Interdisciplinary Simulation-Based Training to Improve Delivery Room Communication

Structured pre-delivery huddles enhance confidence in managing newborns with critical congenital heart disease in the delivery room

BACKGROUND

Newborns with critical congenital heart disease (CCHD) require specialized delivery room management, but varying experience and knowledge can reduce confidence and impact care.

METHODS

A pre-delivery, structured huddle checklist was introduced, addressing team roles, expected physiology, and management plans. PDSA cycles incorporated guidelines and simulation-based education to improve confidence in specialized resuscitation strategies. Surveys were conducted at baseline and 6 months.

RESULTS

Baseline, all-respondent confidence in managing "all types of CCHD" was somewhat confident (median 3/5; IQR 2-4) increasing to moderately confident (4/5; IQR 2-4) at 6 months (p = 0.59). Respondents with 0-3 years' experience showed increased confidence over 6 months in identifying unstable infants (from baseline 24% to 67% moderately/very confident, p = 0.005), prostaglandin E1 needs (from 24% to 62%, p = 0.013) and sedation requirements (from 5% to 33%, p = 0.045).

CONCLUSION

Structured huddles improved confidence among less experienced team members, emphasizing the importance of shared mental models before CCHD deliveries.

Interdisciplinary simulation-based teaching and learning for healthcare professionals: A systematic review and meta-analysis of randomized controlled trials

AIM

This study aimed to investigate the effects of interdisciplinary simulation-based teaching and learning on the interprofessional knowledge of healthcare professionals.

BACKGROUND

Interdisciplinary simulation-based teaching and learning have been employed to prepare learners to collaborate in clinical settings. This strategy could help healthcare professionals to better understand each other, develop interdisciplinary shared values and promote mutual respect between professions, while reducing errors and adverse events in hospital. A meta-analysis was performed to investigate the effects of interdisciplinary simulation-based teaching and learning on healthcare professionals.

DESIGN

A systematic review and meta-analysis.

METHODS

A systematic search was conducted of databases including Academic Search Complete, CINAHL Plus with full text, Cochrane Library, Embase, Medline Complete, PubMed and Web of Science from their inception to September 5, 2023. The study included randomized controlled trials that provided interdisciplinary simulation-based education to healthcare professionals. Protocol trials or studies that did not include median or mean and standard deviation were excluded. The pooled standardized mean differences of outcomes were analyzed using a DerSimonian-Laird random-effects model. Heterogeneity was assessed using I2. Egger's regression test was used to examine publication bias indicated in forest plots.

RESULTS

Ten randomized control trials with a total of 766 participants were included in the pooled analyses. Interdisciplinary simulation-based teaching and learning positively enhanced the interprofessional knowledge of healthcare professionals (pooled SMD = 0.30; 95% CI = 0.10-0.50; p < 0.001). Egger's regression test results were non-significant, indicating that publication bias had little impact on the pooled SMDs.

CONCLUSION

Interdisciplinary simulation-based teaching and learning for health professionals appear to be significantly beneficial for increasing their interprofessional knowledge. This strategy highlights the importance of providing a well-developed scenario with relevant properties, which applies valid and rigorous instruments, to measure behavioral changes induced by interdisciplinary simulation-based teaching and learning.

Simulation for communication training in neonatology

Communication skills training is a core competency for neonatal-perinatal medicine (NPM) fellows, yet many neonatology fellowship programs do not have formal communication skills curricula. Since the late 1990s, experiential learning that includes role-play and simulation has become the standard for communication training. NPM fellows who receive simulation-based communication skills training report greater comfort with difficult conversations in the NICU. Most communication skills studies in neonatology focus on antenatal counseling, with some studies regarding family meetings and end of life conversations. Published examples for simulation-based communication skills curricula exist, with ideas for adapting them to meet the needs of local resources.

Competency-based assessment in neonatal simulation-based training

Simulation is a cornerstone of training in neonatal clinical care, allowing learners to practice skills in a safe and controlled environment. Competency-based assessment provides a systematic approach to evaluating technical and behavioral skills observed in the simulation environment to ensure the learner is prepared to safely perform the skill in a clinical setting. Accurate assessment of competency requires the creation of tools with evidence of validity and reliability. There has been considerable work on the use of competency-based assessment in the field of neonatology. In this chapter, we review neonatal simulation-based training, examine competency-based assessment tools, explore methods to gather evidence of the validity and reliability, and review an evidence-based approach to competency-based assessment using simulation.

