• Hospice: Dying at Home an Undergraduate Nursing Simulation

      Pierce, Amy; Butler, Ryan
      Topic: The Hospice: Dying at Home simulation addressed a gap in undergraduate nursing student education, regarding end-of-life care. During the simulation, nursing students demonstrated novice level skills in caring for clients who were near the end-of-life or actively dying. The simulation promoted the utilization of therapeutic communication and critical thinking skills needed to assess, plan, implement, and evaluate nursing care given to clients and families during the end of life. Context: The simulation was implemented as a final project in a senior nursing course focusing on the care of adults living with chronic illness. Students were required to demonstrate overarching concepts taught throughout the course such as: self-management, uncertainty, spirituality, transitions in care, chronic pain, palliative care, hospice, and death. A checklist of required skills and activities to be utilized was provided for student review and included specific objectives such as performing a head to toe assessment and providing education on the hospice experience. The simulation was held in the Minka, a compact home on the University of Southern Indiana campus, to give students a realistic experience. Grounding: End-of-life simulation addresses a gap in undergraduate nursing education. Time allotted for clinical hours and availability of clinical settings limits nursing students experience of caring for clients and families near the end-of-life (Smith, et al., 2018). The Hospice: Dying at Home simulation gives a large cohort of nursing students the opportunity to care for a client and family near the end-of-life. This simulation provides a basis for how nurses care for and use therapeutic communication. When education on death and dying is minimized in undergraduate nursing programs, nursing students are left unprepared to care for clients and families near the end-of-life (Hjelmfors, Stromberg, Karlsson, Olsson, Jaarsma, 2016). Approach: The simulation took place in two 20-minute parts, first covering admission into home hospice, and subsequently addressing care of the actively dying client. Students were given one week to prepare for the simulation by accessing the academic electronic health record, reading assigned documents, and reviewing the simulation checklist. On the day of the simulation, three students were randomly chosen to participate in each part, assuming the roles of nurse and family members. The remaining students observed the live-streamed simulation from a classroom. The large group met to debrief after each part. In addition to peer and faculty comments, a practicing hospice nurse was on-hand to observe, answer questions, and offer feedback. Discussion: The Hospice: Dying at Home simulation positively impacted student learning by providing a comprehensive end-of-life experience for undergraduate nursing students. Overall, students indicated that the simulation was realistic, the debrief process was engaging, and the educational objectives were met. This simulation could be adapted to a variety of clinical settings including residential and acute care. If live-stream capabilities are not available, the class could be broken down into smaller sections with staggered starts. Caring for clients at the end-of-life is essential; simulation provides an effective method for students to practice this nursing responsibility. References Smith, M.B., Mecieira, T.G.R., Bumbach, M.D., Garbutt, S.J., Citty, S.W., Stephen, A., Keenan, G. (2018). The use of simulation to teach nursing students and clinicians palliative care and end of life communication: A systematic review. American Journal of Hospice and Palliative Medicine. 35(8), 1140-1154. doi: 10.1177/10499091 Hjelmfors, L., Strombert, A., Karlsson, K., Olsson, L., Jaarsma, L. (2016). Simulation to teach nursing students about end-of-life care. Journal of Hospice and Palliative Nursing. 18(6), 512-518. doi: 10.1097/NJH.00000000000000279
    • Summer Fun with IPE: Lesson Learned - Don't Get Burned

      Peak, Katherine; Doerner, Mary; Schmuck, Heather; Andrews, Carly; Cook, Joy
      Healthcare is an increasingly complex environment, comprised of multiple disciplines and clients with various disease processes and psychosocial issues. This complexity requires that all healthcare professionals, regardless of their discipline, be able to effectively work together within teams. The inability to function within a team as well as the inability to communicate effectively and share vital information, prioritize, and make appropriate decisions can result in patient harm and negative outcomes. Competency for effective teamwork is having knowledge of each healthcare professional's roles and responsibilities (Interprofessional Education Collaboration Expert Panel, 2011). While this information can be learned on the job, the ability to prepare future healthcare professionals for working in interprofessional/interdisciplinary teams is crucial. Promoting effective teams and team dynamics requires faculty to provide opportunities for healthcare professions students to have experiences that support interdisciplinary teamwork. Context This scholarly teaching activity evolved from a need to incorporate more interprofessional activities for students during the summer semester. Three disciplines from NURS488, DMS347, and RADT415 came together during the summer 2019 semester to develop an interprofessional activity with a focus on effective communication and teamwork in a simulated environment. The intended student outcomes were to practice effective communication amongst healthcare team members in order to facilitate positive patient outcomes in a triage scenario and to promote mutual respect and increased awareness of