Transcript pptx - HPSN

Stephanie Justice, MSN, RN
Lisa Rohrig, BSN, RN
The Ohio State University
College of Nursing
About Us
Stephanie Justice
Clinical Instructor in Technology Learning Complex
Lisa Rohrig
Director Technology Learning Complex
Objectives
• Learn from our challenges and experience
• Leave with realistic, workable ideas
Purpose & Background
Why 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 areas
Two teams
15 card holders per team
Put the word cards in order to list the 5 areas
No cheating!
5 IOM Core Areas For
Health Professions Education
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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
And now a little comic relief…
Help!
Simulation Development
• Opportunities
• History of IP Sims at OSU
• Planning committee
• What our Sim looks like now
Small Group Brainstorming
Directions:
form groups of 4-5 people each from a different facility
assign one person as timekeeper
each person has 1 minute to list existing and potential collaborations
Collaboration ideas:
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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 appropriate
o Preparation may vary among levels of students
• Credit to students
o Pass/fail, clinical hours (depends on if allowed as
substitution), extra credit, professional development,
volunteer
• Preparation varied among the professions
o Slide show, case review, ISBAR overview
Small Group Brainstorming
Directions: 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 professions
o Theraband
o Acapella
o 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 video
Short 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 Professions
Scheduling conflicts… now what?
• Rounding reports
o Created by each discipline
o 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 chart
LOS 4 days when Sim starts
Patient Care
• After reviewing chart:
Each discipline assesses/meets with patient
• First rounds
Everyone participates
• Implement/reassess
Implement as much as possible
• Second rounds
Ann Arbor
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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 party
Doesn’t remember accident
• Retail job
• Steps at apartment
• Lives with roommate
Ann is a simulator
• Can’t speak when intubated
Big problem for the simulation
How did we solve this problem?
• Can’t move when PT/OT works with her
How 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 actor
Challenges with this:
How to simulate working vent
How to simulate intubation, OG/NG on live patient
Jill Shuman
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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 history
Last 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, tingling
Taught to rub leg
Hold 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
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Did you come to any new realization about your own
profession’s role/value on the team?
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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?
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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
[email protected]
Lisa Rohrig
[email protected]