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Lackie K, Hayward K, Ayn C, Stilwell P, Lane J, Andrews C, Dutton T, Ferkol D, Harris J, Houk S, Pendergast N, Persaud D, Thillaye J, Mills J, Grant S, Munroe A. Creating psychological safety in interprofessional simulation for health professional learners: a scoping review of the barriers and enablers. J Interprof Care 2023; 37:187-202. [PMID: 35403551 DOI: 10.1080/13561820.2022.2052269] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Interprofessional simulation-based education (IP-SBE) supports the acquisition of interprofessional collaborative competencies. Psychologically safe environments are necessary to address socio-historical hierarchies and coercive practices that may occur in IP-SBE, facilitating fuller student participation. A scoping review was conducted to understand the barriers and enablers of psychological safety within IP-SBE. Research papers were eligible if they included two or more undergraduate and/or post-graduate students in health/social care qualifications/degrees and discussed barriers and/or enablers of psychological safety within simulation-based education. Sources of evidence included experimental, quasi-experimental, analytical observational, descriptive observational, qualitative, and mixed-methodological peer-reviewed studies. English or English-translated articles, published after January 1, 1990, were included. Data were extracted by two members of the research team. Extraction conflicts were resolved by the principal investigators. In total, 1,653 studies were screened; 1,527 did not meet inclusion criteria. After a full-text review, 99 additional articles were excluded; 27 studies were analyzed. Psychological safety enablers include prebriefing-debriefing by trained facilitators, no-blame culture, and structured evidenced-based simulation designs. Hierarchy among/between professions, fear of making mistakes, and uncertainty were considered barriers. Recognition of barriers and enablers of psychological safety in IP-SBE is an important first step towards creating strategies that support the full participation of students in their acquisition of IPC competencies.
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Affiliation(s)
| | | | | | - Peter Stilwell
- School of Physical and Occupational Therapy, McGill University
| | | | | | - Tanya Dutton
- Nova Scotia Rehabilitation & Arthritis Centre, Canada
| | - Doug Ferkol
- Centre for Collaborative Clinical Learning and Research
| | | | | | | | | | | | | | - Shannan Grant
- Department of Applied Human Nutrition, Mount Saint Vincent University
| | - Andrew Munroe
- Nova Scotia Rehabilitation & Arthritis Centre, Canada
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Obstetric Simulation Training and Teamwork: Immediate Impact on Knowledge, Teamwork, and Adherence to Hemorrhage Protocols. Simul Healthc 2023; 18:32-41. [PMID: 35136007 DOI: 10.1097/sih.0000000000000641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
INTRODUCTION The Obstetric Simulation Training and Teamwork (OB-STaT) curriculum was an in situ interprofessional program to provide standardized postpartum hemorrhage (PPH) simulation training throughout a health system to decrease PPH morbidity. In this study portion, investigators hypothesized that OB-STaT would increase: (a) team member knowledge in diagnosis and management of PPH, (b) teamwork, (c) adherence to established PPH protocols, and (d) patient satisfaction. METHODS The OB-STaT was implemented at 8 US Navy hospitals between February 2018 and November 2019. Participant PPH treatment and maternal/neonatal resuscitation pretraining/posttraining knowledge was assessed via an 11-item test, whereas teamwork and standardized patient assessment were rated using validated Likert-type scales: the 15-item Clinical Teamwork Scale and 3-item Patient Perception Score, with item ranges of 0 to 10 and 0 to 5, respectively. Local PPH protocol adherence was assessed using role-specific checklists, with a potential maximum of 14 points (anesthesia/nursing) or 22 points (obstetrics). RESULTS Fifty-four interprofessional teams participated. Obstetricians (trainees and attendings) demonstrated significantly improved knowledge test scores (8.33 ± 1.6 vs. 8.66 ± 1.5, P < 0.01). Between the 2 scenarios, overall mean Clinical Teamwork Scale scores improved significantly for all interprofessional teams (5.82 ± 2.0 vs. 7.25 ± 1.9, P < 0.01). Anesthesia, nursing, and obstetric subteams demonstrated significant increases in protocol adherence as measured by critical action scores (12.28 ± 1.7 vs. 13.56 ± 1.0, 12.43 ± 1.6 vs. 13.14 ± 1.3, and 18.14 ± 2.7 vs. 19.56 ± 2.1 respectively, all P < 0.02). Although overall standardized patient satisfaction did not significantly improve, scores for feeling well informed did (3.36 ± 1.0 vs. 3.76 ± 0.8, P < 0.01). CONCLUSIONS The OB-STaT curriculum modestly improved participants' teamwork, communication, and protocol adherence during simulated PPH scenarios; OB-STaT may decrease PPH morbidity.
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Madisa M, Filmalter CJ, Heyns T. Considerations for promoting the implementation of work-based interprofessional education programmes: A scoping review. NURSE EDUCATION TODAY 2023; 120:105617. [PMID: 36368119 DOI: 10.1016/j.nedt.2022.105617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 10/11/2022] [Accepted: 10/23/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND Effective inter-professional collaboration may improve healthcare outcomes, including maternal and child healthcare settings where unfavourable outcomes are often due to communication and collaboration failures. OBJECTIVE Explore the considerations for promoting the implementation of work-based interprofessional education programmes. METHODS A scoping review guided by the methodological framework of Arksery and O'Malley was used to analyse 28 articles published between 2000 and 2020. The reporting was guided by the PRISMA extension for Scoping Reviews. RESULTS Twenty-seven of 28 articles were studies conducted in high-income countries. The review revealed considerations which were themed as 1) mobilisation of resources, 2) helpful learning environment, 3) healthcare professional's valuation and 4) barriers prior to implementing IPE/IPC. Successful implementation of interventions triggered motivation, confidence, self-efficacy, value for IPE/IPC. CONCLUSION Our findings demonstrate that there are specific considerations that can contribute to the uptake of IPE/IPC interventions in the clinical setting.
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Affiliation(s)
- Montlenyane Madisa
- University of Pretoria, Department of Nursing Science, Pretoria, South Africa.
| | - Celia J Filmalter
- University of Pretoria, Department of Nursing Science, Pretoria, South Africa.
| | - Tanya Heyns
- University of Pretoria, Department of Nursing Science, Pretoria, South Africa.
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Rayburn WF, Jenkins C. Interprofessional Collaboration in Women's Health Care: Collective Competencies, Interactive Learning, and Measurable Improvement. Obstet Gynecol Clin North Am 2021; 48:1-10. [PMID: 33573781 DOI: 10.1016/j.ogc.2020.11.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Interprofessional collaboration has the potential to impact our complex, dynamic health care system through team-led or collective core competencies (professionalism, communication, teamwork, interprofessional education) that promote system improvements for quality care and patient safety. Strategies to reduce errors and subsequent adverse outcomes focus on interactive training; simulations and drills; development of protocols, guidelines, and checklists; use of information technology; and relevant interactive educational activities in the workplace. When sustained with a shared vision, good communication, and enthusiasm for the work being done, interprofessional collaboration can lead to measurable improvements in delivery of women's health care.
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Affiliation(s)
- William F Rayburn
- Department of Obstetrics and Gynecology, College of Graduate Studies, Medical University of South Carolina, Charleston, SC 29425, USA.
| | - Carolyn Jenkins
- College of Nursing and College of Graduate Studies, Medical University of South Carolina, Charleston, SC 29425, USA
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Lippke S, Derksen C, Keller FM, Kötting L, Schmiedhofer M, Welp A. Effectiveness of Communication Interventions in Obstetrics-A Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:2616. [PMID: 33807819 PMCID: PMC7967656 DOI: 10.3390/ijerph18052616] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Revised: 02/26/2021] [Accepted: 03/02/2021] [Indexed: 01/13/2023]
Abstract
(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.
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Affiliation(s)
- Sonia Lippke
- Department of Psychology and Methods, Jacobs University Bremen, 28759 Bremen, Germany; (C.D.); (F.M.K.); (L.K.); (M.S.); (A.W.)
| | - Christina Derksen
- Department of Psychology and Methods, Jacobs University Bremen, 28759 Bremen, Germany; (C.D.); (F.M.K.); (L.K.); (M.S.); (A.W.)
| | - Franziska Maria Keller
- Department of Psychology and Methods, Jacobs University Bremen, 28759 Bremen, Germany; (C.D.); (F.M.K.); (L.K.); (M.S.); (A.W.)
| | - Lukas Kötting
- Department of Psychology and Methods, Jacobs University Bremen, 28759 Bremen, Germany; (C.D.); (F.M.K.); (L.K.); (M.S.); (A.W.)
| | - Martina Schmiedhofer
- Department of Psychology and Methods, Jacobs University Bremen, 28759 Bremen, Germany; (C.D.); (F.M.K.); (L.K.); (M.S.); (A.W.)
- Aktionsbündnis Patientensicherheit e.V. (APS), 10179 Berlin, Germany
| | - Annalena Welp
- Department of Psychology and Methods, Jacobs University Bremen, 28759 Bremen, Germany; (C.D.); (F.M.K.); (L.K.); (M.S.); (A.W.)