Identification of Clinician Training Techniques as an Implementation Strategy to Improve Maternal Health: A Scoping Review

Training is a key implementation strategy used in healthcare settings. This study aimed to identify a range of clinician training techniques that facilitate guideline implementation, promote clinician behavior change, optimize clinical outcomes, and address implicit biases to promote high-quality maternal and child health (MCH) care. A scoping review was conducted within PubMed, CINAHL, PsycInfo, and Cochrane databases using iterative searches related to (provider OR clinician) AND (education OR training). A total of 152 articles met the inclusion/exclusion criteria. The training involved multiple clinician types (e.g., physicians, nurses) and was predominantly implemented in hospitals (63%). Topics focused on maternal/fetal morbidity/mortality (26%), teamwork and communication (14%), and screening, assessment, and testing (12%). Common techniques included didactic (65%), simulation (39%), hands-on (e.g., scenario, role play) (28%), and discussion (27%). Under half (42%) of the reported training was based on guidelines or evidence-based practices. A minority of articles reported evaluating change in clinician knowledge (39%), confidence (37%), or clinical outcomes (31%). A secondary review identified 22 articles related to implicit bias training, which used other reflective approaches (e.g., implicit bias tests, role play, and patient observations). Although many training techniques were identified, future research is needed to ascertain the most effective training techniques, ultimately improving patient-centered care and outcomes.

A Literature Study of Medical Simulations for Non-Technical Skills Training in Emergency Medicine: Twenty Years of Progress, an Integrated Research Framework, and Future Research Avenues

Medical simulations have led to extensive developments in emergency medicine. Apart from the growing number of applications and research efforts in patient safety, few studies have focused on modalities, research methods, and professions via a synthesis of simulation studies with a focus on non-technical skills training. Intersections between medical simulation, non-technical skills training, and emergency medicine merit a synthesis of progress over the first two decades of the 21st century. Drawing on research from the Web of Science Core Collection's Science Citation Index Expanded and Social Science Citation Index editions, results showed that medical simulations were found to be effective, practical, and highly motivating. More importantly, simulation-based education should be a teaching approach, and many simulations are utilised to substitute high-risk, rare, and complex circumstances in technical or situational simulations. (1) Publications were grouped by specific categories of non-technical skills, teamwork, communication, diagnosis, resuscitation, airway management, anaesthesia, simulation, and medical education. (2) Although mixed-method and quantitative approaches were prominent during the time period, further exploration of qualitative data would greatly contribute to the interpretation of experience. (3) High-fidelity dummy was the most suitable instrument, but the tendency of simulators without explicitly stating the vendor selection calls for a standardised training process. The literature study concludes with a ring model as the integrated framework of presently known best practices and a broad range of underexplored research areas to be investigated in detail.

Optimizing nurses' enacted scope of practice to its full potential as an integrated strategy for the continuous improvement of clinical performance: A multicentre descriptive analysis

AIM

This study aims at better understanding the relationships between nurses' enacted scope of practice, work environment and work satisfaction, missed care, and organizational indicators of performance.

BACKGROUND

The enacted scope of practice model describes the determinants and consequences of the actual enactment of the nursing scope of practice.

METHOD

A correlational design was used to investigate nurses' enacted scope of practice in five Canadian healthcare centres.

RESULTS

Suboptimal enacted scope of practice were found in the current sample. Significant positive correlations were found between the total enacted scope of practice score, use of qualification, control over tasks, decisional latitude and psychological demand as well as role ambiguity. Moreover, a higher enacted scope of practice was correlated with lower organizational indicators of short-term absenteeism.

CONCLUSION

Results suggest an insufficient deployment of nurses' enacted scope of practice, likely caused by some job characteristics, leading to lower work satisfaction and negative patients and organizational outcomes.

IMPLICATIONS FOR NURSING MANAGEMENT

Optimizing nurses' enacted scope of practice would be a significant integrated strategy for improving organizational performance, patient care and nurses' satisfaction and well-being. Nurses and frontline managers must be involved in the decision-making process necessary to improve nurses' enacted scope of practice.

Prevention of Failure to Rescue in Obstetric Patients: A Realist Review

BACKGROUND

At least 40% of maternal deaths are attributable to failure to rescue (FTR) events. Nurses are positioned to prevent FTR events, but there is minimal understanding of systems-level factors affecting obstetric nurses when patients require rescue.

AIMS

To identify the nurse-specific contexts, mechanisms, and outcomes underlying obstetric FTR and the interventions designed to prevent these events.

METHODS

A realist review was conducted to meet the aims. This review included literature from 1999 to 2020 to understand the systems-level factors affecting obstetric nurses during FTR events using a human factors framework designed by the Systems Engineering Initiative for Patient Safety.

RESULTS

Existing interventions addressed the prevention of maternal death through education of clinicians, improved protocols for care and maternal transfer, and an emphasis on communication and teamwork.

LINKING EVIDENCE TO ACTION

Few researchers addressed task overload or connected employee and organizational outcomes with patient outcomes, and the physical environment was minimally considered. Future research is needed to understand how systems-level factors affect nurses during FTR events.

Simulation-Based Neonatal Resuscitation Team Training: A Systematic Review

CONTEXT

Several neonatal simulation-training programs have been deployed during the last decade, and in a growing number of studies, researchers have investigated the effects of simulation-based team training. This body of evidence remains to be compiled.

OBJECTIVE

We performed a systematic review of the effects of simulation-based team training on clinical performance and patient outcome.

DATA SOURCES

Medline, Embase, Cumulative Index to Nursing and Allied Health Literature, and the Cochrane Library.

