- Email: [email protected]
Fostering interprofessional collaboration and critical thinking between nursing and physical therapy students using high-fidelity simulation
Journal of Interprofessional Education & Practice 10 (2018) 37e40
Contents lists available at ScienceDirect
Journal of Interprofessional Education & Practice journal homepage: http://www.jieponline.com
Short Communication
Fostering interprofessional collaboration and critical thinking between nursing and physical therapy students using high-fidelity simulation Jennifer A. Mai a, *, Renee L. Pilcher b, Molly Frommelt-Kuhle b a b
Clarke University, Physical Therapy Department, 1550 Clarke Drive, Dubuque, IA 52001, USA Clarke University, Nursing Department, 1550 Clarke Drive, Dubuque, IA 52001, USA
a r t i c l e i n f o
a b s t r a c t
Article history: Received 4 January 2017 Received in revised form 28 February 2017 Accepted 8 November 2017
This curricular resource describes a method of interprofessional collaboration between nursing and physical therapy students. The purpose is to describe an experience using high fidelity simulation (HFS) to foster interprofessional collaboration and critical thinking in a mock critical care setting. Nursing and physical therapy students are introduced to HFS prior to interprofessional collaboration. A total of 79 students over 4 academic years evaluated the experience. Retrospective qualitative analysis from student reflections revealed the following themes: realistic, life-like learning experience; valuable learning tool; collaboration and teamwork; and reflection on action. HFS is a valuable tool to incorporate into curriculum to assess learning outcomes that are expected of health care professionals. Interprofessional collaboration could lead to stronger patient-centered care given the sharing of knowledge that occurs across disciplines. © 2017 Elsevier Inc. All rights reserved.
1. Format
3. Objectives
Physical therapy and nursing students engaged in an interprofessional high fidelity simulation (HFS) scenario focusing on critical care in groups of 6e8 individuals with additional students observing. Students were expected to focus on interprofessional communication and responding appropriately to changes in patient status.
The broad objective was to foster interprofessional collaboration and critical thinking in a mock critical care setting. Specifically, students were expected to apply SBAR (Situation, Background, Assessment, and Recommendations) communication technique within interprofessional teams. Students were responsible for the assessment of and response to change in patient status using HFS. Following the scenario, students complete peer and selfassessments of performance followed by guided debriefing from the instructors.
2. Target audience Undergraduate nursing students and graduate level physical therapy (DPT) students formed interprofessional teams. At least two nursing students and three to five DPT students participated in each scenario. Two faculty members representing Nursing and Physical Therapy educational programs were responsible for the development and oversight of the simulation activity.
* Corresponding author. 1550 Clarke Drive, MS 1712, Dubuque, IA 52001, USA. E-mail addresses: [email protected] (J.A. Mai), [email protected] (R.L. Pilcher), [email protected] (M. Frommelt-Kuhle). https://doi.org/10.1016/j.xjep.2017.11.002 2405-4526/© 2017 Elsevier Inc. All rights reserved.
4. Activity description Prior to the interprofessional experience (IPE), students are exposed to HFS through their respective programs. Students are presented with basic shells of 2 cases developed by the instructors to prepare for the experience. Diagnoses for the cases are coronary artery bypass graft or thoracotomy in an intensive care unit setting. In both scenarios, the “patient” has a foley catheter, chest tube, multiple intravenous lines, and dressings. Nursing students review the medical diagnosis, lab values, medications, and SBAR (situation, background, assessment, recommendation) communication
38
J.A. Mai et al. / Journal of Interprofessional Education & Practice 10 (2018) 37e40
technique prior to the IPE. DPT students review the brief case scenario and names of the medications, but do not receive lab values until the start of the lab, as they are expected to determine if lab values would indicate alteration of the physical therapy session. Each scenario has a 20-min time limit. One nursing student or instructor plays the role of the patient voice from the control room. The instructors provide cues to the person regarding appropriate responses for the patient. The IPE lab begins with 2 nursing students completing a brief nursing assessment of the patient. The nursing students then provide report to the DPT students using the SBAR technique. The DPT students work in groups of 3e5 to evaluate the patient. In each case, the patient scenario evolves “on the fly” to adapt to the students responses. The DPT students are expected to recognize and manage problems like cerebrovascular accident, myocardial infarction, low glucose levels, or dealing with patients who have difficult psychosocial concerns or family dynamics. At the end of the scenario, DPT students are expected to report back to the nursing students using the SBAR technique. Each student participates in only one case using the HFS and then acts as an observer for a second case. Up to 8 people are actively engaged in the scenario with up to 8 additional students observing during the simulation. The instructors run a total of 6 scenarios in the same day, which allows approximately 40e50 students to complete the IPE. Students participate in multilayer reflection as part of the debriefing process as described in the assessment section. 