Diana Hopkins-Rosseel

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.

Draping Education to Promote Patient Dignity: Canadian Physiotherapy Student and Instructor Perceptions

PURPOSE To determine the perceptions of educators and students in Canadian entry-level professional physiotherapy programmes with respect to the current draping curriculum and the methods of delivery of that content and to determine if there is a need for additional draping education time and resources in these programmes. METHODS Canadian university physiotherapy students (n=127) and educators (n=183) completed questionnaires designed by the authors. Data were collected via Survey Monkey, exported as Excel files, and analyzed using descriptive statistics and Pearson chi-square analysis. RESULTS Students and educators agreed that dignity as a concept and draping as a skill to protect patient dignity are both important and should be included in Canadian physiotherapy curricula. Respondents also agreed that students often have difficulty with draping. Educators identified barriers to teaching draping while students identified components of an effective educational resource on draping. CONCLUSIONS To enhance the development of effective draping skills among entry-level physiotherapists, draping education should be included in Canadian physiotherapy curricula. An effective draping educational resource should be developed for educators and students. Purpose: To determine the perceptions of educators and students in Canadian entry-level professional physiotherapy programmes with respect to the current draping curriculum and the methods of delivery of that content and to determine if there is a need for additional draping education time and resources in these programmes. Methods: Canadian university physiotherapy students (n=127) and educators (n=183) completed questionnaires designed by the authors. Data were collected via Survey Monkey, exported as Excel files, and analyzed using descriptive statistics and Pearson chi-square analysis. Results: Students and educators agreed that dignity as a concept and draping as a skill to protect patient dignity are both important and should be included in Canadian physiotherapy curricula. Respondents also agreed that students often have difficulty with draping. Educators identified barriers to teaching draping while students identified components of an effective educational resource on draping. Conclusions: To enhance the development of effective draping skills among entry-level physiotherapists, draping education should be included in Canadian physiotherapy curricula. An effective draping educational resource should be developed for educators and students.

High and low contact frequency cardiac rehabilitation programmes elicit similar improvements in cardiorespiratory fitness and cardiovascular risk factors.

Aim Cardiac rehabilitation (CR) is a proven intervention that substantially improves physical health and decreases death and disability following a cardiovascular event. Traditional CR typically involves 36 on-site exercise sessions spanning a 12-week period. To date, the optimal dose of CR has yet to be determined. This study compared a high contact frequency CR programme (HCF, 34 on-site sessions) with a low contact frequency CR programme (LCF, eight on-site sessions) of equal duration (4 months). Methods A total of 961 low-risk cardiac patients (RARE score <4) self-selected either a HCF (n = 469) or LCF (n = 492) CR programme. Cardiorespiratory fitness and cardiovascular risk factors were measured on admission and discharge. Results Similar proportions of patients completed HCF (n = 346) and LCF (n = 351) (p = 0.398). Patients who were less fit (<8 METs) were more likely to drop out of the LCF group, while younger patients (<60 years) were more likely to drop out of the HCF group. Both groups experienced similar reductions in weight (–2.3 vs. –2.4 kg; p = 0.779) and improvements in cardiorespiratory fitness (+1.5 vs. +1.4 METs; p = 0.418). Conclusions Patients in the LCF programme achieved equivalent results to those in the HCF programme. Certain subgroups of patients, however, may benefit from participation in a HCF programme, including those patients who are predisposed to prematurely discontinuing the programme and those patients who would benefit from increased monitoring. The LCF model can be employed as an alternative option to widen access and participation for patients who are unable to attend HCF programmes due to distance or time limitations.

Independent effect of type 2 diabetes beyond characteristic comorbidities and medications on immediate but not continued knee extensor exercise hyperemia.