roles and responsibilities amongst the team members. Grounding Medical Errors are currently the third leading cause of death in the United States. The most common root cause of medical error is failure to communicate, thus further highlighting the need for simulation based interprofessional education (IPE) activities. Designing simulations by applying the International Nursing Association for Clinical Simulation and Learning (INACSL) Standards of Best Practice: Simulation-Enhanced Interprofessional Education (SIM-IPE) required criteria, faculty can begin to develop simulations that allow students of multiple professionals to come together to accomplish the same objectives by communicating clearly and effectively. Simulation based interprofessional education can be supported and guided with Kolbs Experiential Learning Theory. This theory consists of four major parts, all of which can be used to guide the entire simulation process: a concrete experience (simulation), reflective observation (debrief), An abstract conceptualization (post-simulation evaluation), and active experimentation (follow-up simulations, clinical experience, and work experience) (INACSL Standards Committee, 2016). Approach For the scenario, faculty enlisted the help of USIs Public Safety officers to act as Emergency Medical Technicians (EMTs) who were transporting three simulated patients from the field into the simulated hospital emergency room environment. Each EMT presented one of the three patients cases to the receiving team comprised of 1-2 nursing leadership students and either radiography students or diagnostic medical sonography students. One patient was received only by nursing students. Nursing leadership students were then tasked with deciding what triage imaging orders might be necessary for the patient. Two radiography and two diagnostic medical sonography student representatives were present in the simulated hospital emergency room and proceeded to simulate image acquisition and provide radiologists reports on the imaging exams. The remainder of the nursing, diagnostic medical sonography students, and radiography students from the involved courses were in a classroom setting observing a live video feed of each simulation room scenario. The teams of students in the simulation center each took a turn advocating for their patient to the lead surgical nurse as the patient whose condition was most critical, therefore requiring the next available surgical intervention. Following the live simulation, the students from the simulation center joined the other students in the classroom setting for a full debriefing of the activity. This was the first attempt at such a scenario ever attempted in our college. Although simulation has a long history of utilization in single discipline formats for a variety of purposes, bringing together these particular disciplines for an interprofessional learning experience was innovative; especially when combining the collaboration of our public safety officers into the scenario. None of these particular courses had ever had an IPE activity implemented prior to this scenario even though literature supports the multiple benefits of interprofessional education through simulation. Reflection/discussions/lessons learned When reflecting on this interprofessional simulation there were aspects that went well and aspects that presented challenges. When debriefing, simulation leaders conducted a SWOT analysis to discuss what went well and what could be improved. Leadership incorporated their own observations as well as student comments during the debriefing session to help drive the analysis. Strengths included the communication and cooperation of the leadership members involved in designing and implementing the simulation, as well as their strong commitment to an interprofessional learning experience. Another strength was the availability of the colleges state-of-the-art simulation center and the staff member who organizes and administers the simulation process. Lack of clear knowledge about each others profession proved to be a weakness. Students also felt that the simulation should include certain equipment to make it more realistic. In light of these reflections, faculty propose that students create video projects highlighting the scope of practice of their respective professions as an opportunity for future interprofessional simulations. Additional ancillary equipment will be included to promote a more realistic feeling to the simulation. Threats include the reluctance of some students to fully engage in the interprofessional experience. Faculty plan to stress the importance of interprofessional education and collaboration and their roles in the team approach to healthcare. Faculty will thoroughly explain the objectives of the simulation and debrief with students at the conclusion to elicit feedback from all parties involved. Overall, faculty learned that simulations do not go perfectly the first time. Many unexpected circumstances may occur. Debriefing and careful observation are essential to the learning process so that errors can be corrected and a more robust experience can be conducted in the future. References: INACSL Standards Committee (2016, December). INACSL Standards of Best Practice: SimulationSM Simulation-enhanced interprofessional education (sim-IPE). Clinical Simulation in Nursing, 12(S), S34-S38. http://dx.doi.org/10.1016/j.ecns.2016.09.011. Murphy, Joseph G., and William F. Dunn. Medical Errors and Poor Communication. Chest, vol. 138, no. 6, 2010, pp. 1292-1293., doi:10.1378/chest.10-2263. Poore, J. A., Cullen, D. L., & Schaar, G. L. (2014, May). Simulation-based interprofessional education guided by Kolbs experiential learning theory. Clinical Simulation in Nursing, 10(5), e241-e247. http://dx.doi.org/10.1016/j.ecns.2014.01.004.