Student Evaluation of Interprofessional Education Simulation Becky Jensen, PhD, RN Deb Poling, PhD, RN, FNP-BC, CNE

Objectives Discuss methods for involving 3 different disciplines (nursing, dental hygiene, and radiography) in an Interprofessional patient care simulation Identify methodology for determining student satisfaction with the simulation and with collaborating with other disciplines in the simulation Explain application of Institute of Medicine’s recommendations for IPE, simulation in particular, in a health-related program

Our Study Healthcare requires multiple disciplines working together Opportunity to involve 3 different disciplines in a patient care simulation Dental Nursing Radiography Evaluated pre/post attitudes

Your Turn What healthcare disciplines can you imagine working together in IPE Sims? Please list these potential collaborators for use later in this presentation

Research Question What effects do simulation-based IPE have on students’ Confidence levels for patient care and Attitudes toward collaboration?

Terms Interprofessional Education - goal - to prepare all health professions students for deliberatively working together with the common goal of building a safer and better patient- centered and community/population oriented U.S. health care system (Interprofessional Education Collaborative, 2011) Human patient simulation – the use of computerized, high fidelity mannequins that respond to nursing actions Based on Jeffries Nursing Education Simulation FrameworkFramework In general, simulations begin with a stable patient. Patient begins to deteriorate with increasingly less subtle cues Students must act to identify and treat emergent situation

Review of Literature (ROL) Early IPE studies – simulation not used (Robertson & Bandali, 2008). Simulation – IPE positively affects student attitudes related to interprofessional behaviors in the practice settings (Tullmann, Shilling, Goeke, Wright & Littlewood, 2013)

ROL Systematic review of simulation in IPE (Gough, Hellaby, Jones & MacKinnon, 2012) Simulations varied in length of time, fidelity, and healthcare professions represented Most studies included Medical and nursing students Hospital settings

ROL 18 studies included Researchers’ purposes included: Evaluate innovative sims based IPE for increased understanding of roles support of collaboration enhanced team effectiveness in multidiscipline disaster

ROL Barriers cited in literature Getting groups together due to conflicts in schedules Distance Voluntary nature of projects

ROL Key findings Greater understanding of professions Overall positive results in many studies Short term results - no longitudinal exam of affect on practice

ROL Recommendations from systematic review Sim-IPE appropriate teaching strategy Need studies in varied settings More longitudinal studies

Your Turn Please get into groups of 4 – 5 persons and discuss the following: Review potential disciplines to include in IPE Sims Discuss barriers and facilitators that may affect development and use of IPE Sims in your institutions Share potential simulation situations that include all disciplines

The Scenario Manikins - Suzy® and HAL® (Gaumard) Dental Hygiene Clinic – placed in a dental chair Dental students began process with patient complaining of chest pain (2 active and 2 observers – switched roles when patient in xray lab) Called in nurses to evaluate (2 active and 2 observers – switched roles in xray lab) NP called to evaluate – orders for CXR, oxygen, nitro SL, admit to hospital

Scenario continues Client transferred to cart and taken to radiography lab for CXR (2 radiography students participate and 2 observe – switch roles after CXR) Client transferred between buildings to IPFW Hospital ED (nurses reported off to 2 new nurses in ED, who took over care) All participants except ED nurses reported to a debriefing room where they could observe care in the ED

Debriefing All students and faculty debriefed together about What went well How sim might have gone better Collaboration Teamwork Communication

Methods 1. Students gathered before sim Provided brief information about client Completed pre sim surveys Initial Attitudes Toward Collaboration Pre Confidence Scale 2. Scenario enacted 3. Debriefing 4. Completed post sim surveys Post Confidence Scale Attitude Toward Collaboration Simulation Day Evaluation Simulation Design Scale Revised (NLN)

Results Demographic Data Age – (7.1) range 19 – 60 Gender Female - 42 (91%) Ethnicity - Caucasian 42 (93%) Program Dental 18 (35%) Radiography 7 (15%) Nursing 23 (50%) Play video games – no 33 (72%)

Results Experience with high-fidelity manikin None817% 1 – 2 sims1430% 3 – 4 sims37% 5 or more2146%

Scale Results Pre Confidence Scale (α =.95) 16 items with responses from 1 (not at all confident) – 5 (very confident) Confidence related to care of clients with cardiac, respiratory, mental status, and fluid and electrolyte changes Recognize signs and symptoms Accurate assessment Appropriate interventions Evaluate effectiveness of interventions Average total score (9.7)

Scale Results Post Confidence Scale (α =.90) Same 16 items with same responses Average total scale (2.2) Post scale scores for nursing statistically higher than pre scale scores compared to both dental and radiography

Scale Results Initial Attitudes Toward Collaboration (α =.83) 4 item scale with responses from 1 (strongly disagree) to 5 (strongly agree) Average total score (5.8) Average item score 4.40 Attitude Toward Collaborative Learning Scale (α =.96) 12 item scale with same response categories Average total score (5.8) Average item score 4.59

Scale Results Pre to post attitude toward collaboration Average item score did increase slightly but not significantly Perhaps ceiling effect b/c average score before sim was high – 4.4 out of 5 13 participants chose 5 for all items pre sim 19 participants chose 5 for all items post sim A Repeated Measures ANOVA determined there were no significant differences in… pre/post measures across disciplines interaction of time and discipline

Scale Results Simulation Day Evaluation (α =.95) 9 item scale with responses from 1 (strongly disagree) to 5 (strongly agree) Average total score (4.7) Average item score 4.46

Scale Results Simulation Design Scale (Revised – NLN) (α =.94) 17 item scale with responses from 1 (strongly disagree) to 5 (strongly agree) Average total score Average item score subscales Objectives and information – avg item score 3.62 Support – avg item score 4.07 Problem solving – avg item score 4.11 Feedback/guided reflection – avg item score 4.50 Fidelity – avg item score 4.23

Conclusions – Your Turn We would like your ideas: What conclusions can we draw from the results?

Your Turn What thoughts/ideas will you take back to your institutions? Any lingering questions?