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Buljac-Samardzic M, Doekhie KD, van Wijngaarden JDH. Interventions to improve team effectiveness within health care: a systematic review of the past decade. HUMAN RESOURCES FOR HEALTH 2020; 18:2. [PMID: 31915007 PMCID: PMC6950792 DOI: 10.1186/s12960-019-0411-3] [Citation(s) in RCA: 148] [Impact Index Per Article: 37.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Accepted: 09/05/2019] [Indexed: 05/19/2023]
Abstract
BACKGROUND A high variety of team interventions aims to improve team performance outcomes. In 2008, we conducted a systematic review to provide an overview of the scientific studies focused on these interventions. However, over the past decade, the literature on team interventions has rapidly evolved. An updated overview is therefore required, and it will focus on all possible team interventions without restrictions to a type of intervention, setting, or research design. OBJECTIVES To review the literature from the past decade on interventions with the goal of improving team effectiveness within healthcare organizations and identify the "evidence base" levels of the research. METHODS Seven major databases were systematically searched for relevant articles published between 2008 and July 2018. Of the original search yield of 6025 studies, 297 studies met the inclusion criteria according to three independent authors and were subsequently included for analysis. The Grading of Recommendations, Assessment, Development, and Evaluation Scale was used to assess the level of empirical evidence. RESULTS Three types of interventions were distinguished: (1) Training, which is sub-divided into training that is based on predefined principles (i.e. CRM: crew resource management and TeamSTEPPS: Team Strategies and Tools to Enhance Performance and Patient Safety), on a specific method (i.e. simulation), or on general team training. (2) Tools covers tools that structure (i.e. SBAR: Situation, Background, Assessment, and Recommendation, (de)briefing checklists, and rounds), facilitate (through communication technology), or trigger (through monitoring and feedback) teamwork. (3) Organizational (re)design is about (re)designing structures to stimulate team processes and team functioning. (4) A programme is a combination of the previous types. The majority of studies evaluated a training focused on the (acute) hospital care setting. Most of the evaluated interventions focused on improving non-technical skills and provided evidence of improvements. CONCLUSION Over the last decade, the number of studies on team interventions has increased exponentially. At the same time, research tends to focus on certain interventions, settings, and/or outcomes. Principle-based training (i.e. CRM and TeamSTEPPS) and simulation-based training seem to provide the greatest opportunities for reaching the improvement goals in team functioning.
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Affiliation(s)
- Martina Buljac-Samardzic
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Bayle building, p.o. box 1738, 3000 DR Rotterdam, The Netherlands
| | - Kirti D. Doekhie
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Bayle building, p.o. box 1738, 3000 DR Rotterdam, The Netherlands
| | - Jeroen D. H. van Wijngaarden
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Bayle building, p.o. box 1738, 3000 DR Rotterdam, The Netherlands
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Hopwood N, Blomberg M, Dahlberg J, Abrandt Dahlgren M. Three Principles Informing Simulation-Based Continuing Education to Promote Effective Interprofessional Collaboration: Reorganizing, Reframing, and Recontextualizing. THE JOURNAL OF CONTINUING EDUCATION IN THE HEALTH PROFESSIONS 2020; 40:81-88. [PMID: 32404776 DOI: 10.1097/ceh.0000000000000292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
INTRODUCTION Shoulder dystocia is a complex birth emergency where patient outcomes remain a concern. This article investigates the detailed processes of simulation-based continuing education in a hospital where evidence over 10 years demonstrates improvements in practitioner knowledge, enacted practices, and maternal and child outcomes. METHODS Data were collected by video recording teams participating in a shoulder dystocia simulation and debrief. Analysis combined grounded thematic development with purposive coding of enactments of a relevant protocol (the ALSO HELPERR). RESULTS Three themes were identified (three Rs) that capture how effective interprofessional collaboration is promoted through collectively oriented reflection: Reorganizing roles and responsibilities between team members; Reframing the problem of shoulder dystocia from individuals correctly following a protocol, to a team of professionals who need to attune to, respond to, and support one another; and Recontextualizing by collectively "commingling" theoretical knowledge with practical experience to reflect on actions and judgements. DISCUSSION The three Rs are relevant to diverse clinical settings and address gaps in knowledge relating to the process of interprofessional simulation. Together, they constitute a set of principles to inform the design and conduct of continuing education for interprofessional practice through simulation.
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Affiliation(s)
- Nick Hopwood
- Dr. Hopwood: Associate Professor, School of International Studies and Education, University of Technology Sydney, Sydney, Australia, and Department of Curriculum Studies, Stellenbosch Universiteit, Stellenbosch, South Africa. Ms. Blomberg: Professor, Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden, and Department of Obstetrics and Gynecology, Linköping University, Linköping, Sweden. Ms. Dahlberg: Senior Lecturer, Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden. Ms. Abrandt Dahlgren: Professor in Medical Education, Department of Medicine and Health, Linköping University, Linköping, Sweden
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Yang A, Fernando S, Tighe J, O-Halloran M, Morphet J, Kumar A. Introduction of an interprofessional gynaecology surgical skills workshop for undergraduate medical and nursing students. Aust N Z J Obstet Gynaecol 2019; 60:238-243. [PMID: 31650525 DOI: 10.1111/ajo.13086] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Revised: 09/19/2019] [Accepted: 09/24/2019] [Indexed: 01/25/2023]
Abstract
BACKGROUND Medical and nursing students may feel under-prepared to perform basic surgical and gynaecology procedural skills. There also remains scope within undergraduate programs to integrate interprofessional education, and better prepare students for interprofessional collaboration to improve patient care. AIMS A simulation-based gynaecology surgical skills workshop program was introduced for undergraduate medical and nursing students. The aim of this study was to explore students' perceptions of a simulation-based interprofessional gynaecological skills program, using students' pre- and post-workshop confidence in taught skills reported in a post-workshop questionnaire as an outcome measure. MATERIALS AND METHODS One hundred and sixty undergraduate medical (n = 133) and nursing (n = 27) students attended the workshop program at a tertiary university in Melbourne, Australia. A survey was completed by all students immediately after the workshop, addressing students' perceptions of surgical education, the four skill-stations (gowning/gloving, suturing, intrauterine device insertion, and urethral catheterisation), and interprofessional education. A Wilcoxon signed-rank test was performed to compare students' pre- and post-workshop confidence scores. RESULTS Most medical and nursing students (86%) agreed their course should provide more structured surgical education. There was a statistically significant increase in post-workshop self-reported confidence scores for medical and nursing students in all four taught skills. Confidence in interprofessional behaviours also improved in both cohorts, but the improvement in nursing students did not reach statistical significance. CONCLUSIONS Simulation-based, interprofessional, gynaecological surgery skills workshops are practical and valuable additions to undergraduate medical and nursing curricula. Further research should explore long-term retention of procedural skills and changes in interprofessional attitudes in clinical practice.
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Affiliation(s)
- Amy Yang
- Austin Health, Melbourne, Australia
| | - Shavi Fernando
- Department of Obstetrics and Gynaecology, Monash University, Melbourne, Australia
| | - Josie Tighe
- School of Nursing and Midwifery, Monash University, Melbourne, Australia
| | - Monica O-Halloran
- School of Nursing and Midwifery, Monash University, Melbourne, Australia
| | - Julia Morphet
- School of Nursing and Midwifery, Monash University, Melbourne, Australia
| | - Arunaz Kumar
- Department of Obstetrics and Gynaecology, Monash University, Melbourne, Australia
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Ameh CA, Mdegela M, White S, van den Broek N. The effectiveness of training in emergency obstetric care: a systematic literature review. Health Policy Plan 2019; 34:257-270. [PMID: 31056670 PMCID: PMC6661541 DOI: 10.1093/heapol/czz028] [Citation(s) in RCA: 54] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/01/2019] [Indexed: 12/19/2022] Open
Abstract
Providing quality emergency obstetric care (EmOC) reduces the risk of maternal and newborn mortality and morbidity. There is evidence that over 50% of maternal health programmes that result in improving access to EmOC and reduce maternal mortality have an EmOC training component. The objective was to review the evidence for the effectiveness of training in EmOC. Eleven databases and websites were searched for publications describing EmOC training evaluations between 1997 and 2017. Effectiveness was assessed at four levels: (1) participant reaction, (2) knowledge and skills, (3) change in behaviour and clinical practice and (4) availability of EmOC and health outcomes. Weighted means for change in knowledge and skills obtained, narrative synthesis of results for other levels. One hundred and one studies including before-after studies (n = 44) and randomized controlled trials (RCTs) (n = 15). Level 1 and/or 2 was assessed in 68 studies; Level 3 in 51, Level 4 in 21 studies. Only three studies assessed effectiveness at all four levels. Weighted mean scores pre-training, and change after training were 67.0% and 10.6% for knowledge (7750 participants) and 53.1% and 29.8% for skills (6054 participants; 13 studies). There is strong evidence for improved clinical practice (adherence to protocols, resuscitation technique, communication and team work) and improved neonatal outcomes (reduced trauma after shoulder dystocia, reduced number of babies with hypothermia and hypoxia). Evidence for a reduction in the number of cases of post-partum haemorrhage, case fatality rates, stillbirths and institutional maternal mortality is less strong. Short competency-based training in EmOC results in significant improvements in healthcare provider knowledge/skills and change in clinical practice. There is emerging evidence that this results in improved health outcomes.