STUDY SELECTION

Two authors included studies of team training in critical neonatal situations with reported outcomes on clinical performance and patient outcome.

DATA EXTRACTION

Two authors extracted data using a predefined template and assessed risk of bias using the Cochrane risk-of-bias tool 2.0 and the Newcastle-Ottawa quality assessment scale.

RESULTS

We screened 1434 titles and abstracts, evaluated 173 full texts for eligibility, and included 24 studies. We identified only 2 studies with neonatal mortality outcomes, and no conclusion could be reached regarding the effects of simulation training in developed countries. Considering clinical performance, randomized studies revealed improved team performance in simulated re-evaluations 3 to 6 months after the intervention.

LIMITATIONS

Meta-analysis was impossible because of heterogenous interventions and outcomes. Kirkpatrick's model for evaluating training programs provided the framework for a narrative synthesis. Most included studies had significant methodologic limitations.

CONCLUSIONS

Simulation-based team training in neonatal resuscitation improves team performance and technical performance in simulation-based evaluations 3 to 6 months later. The current evidence was insufficient to conclude on neonatal mortality after simulation-based team training because no studies were available from developed countries. In future work, researchers should include patient outcomes or clinical proxies of treatment quality whenever possible.

Effectiveness of Communication Interventions in Obstetrics-A Systematic Review

(1) Background: Obstetric work requires good communication, which can be trained through interventions targeting healthcare providers and pregnant women/patients. This systematic review aims to aggregate the current state of research on communication interventions in obstetrics. (2) Methods: Using the PICOS scheme, we searched for studies published in peer-reviewed journals in English or German between 2000 and 2020. Out of 7018 results, 71 studies were included and evaluated in this synthesis using the Oxford Level of Evidence Scale. (3) Results: The 63 studies that included a communication component revealed a positive effect on different proximal outcomes (i.e., communication skills). Three studies revealed a beneficial effect of communication trainings on distal performance indicators (i.e., patient safety), but only to a limited extent. Most studies simultaneously examined different groups, however, those addressing healthcare providers were more common than those with students (61 vs. 12). Only nine studies targeted expectant mothers. Overall, the evidence level of studies was low (only 11 RCTs), with 24 studies with an evidence level I-II, 35 with level III, and 10 with level IV. (4) Conclusions: Communication trainings should be more frequently applied to improve communication of staff, students, and pregnant women and their partners, thereby improving patient safety.

High-Fidelity simulation-based program improves flow state scale in the perinatal team

BACKGROUND

We aimed to evaluate the degree of realism and involvement, stress management and awareness of performance improvement in practitioners taking part in high fidelity simulation (HFS) training program for delivery room (DR) management, by means of a self-report test such as flow state scale (FSS).

METHODS

This is an observational pretest-test study. Between March 2016 and May 2019, fourty-three practitioners (physicians, midwives, nurses) grouped in multidisciplinary teams were admitted to our training High Fidelity Simulation center. In a time-period of 1 month, practitioners attended two HFS courses (model 1, 2) focusing on DR management and resuscitation maneuvers. FSS test was administred at the end of M1 and M2 course, respectively.

RESULTS

FSS scale items such as unambiguous feed-back, loss of self consciousness and loss of time reality, merging of action and awareness significantly improved (P < 0.05, for all) between M1 and M2.

CONCLUSIONS

The present results showing the high level of practitioner involvement during DR management-based HFS courses support the usefulness of HFS as a trustworthy tool for improving the awareness of practitioner performances and feed-back. The data open the way to the usefulness of FSS as a trustworthy tool for the evaluation of the efficacy of training programs in a multidisciplinary team.

Multi-professional simulation-based team training in obstetric emergencies for improving patient outcomes and trainees' performance

BACKGROUND

Simulation-based obstetric team training focuses on building a system that will anticipate errors, improve patient outcomes and the performance of clinical care teams. Simulation-based obstetric team training has been proposed as a tool to improve the overall outcome of obstetric health care.

OBJECTIVES

To assess the effects of simulation-based obstetric team training on patient outcomes, performance of obstetric care teams in practice and educational settings, and trainees' experience.

SEARCH METHODS

The Cochrane Pregnancy and Childbirth Group's Trials Register, ClinicalTrials.gov and the WHO International Clinical Trials Registry Platform (ICTRP) were searched (14 April 2020), together with references checking and hand searching the available proceedings of 2 international conferences.

SELECTION CRITERIA

We included randomised controlled trials (RCTs) (including cluster-randomised trials) comparing simulation-based obstetric team training with no, or other type of training.

DATA COLLECTION AND ANALYSIS

We used standard methodological procedures expected by Cochrane, to identify articles, assess methodological quality and extract data. Data from three cluster-randomised trials could be used to perform generic inverse variance meta-analyses. The meta-analyses were based on risk ratios (RRs) and mean differences (MDs) with 95% confidence intervals (CIs). We used the GRADE approach to rate the certainty of the evidence. We used Kirkpatrick's model of training evaluation to categorise the outcomes of interest; we chose Level 3 (behavioural change) and Level 4 (patient outcome) to categorise the primary outcomes.

