Cheryl Pulling

Effectiveness of simulation on health profession students' knowledge, skills, confidence and satisfaction.

UNLABELLED Background  Despite the recent wave of interest being shown in high-fidelity simulators, they do not represent a new concept in healthcare education. Simulators have been a part of clinical education since the 1950s. The growth of patient simulation as a core educational tool has been driven by a number of factors. Declining inpatient populations, concerns for patient safety and advances in learning theory are forcing healthcare educators to look for alternatives to the traditional clinical encounter for skill acquisition for students. Objective  The aim of this review was to identify the best available evidence on the effectiveness of using simulated learning experiences in pre-licensure health profession education. Inclusion criteria  Types of studies: This review considered any experimental or quasi-experimental studies that addressed the effectiveness of using simulated learning experiences in pre-licensure health profession practice. In the absence of randomised controlled trials, other research designs were considered for inclusion, such as, but not limited to: non-randomised controlled trials and before-and-after studies. TYPES OF PARTICIPANTS This review included participants who were pre-licensure practitioners in nursing, medicine, and rehabilitation therapy. Types of intervention(s)/phenomena of interest: Studies that evaluated the use of human physical anatomical models with or without computer support, including whole-body or part-body simulators were included. Types of outcome measures  Student outcomes included knowledge acquisition, skill performance, learner satisfaction, critical thinking, self-confidence and role identity. Search strategy  Using a defined search and retrieval method, the following databases were accessed for the period 1995-2006: Medline, CINAHL, Embase, PsycINFO, HealthSTAR, Cochrane Database of Systematic Reviews and ERIC. Methodological quality  Each paper was assessed by two independent reviewers for methodological quality prior to inclusion in the review using the standardised critical appraisal instruments for evidence of effectiveness, developed by the Joanna Briggs Institute. Disagreements were dealt with by consultations with a third reviewer. Data collection  Information was extracted from each paper independently by two reviewers using the standardised data extraction tool from the Joanna Briggs Institute. Disagreements were dealt with by consultation with a third reviewer. Data synthesis  Due to the type of designs and quality of available studies, it was not possible to pool quantitative research study results in statistical meta-analysis. As statistical pooling was not possible, the findings are presented in descriptive narrative form. Results  Twenty-three studies were selected for inclusion in this review including partial task trainers and high-fidelity human patient simulators. The results indicate that there is high learner satisfaction with using simulators to learn clinical skills. The studies demonstrated that human patient simulators which are used for teaching higher level skills, such as airway management, and physiological concepts are useful. While there are short-term gains in knowledge and skill performance, it is evident that performance of skills over time after initial training decline. Conclusion  At best, simulation can be used as an adjunct for clinical practice, not a replacement for everyday practice. Students enjoyed the sessions and using the models purportedly makes learning easier. However, it remains unclear whether the skills learned through a simulation experience transfer into real-world settings. More research is needed to evaluate whether the skills acquired with this teaching methodology transfer to the practice setting such as the impact of simulation training on team function.

Simulation in interprofessional education for patient‐centred collaborative care

AIM This paper is a report of preliminary evaluations of an interprofessional education through simulation project by focusing on learner and teacher reactions to the pilot modules. BACKGROUND Approaches to interprofessional education vary widely. Studies indicate, however, that active, experiential learning facilitate it. Patient simulators require learners to incorporate knowing, being and doing in action. A theoretically based competency framework was developed to guide interprofessional education using simulation. The framework includes a typology of shared, complementary and profession-specific competencies. Each competency type is associated with an intraprofessional, multiprofessional, or interprofessional teaching modality and with the professional composition of learner groups. METHOD The project is guided by an action research approach in which ongoing evaluation generates knowledge to modify and further develop it. Preliminary evaluations of the first pilot module, cardiac resuscitation rounds, among 101 nursing students, 42 medical students and 70 junior medical residents were conducted in 2005-2007 using a questionnaire with rating scales and open-ended questions. Another 20 medical students, 7 junior residents and 45 nursing students completed a questionnaire based on the Interdisciplinary Education Perception scale. FINDINGS Simulation-based learning provided students with interprofessional activities they saw as relevant for their future as practitioners. They embraced both the interprofessional and simulation components enthusiastically. Attitudinal scores and responses were consistently positive among both medical and nursing students. CONCLUSION Interprofessional education through simulation offers a promising approach to preparing future healthcare professionals for the collaborative models of healthcare delivery being developed internationally.