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Affiliation(s)
- Charles A Ameh
- Centre for Maternal and Newborn Health, Department of International Public Health, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, UK
| | - Mselenge Mdegela
- Centre for Maternal and Newborn Health, Department of International Public Health, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, UK
| | - Sarah White
- Centre for Maternal and Newborn Health, Department of International Public Health, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, UK
| | - Nynke van den Broek
- Centre for Maternal and Newborn Health, Department of International Public Health, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, UK
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Greer JA, Haischer-Rollo G, Delorey D, Kiser R, Sayles T, Bailey J, Blosser C, Middlebrooks R, Ennen CS. In-situ Interprofessional Perinatal Drills: The Impact of a Structured Debrief on Maximizing Training While Sensing Patient Safety Threats. Cureus 2019; 11:e4096. [PMID: 31032156 PMCID: PMC6472716 DOI: 10.7759/cureus.4096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Accepted: 02/19/2019] [Indexed: 11/25/2022] Open
Abstract
Introduction In-situ interprofessional emergency team training improves participants' with confidence and knowledge and identifies latent safety threats. This study examined the impact of a structured debrief on an interprofessional perinatal team's ability to identify latent safety threats and assess competency in managing perinatal emergencies. It was hypothesized that latent safety threats would be reduced and checklist compliance would increase during subsequent in-situ perinatal team training. Methods Two in-situ training sessions were held six months apart. The perinatal emergency response team provided care for a standardized patient with preterm twin gestation. Each session included off-ward delivery and resuscitation of the first infant, transportation to appropriate inpatient units, cesarean delivery, and resuscitation of the second twin. Postpartum hemorrhage ensued, requiring massive transfusion protocol activation. Medical experts assessed team performance with critical action checklists. A structured debrief identified latent safety threats, developed action plans, and reviewed checklist compliance. Checklist compliance rates were analyzed using a z-ratio test. Results The first training session: seven teams (75 staff) completed 75% (292/391) critical action checklist items and identified 34 latent safety threats. Second training session: four teams (45 staff) completed 89% (94/106) critical action checklist items. Ten latent safety threats were mitigated during the second session. Utilizing a z-ratio, a significant difference was detected between the overall checklist compliance rates of the two sessions, z = -3.069, p = .002. Post-hoc power calculation was <10%. Conclusions In-situ interprofessional perinatal emergency team training is feasible, identifies latent patient safety threats, and may improve team competency.
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Affiliation(s)
- Joy A Greer
- Obstetrics and Gynecology, Naval Medical Center, Portsmouth, USA
| | | | | | - Rebecca Kiser
- Obstetrics and Gynecology, Naval Medical Center, Portsmouth, USA
| | - Timothy Sayles
- Obstetrics and Gynecology, Naval Medical Center, Portsmouth, USA
| | - Jennifer Bailey
- Obstetrics and Gynecology, Naval Medical Center, Portsmouth, USA
| | - Colleen Blosser
- Obstetrics and Gynecology, Naval Medical Center, Portsmouth, USA
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Affiliation(s)
- Sarah Chitongo
- Midwifery Educator and Manager, Clinical Skills Department, Middlesex University
| | - Fiona Suthers
- Head of Clinical Skills Department, Middlesex University
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Bridging the Gap: Incorporating Simulation into Obstetrics and Gynaecology Undergraduate Medical Education. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2019; 41:191-196.e2. [DOI: 10.1016/j.jogc.2018.03.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2018] [Revised: 03/11/2018] [Accepted: 03/16/2018] [Indexed: 11/20/2022]
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Meeker K, Brown SK, Lamping M, Moyer MR, Dienger MJ. A High-Fidelity Human Patient Simulation Initiative to Enhance Communication and Teamwork Among a Maternity Care Team. Nurs Womens Health 2018; 22:454-462. [PMID: 30389279 DOI: 10.1016/j.nwh.2018.10.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2018] [Revised: 09/06/2018] [Accepted: 09/01/2018] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To use high-fidelity human patient simulation to enhance teamwork and communication during maternity care emergencies. DESIGN Quality improvement initiative. SETTING/LOCAL PROBLEM The labor and delivery team at a large suburban Level 2 facility in the Midwestern United States sought to apply evidence and use simulation to improve communication and teamwork. PARTICIPANTS Approximately 170 maternity care staff members, including nurses, anesthesia providers, and pediatric and obstetric physicians. INTERVENTION/MEASUREMENTS During each simulation, there were two scenarios with a debriefing session at the end of each. Teamwork and communication were evaluated using participant surveys. RESULTS Participants reported improved communication (p = .031) and teamwork (p = .041) after simulation. Additionally, 81% of respondents believed that their ability to perform clinical skills improved. CONCLUSION Use of high-fidelity human patient simulation was associated with improved teamwork and communication for a maternity care team. Simulation has been incorporated into standard education. We hope to sustain successful outcomes by providing ongoing simulation experiences for labor and delivery staff annually.
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Endacott R, Gale T, O’Connor A, Dix S. Frameworks and quality measures used for debriefing in team-based simulation: a systematic review. BMJ SIMULATION & TECHNOLOGY ENHANCED LEARNING 2018; 5:61-72. [DOI: 10.1136/bmjstel-2017-000297] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Accepted: 07/26/2018] [Indexed: 11/03/2022]
Abstract
ObjectivesThe skill of the debriefer is known to be the strongest independent predictor of the quality of simulation encounters yet educators feel underprepared for this role. The aim of this review was to identify frameworks used for debriefing team-based simulations and measures used to assess debriefing quality.MethodsWe systematically searched PubMed, CINAHL, MedLine and Embase databases for simulation studies that evaluated a debriefing framework. Two reviewers evaluated study quality and retrieved information regarding study methods, debriefing framework, outcome measures and debriefing quality.ResultsA total of 676 papers published between January 2003 and December 2017 were identified using the search protocol. Following screening of abstracts, 37 full-text articles were assessed for eligibility, 26 studies met inclusion criteria for quality appraisal and 18 achieved a sufficiently high-quality score for inclusion in the evidence synthesis. A debriefing framework was used in all studies, mostly tailored to the study. Impact of the debrief was measured using satisfaction surveys (n=11) and/or participant performance (n=18). Three themes emerged from the data synthesis: selection and training of facilitators, debrief model and debrief assessment. There was little commonality across studies in terms of participants, experience of faculty and measures used.ConclusionsA range of debriefing frameworks were used in these studies. Some key aspects of debrief for team-based simulation, such as facilitator training, the inclusion of a reaction phase and the impact of learner characteristics on debrief outcomes, have no or limited evidence and provide opportunities for future research particularly with interprofessional groups.
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Medium-fidelity simulation in clinical readiness: a phenomenological study of student midwives concerning teamwork. BMC Nurs 2018; 17:31. [PMID: 30065617 PMCID: PMC6062872 DOI: 10.1186/s12912-018-0303-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2017] [Accepted: 07/16/2018] [Indexed: 11/10/2022] Open
Abstract
Background Teamwork during obstetric emergency ensures good outcomes for both the woman and her baby. Effective teams are characterised by mutual respect, support, and cooperation among team members. Methods This qualitative, interpretive, phenomenological analysis study was conducted on a purposive sample of five, fourth-year Bachelor of Nursing Science student midwives at the University of Fort Hare (UFH). In-depth semi-structured interviews were conducted. Data analysis applied the interpretative phenomenological analysis method. Results Superordinate theme demonstrated teamwork elicited four clustered themes namely delegation of duties, the importance of teamwork, team support, and confident team leader. The participants recognised that there should be a team leader who is capable of delegating duties to other team members in the management of an obstetric emergency, Participants were confident not only to assign duties but to be kept updated of the intervention. They expressed the need to work collaboratively as a team to achieve the desired goal of providing quality care to the woman. The participants maintained that the team must be supportive and be able to help in decision making during simulation of an obstetric emergency. A sense of mutual respect is echoed by some participants in the process of caring for the woman. Some participants were confident at being team leaders and could see themselves as leaders in the real-life clinical situation. Conclusion The participants acknowledge the importance of teamwork in resolving obstetric emergencies. The importance of delegating duties to other team members, providing updated progress report ensures better outcomes for the woman.
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Dahlen HG, Johnson M, Hoolsema J, Norrie TP, Ajwani S, Blinkhorn A, Bhole S, Ellis S, Srinivas R, Yaacoub A, Milat A, Skinner J, George A. Process evaluation of the midwifery initiated oral health-dental service program: Perceptions of midwives in Greater Western Sydney, Australia. Women Birth 2018; 32:e159-e165. [PMID: 30025676 DOI: 10.1016/j.wombi.2018.06.021] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2018] [Revised: 06/29/2018] [Accepted: 06/30/2018] [Indexed: 11/28/2022]
Abstract
BACKGROUND Despite links between poor maternal oral health, adverse pregnancy outcomes and early childhood decay there is limited emphasis on maternal oral health in Australia. To address this, the Midwifery Initiated Oral Health Dental Service (MIOH-DS) program was developed in collaboration with the Australian College of Midwives. AIMS To undertake a process evaluation and explore perceptions of midwives involved in the MIOH-DS program to determine its practicability, acceptability and feasibility if it were to be up-scaled and implemented into clinical practice. METHODS Qualitative content analysis was undertaken on data from three focus groups with 21 midwives. FINDINGS Midwives generally found the MIOH-DS to be acceptable and feasible with potential for widespread scalability. The trust women had in midwives was an important factor in gaining women's attention about oral health in pregnancy. The program assisted in increasing midwives' knowledge and awareness, though some felt it was outside their scope of practice. The oral health assessment tool was acceptable to midwives but some concerns were expressed about undertaking a visual oral inspection. Most midwives stated they were now confident with referring individuals to a dentist. Significant barriers to widespread implementation included the cost of dental care and the continued lack of awareness and misconceptions pregnant women had towards oral health. CONCLUSION Midwives found the MIOH-DS to be acceptable and feasible which are two important barriers to potential implementation at scale. Misconceptions over the importance of oral health by women and cost of accessing dental services still need resolving.
