The Open RN project created over 30 screen-based, virtual simulations with CC-BY 4.0 licensing that can be accessed by simply using a URL and any device connected to the internet.
No special equipment or software is required for students to participate in these media-enhanced case studies that provide immediate formative feedback and promote the development of clinical judgment.
These virtual simulations are also linked from the Open RN OER textbooks.
Below you will find a collection of the virtual simulations developed by WTCS faculty and the Open RN team. Each simulation is designed in H5P and is available under the Creative Commons CC BY 4.0 license, allowing free and open access for faculty to utilize, adapt, or modify them. When incorporating or customizing an Open RN virtual simulation at your institution, please ensure to include an attribution statement in accordance with the CC BY licensing.
Full assessment on arrival to ED including common EOL concerns: pain, dyspnea, GI, skin breakdown, advanced directives
Full assessment on arrival to ED including common EOL concerns: pain, dyspnea, GI, skin breakdown, advanced directives. Manage pain with IV hydromorphone. Interpret ABG results. Provide patient education re: Advanced Directives using video and document; provide therapeutic communication
Actively dying patient has hospice care initiated. Pain is adequately managed using Morphine PO in anticipation of going home, but becomes not verbally responsive with air hunger. Therapeutic communication with mom
Patient dies as student enters room requiring therapeutic communication with grieving mother and implementation of death management protocol with possible notification of Medical Examiner and initiation of organ/tissue donation protocol
Initial pain and cardiac assessment; obtain accurate vitals
STEMI protocol orders received including reviewing labs and administering Nitroglycerin PO/ titrate IV and Heparin IV with math calculation
Assess female patient with atypical chest pain who just presented to ED; recognize need to implement ED STEMI protocol including obtaining and interpreting ECG, starting IV, interpreting labs and titrating administering Nitroglycerin PO/IV and Heparin IV with math calculation. New orders received from cardiologist to prepare to cardiac cath with recognition that renal protection required.
Perform post-cardiac care and monitor for complications; respond to decreased perfusion of leg appropriately
62-year-old male patient with chronic stable heart failure admitted to the skilled nursing facility from home yesterday for rehabilitation due to increasing weakness that has caused several recent falls. Students will perform an overall assessment including heart, lung and edema assessments; communicate with Hector therapeutically; and initiate a basic nursing plan of care.
62-year-old male patient with chronic stable heart failure admitted to the skilled nursing facility from home yesterday for rehabilitation due to increasing weakness that has caused several recent falls. Students will perform an overall assessment including heart, lung and edema assessments; communicate with Hector therapeutically; and initiate a basic nursing plan of care. Abnormal lab results arrive at the start of shift that should be assessed before medications are administered. Students should notify the provider of their concerns. In State 2, new orders are received.
62-year-old male patient with chronic heart failure admitted to the hospital early today for dehydration, for which he received IV Fluids. Students should recognize that he is demonstrating symptoms of fluid overload and notify the physician. This scenario also incorporates IPE with a video of a Respiratory Therapy report, and a progress note written by the Respiratory Therapist for the students to review.
62-year-old male patient with chronic heart failure admitted to the hospital yesterday for dehydration, for which he received IV Fluids, resulting in the development of pulmonary edema. Two hours prior to the start of this shift, the nurse administered STAT IV furosemide. The patient refuses to wear his BiPAP or non-rebreather mask. Before administering scheduled medications, students should notice that lab work has not been drawn since prior to the administration of IV Lasix. The patient begins to develop chest pressure and students should obtain a STAT ECG, which shows the development of PVCs. A 5-minute timer begins, and as the patient becomes increasingly more confused, he goes into Vfib 5 minutes later as the rapid response team arrives. The facilitator can then lead the students in performing CPR and assisting in a “code” situation.
