stephanie justice, msn, rn lisa rohrig, bsn, rn the ohio state university college of nursing
TRANSCRIPT
EVERYONE’S INVITED:OUR INTERPROFESSIONAL SIMULATION EXPERIENCE
Stephanie Justice, MSN, RNLisa Rohrig, BSN, RN
The Ohio State University College of Nursing
About Us
Stephanie JusticeClinical Instructor in Technology Learning Complex
Lisa RohrigDirector Technology Learning Complex
Objectives
• Learn from our challenges and experience
• Leave with realistic, workable ideas
Purpose & BackgroundWhy do Inter-professional (IP) Sims?
• Institute of Medicine core competencies (2003)o Work in interdisciplinary teams
• Quality and Safety Education for Nurses (QSEN) (2005-12)o Knowledge, Skill & Attitude competencies of “Teamwork
and Collaboration”• Inter-Professional Education Collaborative (IPEC) (2011)
o Core competency domains • Values/Ethic for IP practice• Roles/Responsibilities• IP Communication• Teams & Teamwork
5 IOM Core Areas For Health Professions Education
Unscramble to reveal the 5 core areasTwo teams15 card holders per teamPut the word cards in order to list the 5 areasNo cheating!
5 IOM Core Areas For Health Professions Education
• Delivering patient-centered care• Working as part of interdisciplinary teams• Practicing evidence-based medicine• Focusing on quality improvement • Using information technology
Objectives
Not just working together…working together in
their role
Simulation Development• Opportunities
• History of IP Sims at OSU
• Planning committee
• What our Sim looks like now
Small Group BrainstormingDirections: form groups of 4-5 people each from a different facilityassign one person as timekeepereach person has 1 minute to list existing and potential collaborations
Collaboration ideas:• Programs within your facility
ex. midwifery and BSN• Outside hospital or college
independent schools or local hospital• Community provider
Could do squad run into simulated ED with nursing and EMS
Logistics
• Maximizing student participation
• Managing flow during simulation
• Managing resources needed
Student Availability
Simulation Schedule
“IP Sim Days”IP Sim Days Proposal:
• Designated set days each semester • Participating health science colleges “release” (their chosen
group of) students to participate in one IP simulation• Mandatory participation for designated student group• Sent to health science deans• Signed by all of the IP planning committee
Student Involvement Considerations• Matching levels of students
o Range of students that would be appropriateo Preparation may vary among levels of students
• Credit to studentso Pass/fail, clinical hours (depends on if allowed as
substitution), extra credit, professional development, volunteer
• Preparation varied among the professionso Slide show, case review, ISBAR overview
Small Group BrainstormingDirections: Form groups of 4-5 people; assign one person as timekeeper; each person has 1 minute to answer
Discuss:
• Which learners would be a good fit for participation in IP Sims at your facility?
• What types of preparation do you anticipate them needing?
• What incentives do you think might work best for your learners?
Logistics• Maximizing student participation
• Managing flow during simulation
• Managing resources needed
Logistics• Maximizing student participation
• Managing flow during simulation
• Managing resources needed
Space
Supplies and Equipment• Most supplies and equipment from nursing
• Some provided from other health professionso Therabando Acapellao Tube feeding
Personnel• Nursing currently does all set up/tear down
• Nursing provides majority of SPs
• RT leads the research
• Planning committee members facilitate debriefing sessions
Format • Our simulation focuses on communication and understanding
roles of other disciplines
• Students participate in the assessment, rounding, plan and treatment for each patient
• During first Sim we decided to add second rounds
Scenario Development• Reviewed 12 previous simulations as a group
• Looked for patients with complex needs that would require interactions between disciplines
• Took 6 months to choose and update patients to meet the needs of all groups involved
ISBAR rounding videoShort video (approx. 4 minutes)
ISBAR Video
Surprise!• We learned new terminology
Transfemoral• Proper titles
Medical Dietetics• Length of study for each program
Varies greatly• Who can do dressing changes?
Physical Therapy• What’s an Acapella?
Pickle
Missing ProfessionsScheduling conflicts… now what?
