Avkin Vanessa Fields Simulation Owner’s Manual

Vanessa Fields Simulation

Specifications

• Simulation Name: Vanessa Fields
• Designer(s): Amy Cowperthwait, RN, MSN, BC-ACNS, CHSE-A, CEO- Avkin; Megan Weldon, CHSE, Director of Education, Avkin; Kim Anderson, BPS, NRP, CHSE, CSM-Avkin
• Date Designed: 6/11/2020
• Topical Index: Family Practice, Women’s Health, Social Work, Mental Health
• QSEN Competencies Addressed: Patient-Centered Care, Teamwork & Collaboration, Evidence-Based Practice, Quality Improvement, Safety, Informatics
• AACN Essentials Addressed: Knowledge for Nursing Practice, Person-Centered Care, Population Health, Scholarship for the Nursing Discipline, Quality and Safety, Interprofessional Partnerships, Systems-Based Practice, Informatics and Healthcare Technologies, Professionalism, Personal, Professional, and Leadership Development
• Expected Pre-brief Time: 5 minutes
• Expected Simulation Time: 15 minutes
• Expected Debrief Time: 30 minutes
• Expected Total Time: 50 minutes
• Reviewer(s): Hannah Schroeder MSN-Ed, CNE, CHSE, PCCN-K
• Level of Complexity or Participant Experience: Foundations Pre-licensure, Intermediate Pre-licensure, Advanced Pre-licensure
• IPE Sim Opportunity: Yes

Patient History (Vanessa Fields)

• Age: 19
• DOB: 07/03/XXXX
• Gender: Female
• Support/Family: Boyfriend
• Admit Diagnosis: Ectopic pregnancy
• Presenting Complaint: Severe abdominal pain.
• History of Present Illness: Surgical repair of ruptured ectopic pregnancy yesterday.
• Vital Signs: HR: 80, BP: 118/72, RR: 20, O2 Sat: 96% Room Air, Temp: 98.2F, BGL: 80 mg/dL, GCS: 15
• Allergies: Penicillin
• Immunization Status: Unknown
• Primary Care Provider: Kohen
• Religion: Agnostic
• Past Medical History: PID, Abortion x2, Tonsillectomy (age 4)

Usage Instructions

Scenario Overview

This simulation focuses on a 19-year-old patient, Vanessa Fields, who is recovering from a surgical repair of a ruptured ectopic pregnancy. Learners will engage with Vanessa to provide care, education, and negotiate a care plan.

Simulation Objectives

1. Provide removal of catheter and IV using standard protocols and aseptic technique.
2. Build rapport using at least 3 therapeutic communication techniques.
3. Provide patient education and be able to provide at least 3 important facts about the patient’s condition.
4. Demonstrate the ability to negotiate with the patient to develop a care plan.

Pre-Simulation Learning Activities/Assignments

• Foundations Pre-licensure: Learners should have basic classwork (didactic) and skills lab education. No prior clinical experiences in the simulation topic are required.
• Intermediate Pre-licensure: Learners should have all necessary classwork (didactic) and skills lab education for the simulation presented. Learners are minimally in their first semester/rotation of clinical experiences in the simulation topic.
• Advanced Pre-licensure: Learners should have completed all classwork (didactic) and skills lab education in the curriculum. Learners should have had at least 1 semester of clinical experiences in the simulation topic.

Simulation Resources

The following resources are recommended for facilitators and learners:

• AACN – The Essentials: Core Competencies for Professional Nursing Education
• ASPE Standards of Best Practice Evaluating Healthcare Simulation
• Freely available instruments developed to evaluate simulation-based education
• Establishing a Safe Container for Learning in Simulation
• INACSL Standards of Best Practice: Debriefing
• NLN Simulation Innovation and Resource Center (SIRC) Tools and Tips
• Society for Simulation in Healthcare Healthcare Simulationist Code of Ethics
• Society for Simulation in Healthcare – Healthcare Simulation Dictionary
• The 3D Model of Debriefing: Defusing, Discovering and Deepening

Troubleshooting

This section is not detailed in the provided manual. General troubleshooting for simulations often includes:

• Technical Issues: Ensure all simulation equipment (mannequins, monitors, etc.) is fully charged and functioning before the simulation begins. Test audio/visual equipment.
• Learner Engagement: If learners are not engaging, facilitators may need to prompt them with open-ended questions or introduce unexpected events to stimulate critical thinking.
• Standardized Patient (SP) Performance: Ensure the SP is well-briefed and consistent in their role. If an SP deviates, the facilitator may need to gently guide them back to the script or adapt the scenario.
• Time Management: If the simulation runs over or under the expected time, facilitators should be prepared to adjust the scenario’s complexity or the debriefing length accordingly.