Hector Fernandez is a 62-year-old male patient with a history of heart failure, brought into the Emergency Department via EMS. Students receive a handoff report from paramedics, and begin their focused assessments. The scenario progresses to State 2 when the QR Code: Facilitator code is scanned. (Note: The facilitator may also choose to go directly to State 2 and skip the initial assessments.) In State 2, the students receive report that the patient “coded,” and was intubated and placed on mechanical ventilation and the wife is “on her way.” When they enter the room, the wife has Hector’s advanced directives and states, “he wouldn’t want this,” and asks that he is removed from the ventilator. State 3 begins with a video of the respiratory therapist removing the patient from the ventilator. This scenario focuses on advanced directives and therapeutic communication with family members during a crisis and end of life care.
Hector Fernandez is a 62-year-old male patient with a history of heart failure who was brought to the Emergency Department via EMS. He subsequently arrested, was resuscitated, and is now in the ICU on a mechanical ventilator. In State 1, as students are completing their focused assessments, they can assess the patient’s ventilator settings against the Provider Orders by entering the Ventilator tab and viewing the ARISE Virtual Ventilator. Students should notice that the settings do not match the orders and call the Respiratory Therapist. In State 2, the ABG’s result. Students should evaluate the ABG’s and call both the Provider for new orders and the RT to make the changes. In State 3, the Respiratory Therapist has made the ordered ventilator changes and students can reassess the ARISE Virtual Ventilator settings.
Michael L. Milbourn is a 69-year-old male who arrived in the ED via ambulance after walking into an urgent care clinic with worsening chest pain. Students will implement orders for non- STEMI chest pain including titrating IV Nitroglycerin and implementing pre-op orders for Coronary Artery Bypass Grafting (CABG) surgery. Pre-op medication administration orders include: IV Heparin, IV Regular Insulin drip, and an IV antibiotic.
Michael L. Milbourn is a 69-year-old male who just arrived in the ED via ambulance after walking into an urgent care clinic with worsening chest pain. Students will implement the ED protocol for chest pain, which includes obtaining a stat 12 lead ECG and starting two IVs. Then, they will implement orders for both non-STEMI chest pain and pre-op Coronary Artery Bypass Grafting (CABG) surgery. Other student responsibilities associated with medication administration include: titrating IV Heparin, recognizing when the patient becomes hypotensive, and managing the patient safely.
Baby Noah was delivered via a normal spontaneous vaginal birth 2 hours ago. Videos, images and sounds of various newborn assessments are provided for student discussion of: newborn reflexes; head to toe assessment; measurement of head and chest circumference; and administration of screening tests and medications based on facilitator discretion.
Level 2 provides videos to stimulate discussion about newborn safety and parent education, in addition to all of the newborn and assessment videos that are provided in Level 1. Students also have the opportunity to administer a Hepatitis B injection.
Baby Noah was delivered by normal spontaneous vaginal delivery 30 hours ago. Students discover that Noah appears yellow during their assessment today. They may input the transcutaneous bilirubin result in the “bilitool” calculator to determine the baby’s risk for jaundice, as well as provide education to the parents about jaundice. In State 2, they safely implement new orders for phototherapy.
In State 1, students receive vital signs from a student nurse who reports that the father does not want to keep the baby swaddled. Upon entering the room, they discover the un-swaddled newborn near a window with a fan blowing. Students should respond with appropriate nursing actions. In State 2, students receive report from the nurse and are asked to obtain a blood glucose of the baby. Students will implement the glucose screening protocol.