5. Assessment During the scenarios, students are assigned a specific student to observe and provide feedback using the guiding peer assessment questions. Students complete the peer assessment in “real time” as the scenario is running. Following completion of the scenarios, students complete the self-assessment tool. Prior to the faculty led debriefing, the instructors review the peer and self-assessments for consistency and identify any points that may have been observed by the instructors that were not captured by the student assessments. Two videotaped HFS scenarios (one of each diagnosis) are reviewed in a large-group class session. The debriefing process allows all of the students to watch the video and provide feedback regarding whether or not objectives have met. The instructor provides additional guidance, clarification, and/or instruction to ensure that the objectives have been met. Peer assessment questions included: 1. What did the student do well during the scenario? 2. What needs a little more work? 3. General feedback for the group Self-assessment questions included: Case Scenario (Diagnosis) 1. What were your primary concerns in this scenario? 2. Did you miss anything in getting report on this patient? 3. Did you have sufficient knowledge/skills to manage this situation? 4. What did you do well in this scenario? 5. If you were able to do this again, what would you do differently? For the DPT students, the following questions were also added to the self-assessment regarding management of the patient: 6. What are your goals for this patient? 7. Frequency/duration for patient Other questions that the instructor may use during the guided
debriefing included: 1. If you could do something differently, what would that be? 2. Did you feel you needed more information? What information would that be and how would you obtain it? 3. What guided your decision making process? What did you see? Hear? Smell? 4. What information/data did you use when making your decision? 5. Were you reminded of a previous experience? Did this influence your thinking? 6. What were your specific goals? Priorities? 7. What other courses of action did you consider? 8. Did you follow a known rule, policy, procedure, algorithm? 9. If your decision was not the best, what training, knowledge, or information could have helped? 10. How much was time pressure a factor in your decisions/ actions? (Guided debriefing questions adapted from Jeffries1)
6. Evaluation Following the IPE debriefing, all students were invited to complete a series of nine questions regarding their experiences. Data were collected over 4 years with a total of 79 of the 123 invited participants from the Nursing and Physical Therapy programs completing the reflections (response rate 64%). This project was approved by the Institutional Review Board. The data gathered from the participants reflections were analyzed using an adapted version of Colaizzi's seven step method.2 Three researchers were involved with data analysis: 2 were direct instructors of the IPE, high fidelity simulation experience (RP, JM) and 1 researcher had expertise in qualitative data analysis (MK). Each of the three researchers involved in the IPE individually read the participants responses. Written reflections were read and reread to obtain a general sense of the compiled responses. For each written reflection, faculty members extracted significant statements that pertain to the IPE. Meanings were formulated from these significant statements. The formulated meanings were sorted into categories and clustered into themes by the individual researchers. The findings of the evaluation were integrated into an exhaustive description of the IPE. Members of the research team them came together to discuss what themes they had each identified. Finally, validation of the themes was based on consensus of the researchers. Rigor was addressed throughout data analysis by assessing the credibility, transferability, dependability, confirmability and authenticity as previously described by Guba and Lincoln.3 Four themes emerged from data analysis: (1) HFS provides a realistic, lifelike learning experience; (2) HFS is valuable learning tool; (3) HFS stimulates and supports collaboration and teamwork, and (4) HFS helps engender reflection on action. 7. Impact The impact of the IPE using HFS is illustrated through the following themes and exemplar statements. 7.1. Theme one: realistic, life-like learning experience Both DPT and nursing students indicated that the IPE HFS lab was realistic and provided them with drawn-from-life scenarios requiring them to interpret a patient's healthcare status. Students expressed that the HFS experience was much better than a learning
J.A. Mai et al. / Journal of Interprofessional Education & Practice 10 (2018) 37e40
activity using a real human beingdoften a studentdplaying the role of patient. Being able to react in real-time to an actual change in patient status can better prepare healthcare professionals for real-life practice. The students comments speak to critical thinking skills as they have to react in “real-time.” “Awesome, allows you to react to an “actual” event. Better preparation for a real scenario, actually makes your heart jump.” “Being able to witness the sign and symptoms and to be able to react in real time…” “Seeing how quickly a status can change…” “Life like since you can make it talk and manipulate it.” “Being placed in a situation that necessitated critical thinking and a quick clinical decision.”
39
“A good way to simulate the overall team care approach to a patient.” “I thought it was a great way to collaborate with the nursing students since we do it on a regular basis in the real world.”
7.4. Theme four: reflection on action As future healthcare professionals, nursing and DPT students are continually asked to reflect on their clinical interactions with patients and colleagues. Simulation experiences support the reflection process, as students think critically about the actions they took during scenarios. Follow-up debriefing sessions, when students watch themselves in action during a particular scenario, allow deeper insights to emerge and appreciation for clinical decision making to develop. In reflecting what students would have changed about their performance, they identified several areas.