FAQ

This section is not detailed in the provided manual. Common questions for simulation scenarios might include:

• Q: What is the primary learning outcome for this simulation?
  A: The primary learning outcomes revolve around patient care post-ectopic pregnancy, therapeutic communication, patient education, and collaborative care planning.
• Q: Can this simulation be adapted for different learner levels?
  A: Yes, the manual specifies adaptations for Foundations, Intermediate, and Advanced Pre-licensure levels, primarily by adjusting pre-simulation assignments and expectations.
• Q: What resources are available to help facilitators?
  A: A list of recommended resources, including best practice standards and debriefing models, is provided in the ‘Simulation Resources’ section.
• Q: How important is the debriefing session?
  A: Debriefing is crucial for learning and reflection. The manual allocates 30 minutes for debriefing, emphasizing its importance in the overall learning experience.
• Q: What if the patient (Standardized Patient) does not respond as expected?
  A: Standardized Patients are trained to follow a script. If unexpected responses occur, the facilitator may need to intervene subtly to guide the scenario back on track or use it as a teachable moment during debriefing.

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Avkin Simulations
Vanessa Fields

TABLE OF CONTENTS

Scenario Recordkeeping

2

Simulation Resources

3

Concept Map

4

Section 1 Learner Information

5

Section 2 Facilitator Information

9

Section 3 Standardized Patient Information

14

2022 Avkin, Inc.
All rights reserved. No part of this publication may be reproduced, distributed, or transmitted in any form or by any means, without the prior written consent of Avkin, Inc.
Unless otherwise indicated, all Avkin Simulation is the proprietary property of Avkin, Inc. All audio, video, text, photographs, graphics, and files (also referred to as “Content”) including any trademarks, service marks, and logos contained therein (also referred to as “Marks”) are owned and controlled by us or licensed to us and are protected by copyright and trademark laws and other intellectual property rights and unfair competition laws of the United States of America, foreign jurisdictions, and international conventions.
Avkin, Inc. 103 S. James Street Wilmington, Delaware 19804 (302)562-2110 info@avkin.com

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SCENARIO RECORDKEEPING
Simulation Name: Vanessa Fields

Name & Title of Designer(s):

Amy Cowperthwait, RN, MSN, BC-ACNS, CHSE-A, CEO- Avkin
Megan Weldon, CHSE, Director of Education, Avkin Kim Anderson, BPS, NRP, CHSE, CSM-Avkin

Date Designed:

6/11/2020

(Preparation)

Updates/Revisions: Yes Date:

Topical Index:
Select QSEN Competencies Addressed:

Family Practice Women’s Health Social Work Mental Health
Patient-Centered Care Teamwork & Collaboration Evidence-Based Practice Quality Improvement Safety Informatics

Expected Pre-brief Time (minutes): 5

Expected Simulation Time (minutes): 15

Reviewer(s):
Hannah Schroeder MSN-Ed, CNE, CHSE, PCCN-K

Level of Complexity or Participant Experience: Approval/Reviewed by Simulation Coordinator: IPE Sim Opportunity? Yes No
Select AACN Essentials Addressed:
Expected Debrief Time (minutes): 30

Foundations

Pre-licensure

Intermediate

Pre-licensure

Advanced Pre-licensure

Yes

No

Date:

Name:

Undergrad Nursing Advanced Practice Nursing Social Work PA
Knowledge for Nursing Practice Person-Centered Care Population Health Scholarship for the Nursing Discipline Quality and Safety Interprofessional Partnerships Systems-Based Practice Informatics and Healthcare Technologies Professionalism Personal, Professional, and Leadership Development
Expected Total Time (minutes): 50

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SIMULATION RESOURCES AACN -The Essentials: Core Competencies for Professional Nursing Education ASPE Standards of Best Practice Evaluating Healthcare Simulation Freely available instruments developed to evaluate simulation-based education Establishing a Safe Container for Learning in Simulation