MAIN RESULTS

We included eight RCTs, six of which were cluster-randomised trials, involving more than 1000 training participants and more than 200,000 pregnancies/births. Four studies reported on outcome measures on Kirkpatrick level 4 (patient outcome), three studies on Kirkpatrick level 3 (performance in practice), two studies on Kitkpatrick level 2 (performance in educational settings), and none on Kirkpatrick level 1 (trainees' experience). The included studies were from Mexico, the Netherlands, the UK and the USA, all middle- and high-income countries. Kirkpatrick level 4 (patient outcome) Simulation-based obstetric team training may make little or no difference for composite outcomes of maternal and/or perinatal adverse events compared with no training (3 studies; n = 28,731, low-certainty evidence, data not pooled due to different composite outcome definitions). We are uncertain whether simulation-based obstetric team training affects maternal mortality compared with no training (2 studies; 79,246 women; very low-certainty evidence). However, it may reduce neonatal mortality (RR 0.70, 95% CI 0.48 to 1.01; 2 studies, 79,246 pregnancies/births, low-certainty evidence). Simulation-based obstetric team training may have little to no effect on low Apgar score compared with no training (RR 0.99, 95% 0.85 to 1.15; 2 studies; 115,171 infants; low-certainty evidence), but it probably reduces trauma after shoulder dystocia (RR 0.50, 95% CI 0.25 to 0.99; 1 study; moderate-certainty evidence) and probably slightly reduces the number of caesarean deliveries (RR 0.79, 95% CI 0.67 to 0.93; 1 study; n = 50,589; moderate-certainty evidence) Kirkpatrick level 3 (performance in practice) We found that simulation-based obstetric team training probably improves the performance of the obstetric teams in practice, compared with no training (3 studies; 2398 obstetric staff members, moderate-certainty evidence, data not pooled due to different outcome definitions).

AUTHORS' CONCLUSIONS

Simulation-based obstetric team training may help to improve team performance of obstetric teams, and it might contribute to improvement of specific maternal and perinatal outcomes, compared with no training. However, high-certainty evidence is lacking due to serious risk of bias and imprecision, and the effect cannot be generalised for all outcomes. Future studies investigating simulation-based obstetric team training compared to training courses with a different instructional design should carefully consider how and when to measure outcomes. Particular attention should be paid to effect measurement at the level of patient outcome, taking into consideration the low incidence of adverse maternal and perinatal events.

How to agree on what is fundamental to optimal teamwork performance in a situation of postpartum hemorrhage? A multidisciplinary Delphi French study to develop the Obstetric Team Performance Assessment Scale (OTPA Scale)

INTRODUCTION

The objective of this study was to develop a new interdisciplinary teamwork scale, the Obstetric Team Performance Assessment (OTPA), for the management of the post-partum hemorrhage, through consensus agreement of obstetric caregivers. The goal is to provide a reliable tool for teaching and evaluating teams in high-fidelity simulation.

METHODS

This prospective study is based on an expert consensus, using a Delphi method. The authors developed the "OTPA» specifically related to the management of post-partum hemorrhage, using existing recommendations. For the Delphi survey, the scale was distributed to a selected group of experts. After each round of Delphi, authors quantitatively analyzed each element of the scale, based on the percentages of agreement received, and reviewed each comment. This blind examination then led to the modification of the scale. The rounds were continued until 80-100 % agreement with a median overall response score equal to or greater than 8 was obtained for at least 60 % of items. Repeated 3 times, the process led to consensus and to a final version of the OTPA scale.

RESULTS

From February to October 2018, 16 of the 33 invited experts participated in four Delphi cycles. Of the 37 items selected in the first round, only 19 (51.3 %) had an agreement of 80-100% with a median overall response score equal to or greater than 8 in the second round, and a third round was conducted. During this third round, 24 of the 37 items were validated (64.9 %) and 82 of the 88 sub-items obtained 80 %-100 % agreement (93.2 %). The fourth round consisted of proposing a weighting of the different items.

CONCLUSION

Using a structured Delphi method, we provided a new interdisciplinary teamwork scale (OTPA), for the management of the post-partum hemorrhage. Thus, this scale will be able to be used during high-fidelity scenarii to assess performances of various teams facing a scenari of PPH. Moreover, this scale, focusing some crucial aspects of interdisciplinary teamwork will be useful for teaching purpose.

Communication Matters: a Survey Study of Communication Didactics in Obstetrics/Gynecology Residency

BACKGROUND

Delivery of excellent patient care hinges on effective communication. Improved communication between physicians, patients, and colleagues can facilitate shared decision-making and foster successful interprofessional teams. Despite the importance of this skill, little is understood about the status or acceptability of dedicated communication training during obstetrics and gynecology (OB/GYN) residency.

OBJECTIVE

To explore the national landscape of dedicated communication didactics during OB/GYN training.