Potential student activities include: Obtain patient OB/GYN history for initial prenatal visit; Recognize signs of pregnancy; Calculate estimated date of delivery; Compare immunization record to CDC recommendations; Screen for genetic risk factors; Perform medication reconciliation; Identify prenatal risk factors; Provide patient education and counseling
This scenario can be used for high- or low-fidelity simulation. In high-fidelity simulation, the patient videos and tabbed chart content can be used to augment the reality of the simulation. In low-fidelity simulation, the instructor can use role play, in association with the iPad content, to stimulate student critical thinking and discussion about various prenatal care topics. In State 1, the patient arrives for her 28 week visit. Students may administer Rhogam and the glucose challenge tolerance test. Students should also review her immunization record to determine if immunizations are needed at this visit. QR codes are provided that demonstrate the following procedures: measuring the fundus, obtaining fetal heart tones, and performing the Leopold’s maneuver. In State 2, Olivia returns for 36-week visit. QR codes are provided that demonstrate a nonstress test with fetal heart monitoring and an image of the strip for interpretation by students
28-year-old female presenting to the hospital in active labor experiencing contractions at 40w1d. She is 4 cm dilated. Her water breaks as the student meets her in the Labor and Delivery room at 0900. Students provide routine intranatal care throughout all three states. In State 2, Olivia progresses to the Transitions stage and is 7 cm dilated. In State 3: Olivia begins pushing. Several augmented reality videos and images are provided to simulate the progression of the baby through the birth canal. In addition, videos of the husband at the bedside are provided and someone can continue to role-play the husband throughout the scenario to add further family dynamics. This scenario can be used for high- or low-fidelity simulation. In high-fidelity simulation, the patient videos and tabbed chart content can be used to augment the reality of the simulation. In low fidelity simulation, the instructor can use role play, in association with the scenario content, to stimulate student critical thinking and discussion about prenatal care topics.
28-year-old female who was admitted in active labor yesterday at 0800. She had a 26-hour labor with 2 hours of pushing and delivered a healthy baby at 1000 today via vaginal delivery. She has some questions about breastfeeding. Students implement routine postpartum orders. This scenario can be used for or high- or low-fidelity simulation. In high-fidelity simulation, the patient videos and tabbed chart content can be used to augment the reality of the simulation. In low-fidelity simulation, the instructor can use role play, in association with the scenario content, to stimulate student critical thinking and discussion about postnatal care topics.
28-year-old female who delivered a healthy baby via cesarean delivery earlier today, and has some questions about breastfeeding. Students implement routine postpartum orders. This scenario can be used for or high- or low-fidelity simulation. In high-fidelity simulation, the patient videos and tabbed chart content can be used to augment the reality of the simulation. In low-fidelity simulation, the instructor can use role play, in association with the scenario content, to stimulate student critical thinking and discussion about prenatal care topics.
28-year-old female who presented to the hospital twelve hours ago in active labor at 40w1d gestational age. As she progressed to cervical dilation 8 cm, she developed Category 3 fetal heart tones with intermittent late decelerations and light meconium stained fluid. Students will prepare the patient for an emergent Cesarean Section and provide appropriate therapeutic communication to the patient and her husband as they prepare to go into the operating suite. She does have an epidural in place. This scenario can be used for high- or low-fidelity simulation. In high-fidelity simulation, the patient videos and tabbed chart content can be used to augment the reality of the simulation. In low-fidelity simulation, the instructor can use role play, in association with the scenario content, to stimulate student critical thinking and discussion about prenatal care topics. Videos of the husband at the bedside are provided. Someone can continue to role-play the husband’s role throughout the scenario.
Olivia Brooks is 28-year-old female who vaginally delivered a healthy baby earlier today. In State 1, as the students walk into the room, they find the patient standing up with blood dripping down her legs. The patient complains of dizziness as she sinks into the bedside chair. Students should initiate immediate care for the patient in this potentially emergent situation. In State 2, the nurse has assessed the patient and provides report. Students should assist in implementing the postpartum hemorrhage protocol. This scenario can be used for high- or low-fidelity simulation. In high-fidelity simulation, the patient videos and tabbed chart content can be used to augment the reality of the simulation. In low-fidelity simulation, the instructor can use role play, in association with the scenario content, to stimulate student critical thinking and discussion about prenatal care topics.