INACSL Standards of Best Practice: Debriefing NLN Simulation Innovation and Resource Center (SIRC) Tools and Tips Society for Simulation in Healthcare Healthcare Simulationist Code of Ethics Society for Simulation in Healthcare- Healthcare Simulation Dictionary The 3D Model of Debriefing: Defusing, Discovering and Deepening

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CONCEPT MAP

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SECTION 1 LEARNER INFORMATION
SCENARIO OVERVIEW
Vanessa is a 19-year-old female brought into the ER two days ago by her partner for lower abdominal pain. She was quickly diagnosed with an ectopic pregnancy and taken into surgery. After surgery HCPs were concerned with Vanessa’s well-being and suspicious of her living situation. The night nurse was able to build a trusting relationship with Vanessa and she gave her some information that hinted at sex trafficking. Vanessa is scared and unwilling to give any more information. Social services were contacted and would arrive later in the day to attempt to provide Vanessa with options to prevent her from returning to her abusers. You arrived at your 7am shift and were given a handoff from the night nurse. Vanessa’s catheter needs to be assessed and removed. Rapport must be built with her because she is extremely scared and nervous that her partner will return and “punish” her for speaking with her providers. She is in a lot of pain from her procedure and very tired from not being able to sleep much the night previous.
SIMULATION OBJECTIVES
1. Provide removal of catheter and IV using standard protocols and aseptic technique 2. Be able to build rapport using at least 3 therapeutic communication techniques 3. Provide patient education and be able to provide at least 3 important facts about the patient’s
condition 4. Demonstrate the ability to negotiate with patient to develop a care plan
PRE-SIMULATION LEARNING ACTIVITIES/ ASSIGNMENTS
Foundations Pre-licensure- Has basic class work (didactic) and skills lab education. No clinical experiences in the simulation topic.
Intermediate Pre-licensure – Has had all necessary class work (didactic) and skills lab education for simulation presented. Learners are minimally in their first semester/ rotation of clinical experiences in the simulation topic.
Advanced Pre-licensure- Has completed all class work (didactic) and skills lab education in curriculum. Learners have had at least 1 semester of clinical experiences in the simulation topic.

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PATIENT HISTORY

Electronic Health Record

Name: Vanessa Fields

Age: 19

DOB: 07/03/XXXX

Gender: Female

Support/Family: Boyfriend

Height: TBD

Weight: TBD

Admit Diagnosis: Ectopic pregnancy
Presenting Complaint: Severe abdominal pain. History of Present Illness: Surgical repair of ruptured ectopic pregnancy yesterday.

HR: 80

BP: 118/72 RR: 20

O2 Sat: 96% Room Air

Temp: 98.2F

BGL: 80 mg/dL

GCS: 15

Assessment:
Pain: Abdominal pain described as throbbing, increases and becomes sharp when palpated, 3/10. General Behavior/Communication: Withdrawn. Cardiovascular: Normal sinus rhythm. Respiratory: Lung sounds clear. GI: Bowel sounds + in all 4 quadrants, patient reports passing gas. GU: Urinary catheter draining approximately 70 mL per hour. To be discontinued before discharge this am. Extremities: Normal movement and sensation in all extremities, steady gait. Skin: Warm and dry. 2 cm midline abdomen surgical incision below navel covered with dressing. Multiple bruises in various stages of healing on bilateral upper and lower extremities. Patient describes recent fall. Neurological: Alert, awake and oriented to person, place, time, and situation. No neurological deficits. Labs: CBC daily. IVs: 0.9% Sodium Chloride at 125 mL/hour via right forearm 20g PIV.

