Christina Keller MSN, RN, CHSE
Instructor, Radford University Clinical Simulation Center
Katrina Watson MSN, RN
Instructor, Radford University Clinical Simulation Center
The occupational therapy (OT) faculty at Radford University, USA along with the nursing faculty at the university’s clinical simulation center partnered to conduct a simulation learning experience for graduate OT students. These OT students had not yet begun their clinical practicums. The objective of the simulation was to reduce the stress levels of students before entering the clinical environment while also overcoming the challenge of incorporating a high volume of students. Multiple evidence-based studies support the benefits of simulation as an interprofessional teaching method to increase student confidence (e.g. Zhang, Thompson, & Miller, 2011). Caring for more complex and acutely ill patients can be overwhelming for healthcare students. The variety of tubes, lines, drains, and medical support equipment that was once restricted to the hospital setting is now found in skilled nursing facilities, rehabilitation units/hospitals, and home care. It is highly likely that students will interact with these types of ‘clinical devices’ during their time in fieldwork or OT practice.
Nursing and OT faculty collaborated together to provide a unique simulated experience for OT students to assist in transitioning from the classroom to the clinical environment. One of the biggest challenges at this university is coordinating schedules of various healthcare students in order to incorporate more interprofessional learning activities across the curriculums. This innovative initiative was a creative simulation strategy developed to overcome the challenges of scheduling high volumes of students for one educational session with the goal of addressing the need to decrease student stress before entering the clinical environment.
The expertise of full-time simulation nursing faculty was utilized to develop three separate hands on learning stations in a simulated and safe clinical environment.
Station 1 involved the opportunity to practice blood pressure measurements while incorporating peer learning strategies. Simulation faculty members were intentional in using blood pressure measurement as the first station due to the potential that all students were familiar with some aspect of blood pressure measurement. With nursing faculty guidance, each student obtained measurements on their peers. OT faculty facilitated active discussion with students regarding appropriate clinical circumstances in which an OT might need to obtain a blood pressure measurement. Simulation faculty guided active discussion regarding appropriate communication of blood pressure measurements to nursing staff so the nurse and OT can collaboratively address any acute changes in patient status.
Station 2 involved a nursing simulation faculty member assuming the role of a patient who suffered multiple injuries in a motor vehicle crash and required an OT consult. OT students were given the opportunity to care for a standardized patient with a tracheostomy tube (which posed communication challenges), an intravenous line, an indwelling urinary catheter, and a leg brace. This nursing simulation faculty member was able to provide realistic feedback from the patient’s perspective based on the nursing faculty member’s own clinical practice. The OT students conducted a brief assessment and then assisted the patient into a wheelchair while manipulating the artificial lines and medical equipment. The OT faculty member provided feedback on safety and scope of practice for the OT students.
Station 3 utilized a high fidelity simulator with recorded voice responses. The nursing simulation faculty set up this patient’s hospital room with both appropriate findings and safety concerns. After two groups of OT students alternately rotated through stations one and two; the entire group of students participated in station 3 together with a nursing simulation faculty member and an OT faculty member available for prompting and cueing on an as needed basis. The students entered a realistic, acute care hospital room to find a urinary catheter drainage bag and nasal cannula device lying on the floor, an alarming IV pump, and a patient complaining of shortness of breath. The OT students were challenged to decide what priority actions needed to occur upon entering the room. The objective was to identify the safety hazards and patient’s distressed condition, and to notify nursing staff immediately to discuss the plan of care.
Best practice guidelines in simulation suggest that students should complete preparatory work prior to any simulation experience (INACSL, 2016). The students were prepared ahead of time through OT coursework readings and a handout on the acute care environment which included the location and purpose of common tubes, lines, and drains that are commonly seen in the hospital.
The benefits of this simulation experience are numerous. Students stated the experience increased confidence levels and decreased their stress levels before entering complex clinical environments. Some of the other verbalized benefits included: collaborative teamwork, interprofessional problem solving, and faculty role modeling. The interaction across healthcare professions will introduce students to one another’s scope of practice and allow for sharing of knowledge from peer to peer, faculty to student, and student to faculty. The OT faculty and nursing simulation faculty also observed that students were engaged in all three domains of learning during the entire experience: cognitive, psychomotor, and affective domains.
The unique qualities of this interprofessional education (IPE) experience involved the deliberate fusion of several different teaching methodologies into one simulation experience. Students intentionally began the experience in either the peer to peer learning blood pressure station or the standardized patient station. After alternately completing both of these stations, the entire student group finalized the experience by applying what was just learned in an acute care type hospital experience utilizing a high fidelity simulator. Immediately applying what was learned provided students the opportunity to practice somewhat independently from their instructors in a safe, simulated environment. Adult learners must find a learning experience practical and immediately applicable to their lives to motivate learning and promote retention of knowledge (Poore, Cullen, & Schaar, 2014). The OT students were able to immediately apply what was learned in the first two stations in a simulated environment much like the clinical environment into which they are about to enter.
Another unique characteristic of this simulation experience was the involvement of nursing and OT faculty and the role modeling of collaborative communication amongst instructors. The nursing faculty member playing the role of the patient also provided a very uncommon, yet very valuable perspective in order to better facilitate discussion about the approach to care and performance of skills from an acutely injured patient’s perspective.
Lack of time, scheduling conflicts, and high volumes of students are among the most reported challenges in developing IPE activities and can deter efforts to incorporate more IPE activities into other curricula (Titzer, Swenty, & Hoehn, 2012). Healthcare academia requires classroom and clinical hours which makes it difficult to coordinate dates to include multiple professions for shared learning activities. We have taken the first step in addressing this challenge at this university by offering an IPE simulation experience. An advantage of this approach to IPE simulation is the avoidance of scheduling conflicts with a high volume of students.
During the simulated learning experience, OT students verbally reported less stress when anticipating the handling of medical equipment, and when interacting with patients and nurses. The OT faculty participating in the simulation day activities conducted a reflective debriefing session with the students after the simulation and reported positive student feedback from the experience. The students valued being introduced to the medical environment through interaction with a ‘friendly patient’ and gained comfort with handling the medical devices in a safe, relaxed-pace learning environment. Further research on high psychological stress and its detrimental effects on clinical decision-making and performance is needed.
IPE can promote student and faculty learning. A creative simulation experience can allow a full assessment of student learning needs without high risk investments of time, money, and human resources up front. The nursing faculty members acknowledge feeling more comfortable providing this IPE experience with OT faculty present in cases where the OT specific scope of practice needed to be clarified and contrasted from the nursing scope of practice. First semester OT students benefited from observing the nurse and OT faculty modeling the professional interactions needed in practice.
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Image courtesy of RGU