We tested the hypothesis that type 2 diabetes (T2D), when present in the characteristic constellation of comorbidities (obesity, hypertension, dyslipidemia) and medications, slows the dynamic adjustment of exercising muscle perfusion and blunts the steady state relative to that of controls matched for age, body mass index, fitness, comorbidities, and non-T2D medications. Thirteen persons with T2D and 11 who served as controls performed rhythmic single-leg isometric quadriceps exercise (rest-to-6 kg and 6-to-12 kg transitions, 5 min at each intensity). Measurements included leg blood flow (LBF, femoral artery ultrasound), mean arterial pressure (MAP, finger photoplethysmography), and leg vascular conductance (LVK, calculated). Dynamics were quantified using mean response time (MRT). Measures of amplitude were also used to compare response adjustment: the change from baseline to 1) the peak initial response (greatest 1-s average in the first 10 s; ΔLBFPIR, ΔLVKPIR) and 2) the on-transient (average from curve fit at 15, 45, and 75 s; ΔLBFON, ΔLVKON). ΔLBFPIR was significantly blunted in T2D vs. control individuals (P = 0.037); this was due to a tendency for reduced ΔLVKPIR (P = 0.063). In contrast, the overall response speed was not different between groups (MRT P = 0.856, ΔLBFON P = 0.150) nor was the change from baseline to steady state (P = 0.204). ΔLBFPIR, ΔLBFON, and LBF MRT did not differ between rest-to-6 kg and 6-to-12 kg workload transitions (all P > 0.05). Despite a transient amplitude impairment at the onset of exercise, there is no robust or consistent effect of T2D on top of the comorbidities and medications typical of this population on the overall dynamic adjustment of LBF, or the steady-state levels achieved during low- or moderate-intensity exercise.

Identifying patients at low risk for activity-related events: the RARE Score.

PURPOSE: To prospectively assess whether the Risk of Activity Related Events (RARE) Score accurately identifies patients who are at low risk of experiencing an adverse event while exercise training at cardiac rehabilitation. METHODS: Individuals screened for entry into cardiac rehabilitation were classified as high-risk (RARE Score ≥ 4) or low-risk (RARE Score < 4) using the RARE Score. Patients were followed until program completion or withdrawal, and adverse events were documented. RESULTS: Individuals (n = 656) were eligible for analysis (high risk: n = 260; low risk: n = 396). Eleven events (1 major, 10 minor) were recorded during the study, and the overall event rate was low (1 event per 1321 patient hours of exercise training). Individuals triaged as high-risk had significantly more events than the low-risk cohort (high risk: n = 8 vs low risk: n = 3; P = .024) and were 4 times more likely to experience an adverse event (OR: 4.2; 95% CI: 1.0–20.0). More than 99% of low-risk patients were event free (negative predictive value: 99.2%; 95% CI: 98.3–99.8), while participating in exercise at cardiac rehabilitation. CONCLUSION: The RARE Score accurately identifies patients who are at low risk of experiencing adverse events during exercise training at cardiac rehabilitation. The identification of low-risk patients allows for the possibility of reduced on-site supervision and monitoring, or the provision of alternative models of cardiac rehabilitation, including community- or home-based cardiac rehabilitation programs.

Lack of independent effect of type 2 diabetes beyond characteristic comorbidities and medications on small muscle mass exercising muscle blood flow and exercise tolerance

Persons with type 2 diabetes (T2D) are believed to have reduced exercise tolerance; this may be partly due to impaired exercising muscle blood flow (MBF). Whether there is an impact of T2D on exercising MBF within the typical constellation of comorbidities (hypertension, dyslipidemia, obesity) and their associated medications has not been investigated. We tested the hypothesis that small muscle mass exercise tolerance is reduced in persons with T2D versus Controls (matched for age, body mass index, fitness, comorbidities, non‐T2D medications) and that this is related to blunted MBF. Eight persons with T2D and eight controls completed a forearm critical force (fCFimpulse) test as a measure of exercise tolerance (10‐min intermittent maximal effort forearm contractions; the average contraction impulse in the last 30 sec quantified fCFimpulse). Forearm blood flow (FBF; ultrasound) and mean arterial pressure (MAP; finger photoplethysmography) were measured; forearm vascular conductance (FVK) was calculated. Data are means ± SD, T2D versus Control. fCFimpulse was not different between groups (136.9 ± 47.3 N·sec vs. 163.1 ± 49.7 N·sec, P = 0.371) nor was the ∆FBF from rest to during exercise at fCFimpulse (502.9 ± 144.6 vs. 709.1 ± 289.2 mL/min, P = 0.092), or its determinants ∆FVK and ∆MAP (both P > 0.05), although there was considerable interindividual variability. ∆FBF was strongly related to fCFimpulse (r = 0.727, P = 0.002), providing support for the relationship between oxygen delivery and exercise tolerance. We conclude that small muscle mass exercising MBF and exercise tolerance are not impaired in representative persons with T2D versus appropriately matched controls. This suggests that peripheral vascular control impairment does not contribute to reduced exercise tolerance in this population.

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.