METHODS

Residents and program directors (PDs) at ACGME-accredited programs were emailed anonymized surveys. Survey responses pertaining to communication didactics and trainee experiences were evaluated using descriptive statistics and chi-squared tests.

RESULTS

Of 143 PDs, 45 responded (31.5%). Although the total number of residents receiving our survey is unattainable, our 215 resident respondents can be estimated to represent at least 4.4% of trainees. 98.1% of residents reported challenging clinical communication at least monthly, with many reporting this weekly (47.9%) and daily (30.0%). A majority of PDs (77.8%) and residents (67.0%) endorsed interest in communication training. 62.2% of programs reported formally teaching communication skills. Certain topics were infrequently taught yet cited by residents as particularly challenging-such as "diffusing conflict" and "angry patient or family members." PDs tended to significantly overestimate trainee competence in conducting difficult conversations with both patients (p = 0.0003) and interdisciplinary colleagues (p < 0.0001), as compared with resident self-assessments.

CONCLUSIONS

Residents encounter frequent challenging communications interactions, and often feel inadequately equipped to navigate them. Dedicated didactics may provide a critical component to optimally educating of the next generation of trainees within OB/GYN and more broadly.

Validation of a clinical simulation setting in the management of postpartum haemorrhage

OBJECTIVE

To construct and validate a clinical simulation setting for postpartum haemorrhage.

METHOD

Quantitative research of methodological development, carried out from May to July of 2016 with 22 expert judges and 30 students. Analysis was performed from descriptive statistics, Binomial Test and Content Validity Index (CVI), considering CVI ≥ 80%.

RESULTS

Setting construction was based on learning objectives, fidelity, evaluation tool, pre-setting activities and debriefing. Agreement, regarding its validity, was satisfactory in the 23 items analyzed. Items evaluated by judges had CVI> 0.90; in the evaluation by students, CVI was > 0.95.

CONCLUSION

It was considered validated and suitable for training and use by nursing students. Other studies should be carried out in order to test its effectiveness in the construction of theoretical and practical knowledge of both nursing students and nurses during Permanent Education.

Interdisciplinary handover between obstetric nursing and neonatal physician teams: an observational study

OBJECTIVE

We investigated the content and quality of communication of interservice interprofessional handover between obstetric nurses and neonatal physicians for high-risk deliveries.

DESIGN

Observational study.

SETTING

Labour and delivery unit at a tertiary care hospital.

METHOD

We audio-recorded handovers between obstetric and neonatal teams (n=50) and conducted clinician interviews (n=29). A handover content framework was developed and used to qualitatively code missing core and ancillary content and their potential for adverse events.

RESULTS

26 (52%) handovers missed one or more clinical content elements; a third of the handovers missed at least one core clinical content element. Increase in the number of missed clinical content elements increased the odds of potential adverse events by 2.39 (95% CI1.18 to 5.37). Both residents and nurses perceived handovers to be of low quality and inconsistent and attributed it to the lack of a structured handover process.

CONCLUSION

Streamlining handover processes by instituting standardisation approaches for both information organisation and communication can improve the quality of neonatal handovers.

[Medical simulation as a tool in the training of perinatal professionals]

Though technology plays an increasingly important role in modern health systems, human performance remains a major determinant of safety, effectiveness and efficiency of patient care. This is especially true in the delivery room. Thus, the training of professionals must aim not only for the acquisition of theory and practical skills on an individual basis, but also for the learning of teamwork systematically. Training health professionals with simulation enhances their theoretical knowledge and meets formal requirements in literacy, technical skills and communication. Therefore, we intend to explore how, in perinatal care, training with simulation is actually a key teaching tool in initial education and in perpetuation of knowledge. We will approach three main aspects: individual, collective (team) and the impact of simulation in medical practice. The choice of this educational strategy improves the clinical skills that are required for optimal performance in complex, unpredictable and high-stake environments such as the delivery room. Nonetheless, the long term clinical impact of simulation and whether it's modalities, technical or not, are beneficial to the mother and the newborn are areas still to be explored.

Family Presence During Resuscitation: Physicians' Perceptions of Risk, Benefit, and Self-Confidence

BACKGROUND

Families often desire proximity to loved ones during life-threatening resuscitations and perceive clear benefits to being present. However, critical care nurses and physicians perceive risks and benefits. Whereas research is accumulating on nurses' perceptions of family presence, physicians' perspectives have not been clearly explicated. Psychometrically sound measures of physicians' perceptions are needed to create new knowledge and enhance collaboration among critical care nurses and physicians during resuscitation events.

OBJECTIVE

This study tests 2 new instruments that measure physicians' perceived risks, benefits, and self-confidence related to family presence during resuscitation.

METHODS

By a correlational design, a convenience sample of physicians (N = 195) from diverse clinical specialties in 1 hospital in the United States completed the Physicians' Family Presence Risk-Benefit Scale and Physicians' Family Presence Self-confidence Scale.