7.2. Theme two: valuable learning tool
“Be more confident and go with my inner gut.”
Students characterized the high-fidelity simulator as a very beneficial and effective learning tool. The IPE allowed students the opportunity to respond to life-like situations in a less stressful environment. These comments also speak to critical thinking.
“I would do more delegation and work on communication.” “I would have loved to be more involved and take ‘charge’. It was hard to do that when three other students are trying to treat the same patient at the same time.
“It was a great tool, very helpful in seeing abnormal rhythms and patterns.”
“I thought it went well, made all the groups struggle a bit, that's how you learn.”
“Good experience, I was able to respond without pressure of the patient.” “Nice to be put in a real situation rather just learning about them in a textbook.” “It was good to see the technology available to help advance the education of healthcare professionals.” “A less stressful way to practice stressful situations.” “It was helpful, it made me more cognizant of vital monitoring.”
7.5. Suggestions and concerns from students Although not expressive of an identifiable theme in the data, the following comments from students are worth noting, as they may impact how future IPE simulation experiences are conducted. “I did not think that it was that different for us than having a classmate pretend.” “Less people in scenario.”
While the large majority of students regarded the stress-free environment created by HFS as beneficial, a few were somewhat wary of damaging the equipment. “I like it, but it makes me a little nervous knowing how expensive it is.”
7.3. Theme three: collaboration and teamwork Collaboration and teamwork were main themes identified by students in their reflection after the simulation experience. Both nursing and DPT students saw the value in working together as teamda circumstance that occurs regularly in the workplace. Students also were able to gain valuable knowledge of each discipline's role in the delivery of health care. Students note collaboration as beneficial, but students had no prior formal interactions, so in order to collaborate they had to communicate. “I think it is good for the interprofessional collaboration. There is something to be said about not only practicing patient care but practicing how to interact with other professionals.” “It does a nice job of allowing each field to see our role and where it starts and ends.”
“More communication of expectations prior to experience.” “Not completely realistic, PT is all about movement and couldn't really assess that, good experience of dealing with complex medical situations and how to react” “One simman and 30 students, difficult to teach” “Have more cords and lines that would make it more realistic of an ICU patient” The evaluation findings are consistent with conclusions of research studies using HFS.4e8 Most students viewed the experience as positive and had little exposure to patients with complex cardiac and pulmonary issues prior to this experience. HFS makes a positive impact on early learning experiences because of the low stakes inherent in any instructional simulation, which allows for student-centered learning in a realistic yet nonthreatening context. In this experience, HFS provided an optimal experience for students to learn how to manage lines and understand alarms related to physiological changes, communicate with another discipline using SBAR, and react to a change in medical status, which challenged students' clinical decision-making skills. Furthermore, other research studies support the use of guided debriefing as an essential component to the simulation experience.1,9,10
40
J.A. Mai et al. / Journal of Interprofessional Education & Practice 10 (2018) 37e40
The evaluation findings also align with the conclusions of other researchers with regard to interprofessional practice. Participants in multiple studies have viewed interprofessional collaboration activities as positive.11e13 Collaboration and teamwork emerged as themes in several studies. Participants identified that they understood the roles of other healthcare professionals following the IPE.11,13,14 This IPE is unique in that it was completed in a mock critical care setting using HFS which differs from previous studies which have used interprofessional collaboration methods such as case-based seminars,15 team meetings,16 role play,17 and interprofessional courses or workshops.11,13,18 The current experience also promotes the interaction of nurses with physical therapists which occurs daily in a hospital. This experience is innovative in that nursing students collaborated with DPT in using HFS in the management of critically ill patients. Following the IPE simulation, students consistently reported the desire for more time collaborating and working in smaller groups for future experiences. Small groups may conduce to additional hands-on time, but instructors may be challenged to create equally meaningful learning experiences for students who are not participating in the HFS scenario. The institution in which this IPE was conducted owns only one HFS station with two mannequins that can be used at the station. Barriers experienced by instructors participating in this IPE included time, resources, access to the lab (it is used by multiple departments), and the limited number of faculty who have been trained in running the simulation and effectively guiding debriefing. Interprofessional health care teams maintain the health of patients in a variety of settings, drawing on collaboration and teamwork to ensure the best outcome for patients. Sharing knowledge across disciplines helps to enhance patient-centered care. HFS offers opportunities to practice working as part of a health care team caring for patients in a realistic setting. The interprofessional component helps to foster collaboration and critical thinking in a critical care environment. The authors encourage other health care education programs with high-fidelity simulators to consider implementing interprofessional learning experiences using this technology. 