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Affiliation(s)
- Hannah G Dahlen
- School of Nursing & Midwifery, Western Sydney University, Ingham Institute Applied Medical Research, Parramatta 2150, Australia.
| | - Maree Johnson
- Faculty of Health Sciences, Australian Catholic University, Ingham Institute Applied Medical Research, Sydney 2060, Australia.
| | - Julia Hoolsema
- Centre for Oral Health Outcomes & Research Translation (COHORT), Western Sydney University, South Western Sydney Local Health District, Ingham Institute Applied Medical Research, Liverpool 1871, Australia.
| | - Tiffany Patterson Norrie
- COHORT, Western Sydney University, South Western Sydney Local Health District, Ingham Institute Applied Medical Research, Liverpool 1871, Australia.
| | - Shilpi Ajwani
- Sydney Local Health District Oral Health Services, Sydney Dental Hospital, University of Sydney, Sydney Research, Sydney 2010, Australia.
| | - Anthony Blinkhorn
- Faculty of Dentistry, University of Sydney, Sydney, 2006, Australia.
| | - Sameer Bhole
- Sydney Local Health District Oral Health Services, Sydney Dental Hospital, University of Sydney, Sydney Research, Sydney 2010, Australia.
| | - Sharon Ellis
- Camden and Campbelltown Hospitals, South Western Sydney Local Health District, 2170, Australia.
| | - Ravi Srinivas
- South Western Sydney Local Health District Oral Health Services, COHORT, Western Sydney University, University of Sydney, Ingham Institute Applied Medical Research, Liverpool, Australia.
| | - Albert Yaacoub
- Nepean Blue Mountains Local Health District Oral Health Services, Penrith, Australia.
| | - Andrew Milat
- Centre for Epidemiology and Evidence, NSW Ministry of Health, University of Sydney, Australia.
| | - John Skinner
- Faculty of Dentistry, University of Sydney, Sydney, 2006, Australia.
| | - Ajesh George
- COHORT, Western Sydney University, South Western Sydney Local Health District, University of Sydney, Ingham Institute Applied Medical Research, Translational Health Research Institute, Liverpool 1871, Australia.
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Cunningham U, Ward ME, De Brún A, McAuliffe E. Team interventions in acute hospital contexts: a systematic search of the literature using realist synthesis. BMC Health Serv Res 2018; 18:536. [PMID: 29996820 PMCID: PMC6042358 DOI: 10.1186/s12913-018-3331-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2018] [Accepted: 06/26/2018] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Research on team effectiveness in healthcare has focussed on whether effective teams yield positive outcomes for patients and on the effectiveness of team interventions to improve performance. Limited understanding exists of what works for whom within an effective team, or how and why the context in which the team operates enables team members both as individuals and as a collective to enact behaviours that promote positive outcomes. METHODS This realist synthesis of the literature explores the relationship between team interventions, underlying teamwork mechanisms generated by those interventions, and the resultant impact on patient outcomes in an acute hospital context. A systematic search of five healthcare and healthcare management academic databases: PubMed, PsychINFO, CINAHL, ABInform, Emerald Management and three grey literature databases: ERIC, OpenDOAR and Open Grey was undertaken. Five experts in the field were also contacted to source relevant literature. Using PRISMA guidelines, relevant studies published between January 2006 and January 2017 were systematically searched by a team of three people. Drawing on realist methodology, data were synthesised using context, mechanism and outcome configurations as the unit of analysis to identify enablers and barriers to effective team interventions. RESULTS Out of 3347 papers retrieved, 18 were included in the final synthesis. From these, five contextual enablers were identified: an inter-disciplinary focus and flattened hierarchy; effective communication; leadership support and alignment of team goals with organisational goals; credibility of intervention; and appropriate team composition with physician involvement. Ten recurring mechanisms were identified, the most frequently occurring of which was shared responsibility. CONCLUSIONS The advantage of using realist synthesis to extrapolate data from the literature is that it considers the context and mechanisms that will impact effectiveness of healthcare team interventions. This methodological approach provides a different perspective to other types of syntheses and offers insight as to why certain contextual elements may yield more success than others. Findings therefore tend to have more practical implications. Specificity of detail in terms of how external drivers impact on healthcare team interventions was limited in the articles extracted for analysis. This broader perspective is therefore an important consideration for future research.
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Affiliation(s)
- U. Cunningham
- Mater Misericordiae University Hospital, Eccles St, Dublin 7, Ireland
- School of Nursing, Midwifery and Health Systems, University College Dublin, Dublin, Ireland
| | - M. E. Ward
- School of Nursing, Midwifery and Health Systems, University College Dublin, Dublin, Ireland
| | - A. De Brún
- School of Nursing, Midwifery and Health Systems, University College Dublin, Dublin, Ireland
| | - E. McAuliffe
- School of Nursing, Midwifery and Health Systems, University College Dublin, Dublin, Ireland
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Eddy K, Jordan Z, Stephenson M. Health professionals' experience of teamwork education in acute hospital settings: a systematic review of qualitative literature. ACTA ACUST UNITED AC 2018; 14:96-137. [PMID: 27532314 DOI: 10.11124/jbisrir-2016-1843] [Citation(s) in RCA: 68] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
BACKGROUND Teamwork is seen as an important element of patient care in acute hospital settings. The complexity of the journey of care for patients highlights the need for health professionals to collaborate and communicate clearly with each other. Health organizations in western countries are committed to improving patient safety through education of staff and teamwork education programs have been integral to this focus. There are no current systematic reviews of the experience of health professionals who participate in teamwork education in acute hospital settings. OBJECTIVES The objective of this systematic review was to search for the best available evidence on the experiences of health professionals who participate in teamwork education in acute hospital settings. INCLUSION CRITERIA TYPES OF PARTICIPANTS This review considered studies reporting on experiences of registered health professionals who work in acute hospitals. This included medical, nursing and midwifery and allied health professionals. PHENOMENA OF INTEREST The focus of the meta-synthesis was the experiences and reflections of health professionals who were involved in teamwork education in acute hospital settings. CONTEXT The geographical context for this review was acute hospitals in rural or metropolitan settings in Australia and overseas countries. The review focused on the experiences of health professionals who work in acute hospitals and participated in teamwork education programs. TYPES OF STUDIES This review considered studies that focused on qualitative data including, but not limited to, designs such as phenomenology, grounded theory, ethnography, action research and feminist research.In the absence of research studies, other text such as opinion papers, discussion papers and reports were considered. Studies published in English and from 1990 to 2013 were included in this review. SEARCH STRATEGY The literature search for relevant papers occurred between 13 September and 26 October 2013. A three-step search strategy was utilized in this review. The databases searched were PubMed, CINAHL, Embase and Scopus. METHODOLOGICAL QUALITY The standardized critical appraisal tool the Joanna Briggs Institute Qualitative Assessment and Review Instrument (JBI-QARI) was used to assess the methodological quality of included papers. DATA EXTRACTION Data that included statements and text of interest was extracted from papers included in the study using the standardized data extraction tool from JBI-QARI. DATA SYNTHESIS Qualitative research findings were pooled using JBI-QARI. This involved the aggregation and synthesis of findings to generate a set of statements that represented that aggregation. RESULTS In total, 116 papers were selected for analysis of full text, 11 papers were selected for critical appraisal and seven papers were selected for data synthesis. This resulted in 44 findings. The findings were assigned to 16 categories based on identified similarities across the papers. The categories were integrated into six meta-syntheses. These were: Meta-synthesis One: It is important to recognize that organizational culture and expectations have an impact on health professionals' participation and experience of teamwork education. Meta-synthesis Two: Understanding how successful teams function is central to the development of teamwork education programs and the experience of participants. Meta-synthesis Three: A health professional's experience of teamwork education will be influenced by his/her starting point of learning. Meta-synthesis Four: Participants highly value teamwork education programs that are implemented by facilitators who create practical authentic learning opportunities and foster reflection and debriefing for participants. Meta-synthesis Five: High fidelity simulation used with specific communication strategies provides a powerful learning opportunity for health professions to practice teamwork skills. Meta-synthesis Six: Participants have increased confidence and are motivated to apply their newly learnt teamwork skills into their daily practice. CONCLUSIONS The review identified qualitative evidence that can guide organizations and education facilitators in the development and implementation of teamwork education in acute hospital settings. Although the quality of the specific teamwork education programs was an important factor, there were a number of issues that also impacted on the experiences of health professionals who participated in teamwork education programs. These included the context that the program was delivered in, the diversity of health care teams, starting points of individual learners, the type of tools utilized in education programs, the levels of confidence and motivation of learners post training and the opportunity to transfer into practice new learning. IMPLICATIONS FOR PRACTICE Drawing from the synthesized findings of the review, recommendations for practice have been devised in order to guide the development and implementation of teamwork education in acute hospital settings and to improve the experience of participating health professionals. The Joanna Briggs Institute utilizes Grades of Recommendation to rate a health management strategy