RESULTS

Findings supported the internal consistency reliability and construct validity of both new scales. Mean scale scores indicated that physicians perceived more risk than benefit and were confident in managing resuscitations with families present, although more than two-thirds reported feeling anxious. Higher self-confidence was significantly related to more perceived benefit and less perceived risk (P = .001). Younger physicians, family practice physicians, and physicians who previously had invited family presence expressed more positive perceptions (P = .05-.001).

DISCUSSION

These 2 new scales offer a means to assess key perceptions of physicians related to family presence. Further testing in diverse physician populations may further validate the scales and yield knowledge that can strengthen collaboration among critical care nurses and physicians and improve patient and family outcomes.

Interprofessional Simulations Promote Knowledge Retention and Enhance Perceptions of Teamwork Skills in a Surgical-Trauma-Burn Intensive Care Unit Setting

BACKGROUND

The current state of health care encompasses highly acute, complex patients, managed with ever-changing technology. The ability to function proficiently in critical care relies on knowledge, technical skills, and interprofessional teamwork. Integration of these factors can improve patient outcomes. Simulation provides "hands-on" practice and allows for the integration of teamwork into knowledge/skill training. However, simulation can require a significant investment of time, effort, and financial resources. The Institute of Medicine recommendations from 2015 include "strengthening the evidence base for interprofessional education (IPE)" and "linking IPE with changes in collaborative behavior." In one surgical-trauma-burn intensive care unit (STBICU), no IPE existed. The highly acute and diverse nature of the patients served by the unit highlights the importance of appropriate training. This is heightened during critical event situations where patients deteriorate rapidly and the team intervenes swiftly.

PURPOSE

The aims of this study were to (1) evaluate knowledge retention and analyze changes in perceptions of teamwork among nurses and resident physicians in a STBICU setting after completion of an interprofessional critical event simulation and (2) provide insight for future interprofessional simulations (IPSs), including the ideal frequency of such training, associated cost, and potential effect on nursing turnover.

DESIGN

A comparison-cohort pilot study was developed to evaluate knowledge retention and analyze changes in perceptions of teamwork.

METHODS

A 1-hour critical event IPS was held for nurses and resident physicians in a STBICU setting. A traumatic brain injury patient with elevated intracranial pressure, rapid deterioration, and cardiac arrest was utilized for the simulation scenario. The simulation required the team to use interventions to reduce elevated intracranial pressure and then perform cardiac resuscitation according to Advanced Cardiac Life Support guidelines. A semistructured debriefing guided by the TENTS tool highlighted important aspects of teamwork. Participants took knowledge and Teamwork Skills Scale (TSS) pretests, posttests, and 1-month posttests. Mean scores were calculated for each time point (pre, post, and 1-month post), and paired t tests were used to evaluate changes.

RESULTS

Mean knowledge test and TSS scores both significantly increased after the simulation and remained significantly elevated at 1-month follow-up. Participants recommended retraining intervals of 3 to 6 months. Cost of each simulation was estimated to be $324.44. Analysis of nursing turnover rates did not demonstrate a statistically significant reduction in turnover; however, confounding factors were not controlled for.

CONCLUSION

Significant improvements on both knowledge test and TSS scores demonstrate the effectiveness of the intervention, and retention of the information gained and teamwork skills learned. Participants valued the intervention and recommended to increase the frequency of training. Future studies should develop a framework for "best practice" IPS, analyze the relationship with nursing turnover, and ultimately seek correlations between IPS and improved patient outcomes.

Simulation-based education to improve communication skills: a systematic review and identification of current best practice

Background

Good communication in healthcare between professionals and between professionals and patients is important in delivering high-quality care. Evidence of translation of technical skills taught through simulation into the clinical environment has been demonstrated, but the evidence for the impact of communication skills is less well known.

Objectives

To identify and critically appraise the evidence for the impact of communication taught through simulation-based education (SBE) and use this evidence to suggest a model for future SBE interventions for communication skills.

Study selection

MEDLINE, CINAHL, EMBASE and PsycINFO were searched for articles pertaining to communication skills taught through simulation. A content expert was consulted to suggest additional studies. 1754 studies were initially screened for eligibility, with 274 abstracts screened further. 147 full-text articles were further assessed for eligibility, with 79 of these excluded. The remaining 68 studies were reviewed and 18 studies were included in the qualitative synthesis as studies designed to show benefits beyond the simulation centre.

Findings

The 18 identified studies with an impact at a Kirkpatrick level of ≥3, are analysed; 4 looking specifically at communication between healthcare professionals and 14 looking at communication between health professionals and patients or relatives.

Conclusions

There is some evidence that the improvements in communication taught through simulation can be translated into benefits measurable beyond the simulation centre, but this evidence is limited due to the way that most of the studies are designed. We suggest a model for SBE aimed at teaching communication skills that is informed by the current evidence and takes into account the need to collect higher-level outcome data.

Innovative Use of Service-Learning to Enhance Baccalaureate Nursing Education

BACKGROUND

Service-learning is an established pedagogical approach to nursing education found primarily in community nursing. With changing health care landscapes, the expansion of service-learning projects throughout the nursing program provides opportunities to enrich assessment and critical thinking and amplify exposure to determinants of health.