• Rounding reportso Created by each disciplineo First and second rounds
• One of the faculty in each Sim plays the part of the missing profession
• Pharmacy included additional information regarding medications and potential changes
Medical Records• EHR vs. Hard copy
CON has EHR but others don’t use it
• Needed to develop all parts of the chartLOS 4 days when Sim starts
Patient Care• After reviewing chart:
Each discipline assesses/meets with patient
• First roundsEveryone participates
• Implement/reassessImplement as much as possible
• Second rounds
Ann Arbor• MVA unrestrained DUI• Intubated on ventilator (respiratory failure)• Spleen laceration (post op)• Femur fracture – ORIF (post op)• Right chest tube to water seal• OG to suction (with drainage in suction canister)• Dobhoff in nares with tube feed (post-pyloric)• Foley
Ann’s Social History• Social Drinker
Was at a partyDoesn’t remember accident
• Retail job
• Steps at apartment
• Lives with roommate
Ann is a simulator• Can’t speak when intubated
Big problem for the simulationHow did we solve this problem?
• Can’t move when PT/OT works with herHow did we solve this problem?
What is next for Ann?• Possible change for spring simulation to Ann failing SBT or
pneumothorax
• May use an intubation head and live actorChallenges with this:
How to simulate working ventHow to simulate intubation, OG/NG on live patient
Jill Shuman• Post-op trans-femoral amputation• Pneumonia• History of ETOH and benzodiazepines• Post ETOH withdrawal• Bipolar and schizophrenic• Diabetic• Atrial fibrillation• PEG tube with tube feeding- on hold for Cipro• Foley pulled out
More about Jill• Added cultural considerations to simulation
Appalachian
• Complex social historyLast admission was >8 months ago
• Poor appetite
• Coumadin sub-therapeutic
Jill is a live person• How do we amputate the leg?
PT needs to wrap the residual limb
• Infected wound
• Complains of pain, numbness, tinglingTaught to rub legHold in different position when OOB
What is next for Jill?• May change scenario for spring • Experimenting with residual limb model• Add odor to infected wound
Debriefing• Created set of questions
• Keeps everyone involved
• Audiotape session Each person identifies which profession they are with
Debriefing Questions• Now that the simulation is over, what questions do you have
for another profession? (Remember, this is a safe environment)
• Name one thing you learned about another profession. (something they do or something they know, etc…)
• Let’s talk about the collaborations with the different professions during the simulation? o Who did you talk to? What did you talk about? o How did your conversations affect the patient’s plan of
care?
Debriefing Questions• Did you come to any new realization about your own profession’s
role/value on the team?
• Hypothetically, what if you had a conflict with another profession about their recommendation for the patients’ care, how should conflicts be addressed with another profession? o What is the time and place for conflict discussion? o How do you balance respect for another profession with
patient advocacy?
• What will you do differently in practice as a result of this experience
Research• Examining the potential benefits of clinical simulations on
teamwork and communication.
• The research will analyze the attitudes of participants toward the use of multi-disciplinary simulations in clinical education.
• RIPLS (Readiness for Interprofessional Learning Scale)
Qualitative Research Themes
Learning the roles of others
“I would hope that everyone from this takes away a greater respect for the other professions now that we understand what everyone does.”
“Rounds helped see what other professions do. Rounds helped us know what questions we can ask other professions.”
Qualitative Research Themes
The big picture
“So, it is kind of nice to hear everything that’s going on with the patient, to get more of an overview of everything that is going on.”
“You can see how you fit in the picture because when we do nursing sims it’s just all nurses so now you can see the bigger picture.”
Qualitative Research Themes
Increased trust and confidence
“It’s nice to know I can depend on other people to help me with what I do not know much about. It was humbling but also a confidence booster.”
“Something I have learned over the years is that nobody can do what they do without other people. Yea sure I’m the doctor but I can’t do my job without the rest of you guys.”
Qualitative Research Themes
Benefit of simulated setting
“You get a chance to make mistakes and learn from them; and not in a real setting where it’s kind of like fast paced…less stressful.”
Conclusions• Interprofessional education simulation demonstrated a
strategy to better prepare students for the clinical setting
• Reinforces what we see in the literature
• Future research is needed to explore the long term effects of participation
Questions??Stephanie Justice
Lisa Rohrig