8. Required materials In order to implement this curricular experience, a program would need access to a high fidelity simulation mannequin with appropriate clothing for the scenario. Programs could customize other necessary medical equipment based on their individual scenarios. The scenarios described in this report used a chest tube, IV, stethoscopes, sphygmomanometer, gait belt, heart monitor, wheelchair, foley catheter, dressings, and medical identification band. For guided debriefing of the videotaped scenarios, software specific to the high fidelity simulator was required on a computer that could be displayed through a projector. Scenario development guides are available through the National League of Nursing19 and
other simulation textbooks.1,20
References 1. Jeffries P. Simulation in Nursing Education: From Conceptualization to Evaluation. second ed. New York: National League for Nursing; 2012. 2. Shosha GA. Employment of Colaizzi's strategy in descriptive phenomenology: a reflection of a researcher. Eur Sci J. 2012;8(27):31e43. 3. Guba EG, Lincoln YS. Competing paradigms in qualitative research. In: Denzin NK, Lincoln YS, eds. Handbook of Qualitative Research. Thousand Oaks, CA: Sage; 1994. 4. Ohtake PJ, Lazarus M, Schillo R, Rosen M. Simulation experience enhances physical therapist student confidence in managing a patient in the critical care environment. Phys Ther. 2013;93(2):216e228. https://doi.org/10.2522/ ptj.20110463. 5. Silberman NJ, Litwin B, Panzarella KJ, Fernandez-Fernandez A. High fidelity simulation improves physical therapist self-efficacy for acute care clinical practice. J Phys Ther Educ. 2016;30(1):14e24. 6. Bednarek M, Downey P, Williamson A, Ennulat C. The use of human simulation to teach acute care skills in a cardiopulmonary course: a case report. J Phys Ther Educ. 2014;28(3):27e34. 7. Shoemaker MJ, Riemersma L, Perkins R. Use of high fidelity human simulation to teach physical therapist decision-making skills for the intensive cares setting. Cardiopulm Phys Ther J. 2009;20(1):13e18. 8. Smith N, Prybylo S, Connie-Kerr T. Using simulation and patient role play to teach electrocardiographic rhythms to physical therapy students. Cardiopulm Phys Ther J. 2012;23(1):36e42. 9. Sabus C, Macauley K. Simulation in physical therapy education and practice: opportunities and evidence-based instruction to achieve meaningful learning outcomes. J Phys Ther Educ. 2016;30(1):3e13. 10. Lavoie P, Pepin J, Cossette S. Development of a post-simulation debriefing intervention to prepare nurses and nursing students to care for deteriorating patients. Nurse Educ Pract. 2015;15(5):181e191. https://doi.org/10.1016/ j.nepr.2015.01.006. 11. Mellor R, Cottrell N, Moran M. “Just working in a team was a great experience…” e student perspectives on the learning experiences of an interprofessional education program. J Interprof Care. 2013;27:292e297. https:// doi.org/10.3109/13561820.2013.769093. 12. Reeves S, Freeth D, McCrorie P, Perry D. ‘It teaches you what to expect in future…’: interprofessional learning on a training ward for medical, nursing, occupational therapy and physiotherapy students. Med Educ. 2002;36: 337e344. https://doi.org/10.1046/j.1365-2923.2002.01169.x. 13. Robben S, Perry M, van Nieuwenhuijzen L, et al. Impact of interprofessional education on collaboration attitudes, skills, and behavior among primary care professionals. J Contin Educ Health Prof. 2012;32(3):196e204. https://doi.org/ 10.1002/chp.21145. 14. Moyers PA, Metzler CA. Interprofessional collaborative practice in care coordination. Am J Occup Ther. 2014;68(5):500e505. https://doi.org/10.5014/ ajot.2014.685002. 15. Goldberg LR, Koontz JS. Interprofessional case-based problem-solving: learning from the CLARION experience. Perspect Issues High Educ. 2014;17:47e55. https://doi.org/10.1044/aihe17.2.47. 16. New SN, Huff DC, Hutchison LC, et al. Integrating collaborative interprofessional simulation into pre-licensure health care programs. Nurs Educ Perspect. 2015;36(6):396e397. 17. Selle KM, Salamon K, Boarman R, Sauer J. Providing interprofessional learning through interdisciplinary collaboration: the role of “modelling”. J Interprof Care. 2008;22:85e92. https://doi.org/10.1080/13561820701714755. 18. Lachmann H, Ponzer S, Johansson UB, Benson L, Karlgren K. Capturing students' learning experiences and academic emotions at an interprofessional training ward. J Interprof Care. 2013;27:137e145. https://doi.org/10.3109/ 13561820.2012.724124. 19. National League of Nursing Simulation Innovation Resource Center. Available at: http://sirc.nln.org. Accessed February 28, 2017. 20. Ulrich B, Mancini B. Mastering Simulation: A Handbook for Success. Indianapolis, IN: Sigma Theta Tau; 2014.