METHOD

Implementing service-learning in foundational nursing courses allows students to be challenged with the application of complex care management within a context of caring, cultural competence, social responsibility, and self-care initiatives.

RESULTS

Integrating service-learning throughout the nursing curriculum has the potential to make positive, sustainable changes within a community, while simultaneously preparing students to view clients holistically, think critically, and develop cultural competence.

CONCLUSION

Enhancing nursing curriculum by integrating service-learning opportunities can strengthen the learning experience and foster concepts of caring, social responsibility, cultural competence, and self-care. Working with community leaders from diverse groups can lead to sustainable projects that simultaneously benefit the community and nursing education. [J Nurs Educ. 2017;56(9):560-563.].

Use of Placental/Umbilical Blood Sampling for Neonatal Admission Blood Cultures: Benefits, Challenges, and Strategies for Implementation

Placental blood remains an underused resource for early neonatal care despite ample evidence that placental blood provides the same clinical decision making information without the need for painful, invasive blood sampling procedures. Potential benefits of placental/umbilical blood sampling (PUBS) for neonatal admission labs include decreases in pain reactivity, rates of anemia, need for blood transfusions, use of vasopressors, and rates of intraventricular hemorrhage. Here, we present a unique case study of a critically ill infant with contradictory blood culture results from PUBS and direct infant sampling. A negative admission direct sample blood culture result compared with a positive admission PUBS blood culture result suggests that infection may have been missed in the direct infant sample. Relevant placental embryology and circulation is also described, as well as the benefits of PUBS for neonatal admission labs (with focus on the blood culture), challenges associated with PUBS practice, and strategies for implementation of PUBS.

Tackling Quality Improvement in the Delivery Room

Implementation of standardized practices in the delivery room fosters a safe environment to ensure that newborn infants are cared for optimally, whether or not they require extensive resuscitation. Quality improvement (QI) is an excellent methodology for implementation of standardized practices due to the multidisciplinary nature of the delivery room, complexity of tasks involved, and opportunities to track processes and outcomes. This article discusses how the delivery room is a unique environment and presents examples on how to approach delivery room QI. Key areas of potential focus for teams pursuing delivery QI include thermal regulation, optimizing respiratory support, and facilitating team communication.

National Partnership for Maternal Safety: Consensus Bundle on Severe Hypertension During Pregnancy and the Postpartum Period

Complications arising from hypertensive disorders of pregnancy are among the leading causes of preventable severe maternal morbidity and mortality. Timely and appropriate treatment has the potential to significantly reduce hypertension-related complications. To assist health care providers in achieving this goal, this patient safety bundle provides guidance to coordinate and standardize the care provided to women with severe hypertension during pregnancy and the postpartum period. This is one of several patient safety bundles developed by multidisciplinary work groups of the National Partnership for Maternal Safety under the guidance of the Council on Patient Safety in Women's Health Care. These safety bundles outline critical clinical practices that should be implemented in every maternity care setting. Similar to other bundles that have been developed and promoted by the Partnership, the hypertension safety bundle is organized into four domains: Readiness, Recognition and Prevention, Response, and Reporting and Systems Learning. Although the bundle components may be adapted to meet the resources available in individual facilities, standardization within an institution is strongly encouraged. This commentary provides information to assist with bundle implementation.

Consensus Bundle on Severe Hypertension During Pregnancy and the Postpartum Period

Complications arising from hypertensive disorders of pregnancy are among the leading causes of preventable severe maternal morbidity and mortality. Timely and appropriate treatment has the potential to significantly reduce hypertension-related complications. To assist health care providers in achieving this goal, this patient safety bundle provides guidance to coordinate and standardize the care provided to women with severe hypertension during pregnancy and the postpartum period. This is one of several patient safety bundles developed by multidisciplinary work groups of the National Partnership for Maternal Safety under the guidance of the Council on Patient Safety in Women's Health Care. These safety bundles outline critical clinical practices that should be implemented in every maternity care setting. Similar to other bundles that have been developed and promoted by the Partnership, the hypertension safety bundle is organized into four domains: Readiness, Recognition and Prevention, Response, and Reporting and Systems Learning. Although the bundle components may be adapted to meet the resources available in individual facilities, standardization within an institution is strongly encouraged. This commentary provides information to assist with bundle implementation.

Consensus Bundle on Severe Hypertension During Pregnancy and the Postpartum Period

Complications arising from hypertensive disorders of pregnancy are among the leading causes of preventable severe maternal morbidity and mortality. Timely and appropriate treatment has the potential to significantly reduce hypertension-related complications. To assist health care providers in achieving this goal, this patient safety bundle provides guidance to coordinate and standardize the care provided to women with severe hypertension during pregnancy and the postpartum period. This is one of several patient safety bundles developed by multidisciplinary work groups of the National Partnership for Maternal Safety under the guidance of the Council on Patient Safety in Women's Health Care. These safety bundles outline critical clinical practices that should be implemented in every maternity care setting. Similar to other bundles that have been developed and promoted by the Partnership, the hypertension safety bundle is organized into four domains: Readiness, Recognition and Prevention, Response, and Reporting and Systems Learning. Although the bundle components may be adapted to meet the resources available in individual facilities, standardization within an institution is strongly encouraged. This commentary provides information to assist with bundle implementation.

