Blood Transfusions: Simulated and Interactive Practice in Nursing

Introduction

As nursing students make the transition from the classroom to clinical practice, they often lack confidence and experience fear. Because they are not able to practice clinical procedures on actual human beings, students are unable to effectively gauge their learning. However, technological advances allow nursing students to practice important clinical procedures via high-fidelity patient simulation or interactive multimedia. 

Simulated Practice

In the clinical setting, adverse blood reactions are limited, but its consequences are severe, so nursing students should learn how to quickly respond to reactions using a patient simulation. Blood transfusions rely on safe practice and careful management. For example, in the case of a traumatic injury, patients are at risk of Hypovolemic shock. A patient may experience a loss of circulating blood volume due to hemorrhage, so in response, cardiac output will decrease, and the mean arterial pressure will fall. If the blood volume continues to decrease, the patient’s shock will progress. Because the blood volume decreases, patients need to replenish their blood with a blood transfusion. Prentice and O’Rourke (2013) assert that “approximately 0.5% to 3% of blood transfusions result in adverse effects and can also result in fatalities” (p. 207), so it is vital that the nurse is competent in blood administration, and he or she is able to quickly recognize adverse effects.   Sometimes adverse effects are the result of human error, but the human body’s immune system may negatively react to the new blood in his or her system, so it is essential that the novice nurse understand how to type and cross-match blood samples. In order to learn blood transfusion reactions, nursing students may use high-fidelity patient simulation. Because the simulation is lifelike, the nursing student will understand the body’s reactions in a safe environment and avoid risk. 

Learning Objectives

1. Students will witness and discuss safety procedures used in blood transfusions.

2. Students will demonstrate proper assessment of a patient receiving a blood transfusion.

3. Students will identify the differences in 3 blood transfusion reactions.

4. Students will confer appropriate nursing intercessions based on specific blood transfusion reactions.

Simulation

Beforehand, the nursing instructor will decide which of the following blood reactions will occur: acute hemolytic reaction, delayed hemolytic reaction, febrile nonhemolytic reaction, mild allergic reaction, anaphylactic reaction, transfusion-related acute lung injury, transfusion-associated circulatory overload, transfusion-transmitted bacterial infection, posttransfusion purpura, transfusion-related graft vs. host disease (By Sabrina Bielefeldt, 2009, p.29) , so the simulation technician can program the SimMan to display signs and reactions. Starting the simulation, the nursing instructor will oversee nursing students as they take and document vital signs and provide the patient with an overview of what to expect. Nursing students will identify the bag to be used according to the patient’s requisition ID bracelet. After student nurses verify the data, they will check the I.V. site and attach the blood bag. As they open the clamp to adjust the flow with a roller, they will slowly begin the transfusion and take vital signs. Approximately five minutes of the transfusion, the SimMan will begin to experience a reaction. The nursing instructor will pause the simulation in order for the students to assess the reaction based on the physical signs and discuss the intervention. After the students identify the reaction and intervention, the nursing educator will begin the simulation again, so the students can carry out the appropriate interventions.  After the simulation exercise, nursing instructors will debrief students in order to discuss and reflect the exercise and offer feedback. 

Multimedia Presentation

Part of a nurse’s duty requires listening to a patient’s heart. While it is a routine part of an assessment, it is also challenging to distinguish the slight differences in the heartbeats. According to Gesundheit et al. (2009), “Web-based clinical cases (‘‘virtual patients’’, VPs) provide the potential for valid, cost-effective teaching and assessment of clinical skills” for nursing and medical students. For example, a patient may complain of chest pain, so it is essential that the nurse assess the heart rate appropriately in order to determine the patient’s care. Therefore, a multimedia exercise using virtual patients with a variety of heartbeats will allow nursing students to fine-tune their listening skills. Virtual assessments are a cost-effective approach to medical training. While listening to the heart rate is fairly easy in a clinical learning setting, nursing students should be adept at assessing what each heart sound is, so they are able to care for the patient properly. Upon their graduations, nursing students will immediately be responsible for their duties in their hospitals, so gathering as much experience as they can allow them to practice with confidence. Gesundheit et al. (2009) suggests using the software platform, Web-SP, in order to create interactive virtual patients (p.740). Under the observation a preceptor, a virtual patient allows students to practice various skills and allows the nursing instructor easy methods of teaching in case he or she is unable to use an actual clinical setting. In addition, the virtual patient will allow the students to experience a wide variety of factors. 

Student Objectives

1. Students will explain cardiac output.

2. Students will locate the Assessment Points

3. Students will understand influences of various factors in the heartbeat’s regulation.

4. Students will differentiate between irregular heart rate, mid-diastole murmur, mid-systolic murmur, and S1 and S2 sounds by listening to pre-recording MP3 files. 

Multimedia Presentation

The presentation will include written, visual, and auditory cues. One slide will depict the virtual patient. Following the audio instructions, nursing students will locate the 5 assessment points. Thereafter, each slide will represent an mp3 audio of various heart rates. The student has 15 seconds to appropriately define each heart sound. The slides will also have a timer so nursing students are aware of the time. The students should work in pairs, so they are able to provide one another with feedback. After they determine each heart sound, students will discuss the appropriate action depending on their assessment. 

Conclusion

Our advancements in technology have allowed us to use a variety of settings in order to teach nursing students effectively. In addition, multimedia and simulations provide nursing students with what they need the most—practice. Hands-on training is one of the best ways to learn because we learn by experience. In this way, the nursing student is allowed that experience without the risk. Hospitals are the sites of many life threatening situations, and nursing students are expected to, so to speak, hit the ground running. Using technology such as virtual patients and simulated patients provide them with the life-like setting of their future workplace without the danger of mistakes.  

References

Bielefeldt, S., & DeWitt, J. (2009). The rules of transfusion: Best practices for blood product administration. American Nurse Today, 4(2), 27-30. Retrieved from http://www.americannursetoday.com/

Gesundheit, N., Brutlag, P., Youngblood, P., Gunning, W. T., Zary, N., & Fors, U. (2009). The use of virtual patients to assess the clinical skills and reasoning of medical students: Initial insights on student acceptance. Medical Teacher, 31(8), 739-742. doi: 10.1080/01421590903126489

Guimond, M. E., Sole, M., & Salas, E. (2011). Getting ready for simulation-based training: A checklist for nurse educators. Nursing Education Perspectives, 179-185. doi: 10.5480/1536-5026-32.3.179

Moye, M. (2012). Blood typing 101. Nursing Made Incredibly Easy, 10(3), 13-19. doi: 10.1097/01.NME.0000413346.98187.01

Prentice, D., & O’Rourke, T. (2013). Using high-fidelity simulation to teach blood transfusion reactions. The Art and Science of Infusion Nursing, 36(3), 207-2010. Retrieved June 12, 2013, from http://www.ovid.com

WebSim® for healthcare education [An example of a virtual patient]. (n.d.). Retrieved from http://www.prepsim.com/images/catalog/CA000-101virtual.jpg