The Veterans Health Administration places a large focus on establishing local pressure ulcer prevention (PUP) programs. At the VA Roseburg Healthcare System in Roseburg, Oregon, both high- and low-fidelity manikins are complemented with detailed moulage to simulate challenges with the nursing management of pressure ulcers.
Nursing educators and the clinical nurse leader worked together to create a "hands-on" adult learning model for training the nursing staff. The training plan includes specific skills spread out over several stations to reinforce strategies for proper positioning and whole-body skin assessments with the participants. Also included in the PUP learning experience is the identification of possible device-related damage to the skin such as an ulcer from a nasogastric tube, oxygen cannulas or Foley catheters.
Role play of real-life patient care scenarios reinforces techniques for reporting and documentation of skin ulcers. Using standardized communication tools, like the three W's — what I see, what I am concerned about, and what I want to happen — the nursing staff rehearse timely and concise communication to stimulate appropriate intervention from the interdisciplinary team. A final station was included for staging ulcers and dressing a skin tear.
Prior to the nursing staff's participation, the educators piloted the education program with 14 LPN students. The feedback provided by the students and their instructors assisted the educational team with minor revisions to enhance the experience.
Evaluation of the program included pre- and post-knowledge test and narratives. The knowledge test demonstrated improvements in understanding. Students enthusiastically stated that the PUP simulation experience was both realistic and effective for learning. They described an improved awareness for prevention and an increased knowledge in the proper management of pressure ulcers.
The possibilities are limitless with simulation.
Amanda Morrow, BSN, RN, has 37 years nursing experience including employment in medical/surgical patient care and ambulatory care settings. She also worked in an endocrine clinic as a diabetes educator, insulin pump trainer and BLS instructor. With more than 25 years at the VA Roseburg Healthcare System in Oregon, Amanda currently serves as a nurse educator and simulation program coordinator.