Interprofessional resuscitation rounds: a teamwork approach to ACLS education

Purpose: We developed and implemented a series of interprofessional resuscitation rounds targeting fourth year nursing and medical students, and junior residents from a variety of specialty programs. Methods: Each two hour session was conducted in our patient simulation lab, and was held weekly during the academic year. Students were given specific instruction on the roles and responsibilities of resuscitation team members, and then teams of five worked through pre-defined Advanced Cardiac Life Support (ACLS) scenarios on a high fidelity patient simulator. At the end of each session students completed an anonymous evaluation of the program via a standardized questionnaire using Likert rating scales. Results: A total of 222 evaluations (101 nursing students, 42 medical students, and 79 junior residents) were submitted from October 2005 to April 2006. Mean scores reflected a strong consensus that these rounds were valuable for their training, provided a vehicle for understanding team roles in resuscitation, and that these rounds should be mandatory for all medical and nursing trainees. Participants also expressed a desire for additional interprofessional training. Conclusion: Despite challenges inherent in teaching a diverse group of learners, these interprofessional resuscitation rounds were rated highly by nursing and medical trainees as valuable learning experiences.

Evaluating an undergraduate interprofessional simulation-based educational module: communication, teamwork, and confidence performing cardiac resuscitation skills

Purpose Interprofessional (IP) collaboration during cardiac resuscitation is essential and contributes to patient wellbeing. The purpose of this study is to evaluate an innovative simulation-based IP educational module for undergraduate nursing and medical students on cardiac resuscitation skills. Methods Nursing and medical trainees participated in a new cardiac resuscitation curriculum involving a 2-hour IP foundational cardiac resuscitation skills lab, followed by three 2-hour IP simulation sessions. Control group participants attended the existing two 2-hour IP simulation sessions. Study respondents (N = 71) completed a survey regarding their confidence performing cardiac resuscitation skills and their perceptions of IP collaboration. Results Despite a consistent positive trend, only one out of 17 quantitative survey items were significantly improved for learners in the new curriculum. They were more likely to report feeling confident managing the airway during cardiac resuscitation (P = 0.001). Overall, quantitative results suggest that senior nursing and medical students were comfortable with IP communication and teamwork and confident with cardiac resuscitation skills. There were no significant differences between nursing students’ and medical students’ results. Through qualitative feedback, participants reported feeling comfortable learning with students from other professions and found value in the IP simulation sessions. Conclusion Results from this study will inform ongoing restructuring of the IP cardiac resuscitation skills simulation module as defined by the action research process. Specific improvements that are suggested by these findings include strengthening the team leader component of the resuscitation skills lab and identifying learners who may benefit from additional practice in the role of team leader and with other skills where they lack confidence.

Development and Evaluation of an Epidural Analgesia Workshop for Senior Nursing Students

BACKGROUND Most prelicensure nursing students receive little to no training in providing care for patients who receive epidural analgesia, despite exposure in clinical settings and the potential for devastating adverse effects. To develop and pilot an epidural workshop for senior nursing students using standardized patients (SPs), and to evaluate feasibility and learner outcomes. METHOD A 4-hour epidural workshop consisted of a large group lecture and demonstration, small-group practice scenarios, and individual learner evaluation with SPs. Learning outcomes were evaluated using a performance checklist and critical thinking rubric, and pre- and posttests. RESULTS Participants scored well on the performance-based evaluation (mean score of 86% items performed correctly) and rated the workshop highly. However, learners and instructors made several recommendations for improving the learning module for future sessions. CONCLUSION This pilot project demonstrated that an epidural analgesia workshop using SPs is feasible and results in positive learning outcomes and high satisfaction with senior nursing students. [J Nurs Educ. 2018;57(6):359-365.].

