High-Fidelity Simulation to Teach the Role of the Advanced Practice Nurse in Palliative Communication

Submitter Information

Author: Adrienne Markiewicz, MSN, RN, AGACNP-BC Title: Clinical Instructor Institution: University of Wisconsin-Milwaukee Email: markiewi@uwm.edu Coauthors: Natalie McAndrew PhD, RN, ACNS-BC, CCRN-K Competency Category(s) Evidence-Based Practice, Patient-Centered Care Learner Level(s) Graduate Students Learner Setting(s) Skills or Simulation Laboratories Strategy Type Case Studies Learning Objectives

1. Conduct assessments appropriate for care of patient in an organized and systematic manner.
2. Assess and treat pain and suffering in light of patient values, preferences, and expressed needs
3. Value and uphold shared decision-making with empowered patients and families
4. Make clinical judgments, decisions and recommendations that are evidence-based.
5. Demonstrate knowledge of legal and ethical obligations related to patient-centered care.

QSEN Graduate Patient Centered Care Competency
Analyze multiple dimensions of patient-centered care:
• patient/family/community preferences, values
• coordination and integration of care
• information, communication, and education
• physical comfort and emotional support
• involvement of family and friends
• transition and continuity

Elicit patient values, preferences, and expressed needs as part of clinical interview, diagnosis, implementation of care plan, and evaluation of care
Communicate patient values, preferences, and expressed needs to other members of healthcare team
Provide patient-centered care with sensitivity, empathy, and respect for the diversity of human experience
Assess and treat pain and suffering in light of patient values, preferences, and expressed needs

Value seeing health care situations ‘through patients’ eyes’
Respect and encourage individual expression of patient values, preferences, and expressed needs
Value the patient’s expertise with own health and symptoms
Honor learning opportunities with patients who represent all aspects of human diversity
Willingly support patient-centered care for individuals whose values differ from own
Seek to understand one’s personally held values and beliefs about the management of pain or suffering

Strategy Overview

This strategy allows graduate APRN students to practice principles of palliative communication for patients with chronic illness disease trajectory through an unfolding, two-scenario high fidelity simulation of the same patient. By extending the same patient case through two scenarios, students can see a realistic illness trajectory and simulate their role as the APRN in goals of care discussions with both the patient and her family. Pre-briefing materials provide didactic instruction on palliative communication, patient-centered care, and shared decision making. Structured debriefing allows the student to analyze the experience through the lens of patient centered care, affirming the necessity of valuing and upholding shared decision-making, even when disagreements occur. The scenario also examines the legal and ethical implications of shared decision-making in the incapacitated patient.

Submitted Materials PalliativeSimulationDesignPlan-1.docx Handout-for-Students-for-Simulation-1-2.docx Handout-for-Students-for-Simulation-2-1.docx Worksheet-for-Students-to-Complete-During-Sim.docx Additional Materials

Attached to this submission, author can be contacted at markiewi@uwm.edu for additional information.

Evaluation Description

Simulation debriefing was conducted after each scenario with the graduate nurse learners using the debriefing questions found in the simulation progression outline document.