PPMP workshop

WORKSHOP: Using video simulations to teach
students to predict, prevent and manage patient
deterioration and promote safe practice.
Prof Tracy Levett-Jones

Learning Objectives
At the end of this workshop, participants will be able to:
• Discuss the utility and benefits of videoed simulations and the
use of the PPMP model
• Identify key design factors for effective video simulations
• Design a video simulation based on the PPMP model.

• Teaching that begins with questions is both a moral and a
pedagogical choice. A teacher teaches with questions because
she or he believes that it is a better way to teach, and a better
way to be a teacher. Yet to succeed at this, the questions must
be real questions, questions that puzzle, confuse and interest.
-Nicholas Burbles, 1997
• Speak less so that your students learn more …
• -Paul and Elder, 2007.
• Give a man a fish and he will eat for a day. Teach a man to fish
and he will eat for the rest of his life
• -Chinese proverb

Key concepts
• Predict, prevent, manage and promote model
• Nursing management of the surgical patient
• Person-centered care
• Clinical reasoning
• Identification and management of 'the deteriorating patient'
• Patient safety
• Fluid and electrolyte balance
• Pain management
• Wound management
• Malnutrition
• Health promotion

Setting the Scene
Read: ‘Mr Cyril Smith’
• Take note of any information that you think is missing or
inadequate from this introductory medical history.
Rationale
• Patient notes are frequently incomplete. It is important to
recognise the relevance of the information provided as well
as any ‘gaps’.

Activity 1: Predicting
Mr Smith was admitted the night before his surgery as he was considered to
be ‘high risk’. You are a nurse working in a small regional hospital and
responsible for Mr Smith's preoperative care.
Watch the Cyril Smith admission video; and list:
• Any professional issues (positive or negative) that you identify?
• Any issues or concerns that you have about Mr Smith’s physical or
psychosocial status?
• Potential risk factors for Mr Smith.
Rationale
The ability to predict potential problems depends upon nurses’ ability to
‘notice’ and ‘anticipate’. Development of these skills requires practice.

Activity 1: Predicting
Facilitators’ role …
• Guide the discussion – it is likely to be unstructured and much like
brainstorming at this stage.
• Ask 'so what' questions.
• For example, if students identify that Mr Smith's age puts him at risk ask:
Why is Mr Smith's age a concern? How might it impact on postoperative
recovery?
What physiological changes occur with ageing that may impact Mr
Smith’s recovery?
• Promote critical thinking not just information recall!

Activity 2: Predicting
Group work:
Create a simple mind map that
illustrates the risk factors and
concerns that you identified in
the previous activity (and any
relationships between them).
Risk of
falls

Activity 3: Predicting and Preventing
Group work:
• What types of risk
assessments are required to
predict and prevent
complications during Mr
Smith’s hospitalisation?
Risk of
falls
Falls risk
assessment
Nonslip
socks
• Add these risk assessments
to your mind map and link
them to related nursing
actions.

Activity 4: Promoting and Preventing
Group work:
• Identify the types of preoperative
patient education
required for Mr Smith that will
promote health and prevent
complications.
• Add these educational
strategies to your mind map.
Teach deep
breathing/
coughing
exercises
Risk of
Pneumonia
Risk of falls
Falls risk
assessment
Nonslip
socks
• Add appropriate nursing
actions to any of risk factors
that you have not yet
addressed.

Activity 5: Cue Collection, Analysis,
Clustering and Inferring
Review:
• What other information (cues) do you need in
order to plan Mr Smith’s pre and post-operative
care?

Activity 5: Cue Collection, Analysis,
Facilitators’ role …
Clustering and Inferring
• List the cues the students request on the white board. The idea is to
let the students critically think about and identify the information
they need. Do not tell students whether the observations or values
are normal … let them think about, discuss and interpret the
findings and what they mean.
• Help students to begin to cluster information together and make
inferences where appropriate (this can be done on the white board
or on butcher’s paper).
• e.g. BGL 7.8 mmoL + poorly managed diabetes + lives alone
(widower) + possible malnutrition + COPD + albuminaemia = risk of
post-op infection and delayed wound healing.

Activity 6: Person-centred care
• To this point we have focused primarily on the physical aspects of Mr
Smith’s condition. This is not holistic care; neither is this approach personcentred.
Person-centre care means seeing the person not just the patient
or their disease process.
• Person-centre care also means appreciating that each person has a unique
and valuable life history and is part of a family and/or community.
• Reflect on your assumptions as your tutor reads Mr Smith’s life history.
• Is there anything about Mr Smith’s life history than concerns you?

The Smith Family Genogram
X
#
X
A
Male
Female - Deceased
Adopted
Divorced
Cyril (72)
Retired
Joy
Died 2008 (aged 66)
X #
Nelson
Died 2008 (aged 32)
#
Caroline (30)
#
Cliff (44)
#
#
Beth (40)
Nurse
Jamie (18mnths)
Doreen (45)
Teacher
A
#
Sean (44)
Alexis (19) Xavier (14)

Designing video simulations using
PPMP model
• Start with the key clinical and professional concepts and/or learning
objectives that will frame your resource.
• Develop the plan for the video or text-based resource – where possible it
is best to use a ‘real’ clinical scenario. It does not have to be very long to
be meaningful.
• Determine the ‘characters’ you need? What are their roles? What is the
central character’s medical and life history? Create a genogram.
• Develop a series of learning activities based upon the PPMP model.