Board 201 - Program Innovations Abstract Using Standardized Patients to Enhance Interprofessional Infection Control Education for Prelicensure Physiotherapy, Nursing and Medical Students (Submission #962)

Introduction/Background Both interprofessional collaboration and adherence to evidence based infection control practices contribute to patient safety, improved patient outcomes and decreased healthcare costs. Hence, an interprofessional education (IPE) simulation module on infection control skills for intermediate-level health professions students using standardized patients (SPs) was developed and trialed in 2012. Feedback from the 2012 module was incorporated into the 2013 trial and evaluated. Our innovative approach to interprofessional infection control education using SPs aims to prepare prelicensure physiotherapy, nursing and medical students for collaborative, patient-centred practice to enhance patient safety. Methods Prior to attending the IPE sessions, students completed three online modules on chain of transmission, hand hygiene and routine practices. The two hour IPE session included an interactive plenary session with an infection control practitioner (ICP) and four brief simulated clinical scenarios using SPs: 1) Patient with R-sided stroke wants to get up in wheelchair that has roommate’s housecoat is draped on it; 2) Stable patient with HIV is attending clinic for routine checkup. Healthcare worker enters wearing gloves & gown; 3) Patient with dementia and MRSA is ready for discharge post hospitalization fractured ankle; 4) Person with undiagnosed TB in ER reports recent weight loss, coughing for four weeks with greenish sputum, fatigue, fever etc. Interprofessional teams of students interacted with the SPs and were expected to select and utilize supplies and protective equipment appropriate to the level of infection control practices dictated by each unique clinical scenario. Debriefing focused on both infection control skills and interprofessional collaboration. The major changes implemented in 2013 to improve the module were: 1) Session offered earlier in term to avoid conflicts with midterms, assignments and other IPE initiatives; 2) Majority of facilitators were Infection Control Practitioners (ICPs); 3) Formal orientation session was provided to facilitators over lunch and included: 4) Orientation to specific scenarios and debriefing guides; 5) General orientation to facilitating a simulation session; 5) Facilitators also attended the didactic session; 6) Individual scenarios tweaked based on feedback; 7) More extensive instructions provided to students prior to sessions, including expectations for dressing professionally; 8) Perceived learning, interprofessional collaboration and the organization and content of the new learning module were evaluated by feedback from learners through a satisfaction survey and focus groups. Learning outcomes were assessed through an online survey administered before and after the sessions. Informal feedback was also provided by faculty observers and ICP facilitators. Learners reported high satisfaction with the module and its components. Feedback supported the value of the clinical scenarios with SPs in contributing to learning of infection control skills and providing opportunities for learning from and about other health professionals. Learners also identified areas for improvement of the module including providing more practical information and demonstrations during the interactive lecture component. Learner knowledge of infection control practices increased significantly (p<0.03). Participants were least knowledgeable about the minimum time needed to properly wash hands with soap and water, and employing routine practices. Learner confidence performing all infection control skills except for hand hygiene increased significantly following participation in the sessions (p<0.05). Participants were least confident utilizing enhanced precautions and adapting infection control practices to patients’ homes, longterm care and private practice settings. Results: Conclusion Despite having previous education related to infection control practices, intermediate level learners continue to have knowledge gaps and lack of confidence applying these skills. Evaluation Results support the need for intermittent reinforcement of infection control knowledge and skills, with a particular emphasis on the clinical context. Identified knowledge gaps and suggestions for further improvement will be incorporated into future sessions as the IPE infection control module becomes fully integrated within the curricula of the three schools. Disclosures None.