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Putting Words into Action: Using Simulation to Develop Key Communication Skills: An

HEA Collaborative Project

Debbie Lewis, Jim Chapman, Marie O’Boyle-Duggan and Sue Lawrence

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What are we trying to achieve?

To develop communication skills sessions in a BSc (Hons.) to meet the NMC (2010) Standards for Pre-Registration Nursing.

Nurses must be able to:-• Communicate safely and effectively• Build therapeutic relationships taking into account differences, capabilities and needs• Be able to engage in, maintain, and disengage from therapeutic relationships • Use a range of communication kills and technologies• Use verbal, non-verbal and written communication• Recognise the need for an interpreter• Address communication in diversity• Promote well-being and personal safety• Identify ways to communicate and promote healthy behaviour • Maintain accurate, clear and complete written or electronic records• Respect and protect confidential information

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What has gone before?

• Evidence of confusion in what needs to taught, varying degrees of provision and a lack of Field specific training (Chant et al, 2002).

• Few receive training on dealing with end-of-life care issues, dealing with anger and distress or communicating by telephone.

• Using skills checklist and counselling models may not be transferable in all practise areas.

• Effective evaluation and a progression from simple to complex skills has been lacking.

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Research Evidence

Building on key research evidence:Maguire et al (1996)Fallowfield et al (2002, 2003)Wilkinson et al (1998, 2002, 2008)

[Bit about LD here?/Marie]

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Phase I – Training Actors

Pilot funding via the Centre for Health and Social Care Research for: • Four 3rd year students from Birmingham School

of Acting.• Three existing actors from Learning Disabilities

nursing. • They also helped design scenarios linked to clinical practice.

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Clinical Scenarios Field specific but each session aimed to include all Fields.

Adult Nursing

After a ward round responding to patient’s request ‘What does palliative mean?’ Responding to a shocked and distressed patient after a consultation in an Outpatient

Clinic. Helping an irritable and aggressive older patient who is unlikely to be able to return

home. Approaching a relative of a large extended family who are staying on the ward beyond

normal visiting times.

Mental Health

Approaching a patient having found a half empty whisky bottle under their bed. Helping an aggressive, bed bound patient who has been moved from another ward and

is suffering nicotine withdrawal. Dealing with an approach from a patient to meet up with them for a drink after their

discharge from the ward.

Clinical Scenarios

Children’s Nursing

Discussing the care of a baby with a cold with her anxious and socially isolated mother.

Gaining dialogue with a withdrawn adolescent patient with a cystic fibrosis patient after the death of their close friend.

Learning Disabilities

Assessing pain in a patient with moderate learning difficulties and limited speech who wants to return to her home.

Managing a patient in casualty with autism and limited speech who wants to remove a head dressing.

Phase II - Delivery of Sessions

• Delivery of 26 two hour sessions [October cohort] before the first year’s students first clinical placement.

• Groups size varied from 9 to 20 students. • A lesson plan included an introductory

PowerPoint with suggested ground and feedback rules and guidance for facilitators.

Systematic Evaluation

• Actor training was evaluated.• Representative sample of 300 students [290

returned, reduced to 271 by ‘missing data’] completed anonymous Pre- and Post-session quantative confidence survey adding comments.

• Facilitators and actors were asked to contribute to the evaluation process.

Quantitative Data Analysis

1 2 3 4 5 6 7 8 9 100

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Pre-sessionPost-session

Quantitative Data Analysis

• 82 students participated in sessions and 196 observed giving feedback. Data analysis indicated that both participants and observer’s confidence increased after the sessions building on existing Faculty knowledge (O’Boyle-Duggan, 2012).

• Larger ‘effect size’ for participants statistically significant increase across nursing Fields.

Qualitative Feedback

Student feedback:• “Talk to them and ask questions – will allow them

to open up. This session taught me to concentrate solely on patient and relatives and them expressing their concerns”.

• “Need practice to gain confidence and become more competent”.

• “Really good to engage with a ‘real-life’ situation: very beneficial to the care we will provide”.

Actors Feedback

• “I guess all of us have been in a situation where we have been misunderstood by a nurse or doctor and it is a great feeling to see all of these talented young people really try to get to the bottom of a problem...”

• “Personally, I loved working as a role-player. It gave me

a chance to work a little more on my improvisation skills and respond immediately to whatever the student nurse came up with in the scenario. They seem to have fully understood in theory how to approach a patient and were very keen to try out everything they had learned”.

Facilitator Feedback

• The session pack was well received with informal discussions on ways of gaining student participation.

• It was suggested the sessions may have helped students in a gaining good scores in an OSCE exam shortly after the Communication Skills Simulation sessions.

• Smaller groups sizes were requested but practically this is difficult.

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Publications

LEWIS D., O’BOYLE-DUGGAN M., CHAPMAN J., DEE P., SELLNER K., GORMAN S. (2013) ‘Putting

Words into Action Project’: using role play in skills training. B J Nurs. Vol. 22 (11): 638-644.

References

Fallowfield L, Jenkins V, Farewell V, Saul J, Duffy A, Eves R (2002) Efficacy of a Cancer Research UK communication skills training model for oncologists: a randomised controlled trial. Lancet. Vol.359 Feb 22, pp.650-656. Fallowfield L, Jenkins V, Farewell V, Solis-Trapala, I (2003) Enduring impact of communication skills training: results of a 12-month follow–up. Br J Cancer. 89, 1445-1449. O’Boyle-Duggan M, Grech J, Brandt R (2012) Effectiveness of live simulation of patients with intellectual disabilities. J Nurs Edu. Vol 51(6): 335-342. Maguire P, Booth K, Elliott C, Jones B (1996) Helping health professionals involved in cancer care acquire key interviewing skills – the impact of workshops. Eur J Cancer. Vol. 32A (9) 1486-1489. Nursing and Midwifery Council (2011) Standards of Proficiency for Pre-registration Nursing Education. Available from:- http://www.nmc-uk.org/Educators/Standards-for-education/Standards-of-proficiency-for-pre-registration-nursing-education/. Accessed on 24.7.12 Wilkinson S, Linsell I, Perry R, Blanchard K (2008) Communication skills training for nurses working with patients with heart disease. British Journal of Cardiac Nursing. 3 (10): 475-81.