Contents lists available at ScienceDirect
Journal of Interprofessional Education & Practice journal homepage: http://www.jieponline.com
Short Communication
Fostering interprofessional collaboration and critical thinking between nursing and physical therapy students using high-fidelity simulation Jennifer A. Mai a, *, Renee L. Pilcher b, Molly Frommelt-Kuhle b a b
Clarke University, Physical Therapy Department, 1550 Clarke Drive, Dubuque, IA 52001, USA Clarke University, Nursing Department, 1550 Clarke Drive, Dubuque, IA 52001, USA
a r t i c l e i n f o
a b s t r a c t
Article history: Received 4 January 2017 Received in revised form 28 February 2017 Accepted 8 November 2017
This curricular resource describes a method of interprofessional collaboration between nursing and physical therapy students. The purpose is to describe an experience using high fidelity simulation (HFS) to foster interprofessional collaboration and critical thinking in a mock critical care setting. Nursing and physical therapy students are introduced to HFS prior to interprofessional collaboration. A total of 79 students over 4 academic years evaluated the experience. Retrospective qualitative analysis from student reflections revealed the following themes: realistic, life-like learning experience; valuable learning tool; collaboration and teamwork; and reflection on action. HFS is a valuable tool to incorporate into curriculum to assess learning outcomes that are expected of health care professionals. Interprofessional collaboration could lead to stronger patient-centered care given the sharing of knowledge that occurs across disciplines. © 2017 Elsevier Inc. All rights reserved.
1. Format
3. Objectives
Physical therapy and nursing students engaged in an interprofessional high fidelity simulation (HFS) scenario focusing on critical care in groups of 6e8 individuals with additional students observing. Students were expected to focus on interprofessional communication and responding appropriately to changes in patient status.
The broad objective was to foster interprofessional collaboration and critical thinking in a mock critical care setting. Specifically, students were expected to apply SBAR (Situation, Background, Assessment, and Recommendations) communication technique within interprofessional teams. Students were responsible for the assessment of and response to change in patient status using HFS. Following the scenario, students complete peer and selfassessments of performance followed by guided debriefing from the instructors.
2. Target audience Undergraduate nursing students and graduate level physical therapy (DPT) students formed interprofessional teams. At least two nursing students and three to five DPT students participated in each scenario. Two faculty members representing Nursing and Physical Therapy educational programs were responsible for the development and oversight of the simulation activity.
* Corresponding author. 1550 Clarke Drive, MS 1712, Dubuque, IA 52001, USA. E-mail addresses: [email protected] (J.A. Mai), [email protected] (R.L. Pilcher), [email protected] (M. Frommelt-Kuhle). https://doi.org/10.1016/j.xjep.2017.11.002 2405-4526/© 2017 Elsevier Inc. All rights reserved.
4. Activity description Prior to the interprofessional experience (IPE), students are exposed to HFS through their respective programs. Students are presented with basic shells of 2 cases developed by the instructors to prepare for the experience. Diagnoses for the cases are coronary artery bypass graft or thoracotomy in an intensive care unit setting. In both scenarios, the “patient” has a foley catheter, chest tube, multiple intravenous lines, and dressings. Nursing students review the medical diagnosis, lab values, medications, and SBAR (situation, background, assessment, recommendation) communication
38
J.A. Mai et al. / Journal of Interprofessional Education & Practice 10 (2018) 37e40
technique prior to the IPE. DPT students review the brief case scenario and names of the medications, but do not receive lab values until the start of the lab, as they are expected to determine if lab values would indicate alteration of the physical therapy session. Each scenario has a 20-min time limit. One nursing student or instructor plays the role of the patient voice from the control room. The instructors provide cues to the person regarding appropriate responses for the patient. The IPE lab begins with 2 nursing students completing a brief nursing assessment of the patient. The nursing students then provide report to the DPT students using the SBAR technique. The DPT students work in groups of 3e5 to evaluate the patient. In each case, the patient scenario evolves “on the fly” to adapt to the students responses. The DPT students are expected to recognize and manage problems like cerebrovascular accident, myocardial infarction, low glucose levels, or dealing with patients who have difficult psychosocial concerns or family dynamics. At the end of the scenario, DPT students are expected to report back to the nursing students using the SBAR technique. Each student participates in only one case using the HFS and then acts as an observer for a second case. Up to 8 people are actively engaged in the scenario with up to 8 additional students observing during the simulation. The instructors run a total of 6 scenarios in the same day, which allows approximately 40e50 students to complete the IPE. Students participate in multilayer reflection as part of the debriefing process as described in the assessment section. 