Allergies:

Immunization Status:

Penicillin

Unknown

Primary Care Provider: Kohen

Religion: Agnostic

Past Medical History:
PID Abortion x2 Tonsillectomy, age 4

Current Home Medications: None

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LAB RESULTS

CBC

TEST

RBC

MCV MCH

MCHC

RDW

HEMOGLOBIN

HEMATOCRIT

RETICULOCYTES

WBC DIFFERENTIAL % NEUTROPHILS SEGS BANDS EOSINOPHILS BASOPHILS LYMPHOCYTES MONOCYTES PLATELETS

RESULT

Yesterday

This AM

4.1

4.1

82

82

31

30

34

35

11.4

11.9

10.0

11.5

35

37

1.0

1.0

REFERENCE RANGE
4-6 80 – 98 27 – 31 32 – 36 11.5 14.5 12 18 g/dL 38 54 % 0.5 -1.5

4.5

5.0

4,500 10,000

58 60 4 3 1 27 4 155,000

68 62 5 2 1 30 5 160,000

50 70 50 – 65
0-5 0-3 1-3 25 – 35 2-6 150,000 400, 000

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ACTIVE ORDERS & MAR
Current Active Orders: Admit – surgery, Dr. Kohen Medications: o 0.9% Sodium Chloride at 125 mL/hour o Ceftriaxone 250 mg IVP, once o Doxycycline 100 mg by mouth BID x 10 days o Oxycodone 5mg by mouth every 4 hours for pain 7-10 o Ibuprofen 600mg by mouth q 6 h as needed for pain <7 Nursing: o Vital Signs q 4h Labs: o CBC daily Consult: o Social Work o

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SECTION 2 FACILITATOR INFORMATION
LEVEL OF LEARNER
Foundations Pre-licensure- Has basic class work (didactic) and skills lab education. No clinical experiences in the simulation topic.
Intermediate Pre-licensure – Has had all necessary class work (didactic) and skills lab education for simulation presented. Learners are minimally in their first semester/ rotation of clinical experiences in the simulation topic.
Advanced Pre-licensure- Has completed all class work (didactic) and skills lab education in curriculum. Learners have had at least 1 semester of clinical experiences in the simulation topic.

SIMULATION SET-UP / AVKIN PRODUCTS / NEEDED EQUIPMENT / SUPPLIES / PROPS

Needed equipment Avstick Avcath Avkin Vital Signs simulated BP Cuff, pulse oximeter and thermometer
EHR

Learner supplies Stethoscope Professional Dress

Presentation of the patient
Patient is wearing hospital gown
Appliances, etc.: None
Moulage: Multiple bruises in various stages of healing on
bilateral upper and lower extremities Branding tattoo (Dollar sign with trafficker’s
name, his initial w/crown or barcode, located on the back of the neck, shoulder, or on chest upside down so she sees it when she looks down.) 2 cm midline abdomen surgical incision below navel covered with dressing
Lying in hospital bed or stretcher

SIMULATION OBJECTIVES FOR HEALTHCARE LEARNER(S) 1. Provide catheter and IV removal using standard protocols and aseptic technique 2. Be able to build rapport using at least 3 therapeutic communication techniques 3. Provide patient education and be able to provide at least 3 important facts about the patient’s condition 4. Demonstrate the ability to negotiate with patient to develop a care plan

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PRE-BRIEFING INFORMATION/ SBAR REPORT Pre-briefing Information- Scan QR code for detailed information
Facilitator SBAR Report Situation: Patient was admitted yesterday for a nearly ruptured ectopic pregnancy and taken to surgery for a Left Salpingo-Oophorectomy (LSO) via salpingectomy. She has a small bandage dressing over a 2 cm incision with 2 stitches midline to abdomen just below the navel. Her surgery was successful, and she is recovering. Also screened positive for chlamydia. She has a history of PID several times in the past. Admits multiple partners and was not open to discussing with her partner. Health department reporting and notification standards have been followed. Doctor cleared her for discharge following morning lab results and a consult with social services. Before she goes, she needs her foley and IV d/c’d. Background: She has been treated for PID on two prior occasions this year. Male visitor, she identified her boyfriend has been in the room often, she does not speak when he is present. Sometimes she seems really upset; overall she seems sad and withdrawn. Assessment: Alert and oriented, withdrawn, Abdominal pain described as throbbing, increases and becomes sharp when palpated, 3/10. IV is normal saline running at 125 mL/ hour. Foley catheter in place with 200 mL emptied 1 hour ago. Recommendations and Active Orders: Remove foley catheter and IV, social work consult for trafficking concerns, discharge planning and instruction

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FLOW OF SIMULATION

Phase ID & Patient Presentation Pre-brief (See below) 0-5 minutes Initial Assessment: HR:76 BP: 122/76 RR: 18 SpO2: 96% T: 98.2F ECG: Sinus Rhythm 5-10 minutes Focused Assessment 10-15 minutes
Debriefing 20-60 minutes

