Penni Watts, PhD, RN, CHSE
CHSE-A ONLINE PORTFOLIO
Educational Activity
"Advanced Team Communication Simulation"
BACKGROUND:
Senior nursing students are near graduating and becoming independent clinicians in the healthcare setting. Often clinical practicums and clinical experiences are not always sufficient in providing exposure to certain clinical concepts necessary to function as a new graduate nurse. Our school determined several issues that needed to be addressed via simulation. These were determined by new graduate feedback, senior practicum clinical logs, and feedback from area stakeholders. These included: cognitive bias, resuscitation skills, dealing with challenging team members, team work skills, and assessment. In addition, these needs were matched by our medical schools 4th year Emergency Room clerkship director as needs by these interns and was an ideal situation to make the activity an interprofessional experience.
DESIGN:
The Advanced Team & Communication Simulation experience is conducted at the beginning of the fifth semester in the BSN nursing program. The simulation experience was designed as an experience with three simulation rotations within one time frame. Each group of students would spend one hour in each room for a total course time of 3.5 hours. With a class of over 100 nursing students, this was conducted over 3 days so the group sizes were smaller allowing for more hands on by each student. 3 medical students attended each session. The experience begins with a team building activity such as Leggo exercise or a “life size” charades of symptoms of the sympathetic nervous system with 4th year medical students and nursing students.
Each simulation involved case development and a debriefing plan that was mutually prepared and planned by both medicine and nursing faculty. Run-thrus were conducted for each case at the inception of the experience. Consistent faculty are used if possible and new faculty that help are trained and paired with an experienced team member for that event.
OVERALL GOAL: The purpose of this simulation experience was for the nursing and medical students to work as a team managing care in three different simulated cases. This experience occurs in the last year/semester of their academic program and is focused on more complex patients and higher level situations.
COURSE OBJECTIVES:
Simulation 1: “Cognitive Bias”
Objective 1: Manage care of a patient presenting with chest pain and include all potential differential diagnoses.
Objective 2: Improve teamwork and communication within the team and with a family member.
Simulation 2: “Rapid Cycle Deliberate Practice (RCDP) Resuscitation/ACLS”
Objective 1: To refine resuscitation skills using RCDP
Objective 2: To practice ACLS algorithms utilizing RCDP
Simulation 3: “Sepsis/Difficult Team Member” (scenario information and debriefing guide attached)
Objective 1: Apply sepsis protocol to care of a nursing home patient
Objective 2: Manage situation with a difficult/challenging team member
Objective 3: Perform a comprehensive physical assessment
DEBRIEFING:
A standardized debriefing structure is used for each of the simulations. Individualized debriefing guides were developed for each simulation based upon learning objectives, type of simulation, and clinical concepts of the case. The basic structure of debriefing is outlined in our Debriefing Guide. The nursing and medicine faculty work together to negoiate roles and structure and plan the debriefing prior to the session.
These experiences are used for formative learning within our BSN curriculum and the medical school curriculum. Course faculty observe each simulation to identify weaknesses of learners, gaps in curriculum, as well as skill deficits. Learners are asked to determine areas they need to work on and discuss with their preceptor in their senior clinical practicum. Senior nursing students are also asked to reflect anecdotally regarding the simulation experience within their clinical logs. These logs are reviewed by course faculty who then summarize learning as well as gaps and use them to revise and update curricula and simulation exercises.
EVALUATION
Evaluation of the simulation experience is conducted at the end of the entire event. This evaluation form is used for all simulation experiences at our university.This information is collected, entered into an electronic system, and a summary of data is created. This is a formative assessment experience and is not graded. Faculty of both medicine and nursing observe students performance and the debriefing to determine gaps in the curriculum or individual learning needs, as well as whether team skills are being used appropriately. We have not moved to a formal team assessment tool at this time. Faculty are also evaluated periodically during these events using the DASH (Debriefing Assessment for Simulation in Healthcare). The DASH assessment is completed by an expert simulation educator at our university.
QUALITY IMPROVEMENT
Post course debriefs also include a review of the evaluations of the experience, anecdotal observations, and any difficult or challenging situations of the event. Informal focus groups with learners are held towards the end of the semester to identify how learning activities from the semester helped them develop as independent providers during their clinical practicum. These sessions include discussion of the simulation experiences and how they added and supported learners towards being independent new graduate nurses. Post semester evaluations are also collected as part of our institutions ongoing evaluation and assessment of learning. Post course debriefs occur for ongoing quality improvement and to ensure quality simulation experiences and open and thoughtful feedback is given to all those involved. Course evaluations are reveiwed to continue making tweaks and changes to improve the experiences
SIMULATION CURRICULUM
Interprofessional simulation curriculum includes experiences during each of the nursing students 5 semester program and intermittently during the medical schools program. Early semesters focused on history, physical, and general communication among the team. Subsequent semesters include progression of difficulty and complexity of simulated cases. The Advanced Team and Communication Simulations are the culmination of all previous simulation experiences. Expectations and independence are expected and a student-centered approach is taken. Higher level thinking and critical reasoning skills are needed in these advanced activities.