5. Assessment During the scenarios, students are assigned a specific student to observe and provide feedback using the guiding peer assessment questions. Students complete the peer assessment in “real time” as the scenario is running. Following completion of the scenarios, students complete the self-assessment tool. Prior to the faculty led debriefing, the instructors review the peer and self-assessments for consistency and identify any points that may have been observed by the instructors that were not captured by the student assessments. Two videotaped HFS scenarios (one of each diagnosis) are reviewed in a large-group class session. The debriefing process allows all of the students to watch the video and provide feedback regarding whether or not objectives have met. The instructor provides additional guidance, clarification, and/or instruction to ensure that the objectives have been met. Peer assessment questions included: 1. What did the student do well during the scenario? 2. What needs a little more work? 3. General feedback for the group Self-assessment questions included: Case Scenario (Diagnosis) 1. What were your primary concerns in this scenario? 2. Did you miss anything in getting report on this patient? 3. Did you have sufficient knowledge/skills to manage this situation? 4. What did you do well in this scenario? 5. If you were able to do this again, what would you do differently? For the DPT students, the following questions were also added to the self-assessment regarding management of the patient: 6. What are your goals for this patient? 7. Frequency/duration for patient Other questions that the instructor may use during the guided
debriefing included: 1. If you could do something differently, what would that be? 2. Did you feel you needed more information? What information would that be and how would you obtain it? 3. What guided your decision making process? What did you see? Hear? Smell? 4. What information/data did you use when making your decision? 5. Were you reminded of a previous experience? Did this influence your thinking? 6. What were your specific goals? Priorities? 7. What other courses of action did you consider? 8. Did you follow a known rule, policy, procedure, algorithm? 9. If your decision was not the best, what training, knowledge, or information could have helped? 10. How much was time pressure a factor in your decisions/ actions? (Guided debriefing questions adapted from Jeffries1)
6. Evaluation Following the IPE debriefing, all students were invited to complete a series of nine questions regarding their experiences. Data were collected over 4 years with a total of 79 of the 123 invited participants from the Nursing and Physical Therapy programs completing the reflections (response rate 64%). This project was approved by the Institutional Review Board. The data gathered from the participants reflections were analyzed using an adapted version of Colaizzi's seven step method.2 Three researchers were involved with data analysis: 2 were direct instructors of the IPE, high fidelity simulation experience (RP, JM) and 1 researcher had expertise in qualitative data analysis (MK). Each of the three researchers involved in the IPE individually read the participants responses. Written reflections were read and reread to obtain a general sense of the compiled responses. For each written reflection, faculty members extracted significant statements that pertain to the IPE. Meanings were formulated from these significant statements. The formulated meanings were sorted into categories and clustered into themes by the individual researchers. The findings of the evaluation were integrated into an exhaustive description of the IPE. Members of the research team them came together to discuss what themes they had each identified. Finally, validation of the themes was based on consensus of the researchers. Rigor was addressed throughout data analysis by assessing the credibility, transferability, dependability, confirmability and authenticity as previously described by Guba and Lincoln.3 Four themes emerged from data analysis: (1) HFS provides a realistic, lifelike learning experience; (2) HFS is valuable learning tool; (3) HFS stimulates and supports collaboration and teamwork, and (4) HFS helps engender reflection on action. 7. Impact The impact of the IPE using HFS is illustrated through the following themes and exemplar statements. 7.1. Theme one: realistic, life-like learning experience Both DPT and nursing students indicated that the IPE HFS lab was realistic and provided them with drawn-from-life scenarios requiring them to interpret a patient's healthcare status. Students expressed that the HFS experience was much better than a learning
J.A. Mai et al. / Journal of Interprofessional Education & Practice 10 (2018) 37e40
activity using a real human beingdoften a studentdplaying the role of patient. Being able to react in real-time to an actual change in patient status can better prepare healthcare professionals for real-life practice. The students comments speak to critical thinking skills as they have to react in “real-time.” “Awesome, allows you to react to an “actual” event. Better preparation for a real scenario, actually makes your heart jump.” “Being able to witness the sign and symptoms and to be able to react in real time…” “Seeing how quickly a status can change…” “Life like since you can make it talk and manipulate it.” “Being placed in a situation that necessitated critical thinking and a quick clinical decision.”
39
“A good way to simulate the overall team care approach to a patient.” “I thought it was a great way to collaborate with the nursing students since we do it on a regular basis in the real world.”
7.4. Theme four: reflection on action As future healthcare professionals, nursing and DPT students are continually asked to reflect on their clinical interactions with patients and colleagues. Simulation experiences support the reflection process, as students think critically about the actions they took during scenarios. Follow-up debriefing sessions, when students watch themselves in action during a particular scenario, allow deeper insights to emerge and appreciation for clinical decision making to develop. In reflecting what students would have changed about their performance, they identified several areas.