SP Interaction/ Cues
***SP should not be in the room if pre-brief is conducted in the patient room
SP Interaction/Cues Quiet and
withdrawn, does not answer well just yes or no until rapport is built Does not make eye contact, always looking down. SP Interaction/Cues Fearful and reserved. She will be very tired and not wanting to give any more information than necessary Feels like seeing anyone else is unnecessary Denies being abused or trafficked if asked directly SP preparing notes for debriefing Co Debriefing With an SP

Expected Actions and Progression

Notes: Facilitator led: Fiction contract, confidentiality statement, appropriate information regarding videotaping, SBAR Report Note: Learners should not see SP prior to start of the simulation

Correct Action: Vital signs and
focused assessment. Build rapport with patient using therapeutic communication

Debriefing Opportunities:
Remove foley and IV without building rapport
Not taking a primary assessment

Correct Action:

Debriefing

Enlist assistance to remove (not forcibly) “family”, need to create a paperwork issue, etc.
Should understand the issue to prevent “family” from visiting patient

Opportunities: Trying to intervene
without a plan for assistance. Removing foley or IV prior to a clear patient plan will cause patient to “chicken out” and leave AMA. Probing too much into the patient’s history without using therapeutic communication

Debrief based on completion of objectives and opportunities in conjunction with INACSL SOBP.

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Debriefing Points 1
1. Reaction/Description a. Provide reminders of the basic assumption and psychological safety. b. Provide instruction/information on the 3 phases of the debriefing process, Reaction/Description, Understanding/Analysis, Application/Summary c. Seek Learner feedback and emotion surrounding the simulation. i. Ask open ended questions ii. What do they think went well? iii. What did they struggle with? iv. Did they apply any of their knowledge from prior simulations into this one? If yes, what was it?
Tip- Facilitator silence provides greater opportunity for learner reflection.
2. Understanding/Analysis a. Seek SP feedback when they are ready to provide it. i. Ask any appropriate questions that were asked in the Reaction/Description phase. ii. Allow learners to ask SP questions. iii. As a facilitator feel free to seek clarification from the SP on the feedback or other poignant moments during the simulation b. Discuss the simulation objectives that were met and opportunities for improvement. i. Explore and review the phases of the simulation ii. Work through the layers of thought and actions a. What happened during each phase? b. What was the thought process connected to the actions? iii. Allow the opportunity for questions or concerns to be discussed.
3. Application/Summary a. Discuss key learning points b. Clarify any unanswered questions c. Discuss key take-away’s d. Seek application of knowledge for future practice from each learner e. Final thoughts and questions

1 Abulebda K, Auerbach M, Limaiem F. Debriefing Techniques Utilized in Medical Simulation. [Updated 2021 Oct 1]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK546660/

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PATIENT NAME BAND & MEDICATION LABELS
0.9% Sodium Chloride
Not for Human Use Simulation Only
Oxycodone 5mg tablet Rx only, 100 tablets
Not for Human Use Simulation Only
Doxycycline 100mg tablet Rx only, 10 tablets
Not for Human Use Simulation Only
Fields, Vanessa
07/03/XXXX Age:19 MRN: 12345678

Ibuprofen 200 mg tablet
300 tablets
Not for Human Use Simulation Only
Ceftriaxone 250mg vial
Not for Human Use Simulation Only
Hospitalized days: 1