Assess abdomen with seat belt sign; assess pain by using FACES scale and interviewing parent; obtain accurate VS; decide about prn pain medication
Collect routine pediatric visit data; Review the patient’s Asthma Action Plan, document using the Vitals tab and Growth Chart, and perform some coaching regarding the Asthma Action Plan and Patient Education Handouts.
Collect routine pediatric visit data; Obtain a peak flow reading and evaluate the patient’s accuracy in using his Albuterol inhaler. Videos are provided to allow the student to evaluate if the patient is performing these techniques properly or not. Communicate results to provider; receive new orders; review the patient’s new Asthma Action Plan and perform some coaching regarding the Asthma Action Plan and other patient handouts provided.
Collect patient data and review the Asthma Protocol. Obtain a peak flow reading to determine the severity of the asthma attack. Administer a nebulizer treatment and repeat the peak flow reading. Discuss findings with the provider and receive new orders. Use the patient education handouts provided to coach the patient about improved asthma self-management.
Utilize the Asthma Protocol; recognize that respiratory arrest is imminent, and call 911. May attempt to perform a peak flow reading but patient is too short of breath to do so. Administer a nebulizer treatment per protocol while waiting for the ambulance to arrive. When paramedics arrive, students provide an SBAR report to the paramedics.
Collect routine pediatric visit data; Review the patient’s Asthma Action Plan, document using the Vitals tab and Growth Chart, and perform some coaching regarding the Asthma Action Plan and Patient Education Handouts.
Assess abdomen with seat belt sign; assess pain by using FACES scale and interviewing parent; decide about prn pain medication while awaiting CT results; Intervene appropriately when parent becomes verbally abusive; administer ondansetron for nausea
Patient arrives post-small bowel repair on PCA; assess using sedation scale; administer IV Gentamycin and Diphenhydramine; provide therapeutic communication to parent
Post-op care for small bowel repair; PCA management; assess using sedation scale; administer IV Gentamycin and Diphenhydramine; provide therapeutic communication to parent
Post-op care for small bowel repair; PCA management; assess using sedation scale; patient becomes not responsive with respiratory depression; naloxone administered; ABGs interpreted; Fentanyl IV administered for pain; therapeutic communication with parent during crisis
Clint D. Fullerton is a 67 year old male who was admitted to the medical/surgical floor for treatment of a non-healing left ankle wound. Mr. Fullerton resides at a local skilled nursing facility secondary to self-care deficits and being a brittle diabetic. He had multiple rounds of antibiotic treatment with no successful results.
Clint D. Fullerton is a 67 year old male who was admitted to the medical/surgical floor for treatment of a non-healing left ankle wound. Mr. Fullerton resides at a local skilled nursing facility secondary to self-care deficits and being a brittle diabetic. He had multiple rounds of antibiotic treatment with no successful results. Last night he developed foul smelling diarrhea.
Start CourseClint D. Fullerton is a 67 year old male who was admitted to the medical/surgical floor for treatment of a left ankle ulceration and is on contact precautions for CDiff. He has a past history of diabetes, hypertension, venous insufficiency and self-care deficits. He has a PICC line in the left brachial. His last Vancomycin dose was last night at 2000 so he is due for his morning dose. Peak Vancomycin levels were drawn after last night’s dose, but the night RN has not seen the critically elevated results yet.
Clint D. Fullerton is a 67-year-old male who was admitted to the medical/surgical floor 2 days ago for treatment of a left ankle ulceration and is on contact precautions for CDiff. He has a past medical history of diabetes, venous insufficiency and self-care deficits. He has a PICC line in the left brachial for Vancomycin, but the Vancomycin was held last night secondary to an elevated peak level. Last night he had difficulty breathing so labs were ordered, Lasix 40 mg was given and RT was consulted. He refused BiPAP despite multiple attempts by RT. Upon assessment, the student(s) discover the patient is significantly worse secondary to renal failure and fluid overload. When the MD is notified, new orders for a chest x-ray, ABG’s and to transfer to ICU are given.