Author: Celeste M. Alfes, DNP, RN
Title: Assistant Professor & Director of The LRC
Institution: Frances Payne Bolton School of Nursing
Patient-Centered Care, Teamwork and Collaboration
Pre-Licensure ADN/Diploma, Pre-Licensure BSN, RN to BSN
Skills or Simulation Laboratories
1. Integrate understanding of multiple dimensions of patient centered care, physical comfort, and emotional support (Patient Centered Care)
2. Discuss principles of effective communication (Patient Centered Care and Teamwork)
3. Recognize contributions of individuals and groups to help patients and their family members achieve health goals (Patient Centered Care)
4. Discuss effective strategies for communicating and resolving conflict (Teamwork).
1. Provide patient centered care with sensitivity and respect, assess for presence and levels of pain and physical and emotional comfort (Patient Centered Care).
2. Act with integrity, consistency, and respect for differing views on pain therapy (Patient Centered Care)
3. Integrate the contributions of others who play a role in helping the patient and their family members achieve their goals (Teamwork).
1. Appreciate the role of the nurse in relief of all types and sources of pain and suffering (Patient Centered Care & Teamwork)
2. Value continuous improvement of own communication and conflict resolution skills (Teamwork)
3. Value teamwork and the different styles of communication used by patients, families, and health care providers (Teamwork).
This is a brief simulation centered on the principles of effective communication, patient centered care, and team work. This is designed to be student’s first exposure to a simulation activity involving a human patient simulator. Thus, the activity is completed in 30 minutes and involves basic role playing with a high fidelity simulator. Beginning nursing students are assigned roles and asked to role play a comfort care scenario designed to introduce first year students to the importance of effective communication, team work, and delivering comfort care to patients experiencing pain. Groups of no more than 5 students are suggested for this activity.
1. The student will be able to assess Mr. Burns’ level of comfort using the nursing process.
2. The student will be able to provide nursing interventions to address the need for increased level of comfort.
3. The student will be able to formulate a nursing diagnosis and plan of care for Mr. Burns as a post-reflection activity.
4. The student will involve the patient, patient’s wife, and the other nursing student(s) to deliver effective comfort care.
5. The student will demonstrate teamwork and collaboration while delivering effective comfort care interventions.
The simulation is introduced with a 5 minute introductory video created to visually introduce students to Mr. Burns, a 63 year old male who is 3 days post right knee replacement. The video begins with Mr. Burns being wheeled back to his room by a physical therapist after his morning PT session. The students see and hear Mr. Burns moaning in pain as his visually upset wife trails behind.
After the video, the students are given a brief set of instructions, asked to draw one of five roles, and then instructed to begin delivering care to Mr. Burns, played by Sim Man, a human patient high fidelity simulator. The 5 roles for the experience are Student Nurse 1, Student Nurse 2, Mrs. Burns, and Observer 1 and 2. Props for the scenario include an ice pack, blanket, pillow, music, deck of cards, portable phone, TV remote, lotion, pain scale, and bath blanket.
The focus of the simulation is to encourage the 2 nursing students to work as a team and implement the effective communication skills and non-pharmacological comfort care measures (positioning, elevating extremity, assessing pain level, applying ice, using distraction, music, TV, playing cards, etc) they learned in lecture during the previous week. The experience addresses the QSEN competencies of Patient Centered Care as well as Teamwork and Collaboration. Students are given the opportunity to work as a team to implement effective nursing interventions with a patient experiencing pain. Students role play with a high fidelity simulator to deliver patient centered care while also trying to accommodate Mrs. Burn’s needs. Students are give up to 10 minutes to role play the scenario with minimal prompting from faculty.
Sim Man has been programmed to give appropriate responses related to pain including location, intensity, aggravating and alleviating factors, that assist in answering students questions. Faculty are always on hand to provide helpful responses to keep the simulation running. The observers are asked to take notes during the simulation, noting signs of patient centered care, teamwork strategies, and effective and non-effective interventions that will be shared during the 10 minute debriefing session. When time allows, it is often helpful to repeat the scenario and have students assume a different role the second time.
It should be noted this experience is student’s first exposure to a human patient simulator so the simulation is brief, involves role play, and focuses on the very basic achievement of effective communication, working as a team, and patient centered care. We feel strongly that students should be exposed to simulation in their very first nursing course. Simulations should build in their complexity as the student progresses through their program. For more advanced students, we would involve the roles of PT, physician, advanced practice nurse to promote more in-depth levels of teamwork and collaboration. This scenario could be adapted to the advanced learner or student who has completed TEAM steps training with a more in-depth focus on teamwork and collaboration.
Every simulation conducted in our school identifies the QSEN competencies addressed, the KSA’s associated with the simulation, NCLEX test plan categories addressed, suggestions for changing the complexity of the scenario, and a list of QSEN focused questions for the debriefing session to assess whether the QSEN competencies were obtained or not.
The NCLEX test plan highlights possible categories that can be highlighted in this scenario.
Depending on the time available and level of student, more categories can be addressed.
I have a link to our five minute introductory video for the Mr. Burns Simulation described here. If published, I would be willing to supply the link to the video to enhance the use of this teaching strategy. Please contact me at firstname.lastname@example.org.
Evaluation Methods: Faculty develop QSEN based debriefing questions aimed to assess whether the competencies were achieved. Some sample questions used to evaluate Patient Centered Care:
1. Describe how you involved family members in the patient care?
2. How did the patient describe his symptoms’? Describe your assessment of this patient’s pain.
3. What intervention did you apply and was it therapeutic?
4. Describe the level of caring that was demonstrated in your communication with your patient.
Some sample questions used to evaluate Teamwork and Collaboration:
1. Describe your efforts to collaborate with Mrs. Burns and your fellow nursing student.
2. Were the roles used during the simulation clear, why or why not? Would it be helpful to involve teamwork with PT?
3. Describe your utilization of resources, Was communication closed loop and clear? Was there a conflict? and was the conflict resolved?
4. How did you utilize your resources when working as a team with Mrs. Burns and your fellow nursing student?
Suggestions for changing the complexity of this scenario to adapt to different levels of learners:
1. Have participants repeat the simulation, selecting different roles the second time, consider adding physical therapy, a physician, and advanced practice nurse.
2. Have Mr. Burns develop shortness of breath or chest pain for a sophomore level/med/surg experience.
3. Include a heart monitor and have Mr. Burns develop Atrial Fibrillation.
Student/Faculty Satisfaction: This is our most popular simulation. Both students and faculty enjoy the focus on patient centered comfort care, communication, and teamwork. Freshmen BSN students in their first semester freshmen year complete the simulation during their first clinical rotation. Although somewhat hesitant to communicate with a simulator at the beginning, the majority of students thoroughly enjoy the experience and ask for more opportunities to work with Sim Man during the semester.
Faculty are rewarded with positive feedback from the students and feel this is an excellent way to role play and assess the QSEN competencies: Patient Centered Care and Teamwork/Collaboration with the beginning level student. More advanced students could use this scenario and include students from other disciplines. The challenge to incorporating more simulations in our program is finding time for faculty to develop future scenarios. There seems to be a need to schedule protected time off for faculty to develop, implement, and evaluate simulations and QSEN focused experiences.