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SECTION 3 STANDARDIZED PATIENT INFORMATION SIMULATION OBJECTIVES FOR HEALTHCARE LEARNER(S)
1. Provide catheter care using standard protocols and aseptic technique 2. Be able to build rapport using at least 3 therapeutic communication techniques 3. Provide patient education and be able to provide at least 3 important facts about the patient’s
condition 4. Demonstrate the ability to negotiate with patient to develop a care plan LEVEL OF HEALTHCARE LEARNER(S) Foundations Pre-licensure- Has basic class work (didactic) and skills lab education. No clinical experiences in the simulation topic. Intermediate Pre-licensure – Has had all necessary class work (didactic) and skills lab education for simulation presented. Learners are minimally in their first semester/ rotation of clinical experiences in the simulation topic. Advanced Pre-licensure- Has completed all class work (didactic) and skills lab education in curriculum. Learners have had at least 1 semester of clinical experiences in the simulation topic.
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CHARACTER DESCRIPTION (PATIENT)
Standardized Patient Name: Vanessa Fields Age: 19 Birthday: 07/03/XXXX Current Emotional Status: Uncertain, anxious, nervous, scared, suspicious. Environment: PACU or med-surg floor. Profession: Sex Worker; if asked she will say odd jobs to make rent. Background and Guidelines: Vanessa was raised in a conservative upper middle class suburban family. She was raised going to church and instilled with a moral compass of what is right and wrong. Vanessa has always rejected this conventional way of life. She felt caged in and wanted to be free of her parent’s strict rules. Vanessa got expelled from her private Christian school after starting a fire in the bathroom. Vanessa went to the local public school and quickly fell into a dysfunctional group. She started smoking, drinking, and skipping school. Her new best friend Ashley would tell her all the time how strict her parents are and that she should not have to deal with them if they don’t support her. Ashley and Vanessa decided to run away at the age of 16. They quickly went to the corner store when they were approached by an older man he went by Ace. Ashley said that he was her friend that she met on Facebook. He quickly told them that they were too pretty to be eating at a corner store and he was going to take them to a nice dinner. Vanessa quickly felt comfortable with Ace. He would ask about her family and he would reassure her he would take care of her. Vanessa felt protected and trusted him. Vanessa lives with many roommates, people are always coming and going but Ace makes it very clear that they are family, and all have to contribute to the household to make it work. Vanessa started prostitution to help provide for the family. Vanessa and Ashley were separated, and she is not in contact with her anymore. Vanessa could see anywhere from 10-20 clients. When Vanessa would come home with good money she would be rewarded with extra time and attention from Ace, love she never got from her family. Seeing his excitement made her feel proud and supported like bringing home an A. Ace collects all of Vanessa’s money after a night out, he says it is “her rent” to stay there. She knew prostitution was not ideal, but she is a high school dropout and has no other way to “pay her rent”. Ace sometimes uses Amber, who is his sister, enforce behaviors with the other sisters and go places with the sisters when it would raise suspicion if he went. Vanessa has never seen him punish Amber and he treats her like she actually could be his sister. Ace is very manipulative. If Vanessa doesn’t do something simple like get him a sandwich, he will become violent and hit, punch or spit on her. After the violence Ace will make it clear that she was disrespectful and that is what caused the violence to happen. Vanessa blames herself if violence happens to her. A few months ago, Ace had a rope around her neck strangling her to the point of blacking out. This scared Vanessa but she reassured herself that if she didn’t talk back that it wouldn’t happen again. Vanessa believes that Ace loves her and takes care of her and the rest of the girls living at the house. Vanessa uses heroin every day, it numbs her to what she has to do with her clients and honestly everyone she knows uses. Vanessa has had two home abortions that really scared her. Over the years she feels numb, numb to life, numb to Ace, numb to the abortions. Vanessa does not think she is being controlled or manipulated. She believes she is surviving and would rather be “free” than back with her parents who never cared about her. Two days ago, Vanessa came into the ER with extreme pain in her abdomen. She came in alone after Ace dropped her off. Vanessa found out she was having an ectopic pregnancy (pregnancy in the fallopian tubes). She went into surgery that day and has been recovering ever since. She disclosed to the nurse that she uses heroin and has had unprotected sex with countless partners. She felt judged and has really shut down to the nurses. She does not want them to call the cops and get in any trouble.