7.2. Theme two: valuable learning tool
“Be more confident and go with my inner gut.”
Students characterized the high-fidelity simulator as a very beneficial and effective learning tool. The IPE allowed students the opportunity to respond to life-like situations in a less stressful environment. These comments also speak to critical thinking.
“I would do more delegation and work on communication.” “I would have loved to be more involved and take ‘charge’. It was hard to do that when three other students are trying to treat the same patient at the same time.
“It was a great tool, very helpful in seeing abnormal rhythms and patterns.”
“I thought it went well, made all the groups struggle a bit, that's how you learn.”
“Good experience, I was able to respond without pressure of the patient.” “Nice to be put in a real situation rather just learning about them in a textbook.” “It was good to see the technology available to help advance the education of healthcare professionals.” “A less stressful way to practice stressful situations.” “It was helpful, it made me more cognizant of vital monitoring.”
7.5. Suggestions and concerns from students Although not expressive of an identifiable theme in the data, the following comments from students are worth noting, as they may impact how future IPE simulation experiences are conducted. “I did not think that it was that different for us than having a classmate pretend.” “Less people in scenario.”
While the large majority of students regarded the stress-free environment created by HFS as beneficial, a few were somewhat wary of damaging the equipment. “I like it, but it makes me a little nervous knowing how expensive it is.”
7.3. Theme three: collaboration and teamwork Collaboration and teamwork were main themes identified by students in their reflection after the simulation experience. Both nursing and DPT students saw the value in working together as teamda circumstance that occurs regularly in the workplace. Students also were able to gain valuable knowledge of each discipline's role in the delivery of health care. Students note collaboration as beneficial, but students had no prior formal interactions, so in order to collaborate they had to communicate. “I think it is good for the interprofessional collaboration. There is something to be said about not only practicing patient care but practicing how to interact with other professionals.” “It does a nice job of allowing each field to see our role and where it starts and ends.”
“More communication of expectations prior to experience.” “Not completely realistic, PT is all about movement and couldn't really assess that, good experience of dealing with complex medical situations and how to react” “One simman and 30 students, difficult to teach” “Have more cords and lines that would make it more realistic of an ICU patient” The evaluation findings are consistent with conclusions of research studies using HFS.4e8 Most students viewed the experience as positive and had little exposure to patients with complex cardiac and pulmonary issues prior to this experience. HFS makes a positive impact on early learning experiences because of the low stakes inherent in any instructional simulation, which allows for student-centered learning in a realistic yet nonthreatening context. In this experience, HFS provided an optimal experience for students to learn how to manage lines and understand alarms related to physiological changes, communicate with another discipline using SBAR, and react to a change in medical status, which challenged students' clinical decision-making skills. Furthermore, other research studies support the use of guided debriefing as an essential component to the simulation experience.1,9,10
40
J.A. Mai et al. / Journal of Interprofessional Education & Practice 10 (2018) 37e40
The evaluation findings also align with the conclusions of other researchers with regard to interprofessional practice. Participants in multiple studies have viewed interprofessional collaboration activities as positive.11e13 Collaboration and teamwork emerged as themes in several studies. Participants identified that they understood the roles of other healthcare professionals following the IPE.11,13,14 This IPE is unique in that it was completed in a mock critical care setting using HFS which differs from previous studies which have used interprofessional collaboration methods such as case-based seminars,15 team meetings,16 role play,17 and interprofessional courses or workshops.11,13,18 The current experience also promotes the interaction of nurses with physical therapists which occurs daily in a hospital. This experience is innovative in that nursing students collaborated with DPT in using HFS in the management of critically ill patients. Following the IPE simulation, students consistently reported the desire for more time collaborating and working in smaller groups for future experiences. Small groups may conduce to additional hands-on time, but instructors may be challenged to create equally meaningful learning experiences for students who are not participating in the HFS scenario. The institution in which this IPE was conducted owns only one HFS station with two mannequins that can be used at the station. Barriers experienced by instructors participating in this IPE included time, resources, access to the lab (it is used by multiple departments), and the limited number of faculty who have been trained in running the simulation and effectively guiding debriefing. Interprofessional health care teams maintain the health of patients in a variety of settings, drawing on collaboration and teamwork to ensure the best outcome for patients. Sharing knowledge across disciplines helps to enhance patient-centered care. HFS offers opportunities to practice working as part of a health care team caring for patients in a realistic setting. The interprofessional component helps to foster collaboration and critical thinking in a critical care environment. The authors encourage other health care education programs with high-fidelity simulators to consider implementing interprofessional learning experiences using this technology. 