in terms of its desirable effects, evidence of adequate quality supporting its use, benefits of use, and the inclusion of patient experience, values and preferences. A strong recommendation has a Grade A and a weak recommendation has a Grade B. The FAME (Feasibility, Appropriateness, Meaningfulness and Effectiveness) scale was used to inform the strength of the following six recommendations for practice from the review: RECOMMENDATION ONE: All members of a team should be encouraged by their organization/managers to participate in teamwork education programs in order to foster a positive culture of learning and teamwork within the team.JBI Recommendation: Grade A. This recommendation is appropriate and applicable to all health professionals in acute hospital settings, is associated with positive experiences for participants of teamwork education programs and has a beneficial effect on participants. RECOMMENDATION TWO Facilitators of teamwork education programs should understand how successful teams function and consider these factors when planning or delivering training.JBI Recommendation: Grade A. This recommendation is associated with positive experiences for participants and creates a beneficial effect to the quality of a teamwork education program. RECOMMENDATION THREE Facilitators of teamwork education programs need to explore participant learning needs and their prior experiences of working in teams before implementing teamwork education programs.JBI Recommendation: Grade A. This recommendation creates a beneficial effect to the participants of teamwork education programs and to the quality of education provided by facilitators. RECOMMENDATION FOUR Facilitators of teamwork education programs should provide learning opportunities that are practical, authentic to participants and foster constructive debriefing and reflection.JBI Recommendation: Grade A. This recommendation is applicable to all health professionals and circumstances in which teamwork education occurs, is associated with positive experiences and has a beneficial effect on participants. RECOMMENDATION FIVE High fidelity simulation should be considered in acute hospitals for the training of teamwork skills in addition to clinical skills. Scenarios provide realistic opportunities for participants to practice communication strategies that enhance teamwork.JBI Recommendation: Grade A. This recommendation is applicable to all health professionals and circumstances in which teamwork education occurs and has a beneficial effect on participants of education programs. RECOMMENDATION SIX Team managers should harness the new confidence and motivation of staff around teamwork skills following participation in teamwork education programs and ensure that there are opportunities in the workplace to apply new skills and knowledge into daily practice.JBI Recommendation: Grade A. This recommendation is applicable to all health professionals and circumstances in which teamwork education occurs, is adaptable to a variety of circumstances and has a beneficial effect on health professional's daily practice of teamwork skills. IMPLICATIONS FOR RESEARCH In order to strengthen the evidence base about teamwork education in acute hospital settings there needs to be quantitative and qualitative research into:How organizations that have successfully embedded a culture of collaboration and safety in health teams have planned, implemented and evaluated teamwork education programs in acute hospital settings?What are the characteristics of teams that have led to successful participation in teamwork education and positive outcomes for team performance?What are the experiences, training and support provided to education facilitators who successfully implement teamwork education programs in acute hospitals?
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Affiliation(s)
- Kylie Eddy
- Joanna Briggs Institute, Faculty of Health Sciences, University of Adelaide, South Australia, Australia
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Banke-Thomas A, Wilson-Jones M, Madaj B, van den Broek N. Economic evaluation of emergency obstetric care training: a systematic review. BMC Pregnancy Childbirth 2017; 17:403. [PMID: 29202731 PMCID: PMC5716021 DOI: 10.1186/s12884-017-1586-z] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2017] [Accepted: 11/20/2017] [Indexed: 12/20/2022] Open
Abstract
Background Training healthcare providers in Emergency Obstetric Care (EmOC) has been shown to be effective in improving their capacity to provide this critical care package for mothers and babies. However, little is known about the costs and cost-effectiveness of such training. Understanding costs and cost-effectiveness is essential in guaranteeing value-for-money in healthcare spending. This study systematically reviewed the available literature on cost and cost-effectiveness of EmOC trainings. Methods Peer-reviewed and grey literature was searched for relevant papers published after 1990. Studies were included if they described an economic evaluation of EmOC training and the training cost data were available. Two reviewers independently searched, screened, and selected studies that met the inclusion criteria, with disagreements resolved by a third reviewer. Quality of studies was assessed using the Consolidated Health Economic Evaluation Reporting Standards statement. For comparability, all costs in local currency were converted to International dollar (I$) equivalents using purchasing power parity conversion factors. The cost per training per participant was calculated. Narrative synthesis was used to summarise the available evidence on cost effectiveness. Results Fourteen studies (five full and nine partial economic evaluations) met the inclusion criteria. All five and two of the nine partial economic evaluations were of high quality. The majority of studies (13/14) were from low- and middle-income countries. Training equipment, per diems and resource person allowance were the most expensive components. Cost of training per person per day ranged from I$33 to I$90 when accommodation was required and from I$5 to I$21 when training was facility-based. Cost-effectiveness of training was assessed in 5 studies with differing measures of effectiveness (knowledge, skills, procedure cost and lives saved) making comparison difficult. Conclusions Economic evaluations of EmOC training are limited. There is a need to scale-up and standardise processes that capture both cost and effectiveness of training and to agree on suitable economic evaluation models that allow for comparability across settings. Trial registration PROSPERO_CRD42016041911. Electronic supplementary material The online version of this article (10.1186/s12884-017-1586-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Aduragbemi Banke-Thomas
- Centre for Maternal and Newborn Health, Liverpool School of Tropical Medicine, L3 5QA, Liverpool, UK
| | - Megan Wilson-Jones
- Centre for Maternal and Newborn Health, Liverpool School of Tropical Medicine, L3 5QA, Liverpool, UK
| | - Barbara Madaj
- Centre for Maternal and Newborn Health, Liverpool School of Tropical Medicine, L3 5QA, Liverpool, UK
| | - Nynke van den Broek
- Centre for Maternal and Newborn Health, Liverpool School of Tropical Medicine, L3 5QA, Liverpool, UK.
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McLelland G, Perera C, Morphet J, McKenna L, Hall H, Williams B, Cant R, Stow J. Interprofessional simulation of birth in a non-maternity setting for pre-professional students. NURSE EDUCATION TODAY 2017; 58:25-31. [PMID: 28823781 DOI: 10.1016/j.nedt.2017.07.016] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/02/2016] [Revised: 06/27/2017] [Accepted: 07/30/2017] [Indexed: 06/07/2023]
Abstract
BACKGROUND Simulation-based learning is an approach recommended for teaching undergraduate health professionals. There is a scarcity of research around interprofessional simulation training for pre-professional students in obstetric emergencies that occur prior to arrival at the maternity ward. OBJECTIVES The primary aims of the study were to examine whether an interprofessional team-based simulated birth scenario would improve undergraduate paramedic, nursing, and midwifery students' self-efficacy scores and clinical knowledge when managing birth in an unplanned location. The secondary aim was to assess students' satisfaction with the newly developed interprofessional simulation. DESIGN Quasi-experimental descriptive study with repeated measures. SETTING Simulated hospital emergency department. PARTICIPANTS Final year undergraduate paramedic, nursing, and midwifery students. METHODS Interprofessional teams of five students managed a simulated unplanned vaginal birth, followed by debriefing. Students completed a satisfaction with simulation survey. Serial surveys of clinical knowledge and self-efficacy were conducted at three time points. RESULTS Twenty-four students participated in one of five simulation scenarios. Overall, students' self-efficacy and confidence in ability to achieve a successful birth outcome was significantly improved at one month (p<0.001) with a magnitude of increase (effect) of 40% (r=0.71) and remained so after a further three months. Clinical knowledge was significantly increased in only one of three student groups: nursing (p=0.04; r=0.311). Students' satisfaction with the simulation experience was high (M=4.65/5). CONCLUSIONS Results from this study indicate that an interprofessional simulation of a birth in an unplanned setting can improve undergraduate paramedic, nursing and midwifery students' confidence working in an interprofessional team. There was a significant improvement in clinical knowledge of the nursing students (who had least content about managing birth in their program). All students were highly satisfied with the interprofessional simulation experience simulation.
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Affiliation(s)
- Gayle McLelland
- School of Nursing and Midwifery, Monash University, PO Box 527, Frankston, Victoria 3199, Australia.
| | - Chantal Perera
- Faculty of Science Health and Engineering, School of Nursing, Midwifery and Paramedicine, University of Sunshine Coast, Sippy Downs, Queensland 4556, Australia.
| | - Julia Morphet
- School of Nursing and Midwifery, Monash University, PO Box 527, Frankston, Victoria 3199, Australia.
| | - Lisa McKenna
- Nursing and Midwifery, George Singer Building room 317, College of Science Health and Engineering, La Trobe University, Bundoora, VIC 3086, Australia; School of Nursing and Midwifery, University of Queensland, Australia.
| | - Helen Hall
- School of Nursing and Midwifery, Monash University, PO Box 527, Frankston, Victoria 3199, Australia.
| | - Brett Williams
- Department of Community Emergency Health and Paramedic Practice, Monash University, PO BOX 527, Frankston, Victoria 3199, Australia.
| | - Robyn Cant
- School of Nursing and Midwifery, Monash University, Building 903, Clyde Road, Berwick, Victoria 3806, Australia.
| | - Jill Stow
- School of Nursing and Midwifery, Monash University, PO Box 527, Frankston, Victoria 3199, Australia.
