastitis, PPH, PPD Didactic review and question and response duration with students. Threats and signs and symptoms. Nursing interventions. Telehealth Script: Live Patient and Anticipated Student Nurse Responses Client Reaction: Student Nurse Reaction: Trainee Nurse: Introduce themselves and inquire about the voice message requesting a telehealth service. Customer: Yes, I did. Thank you for calling me back!I have actually been trying to breastfeed this child; I didn’t attempt to breastfeed the very first baby because she was so little and born early. However I believed considering that this baby was bigger, I would try to breastfeed him. I got assistance in the health center, but they told me I had an incorrect lock and I wound up getting some blisters on my nipples. It was really uncomfortable initially. Now, the pain I have actually been having seems to be getting worse. PAUSE(allow time for students to evaluate and respond) Student Nurse: Empathetic Response: “I’m sorry you aren’t feeling well.” -Mastitis: Must evaluate for mastitis based upon signs reported. Should ask about temperature? Explain the pain? Is it localized to one area? Customer: I started noticing that not only is it uncomfortable but its tender too. Student Nurse: Mastitis-Should assess for mastitis based on signs reported. Should ask about temperature level? Describe the discomfort? Is it localized to one location? Asks questions related to the symptoms (qualities of a symptom) inflammation, discharge, pain scale, fever, chills, and so on. Customer: I see what looks like red streaks and I can barely breastfeed without weeping and he’s sobbing all the time since he’s hungry Trainee Nurse: Mastitis-Should assess for mastitis based upon signs reported. Should inquire about temperature? Describe the pain? Is it localized to one location? Client: In the beginning, I was so cold and felt so bad, like my body harmed all over, even my bones harmed, I felt like I had a fever. I do not really have a way of taking my temperature, but I am shivering all the time and my skin feels hot. Trainee Nurse: I will report these findings to the healthcare provider. You potentially have an infection of the breast. In the meantime, you might attempt cold compresses to aid with the discomfort. Students may likewise ask if the Ibuprofen PRN noted on the health record has actually been aiding with the discomfort. Client: I’m tired and I just require assistance. Trainee Nurse: PPD-Should acknowledge that client appears disheveled, discusses weeping a lot, and sensation beat. Should inquire about sensations? Possibly utilize EPDS tool for questioning? Ask if having ideas of damaging self or others. Customer: And, I googled that breastfeeding helped my uterus to agreement and would helpmy bleeding be less but it seems to just have actually increased and is getting much heavier and heavier.PAUSE(allow time for trainees to analyze and respond) Trainee Nurse: PPH-Should inquire about the bleeding. Ask questions such as how heavy is the bleeding, how typically are you changing pads, color, and so on …? Explain just how much of the pad is saturated. Client: I don’t know if it’s because he’s not nursing well and he’s spitting up all the time. I simply do not know. I think I keep in mind at delivery they were worried about the afterbirth taking so long but they told me it would be okay. Student Nurse: Ought to ask about the bleeding. Ask concerns such as how heavy is the bleeding, how typically are you altering pads, etc. …? Inform me more about the spitting. How is baby? How much spitting? How many damp diapers altered? How many bowel movements/loose? Customer: Not just is my breast harming but I am feeling weak and light headed and I do not’ understand if it’s the fever or what. I’m even type of concerned I may have COVID. Would that make me feel weak and my heart race? I seem like the infant is great they said she simply has a little reflux. Trainee Nurse: PPH: Need to inquire about the bleeding. Ask questions such as how heavy is the bleeding, how typically are you changing pads, etc. …? COVID-Have you took a trip beyond the nation? Have you been exposed to anybody with a known favorable case? Customer: I didn’t pay a lot of attention to the bleeding in the beginning due to the fact that they told me when I left the health center that it would increase due to the fact that I would be moving around more however I seem to be filling a pad a lot more. No, I have actually not been out of the country or around anyone who has tested positive. Student Nurse: PPH: Need to again inquire about the bleeding. Ask questions such as how heavy is the bleeding, how often are you altering pads, and so on …? COVID: responded to unfavorable questions, should comprehend that customer is most likely symptomatic from the blood loss. Client: In some cases 2 to 3 times an hour. TIME OUT (permit time for trainees to analyze details and respond) Intense red. In some cases big clots. Well you know it simply harms so bad and I’m tired and I feel so unusual, I have actually called my mom, my sister, and my good friend over to look after the child since I simply can’t deal right now. Student Nurse: Trainee must advise having someone bring the client in to the health center for examination because she is also symptomatic. Suggest calling emergency situation services to transfer if no one is available to bring her in and recommend no driving. Trainees should acknowledge this is an excessive amount of bleeding. Client: As students are using suggestions and informing the customer what they are going to report to the physician, the client loses consciousness. Trainee Nurse: should understand to call 911/Emergency Solutions * Once the student states to call 911/Emergency services, the simulation is complete. DebriefingBegin the debriefing with the following declarations: “Let’s begin by concentrating on what occurred throughout your discussion with the client without judging our efficiency.” The instructor will continue the conversation by specifying, “What took place next?” When the trainer has engaged trainees in contemplating the telehealth triage simulation experience, he/she will transition to a deep-dive analysis and reflection period. Analysis Reflection Content: Analysis of Interaction This telehealth triage experience was developed for trainees to have a chance to demonstrate reliable communication. How did you react to the client? What concerns did you ask? What extra concerns could you ask? Would you rephrase any of your questions? Which ones and why? Why did you respond in this way? What obstacles did you face associated to communicating through videoconferencing? Exist extra people with whom you interacted (peers? Instructor?) What other specialists might be handy to you in this case? What compassionate declarations were provided? What could you have said and when? When talking with clients in the health center, how could you show empathy? What would you state and why? Examples consist of: Inform me more, I comprehend, what occurred next, I’m sorry you aren’t feeling well. Analysis of Risks and Signs and Symptoms This simulation experience was also created to supply trainees with a chance to analyze postnatal risk factors. What declarations did the client make that worried you the most? Why? What actions did you take in action to the client’s statements? Why? What were the risk aspects? What were you thinking about as the client shared her s/s? What threat factors/signs/symptoms were missed out on? How did you interpret pertinent risk elements and findings connected to PPH, mastitis, and PPD? What extra information or resources do you need? What would you do differently? Why? What was the most considerable or priority concern? Why? Analysis of Nursing Interventions and Plan of Care In this medical experience trainee nurses were to create a plan of care based upon evaluation findings. What was your plan of care for the client? What extra details did you need? What would you do differently? Why? How could you utilize this information when looking after clients in the health center or another setting? Go over how they felt when the customer lost consciousness. What details might be required for the nurse to report to emergency situation services (i.e. address, history, etc. …) Who should be gotten in touch with and why? How did they respond to the client? How did they feel? Why did they feel this way? Simulation Paperwork and Examination of Simulation Experience Each student completes the telehealth documents type and sends to their scientific manager. Trainees are given the link to complete a simulation evaluation.

Source: healio.com

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