e405 Presentation Abstracts from 2012 INACSL Conference

Our nursing staff development department offers an ‘‘RNRefresher Course’’targeted to those nurseswhowant to update their knowledge base and clinicalskills to increase their marketability in the workforce when competingagainst those who are more clinically current. While the course waspreviously limited to classroom learning, the addition of clinical simulationhas added excitement and application opportunities to the course.

Methods: Previously the RN refresher course was mainly a didactic learningexperience taking place over 5 weeks for three days a week. Guest lecturerspresented on topics related to each physiological system such as cardiovas-cular and pulmonary. Additionally classes on pharmacology, legal issues, andother current trendswere included. Several hours were devoted to participantspracticing basic nursing skills such as IV and urinary catheter insertions.While the course was popular to those who needed this requirement to applyfor a job, the course was still without engagement and interactive learningactivities. Clinical simulation activitieswere incorporated into the program toprovide experiences thatwouldhelp the nurses refresh and enhance their skillsand assessment techniques as well as utilize clinical reasoning.

Results: Three days of clinical simulation were developed focusing on 1)resuscitation management, 2) shift assessment, and 3) critical thinking. Thesimulated experienceswere immersive andnon-intimidating. Feedback fromthe participants was extremely positive. They expressed enthusiasm for theimproved and innovative way of learning and overwhelmingly wanted moreopportunities in the simulation lab and less classroom lecture. Not only didthe participants benefit, but staff development personnel became interestedand excited about the potential benefits of clinical simulation. We willdiscuss the planning and development of these simulations and how theyformalized during the course as well as barriers and limitations.

Evaluating the Effectiveness of Simulation to Increase ClinicalJudgment in Patient Care Situations using a MultidisciplinaryApproach

Level of Presentation: Novice

Lynn White, RN, MSN, CNS, Simulation Support Specialist, Avera

McKennan Hospital, Assistant Professor of Nursing, Augustana

College, 1325 S Cliff Ave, Sioux Falls, SD 57117, 605-261-1638,

lynn.white@augie.edu

Darcy Sherman-Justice, MS, RN, NE-BC, Avera McKennan Hospital,

Director of Nursing Integration

Objectives:

a. Participants will describe how to successfully integrate multiple disci-plines in simulation scenarios conducted in a hospital simulation center.

b. Participants will discuss the how interdisciplinary simulation im-pacted confidence, improved communication and teamwork andwill effect clinical practice in an emergent situation.

Background/purpose: Recognizing that new and experienced staff oftenstrugglewith effective communication techniques in a crisis situation, pharmacyand respiratory therapy (RT) staff were invited to join newly hired nursing staffin code blue simulation scenarios. The purpose of this study was to provide anopportunity to promote interdisciplinary teamwork in an emergent setting.

Methods/aims or expected outcomes: This descriptive research studyused a convenience sample of 38 staff comprised of new graduate RN’s hiredwithin the past 2-3 months, respiratory therapists, and pharmacy staff. Asimulation scenario was conducted in which the simulated patient’scondition deteriorated to cardiac and respiratory arrest. When the RNparticipant’s recognized the need for intervention and called a ‘‘code blue,’’RT and pharmacy staff arrived to assist, along with an ACLS trained teamleader tomanage the care of this patient. The scenario varied slightly for eachgroup, allowing for different areas of practice, but always culminated in thepatient requiring cardiopulmonary resuscitation. A post simulation ques-tionnaire was completed by each participant evaluating confidence prior toand after participating in the scenario. Additional areas on the questionnaireaddressed promotion of interdisciplinary communication and teamwork, andwhether participation in this scenario will change their clinical practice.

Findings or evaluation data: Findings showed that confidence in providingthe type of care that the simulated patient in cardiopulmonary arrest required

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prior to participation in this scenariowas 45% lowor very low, and 39%neutral.Confidence in providing care increased to 52% very high or high with 45%remaining neutral. A point to note is that many of the RT staff had experiencewith cardiopulmonary arrest situations prior to this simulation session. 86% ofthe participants strongly agreed that participation in the scenario helped topromote interdisciplinary communication and teamwork. Participant commentsrevealed ‘‘the communication will be clearer and louder’’ and ‘‘I understandwhat goes on and how valuable working with a team is in a situation like this.’’

Conclusions/implications: The benefits of involvingmultiple disciplines insimulation scenarios are clearly positive. Management from the disciplinesinvolved in this scenario have requested further sessions to enable more staffto participate. Plans are to also incorporate medical residents into thesimulation scenarios, thus adding another layer of benefit for all participants.

Relevance to conference themes: This project meets the conferenceobjective of determining new directions for our simulation center. Recog-nizing areas of multidisciplinary expansion and further development ofsimulation as an orientation and educational methodology within the acutecare practice setting is a goal of this hospital administration. This project is inline with suggestions from the IOM and QSEN regarding teamwork andcommunication effecting quality of patient care.

Using Simulated Patients to Identify and Manage Communication Gaps

Level of Presentation: Novice

Rita M. Wick, MSN, RN, Simulation Coordinator, Berkshire Health

Systems, 725 North Street, Pittsfield, MA 01201, (413) 447-2177,

rwick@bhs1.org

Objectives

1. Analyze the use of standardized patients (SPs) for identifying gaps incommunication within the healthcare team.

2. Validate the use of SPs in improving methods of communication be-tween members of the healthcare team and patient family members.

Simulation was introduced to Berkshire Health Systems in 2008, but the

program did not initially incorporate the use of standardized patients (SPs).

In early 2011, the value of such an addition to our program was recognized

when an actual patient event was reviewed. A committee of educators from

throughout the institution gathered to plan a retreat for the medical residents

in which communication would be practiced, reviewed, critiqued, and

enhanced. SPs were chosen as the method with which to introduce more

therapeutic methods of both verbal and nonverbal communication.

A retreat for our residents was held in May 2011 in which they were

divided into several small groups, each with 4 or 5 members: the resident

communicating with the family member of a deceased patient; the family

member (portrayed by a variety of SPs, who included nurses); and observers

whowere asked to critique the interaction. Eachmemberwas given a slightly

different version of the scenario based on his/her role. At the end of the given

time period, the members of each group discussed the scenario amongst

themselves and were then brought together as a large group for the

opportunity to reflect, ask questions, and discuss alternative methods of

handling the interaction. After a presentation on interviewing, communica-

tion, dealingwith angry patients and families, and learning how to apologize,

the participants were divided into new groups and were afforded the

opportunity to revisit the scenario using the discussion points and tools

gathered in the previous sessions.

All participants affirmed the value of this program, which allowed

them to experience first-hand the angst of delivering or receiving

unpleasant news and the potential responses faced, as well as practicing

communication techniques that will enable them to be better equipped

the next time such a difficult situation might be encountered. Addition-

ally, those acting as SPs saw the merit of putting themselves in the shoes

of an angry family member, while validating the difficulties experienced

by residents in such a situation. The participants (as well as adminis-

tration) have voiced hopes that this retreat will become at least an annual

event for residents and other healthcare providers within the BHS

community.

e416 � Clinical Simulation in Nursing � Volume 8 � Issue 8