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Kent F, Nankervis K, Johnson C, Hodgkinson M, Baulch J, Haines T. 'More effort and more time.' Considerations in the establishment of interprofessional education programs in the workplace. J Interprof Care 2017; 32:89-94. [PMID: 29083262 DOI: 10.1080/13561820.2017.1381076] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
The argument for integrating interprofessional education (IPE) activities into the workplace has been made concurrently with the call for collaborative clinical practice. An exploratory case study investigation of existing activities in a large metropolitan health care network was undertaken to inform the development of future IPE initiatives. Purposive sampling invited clinicians involved in the design or delivery of workplace IPE activities to participate in a semi-structured interview to discuss their existing programs and the opportunities and challenges facing future work. Interviews were audiotaped, transcribed and thematically analysed. In total, 15 clinicians were interviewed representing medicine, nursing, occupational therapy, pharmacy, physiotherapy, psychology, social work and speech pathology. The IPE programs identified included one medical and midwifery student workshop, several dedicated new graduate or intern programs combining the professions and multiple continuing professional development programs. Three dominant themes were identified to inform the development of future work: clinician factors, organisational factors and IPE considerations. In addition to the cultural, physical and logistical challenges associated with education that integrates professions in the workplace, the time required for the design and delivery of integrated team training should be accounted for when establishing such programs. Considerations for sustainability include ongoing investment in education skills for clinicians, establishment of dedicated education roles and expansion of existing education activities.
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Affiliation(s)
- Fiona Kent
- a WISER Unit, Monash Health and Faculty Medicine, Nursing Health Sciences , Monash University , Melbourne , Australia
| | - Katrina Nankervis
- b Nursing and Midwifery Education and Strategy , Monash Health , Melbourne , Australia
| | - Christina Johnson
- c Monash Doctors Education and General Medicine, Monash Health and Faculty Medicine, Nursing Health Sciences , Monash Health , Melbourne , Australia
| | | | - Julie Baulch
- e School of Clinical Sciences, Monash Health and Faculty Medicine, Nursing Health Sciences , Monash University , Melbourne , Australia
| | - Terry Haines
- f Allied Health Research Unit, Monash Health and School of Primary and Allied Health , Monash University , Melbourne , Australia
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Carolan-Olah M, Kruger G, Brown V, Lawton F, Mazzarino M, Vasilevski V. Communicating out loud: Midwifery students' experiences of a simulation exercise for neonatal resuscitation. Nurse Educ Pract 2017; 29:8-14. [PMID: 29144999 DOI: 10.1016/j.nepr.2017.10.027] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2017] [Revised: 09/27/2017] [Accepted: 10/21/2017] [Indexed: 11/16/2022]
Abstract
Midwifery students feel unprepared to deal with commonly encountered emergencies, such as neonatal resuscitation. Clinical simulation of emergencies may provide a safe forum for students to develop necessary skills. A simulation exercise, for neonatal resuscitation, was developed and evaluated using qualitative methods. Pre and post-simulation questions focussed on student confidence and knowledge of resuscitation. Data were analysed using a thematic analysis approach. Pre-simulation questions revealed that most students considered themselves not very confident/unsure about their level of confidence in undertaking neonatal resuscitation. Most correctly identified features of the neonate requiring resuscitation. Post-simulation, students indicated that their confidence and knowledge of neonatal resuscitation had improved. Themes included: gaining confidence; understanding when to call for help; understanding the principles of resuscitation; tailoring simulation/education approaches to student needs. Students benefits included improved knowledge, confidence and skills. Participants unanimously suggested a program of simulation exercises, over a longer period of time, to reinforce knowledge and confidence gains. Ideally, students would like to actively participate in the simulation, rather than observe.
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Affiliation(s)
- Mary Carolan-Olah
- College of Health and Biomedicine, St Alban's Campus, Victoria University, PO Box 14228, Melbourne 8001, Australia.
| | - Gina Kruger
- College of Health and Biomedicine, St Alban's Campus, Victoria University, PO Box 14228, Melbourne 8001, Australia.
| | - Vera Brown
- College of Health and Biomedicine, St Alban's Campus, Victoria University, PO Box 14228, Melbourne 8001, Australia.
| | - Felicity Lawton
- College of Health and Biomedicine, St Alban's Campus, Victoria University, PO Box 14228, Melbourne 8001, Australia.
| | - Melissa Mazzarino
- College of Health and Biomedicine, St Alban's Campus, Victoria University, PO Box 14228, Melbourne 8001, Australia.
| | - Vidanka Vasilevski
- College of Health and Biomedicine, St Alban's Campus, Victoria University, PO Box 14228, Melbourne 8001, Australia.
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Oseni Z, Than HH, Kolakowska E, Chalmers L, Hanboonkunupakarn B, McGready R. Video-based feedback as a method for training rural healthcare workers to manage medical emergencies: a pilot study. BMC MEDICAL EDUCATION 2017; 17:149. [PMID: 28859651 PMCID: PMC5580284 DOI: 10.1186/s12909-017-0975-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/07/2016] [Accepted: 08/07/2017] [Indexed: 05/21/2023]
Abstract
BACKGROUND Video-based feedback has been shown to aid knowledge retention, skills learning and improve team functionality. We explored the use of video-based feedback and low fidelity simulation for training rural healthcare workers along the Thailand-Myanmar border and Papua New Guinea (PNG) to manage medical emergencies effectively. METHODS Twenty-four study participants were recruited from three Shoklo Malaria Research Unit clinics along the Thailand-Myanmar border and eight participants from Kudjip Nazarene Hospital, PNG. The teams were recorded on video managing a simulated medical emergency scenario and the video was used to aid feedback and assess performance using Observed Structured Clinical Examination (OSCE) scoring and Team Emergency Assessment Measure (TEAM) questionnaire. The process was repeated post-feedback at both sites and at 6 weeks at the Thailand-Myanmar border site. Thailand-Myanmar border participants' individual confidence levels and baseline knowledge (using OSCE scoring) were assessed before team assessment and feedback at week 1 and repeated post-feedback and at 6 weeks. Focus group discussions (FGD) were held at each Thailand-Myanmar border clinic at week 1 (8 participants at each clinic). RESULTS Individual paired tests of OSCE scores showed significant improvement post-feedback at week 1 (p < 0.001) and week 6 (p < 0.001) compared to baseline OSCE scores. There was a trend for increased team OSCE scores compared to baseline at week 1 (p = 0.068) and week 6 (p = 0.109) although not significant. Thailand-Myanmar border TEAM scores demonstrated improvement post-feedback mainly in leadership, teamwork and task management which was sustained up to week 6. PNG showed an improvement mainly in teamwork and task management. The global rating of the teams' non-technical performance at both sites improved post feedback and at week 6 on the Thailand-Myanmar border site. Self-rated confidence scores by Thailand-Myanmar border participants increased significantly from baseline following training at week 1 (p = 0.020), and while higher at 6 weeks follow up than at baseline, this was not significant (p = 0.471). The FGD revealed majority of participants felt that watching the video recording of their performance and the video-based feedback contributed most to their learning. CONCLUSION Video-assisted feedback resulted in an improvement in clinical knowledge, confidence and quality of teamwork for managing medical emergencies in two low resource medical facilities in South East Asia and the South Pacific.
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Affiliation(s)
- Zainab Oseni
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, 63110 Thailand
| | - Hla Hla Than
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, 63110 Thailand
| | - Edyta Kolakowska
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, 63110 Thailand
| | - Lauren Chalmers
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, 63110 Thailand
| | - Borimas Hanboonkunupakarn
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, 10400 Thailand
| | - Rose McGready
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, 63110 Thailand
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, OX3 7FZ UK
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Affiliation(s)
- Louise Yuill
- Midwifery lecturer/simulation lead, University of Salford
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Farrar Highfield ME, Scharf-Swaller C, Chu L. Effect of Nurse-Led Review Plus Simulation on Obstetric/Perinatal Nurses' Self-Assessed Knowledge and Confidence. Nurs Womens Health 2016; 20:568-581. [PMID: 27938797 DOI: 10.1016/j.nwh.2016.10.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2016] [Revised: 07/18/2016] [Indexed: 11/25/2022]
Abstract
Simulation may help both novice and experienced clinicians maintain competence in managing high-risk, low-frequency obstetric and perinatal complications and emergencies. Therefore, we designed a pre-/posttest study to determine whether a day of nurse-led lecture plus low-fidelity simulation would increase registered nurses' self-assessed knowledge and confidence in managing five high-risk obstetric/perinatal situations. The Nursing Management of OB/Perinatal Complications & Emergencies (NursOB) scale was distributed to 67 labor/birth and postpartum nurses before and after a simulation training day. Preliminary findings supported validity and reliability of the NursOB scale, but nurses' knowledge and confidence did not improve after the simulation (p < .05). Anecdotally, nurses' interest in competence reviews was reinvigorated, and we gained practical knowledge in simulation delivery. Future simulations could enhance outcome measures, improve drills, and establish criterion-related validity of the NursOB scale. More research is warranted.