8. Required materials In order to implement this curricular experience, a program would need access to a high fidelity simulation mannequin with appropriate clothing for the scenario. Programs could customize other necessary medical equipment based on their individual scenarios. The scenarios described in this report used a chest tube, IV, stethoscopes, sphygmomanometer, gait belt, heart monitor, wheelchair, foley catheter, dressings, and medical identification band. For guided debriefing of the videotaped scenarios, software specific to the high fidelity simulator was required on a computer that could be displayed through a projector. Scenario development guides are available through the National League of Nursing19 and
other simulation textbooks.1,20
References 1. Jeffries P. Simulation in Nursing Education: From Conceptualization to Evaluation. second ed. New York: National League for Nursing; 2012. 2. Shosha GA. Employment of Colaizzi's strategy in descriptive phenomenology: a reflection of a researcher. Eur Sci J. 2012;8(27):31e43. 3. Guba EG, Lincoln YS. Competing paradigms in qualitative research. In: Denzin NK, Lincoln YS, eds. Handbook of Qualitative Research. Thousand Oaks, CA: Sage; 1994. 4. Ohtake PJ, Lazarus M, Schillo R, Rosen M. Simulation experience enhances physical therapist student confidence in managing a patient in the critical care environment. Phys Ther. 2013;93(2):216e228. https://doi.org/10.2522/ ptj.20110463. 5. Silberman NJ, Litwin B, Panzarella KJ, Fernandez-Fernandez A. High fidelity simulation improves physical therapist self-efficacy for acute care clinical practice. J Phys Ther Educ. 2016;30(1):14e24. 6. Bednarek M, Downey P, Williamson A, Ennulat C. The use of human simulation to teach acute care skills in a cardiopulmonary course: a case report. J Phys Ther Educ. 2014;28(3):27e34. 7. Shoemaker MJ, Riemersma L, Perkins R. Use of high fidelity human simulation to teach physical therapist decision-making skills for the intensive cares setting. Cardiopulm Phys Ther J. 2009;20(1):13e18. 8. Smith N, Prybylo S, Connie-Kerr T. Using simulation and patient role play to teach electrocardiographic rhythms to physical therapy students. Cardiopulm Phys Ther J. 2012;23(1):36e42. 9. Sabus C, Macauley K. Simulation in physical therapy education and practice: opportunities and evidence-based instruction to achieve meaningful learning outcomes. J Phys Ther Educ. 2016;30(1):3e13. 10. Lavoie P, Pepin J, Cossette S. Development of a post-simulation debriefing intervention to prepare nurses and nursing students to care for deteriorating patients. Nurse Educ Pract. 2015;15(5):181e191. https://doi.org/10.1016/ j.nepr.2015.01.006. 11. Mellor R, Cottrell N, Moran M. “Just working in a team was a great experience…” e student perspectives on the learning experiences of an interprofessional education program. J Interprof Care. 2013;27:292e297. https:// doi.org/10.3109/13561820.2013.769093. 12. Reeves S, Freeth D, McCrorie P, Perry D. ‘It teaches you what to expect in future…’: interprofessional learning on a training ward for medical, nursing, occupational therapy and physiotherapy students. Med Educ. 2002;36: 337e344. https://doi.org/10.1046/j.1365-2923.2002.01169.x. 13. Robben S, Perry M, van Nieuwenhuijzen L, et al. Impact of interprofessional education on collaboration attitudes, skills, and behavior among primary care professionals. J Contin Educ Health Prof. 2012;32(3):196e204. https://doi.org/ 10.1002/chp.21145. 14. Moyers PA, Metzler CA. Interprofessional collaborative practice in care coordination. Am J Occup Ther. 2014;68(5):500e505. https://doi.org/10.5014/ ajot.2014.685002. 15. Goldberg LR, Koontz JS. Interprofessional case-based problem-solving: learning from the CLARION experience. Perspect Issues High Educ. 2014;17:47e55. https://doi.org/10.1044/aihe17.2.47. 16. New SN, Huff DC, Hutchison LC, et al. Integrating collaborative interprofessional simulation into pre-licensure health care programs. Nurs Educ Perspect. 2015;36(6):396e397. 17. Selle KM, Salamon K, Boarman R, Sauer J. Providing interprofessional learning through interdisciplinary collaboration: the role of “modelling”. J Interprof Care. 2008;22:85e92. https://doi.org/10.1080/13561820701714755. 18. Lachmann H, Ponzer S, Johansson UB, Benson L, Karlgren K. Capturing students' learning experiences and academic emotions at an interprofessional training ward. J Interprof Care. 2013;27:137e145. https://doi.org/10.3109/ 13561820.2012.724124. 19. National League of Nursing Simulation Innovation Resource Center. Available at: http://sirc.nln.org. Accessed February 28, 2017. 20. Ulrich B, Mancini B. Mastering Simulation: A Handbook for Success. Indianapolis, IN: Sigma Theta Tau; 2014.