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This morning Ace came to the hospital to pick up Vanessa, while the nurses were out of the room, he told her it is “time to get back to work.” He made it clear that rent is due, and they need her share of it. Vanessa feels guilty for not pulling her weight and supporting the family. Ace has asked about her pain medication and how much she is getting. He has made it clear that if they can sell some of that they will be able to make up for her loss of contribution and he won’t make her sleep outside. Environment/setting/location: PACU or med-surg floor. Health: 2 abortions and previous episodes of STIs, currently diagnosed with chlamydia and ruptured ectopic pregnancy which had to be surgically repaired. Family: Ran away from home views her roommates as her family since they support her. If asked about her parents, she will say “she doesn’t have any.” Housing: Small dirty house lives with about 10 people, “people come and go all the time” Social History: Heroin daily, doesn’t know how much. Drinks whatever she can get almost all day every day. Her roommates are the only people she talks to. Academic: Dropped out of HS in 10th grade. Interaction Guidelines: Vanessa just wants to go home. If anyone tries to dig down into her history or starts asking too many questions, she appears to have a tough persona and will not easily divulge info. She feels guilty for leaving the rest of the family to pay the rent. She wants to get back to work to help out. When Ace/Amber is in the room, she is very careful what she says. She does not make small talk, but she will sit in silence. Vanessa will be short with her answers and is very pleasant but not very emotional or talkative. Vanessa might ask some follow up questions about post op or when she can return to normal activities. She wants to know about her pain medication and how often she can get it refilled. She plans to give it to Ace to sell. Vanessa is more subtle than Ace. Vanessa is not as forward with the questions, but she does not show embarrassment or correct him in any way. Vanessa is afraid of Ace; she knows what he is capable of. She knows he is upset about all of the lost money so is on edge and afraid of what he might do is she says or does the wrong thing. If Ace is asked to leave the room and Vanessa is asked about abuse, she will deny any abuse, she will say she is 19 and just because people don’t like her lifestyle does not mean there is a problem. She does not want Ace to get mad or she will ask for him to come back in. She is trying to be the peacemaker and not have Ace, or the nurse mad and just get out of the hospital and get back home.

Sex Trafficking Survivor’s Perspective

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CHARACTER DESCRIPTION (FAMILY MEMBER/OTHER)
Name: Ace or Amber Hamilton Relationship: Sex trafficking handler (Ace -pimp/ called boyfriend or daddy) or (Amber madam/pimp/sister or sister wife) Neither of these roles is actually related to Vanessa, they are part of the trafficking circle. Appearance: Clean cut and well-groomed with nice clothing. Education: Ace/Amber is articulate but struggle to keep the street slang out of his/her conversation. Adding in a Ma’am or Sir or other verbal respect as an afterthought in the course of conversation. As he/she becomes more frustrated, slang and bad language become more pronounced. Background and Guidelines: Ace/Amber is here for one goal and one goal only – to retrieve Vanessa. She is a piece of property and by being in the hospital, she is costing Ace/Amber money. He/she will take over all conversation in the room and not allow Vanessa to answer questions. The goal is to get in and get out. Ace/Amber will be carefully watching Vanessa to make sure she keeps her eyes down, glaring at her if she makes any eye contact. If he/she feels staff becoming suspicious he/she may start touching Vanessa in an affectionate way such as holding her hand, rubbing her shoulder, or moving/stroking her hair. Ace/Amber will stop after a short time because it is not a normal behavior. Interaction Guidelines: Vanessa said she would be ready for discharge when Ace/Amber arrived, and she is still hooked up to all kinds of tubes. Ace’s/Amber’s first attempt to speed things along comes from a sweet-talking complimentary style meant to manipulate. When things don’t progress fast enough, he/she will begin to become more aggressive in tone and demeanor and making excuses like his/her car is double parked or he/she has another appointment. Anything providers say or imply, Ace/Amber will have an answer or a fix. Even going so far as to indicate one of the sisters at home is a nurse and can take care of Vanessa if it will get them out faster. If the provider tries to remove Ace/Amber from the room, he/she will be resistive. If the attempts become convincing enough that leaving will get Vanessa out quicker or if they contact security (this will cause a huge fight and Vanessa will be very upset), Ace/Amber will leave instructing Vanessa to call when she is disconnected from all of the tubes and she can go home.

DRESS REHEARSAL
Dress rehearsal should be scheduled in advance of the first scheduled simulation. (Identify length of time expected for dress rehearsal.) This will be scheduled one week prior to SPs needing to portray a role.
Your SP Educator will lead for dress rehearsal. If this is a new simulation, the subject matter expert will attend with the SP Educator to provide notes and answer any questions.
There will be a BRIEF simulation overview which will include information on what the learners will be told and an introduction to the Avkin products used in this learning experience.
Make sure you bring or wear the right clothing for the dress rehearsal (see below). Here is a rundown of the structure for the dress rehearsal
o Brief rundown/ discussion of flow
o One of the SPs performing as Vanessa will get fully dressed and start the dress rehearsal.
o Additional SPs will observe from the control room or remain quiet observing from a different vantage point in the room.
o The SP Educator will pause the interaction after about 5 minutes.
o The SP Educator and/or subject matter expert will give coaching notes so all SPs can apply them. Allow time for clarifying questions.
o The next SP is selected to be Vanessa and the other SPs will observe.
o The first SP will stay to observe the remaining SPs performance(s) from the control room.