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Hart PL, Spiva L, Dolly L, Lang-Coleman K, Prince-Williams N. Medical-surgical nurses' experiences as first responders during deterioration events: a qualitative study. J Clin Nurs 2016; 25:3241-3251. [PMID: 27523817 DOI: 10.1111/jocn.13357] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/27/2016] [Indexed: 11/27/2022]
Abstract
AIM AND OBJECTIVE To explore and understand the experiences of medical-surgical nurses as first responders during clinical deterioration events. BACKGROUND Nurses are key players in identifying and responding to deterioration events to escalate the level of care essential to address specific needs of patients. Delays in recognising signs and symptoms of patient deterioration and activation of Rapid Response Teams have been linked to a lack of nontechnical skills (leadership, teamwork, situational awareness) resulting in increased patient morbidity and mortality. DESIGN A descriptive, qualitative approach was used. METHODS A purposive sample of 28 medical-surgical nurses was recruited and interviewed from an integrated healthcare system located in the USA. Interviews were conducted from October 2014-February 2015. Interviews were audio recorded and transcribed verbatim. Transcripts were entered into MaxQDA. The constant comparative method was used for data analysis. RESULTS Three patterns emerged from the data analysis: Recognising and Responding to the Event, Managing the Event and Challenges Encountered during the Event. From the patterns, seven themes emerged. Themes for pattern one, Recognising and Responding, were early warning signs, continuity in patient care assignments and intuition. Themes for pattern two, Managing the Event, were cognitive, technical and behavioural skills. The theme for pattern three, Challenges Encountered during the Event, was work environment complexity. CONCLUSION Listening to the stories of medical-surgical nurses provided insight into how they recognised and managed patients experiencing clinical deterioration events. Furthermore, insight into the challenges that medical-surgical nurses encountered in caring for deteriorating patients were identified. RELEVANCE TO CLINICAL PRACTICE Implication for practice in the areas of continuity of patient assignments, formal clinical deterioration education, work environment and team collaboration and communication was presented.
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Affiliation(s)
- Patricia L Hart
- WellStar School of Nursing, Kennesaw State University, Kennesaw, GA, USA.
| | | | - Lonnie Dolly
- WellStar Kennestone Regional Medical Center, Marietta, GA, USA
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Abstract
The purposes of this study were to describe changes in perinatal nurse (n = 70) and physician (n = 88) perceptions of teamwork and safety climate after implementing a 6-month Crew Resource Management training program and compare responses between nurses and physicians. The Teamwork and Safety Climate Survey was administered prior to and 1 year after the intervention. There were significant improvements in nurse and physician perceptions of teamwork and safety climate; however, physicians perceived teamwork more positive than nurses.
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Reeves S. Why we need interprofessional education to improve the delivery of safe and effective care. INTERFACE-COMUNICACAO SAUDE EDUCACAO 2016. [DOI: 10.1590/1807-57622014.0092] [Citation(s) in RCA: 62] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Interprofessional education (IPE) is an activity that involves two or more professions who learn interactively together to improve collaboration and the quality of care. Research has continually revealed that health and social care professionals encounter a range of problems with interprofessional coordination and collaboration which impact on the quality and safety of care. This empirical work resulted in policymakers across health care education and practice to invest in IPE to help resolve this collaborative failures. It is anticipated that IPE will provide health and social care professionals with the abilities required to work together effectively in providing safe high quality care to patients. Through a discussion of a range of key professional, educational and organization issues related to IPE, this paper argues that this form of education is an important strategy to improve the delivery of safe and effective care
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Affiliation(s)
- Scott Reeves
- Kingston University & St George’s, United Kingdom
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Carolan-Olah M, Kruger G, Brown V, Lawton F, Mazzarino M. Development and evaluation of a simulation exercise to prepare midwifery students for neonatal resuscitation. NURSE EDUCATION TODAY 2016; 36:375-380. [PMID: 26521034 DOI: 10.1016/j.nedt.2015.09.009] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/23/2015] [Revised: 09/11/2015] [Accepted: 09/17/2015] [Indexed: 06/05/2023]
Abstract
BACKGROUND Simulation provides opportunities for midwifery students to enhance their performance in emergency situations. Neonatal resuscitation is one such emergency and its management is a major concern for midwifery students. OBJECTIVES This project aimed to develop and evaluate a simulation exercise, for neonatal resuscitation, for 3rd year midwifery students. DESIGN A quantitative survey design was employed using questions from two previously validated questionnaires: (1.) Student Satisfaction and Self-Confidence in Learning and (2.) the Clinical Teamwork Scale (CTS). SETTING Australian university. PARTICIPANTS 40 final year midwifery students were invited to participate and 36 agreed to take part in the project. RESULTS In pre-simulation questionnaires, students reported low levels of confidence in initiating care of an infant requiring resuscitation. Most anticipated that the simulation exercise would be useful to better prepare them respond to a neonatal emergency. Post-simulation questionnaires reported an increase in student confidence, with 30 of 36 students agreeing/ strongly agreeing that their confidence levels had improved. Nonetheless, an unexpected number of students reported a lack of familiarity with the equipment. CONCLUSIONS The single simulation exercise evaluated in this project resulted in improved student confidence and greater knowledge and skills in neonatal resuscitation. However, deficits in handling emergency equipment, and in understanding the role of the student midwife/midwife in neonatal resuscitation, were also noted. For the future, the development and evaluation of a programme of simulation exercises, over a longer period, is warranted. This approach may reduce stress and better address student learning needs.
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Affiliation(s)
- Mary Carolan-Olah
- Centre for Health and Chronic Disease, College of Health and Biomedicine, St Alban's Campus, Victoria University, PO Box 14228, Melbourne 8001, Australia.
| | - Gina Kruger
- Centre for Health and Chronic Disease, College of Health and Biomedicine, St Alban's Campus, Victoria University, PO Box 14228, Melbourne 8001, Australia.
| | - Vera Brown
- Centre for Health and Chronic Disease, College of Health and Biomedicine, St Alban's Campus, Victoria University, PO Box 14228, Melbourne 8001, Australia.
| | - Felicity Lawton
- Centre for Health and Chronic Disease, College of Health and Biomedicine, St Alban's Campus, Victoria University, PO Box 14228, Melbourne 8001, Australia.
| | - Melissa Mazzarino
- Centre for Health and Chronic Disease, College of Health and Biomedicine, St Alban's Campus, Victoria University, PO Box 14228, Melbourne 8001, Australia.
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Vermeulen J, Beeckman K, De Clercq G, Vandelannoote I, Gucciardo L, Laubach M, Swinnen E. Inter-professional Perinatal Simulation training: A valuable educational model to improve competencies amongst student midwives in Brussels, Belgium. Midwifery 2015; 33:49-51. [PMID: 26719196 DOI: 10.1016/j.midw.2015.11.020] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2015] [Revised: 10/31/2015] [Accepted: 11/30/2015] [Indexed: 11/17/2022]
Abstract
Simulation training is a powerful and evidence-based teaching method for students and healthcare professionals. The described educational model of Inter-professional Perinatal Simulation training is the result of a collaborative project with the Erasmus University College Brussels, the Medical School of the Vrije Universiteit Brussel (VUB) and the University Hospital Brussels. This model enhances student midwives to acquire competencies in all fields of midwifery according to national and European legislation and to the International Confederation of Midwives Global Standards for Midwifery Education. In our educational program, simulation training enhanced the achievement of decision-making and inter-professional communication competences.
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Affiliation(s)
- Joeri Vermeulen
- Erasmus University College Brussels, Department Health Care, Knowledge Centre Brussels Integrated Care, Midwifery Section, Belgium.
| | - Katrien Beeckman
- Erasmus University College Brussels, Department Health Care, Knowledge Centre Brussels Integrated Care, Midwifery Section, Belgium; University Hospital Brussels, Vrije Universiteit Brussel, Department of Obstetrics and Prenatal Medicine, Belgium; Vrije Universiteit Brussel (VUB), Nursing and Midwifery Research Unit, Faculty of Medicine and Pharmacy & Universitair Ziekenhuis Brussel, Belgium
| | - Gerlinde De Clercq
- Erasmus University College Brussels, Department Health Care, Knowledge Centre Brussels Integrated Care, Midwifery Section, Belgium
| | - Isabelle Vandelannoote
- Erasmus University College Brussels, Department Health Care, Knowledge Centre Brussels Integrated Care, Midwifery Section, Belgium
| | - Léonardo Gucciardo
- Vrije Universiteit Brussel (VUB), Faculty of Medicine and Pharmacy, Belgium; University Hospital Brussels, Vrije Universiteit Brussel, Department of Obstetrics and Prenatal Medicine, Belgium
| | - Monika Laubach
- Vrije Universiteit Brussel (VUB), Faculty of Medicine and Pharmacy, Belgium; University Hospital Brussels, Vrije Universiteit Brussel, Department of Obstetrics and Prenatal Medicine, Belgium
| | - Eva Swinnen
- Erasmus University College Brussels, Department Health Care, Knowledge Centre Brussels Integrated Care, Midwifery Section, Belgium; Vrije Universiteit Brussel (VUB), Faculty of Physical Education and Physiotherapy, Rehabilitation Research, Belgium
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Abstract
A longitudinal, repeated-measures design with intervention and comparison groups was used to evaluate the effect of a training curriculum based on TeamSTEPPS with video vignettes focusing on fall prevention. Questionnaires, behavioral observations, and fall data were collected over 9 months from both groups located at separate hospitals. The intervention group questionnaire scores improved on all measures except teamwork perception, while observations revealed an improvement in communication compared with the control group. Furthermore, a 60% fall reduction rate was reported in the intervention group. Team training may be a promising intervention to reduce falls.
