Scenario Learning Objectives
The scenario is the clinical situation used for simulation. Each scenario should be based on 3 categories of learning objectives:
Cognitive skills—knowledge about newborn physiology and evidence-based resuscitation practices
Technical skills—hands-on skills, such as positive-pressure ventilation (PPV)
Behavioral skills— skills described in NRP Key Behavioral Skills that help ensure effective communication and teamwork
Creating the Scenario
Creating scenarios takes preparation and forethought. Effective scenarios help learners achieve the learning objectives as well as set the stage for the important learning that occurs during debriefing. A well-written scenario compels learners to integrate cognitive, technical, and behavioral skills while working under intense time pressure.
The instructor assesses the team's needs and bases scenarios on those learning objectives. The instructor has specific learning objectives in mind and sets up a plausible scenario when answering the 4 pre-birth questions from the team. For example, a simple PPV scenario should include an apneic baby who requires at least the first couple of MR. SOPA steps before the team can achieve chest movement with PPV and an increasing heart rate. The experienced instructor facilitates the scenario so that the learners have the opportunity to demonstrate the cognitive, technical, and behavioral skills required in a plausible clinical scenario.
An experienced instructor may be able to create a scenario "on the fly" by answering the team’s four pre-birth questions and stating “additional risk factors” that make sense for the desired resuscitation skills the team should demonstrate in order to meet the scenario learning objectives.
However, there are advantages to using a Scenario Template form to create (and avoid re-creating!) your scenarios.
The Scenario Template gives the instructor a form for organizing an effective scenario based on the team’s learning objectives.
The Scenario Template helps your assistants and other instructors set up for the simulation exercise, know which visual, auditory, and tactile cues are important to include, and know what to expect from learners during the scenario.
The Scenario Template give the person who will debrief the team a place to make notes during or immediately after the scenario, which helps guide debriefing.
Here is how the Instructor Toolkit can help you create scenarios while you are developing your skills, when creating a complex scenario (for example, when using embedded participants), and when you want to create scenarios as lasting documents for use by different instructors:
Formulate learning objectives. Before you create a scenario, assess learners’ needs and formulate the learning objectives. For examples of learning objectives, go to the Performance Checklists at the end of each textbook lesson.
Use the NRP Scenario Builder. The Scenario Builder will help you create scenarios for newborn resuscitation by letting you choose which resuscitation skill(s) meet your learning objectives, providing plausible answers to the four pre-birth questions, and providing “additional risk factors” that make sense for your scenario’s level of complexity.
Fill in the Scenario Template. The Scenario Template is a form that you can customize to create a complete scenario. The Scenario Template details the specifics for the scenario. This includes setup, props, required number of participants, roles of scenario assistants, and expected interventions from learners. During the scenario, you may use this form for making notes to help guide debriefing. It also includes debriefing questions.
After you develop a new scenario, do a “dry run” with NRP volunteers to make sure it works as you intended. You may discover that you have forgotten an important visual, auditory or tactile cue. Record any changes on the template. Ultimately, you will build a library of tested and proven scenarios.
Preparing the Setting
After you have designed a plausible scenario, set up the scenario environment to seem as realistic as possible. You may have access to an actual setting, such as an unoccupied delivery room, newborn stabilization room, or operating room where cesarean birth occurs.
If not, set up a newborn resuscitation area that resembles the actual birth setting as closely as possible. You don’t need every detail of an actual birth setting. Decide which visual, auditory, and tactile cues are most important for eliciting learner actions to meet the learning objectives. Here are some strategies for creating a realistic setting:
A radiant warmer is a powerful visual and auditory cue. Allow learners to turn on the heat, start the Apgar timer, and operate the other functions. On some models the suction and oxygen equipment may be on the warmer.
If you use a T-piece resuscitator, make it operational by connecting it to a compressed air source (from the wall, from tanks, a compressor, or aquarium pump).
It is not essential to use blended oxygen during simulation as long as the learners can "adjust" the oxygen concentration by turning a knob (an actual knob or an image of a knob) from 21% to 100% oxygen.
If you must practice resuscitation on a conference room table, try to set up visual cues for the heat source on a radiant warmer, suction and oxygen, and whatever system is used at your hospital to call for additional help. A mock head wall poster, such as the NRP Equipment Poster, is a simple model that allows learners to simulate preparing equipment for resuscitation.
Simulation on radiant warmer and on a conference room table
Preparing the Manikin
Consider using simulated body fluids to enhance realism. Easy recipes for blood, vernix, and meconium, as well as application and clean up strategies, are available in the The Art of Moulage: Guidelines, Recipes, and Easy Techniques.
If you do not want to spend a lot of time with moulage, moisten a blanket or towel to simulate body fluids and spray it lightly with simulated blood.
Technology is not the key to quality simulation and debriefing. The methodology, such as auditory and visual cues used for realism, and the instructor skills during debriefing, have more to do with the quality of the experience than the use of high-tech equipment.
Video recording is beneficial to a complete learning experience, and filming can be done on your phone, tablet, or video recorder. Learners should be assured that video will be deleted immediately after use, and the recording is not used for any purpose outside the individual’s NRP Provider Course without written consent from the individuals in the video.
The video can be used during debriefing to review selected time periods, interventions, and examples of key behavioral skills. Pause the video for discussion. Do not show the video from start to finish.