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o The dress rehearsal is completed once all individuals have had an opportunity to play in character, and all have observed each other play the same roles.
o The dress rehearsal is completed once all individuals have had an opportunity to play in character, and all have observed each other play the same roles.
The SP Educator will review the flow of debriefing for this specific simulation. Make sure the SP Educator gives you a “safe” word to use if you feel uncomfortable. This word
will stop simulation. Make sure all of your questions are answered before leaving the dress rehearsal. Review all of your scheduled simulation hours while everyone is still there to make sure there are
no conflicts.
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STANDARDIZED PATIENT DRESS
Standardized Patient Equipment, Supplies, and Prop Requirements: (Moulage, make-up, arm sling/leg splint, etc.) Moulage: Branding tattoo (Dollar sign with trafficker’s name, his initial w/crown or barcode, located on the back of the neck, shoulder, or on chest upside down so she sees it when she looks down.) Multiple bruises on upper and lower extremities in various stages of healing. 2 cm surgical incision to the midline abdomen covered by a dressing. Dress: SPs should bring their personal tank top and shorts. Institution to supply the hospital gown. Props: None. Avkin Products: Avcath, Avstick
Avstick- Wearable IV Sleeve. It has several layers of protection in it so you will not get stuck with the needle. Be sure the learners are looking for a “vein” on the Avstick. You can look away as they are getting ready to place the intravenous line and a vibration will tell you when the needle has penetrated the skin so you can react the way you have been taught in dress rehearsal to the actual insertion of the IV. Avcath- Wearable pelvic overlay with changeable male or female genitalia. Palpable pressurized bladder allows for palpation and bladder scanning. Application of betadine will be cold and when the catheter is inserted a vibration will alert you to intensify your reaction in the manner that was taught in dress rehearsal.

Avcath SP Education

Avstick SP Education

STANDARDIZED PATIENT PREPARATORY INFORMATION/ ASSIGNMENT Memorize Character Description Attend Dress Rehearsal, be prepared, and fully engage in this experience

Sex Trafficking Survivor’s Perspective

2020 Avkin, Inc.

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FLOW OF SIMULATION Phase ID & Patient Presentation Pre-brief (See below)
0-5 minutes
Initial Assessment: HR:76 BP: 122/76 RR: 18 SpO2: 96% T: 98.2F ECG: Sinus Rhythm 5-10 minutes Focused Assessment 10-15 minutes
Debriefing 20-60 minutes

SP Interaction/ Cues Expected Actions and Progression

***SP should not be in the room if pre-brief is conducted in the patient room
SP Interaction/Cues Quiet and
withdrawn, does not answer well just yes or no until rapport is built Does not make eye contact, always looking down. SP Interaction/Cues Fearful and reserved. She will be very tired and not wanting to give any more information than necessary Feels like seeing anyone else is unnecessary Denies being abused or trafficked if asked directly SP preparing notes for debriefing Co Debriefing With an SP

Notes: Facilitator led: Fiction contract, confidentiality statement, appropriate information regarding videotaping, SBAR Report Note: Learners should not see SP prior to start of the simulation

Correct Action: Vital signs and
focused assessment. Build rapport with patient using therapeutic communication

Debriefing Opportunities:
Remove foley and IV without building rapport
Not taking a primary assessment

Correct Action:

Debriefing

Opportunities:

Enlist assistance to

remove (not forcibly) “family”, need to create a paperwork issue, etc. Should understand the issue to prevent “family” from visiting patient

Trying to intervene without a plan for assistance.
Removing foley or IV prior to a clear patient plan will cause patient to “chicken out” and leave AMA.
Probing too much into the patient’s history

without using

therapeutic

communication

Debrief based on completion of objectives and opportunities in conjunction with INACSL SOBP.

2020 Avkin, Inc.

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