Adaptation of non-technical skills behavioural markers for delivery room simulation

BACKGROUND

Simulation in healthcare has proved to be a useful method in improving skills and increasing the safety of clinical operations. The debriefing session, after the simulated scenario, is the core of the simulation, since it allows participants to integrate the experience with the theoretical frameworks and the procedural guidelines. There is consistent evidence for the relevance of non-technical skills (NTS) for the safe and efficient accomplishment of operations. However, the observation, assessment and feedback on these skills is particularly complex, because the process needs expert observers and the feedback is often provided in judgmental and ineffective ways. The aim of this study was therefore to develop and test a set of observation and rating forms for the NTS behavioural markers of multi-professional teams involved in delivery room emergency simulations (MINTS-DR, Multi-professional Inventory for Non-Technical Skills in the Delivery Room).

METHODS

The MINTS-DR was developed by adapting the existing tools and, when needed, by designing new tools according to the literature. We followed a bottom-up process accompanied by interviews and co-design between practitioners and psychology experts. The forms were specific for anaesthetists, gynaecologists, nurses/midwives, assistants, plus a global team assessment tool. We administered the tools in five editions of a simulation training course that involved 48 practitioners. Ratings on usability and usefulness were collected.

RESULTS

The mean ratings of the usability and usefulness of the tools were not statistically different to or higher than 4 on a 5-point rating scale. In either case no significant differences were found across professional categories.

CONCLUSION

The MINTS-DR is quick and easy to administer. It is judged to be a useful asset in maximising the learning experience that is provided by the simulation.

Huddles and Debriefings: Improving Communication on Labor and Delivery

Interprofessional teams work together on the labor and delivery unit, where clinical care is often unscheduled, rapidly evolving, and fast paced. Effective communication is key for coordinated delivery of optimal care and for fostering a culture of community and safety in the workplace. The preoperative huddle allows for information sharing, cross-checking, and preparation before the start of surgery. Postoperative debriefings allow the operative team to engage in ongoing process improvement. Debriefings after adverse events allow for shared understanding, mutual healing, and help mitigating the harm to potential "second victims."

Assessment of Developmental Progress Using an Objective Structured Clinical Examination-Simulation Hybrid Examination for Obstetrics and Gynecology Residents

OBJECTIVE

The Test of Integrated Professional Skills (TIPS) is an objective structured clinical examination-simulation hybrid examination that assesses resident integration of technical, cognitive, and affective skills in Obstetrics and Gynecology (OBGYN) residents. The aim of this study was to analyze performance patterns and reactions of residents to the test to understand how it may fit within a comprehensive assessment program.

DESIGN

A retrospective, mixed methods review of the design and implementation of the examination, patterns of performance of trainees at different levels of training, focus group data, and description of use of TIPS results for resident remediation and curriculum development.

SETTING

OBGYN residents at New York University Langone Medical Center, a tertiary-care, urban academic health center.

PARTICIPANTS

OBGYN residents in all years of training, postgraduate year-1 through postgraduate year, all residents completing the TIPS examination and consenting to participate in focus groups were included.

RESULTS

In all, 24 residents completed the TIPS examination. Performance on the examination varied widely among individuals at each stage of training, and did not follow developmental trends, except for technical skills. Cronbach α for both standardized patient and faculty ratings ranged from 0.69 to 0.84, suggesting internal consistency. Focus group results indicated that residents respond to the TIPS examination in complex ways, ranging from anxiety about performance to mixed feelings about how to use the data for their learning.

CONCLUSION

TIPS assesses a range of attributes, and can support both formative and summative evaluation. Lack of clear developmental differences and wide variation in performance by learners at the same level of training support the argument for individualized learning plans and competency-based education.

Teaching Labor Support: An Interprofessional Simulation

Support for women during labor encompasses the continuous presence of a person who provides psychosocial, emotional, and physical support. Providing labor support to women in the intrapartum setting is a core midwifery competency and a clinical skill that midwifery students are expected to master. Instruction on labor support is a common objective in midwifery education intrapartum courses and skills labs, yet there is no standard for teaching this skill to midwifery students. Thus, in order to accomplish this objective, we created an interprofessional simulation on labor support that involves the use of a standardized patient, a written scenario, an interprofessional team of nursing and midwifery students, faculty observations, and a reflective debrief. The goals of the labor support simulation are to allow midwifery students the opportunity to practice intrapartum labor support techniques and interprofessional communication prior to entering the clinical setting. A postsimulation structured debrief allows for student learning and reflection. This article describes the design, planning, and implementation of this unique simulation experience. This article is part of a special series of articles that address midwifery innovations in clinical practice, education, interprofessional collaboration, health policy, and global health.