The Mega Code: Encompassing the Curriculum Across the Lifespan

Objectives: 1) to increase student exposure to inter-professional simulation experiences, 2) to give students a capstone simulation experience incorporating the lifespan concepts of newborn, maternal delivery, adult critical care and patient death.

During the course of a baccalaureate education, nursing students often encounter

unintentional or unexpected patient experiences. Challenging critically ill patients to the unfortunate cardiac arrest; students require a basic foundation of knowledge. The use of simulation has helped not only with skills, but with patient situations encountered during clinical rotations. However, incorporating inter-professional educational simulation opportunities can be challenging for a nursing program in an isolated rural community lacking other professional or technical health profession programs.

Our senior class asked for a mega code as part of their final capstone simulation. Faculty members carefully considered the request and developed a scenario based on each area of clinical specialty. To properly prepare the students, it was decided to not only address the critical care component of a cardiac event, but incorporate family centered care, ethics, maternal-child and inter-professional collaboration. A simulation outline was developed involving a 34-week gestation woman recently diagnosed with H1N1 admitted to the Intensive Care Unit with worsening respiratory symptoms. The patient would require an emergency cesarean section, develop a fatal cardiac rhythm and expire. Students were required to care for the patient, a premature infant and provide emotional support for her distraught spouse. The simulation included pastoral care (our campus minister), an actor portraying the father (an actor unknown to the students), a CRNA assisting with the intubation, including medication administration and a nurse practitioner to assist with care of the premature newborn and C-section. Prior to the simulation, students prepared with a concept map on H1N1, obstetric pharmacology and ACLS guidelines and medications. Students had the opportunity to review the patient’s ventilator settings and current medications along with an SBAR report approximately fifteen minutes prior to the start of the simulation. All students were briefed on manic settings and available equipment in the room.

Student satisfaction and perception of learning was measured with a guided reflection tool. Positive student feedback regarding the capstone simulation set in motion a plan to increase the simulation program in our final clinical course from 10% to 25%. Another benefit of program has been the addition of ACLS certification available to all senior nursing students. The capstone simulation program will be continued in future courses.