Cerumen Impaction, Lavage; A Simulation Fellow’s Project Summary
By Karen G. Keller, RN, BS, BSN, MSN, APRN-BC
Simulation Fellow/APRN Cardiology
Dayton Veterans Affairs Medical Center
DAYTON, Ohio – An ear examination simulator and high-fidelity mannequin was purchased by the Dayton Veterans Affairs Medical Center (DVAMC) in support of the DVAMC and Office of Rural Health (ORH) Initiative for fiscal year 2019. In utilizing the new equipment, the training objectives for the nursing staff included effective communication with the health care team regarding abnormal ear symptoms and to perform proper ear lavage techniques. The provider’s learning objectives were to identify various ear pathologies, as well as perform proper ear lavage techniques.
Simulation modalities were determined based on the mannequin being cloud based, lightweight, easy to move and able to respond to questions with realistic responses.
During training, nursing staff interviewed the mannequin named “Alex” to identify his cerumen impaction as he presented for a routine exam. The ear examination simulator allowed staff to visualize cerumen impaction and select their choice of approved equipment to irrigate and remove the impaction.
A computer tablet application was created for community-based outpatient clinics’ (CBOC) data collection using Kirkpatrick’s level one and level three questionnaires. Information from 17 sites (medical centers and CBOCs), involving 163 learner participants were sent to ORH Quarterly. All results were met with objective one being to identify abnormal ear symptoms, and objective two to perform an ear lavage.
Identified barriers included competing priorities for time and mandated programs, along with the recent national Resuscitation Education Initiative (REdI) program which impacted the availability of participants. Also, Alex is cloud based and needed good cellular reception. In some areas of the facilities, cellular reception was weaker and slowed his responses which decreased his realism of having a conversation with the staff or providers.
An ear wax educational brochure is now available. The brochure was approved after several months of working in collaboration with audiology, primary care, the DAVMC Veterans health education coordinator, health promotion manager, public affairs specialist and patient committee review.
This project was presented to the national VA community of practice (COP) call, SimLEARN/ simulation fellows call and to the DVAMC/CBOC advanced practice nurses (APRN’s) monthly meeting for continuing nursing education units.
A special thanks to the SimLEARN staff, fellow’s simulation program, and SVAMC simulation co-director’s Dr. Ankur Gupta, staff physician, and Kateri Gabriele, simulation operations manager.
In the photo, Dr. Ankur Gupta performs a simulation ear examination. (VA photo by Karen Keller)