Simulated Learning Experience in Advance Care Planning Conversations

Prevention of Acute Hospital Transfers for Long-Term Care Residents at the End of Life

BackgroundLong-term care (LTC) residents continue to be acutely transported to the hospital at the end of life (EOL). This frail and dependent population are known to have multiple chronic conditions with more acute and complex medical care needs, which places them at risk for frequent transfers to the hospital. When these multifactorial events transpire at the EOL, they are deemed inappropriate in terms of patient care and healthcare costs. Yet these costly, unnecessary and burdensome transitions still occur, regardless of adverse clinical outcomes and jeopardizing the quality of EOL care provided to LTC residents.ObjectiveTo highlight the burdensome impact acute hospital transfers have on LTC residents at the EOL with the detriment to quality of life and care, in addition to providing strategies to prevent these unnecessary events.FindingsLong-term care residents are a vulnerable population with advanced comorbidities who often require high acuity care and are subject to preventable transfers to the hospital at the EOL. These disruptions in EOL care cause harm and complications, negatively impacting quality of care. The consequences of these events can be mitigated with early advance care planning to include documentation of EOL care goals, onsite medical clinicians to make critical decisions and provide care within LTC facilities, and adequate staffing with proper palliative and hospice care training.ConclusionImmediate action is needed to advocate for this high risk population and implement interventions to prevent hospital transfers at the EOL, therefore improving quality of care and positively influencing LTC residents' EOL experience.

Development of the neurological simulation program e-learning version (Neuro Sim-e)

It is difficult to coordinate the working hours of busy clinical nurses and provide lectures, but e-learning can be used during their spare time. Therefore, this study aimed to share our experience in developing and implementing the neurology simulation program e-learning version (Neuro Sim-e). Needs analysis was conducted, and the Neuro Sim-e was developed. Four evaluation questionnaires: attention, relevance, confidence, and satisfaction (ARCS) etc., were examined. We developed the Neuro Sim-e, which consists of three scenarios. The subjects were 20 nurses. Regarding the "attention", "relevance", "reliability", and "satisfaction" of the Neuro Sim-e, 70.0%, 95.0%, 65.0%, and 90.0% of the respondents answered "rather agree" or higher, respectively. The Neuro Sim-e obtained positive feedback via ARCS evaluation and provided adequate results as an overall assessment. It is too early to conclude whether it is as effective as or better than a mannequin-based simulation, but this study provided learning materials that nurses could use in their spare time.

Objective and Subjective Stress Parameters in Response to High and Low-Fidelity Simulation Activities

Nursing graduates are required to have both excellent theoretical and practical skills that should be used during stressful emergency interventions. Since the received knowledge should be practiced to gain skills and trained to achieve competences, simulation exercises can be beneficial to even reduce the stress that each individual may face during emergency management of patients. A total of 146 first-year nursing students participated in the study, including 124 women and 22 men aged between 19 and 50 years, with a mean age of 32 years. The objective method estimated psychophysiological parameters (serum cortisol). Objective and subjective methods were used. The subjective method assessed stress experienced by students based on the standardized Stress Appraisal Questionnaire Version B for dispositional assessment. The study was conducted in the Monoprofile Medical Simulation Centre at the University of Economics and Innovation in Lublin, Poland and was approved by the University Research Ethics Committee. Both participants under and over 25 years of age showed increased levels of stress after low and high-fidelity simulations, with statistically significantly higher stress levels found for the low fidelity method. Low-fidelity simulation methods generated a greater increase in cortisol levels, indicating a higher stress level than the high-fidelity methods. The analysis of the scores obtained in the Stress Appraisal Questionnaire (KOS-B) showed that higher cortisol levels after the low-fidelity simulation reduced the subjective perception of a threat, while higher cortisol levels before the high-fidelity simulation promoted higher intellectual activity among the students. Levels of stress in the education of nursing students using low and high-fidelity methods can limit the sense of threat and activate professional task performance. The use of low and high-fidelity simulation does not generate destructive stress levels.