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The role of simulation in continuing medical education for acute care physicians: a systematic review. Crit Care Med 2015; 43:186-93. [PMID: 25343571 DOI: 10.1097/ccm.0000000000000672] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
OBJECTIVES We systematically reviewed the effectiveness of simulation-based education, targeting independently practicing qualified physicians in acute care specialties. We also describe how simulation is used for performance assessment in this population. DATA SOURCES Data source included: DataMEDLINE, Embase, Cochrane Database of Systematic Reviews, Cochrane CENTRAL Database of Controlled Trials, and National Health Service Economic Evaluation Database. The last date of search was January 31, 2013. STUDY SELECTION All original research describing simulation-based education for independently practicing physicians in anesthesiology, critical care, and emergency medicine was reviewed. DATA EXTRACTION Data analysis was performed in duplicate with further review by a third author in cases of disagreement until consensus was reached. Data extraction was focused on effectiveness according to Kirkpatrick's model. For simulation-based performance assessment, tool characteristics and sources of validity evidence were also collated. DATA SYNTHESIS Of 39 studies identified, 30 studies focused on the effectiveness of simulation-based education and nine studies evaluated the validity of simulation-based assessment. Thirteen studies (30%) targeted the lower levels of Kirkpatrick's hierarchy with reliance on self-reporting. Simulation was unanimously described as a positive learning experience with perceived impact on clinical practice. Of the 17 remaining studies, 10 used a single group or "no intervention comparison group" design. The majority (n = 17; 44%) were able to demonstrate both immediate and sustained improvements in educational outcomes. Nine studies reported the psychometric properties of simulation-based performance assessment as their sole objective. These predominantly recruited independent practitioners as a convenience sample to establish whether the tool could discriminate between experienced and inexperienced operators and concentrated on a single aspect of validity evidence. CONCLUSIONS Simulation is perceived as a positive learning experience with limited evidence to support improved learning. Future research should focus on the optimal modality and frequency of exposure, quality of assessment tools and on the impact of simulation-based education beyond the individuals toward improved patient care.
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Interprofessional simulation to improve safety in the epilepsy monitoring unit. Epilepsy Behav 2015; 45:229-33. [PMID: 25812939 DOI: 10.1016/j.yebeh.2015.01.018] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2014] [Revised: 12/18/2014] [Accepted: 01/13/2015] [Indexed: 11/21/2022]
Abstract
OBJECTIVE Patient safety is critical for epilepsy monitoring units (EMUs). Effective training is important for educating all personnel, including residents and nurses who frequently cover these units. We performed a needs assessment and developed a simulation-based team training curriculum employing actual EMU sentinel events to train neurology resident-nurse interprofessional teams to maximize effective responses to high-acuity events. METHODS A mixed-methods design was used. This included the development of a safe-practice checklist to assess team response to acute events in the EMU using expert review with consensus (a modified Delphi process). All nineteen incoming first-year neurology residents and 2 nurses completed a questionnaire assessing baseline knowledge and attitudes regarding seizure management prior to and following a team training program employing simulation and postscenario debriefing. Four resident-nurse teams were recorded while participating in two simulated scenarios. Employing retrospective video review, four trained raters used the newly developed safe-practice checklist to assess team performance. We calculated the interobserver reliability of the checklist for consistency among the raters. We attempted to ascertain whether the training led to improvement in performance in the actual EMU by comparing 10 videos of resident-nurse team responses to seizures 4-8months into the academic year preceding the curricular training to 10 that included those who received the training within 4-8months of the captured video. RESULTS Knowledge in seizure management was significantly improved following the program, but confidence in seizure management was not. Interrater agreement was moderate to high for consistency of raters for the majority of individual checklist items. We were unable to demonstrate that the training led to sustainable improvement in performance in the actual EMU by the method we used. CONCLUSIONS A simulated team training curriculum using a safe-practice checklist to improve the management of acute events in an EMU may be an effective method of training neurology residents. However, translating the results into sustainable benefits and confidence in management in the EMU requires further study.
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Wenk M, Pöpping DM. Simulation for anesthesia in obstetrics. Best Pract Res Clin Anaesthesiol 2015; 29:81-6. [DOI: 10.1016/j.bpa.2015.01.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2015] [Accepted: 01/28/2015] [Indexed: 11/25/2022]
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Liu CW, Sng BL, Farida I. Obstetric anesthesia training: Facilitating teaching and learning. TRENDS IN ANAESTHESIA AND CRITICAL CARE 2015. [DOI: 10.1016/j.tacc.2014.11.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Rosenman ED, Shandro JR, Ilgen JS, Harper AL, Fernandez R. Leadership training in health care action teams: a systematic review. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2014; 89:1295-306. [PMID: 25006708 DOI: 10.1097/acm.0000000000000413] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
PURPOSE To identify and describe the design, implementation, and evidence of effectiveness of leadership training interventions for health care action (HCA) teams, defined as interdisciplinary teams whose members coordinate their actions in time-pressured, unstable situations. METHOD The authors conducted a systematic search of the PubMed/MEDLINE, CINAHL, ERIC, EMBASE, PsycINFO, and Web of Science databases, key journals, and review articles published through March 2012. They identified peer-reviewed English-language articles describing leadership training interventions targeting HCA teams, at all levels of training and across all health care professions. Reviewers, working in duplicate, abstracted training characteristics and outcome data. Methodological quality was evaluated using the Medical Education Research Study Quality Instrument (MERSQI). RESULTS Of the 52 included studies, 5 (10%) focused primarily on leadership training, whereas the remainder included leadership training as part of a larger teamwork curriculum. Few studies reported using a team leadership model (2; 4%) or a theoretical framework (9; 17%) to support their curricular design. Only 15 studies (29%) specified the leadership behaviors targeted by training. Forty-five studies (87%) reported an assessment component; of those, 31 (69%) provided objective outcome measures including assessment of knowledge or skills (21; 47%), behavior change (8; 18%), and patient- or system-level metrics (8; 18%). The mean MERSQI score was 11.4 (SD 2.9). CONCLUSIONS Leadership training targeting HCA teams has become more prevalent. Determining best practices in leadership training is confounded by variability in leadership definitions, absence of supporting frameworks, and a paucity of robust assessments.
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Affiliation(s)
- Elizabeth D Rosenman
- Dr. Rosenman is acting instructor, Division of Emergency Medicine, University of Washington School of Medicine, Seattle, Washington. Dr. Shandro is associate professor, Division of Emergency Medicine, University of Washington School of Medicine, Seattle, Washington. Dr. Ilgen is assistant professor, Division of Emergency Medicine, University of Washington School of Medicine, Seattle, Washington. Ms. Harper is associate librarian, Health Sciences Library, University of Washington Library Services, Seattle, Washington. Dr. Fernandez is associate professor, Division of Emergency Medicine, University of Washington School of Medicine, Seattle, Washington
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Doyle J, Newhouse L, Flora R, Burkett A. Planning a collaborative conference to provide interdisciplinary education with a focus on patient safety in obstetrics. Nurs Womens Health 2014; 18:130-6. [PMID: 24750652 DOI: 10.1111/1751-486x.12109] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Collaboration is an important component of evidence-based practice in modern health care. A number of publications have touted the benefits of "team training" to improve obstetric outcomes during emergent situations. In August 2011, the Ohio sections of the Association of Women's Health, Obstetric and Neonatal Nurses (AWHONN) and the American Congress of Obstetricians and Gynecologists (ACOG) held a joint conference that focused on interdisciplinary education to promote patient safety. This joint venture drew more than 120 attendees, 12 exhibitors and 17 poster displays. Evaluations were positive and attendees cited planned practice changes for themselves as well as for their respective institutions.
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Chalwin RP, Flabouris A. Utility and assessment of non-technical skills for rapid response systems and medical emergency teams. Intern Med J 2014; 43:962-9. [PMID: 23611153 DOI: 10.1111/imj.12172] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2013] [Accepted: 04/14/2013] [Indexed: 11/28/2022]
Abstract
Efforts are ongoing to improve outcomes from cardiac arrest and medical emergencies. A promising quality improvement modality is use of non-technical skills (NTS) that aim to address human factors through improvements in performance of leadership, communication, situational awareness and decision-making. Originating in the airline industry, NTS training has been successfully introduced into anaesthesia, surgery, emergency medicine and other acute medical specialities. Some aspects of NTS have already achieved acceptance for cardiac arrest teams. Leadership skills are emphasised in advanced life support training and have shown favourable results when employed in simulated and clinical resuscitation scenarios. The application of NTS in medical emergency teams as part of a rapid response system attending medical emergencies is less certain; however, observations of simulations have also shown promise. This review highlights the potential benefits of NTS competency for cardiac arrest teams and, more importantly, medical emergency teams because of the diversity of clinical scenarios encountered. Discussion covers methods to assess and refine NTS and NTS training to optimise performance in the clinical environment. Increasing attention should be applied to yielding meaningful patient and organisational outcomes from use of NTS. Similarly, implementation of any training course should receive appropriate scrutiny to refine team and institutional performance.
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Affiliation(s)
- R P Chalwin
- Intensive Care Unit, Lyell McEwin Hospital, Adelaide, South Australia, Australia.
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Langlois S, Goudreau J, Lalonde L. Scientific rigour and innovations in participatory action research investigating workplace learning in continuing interprofessional education. J Interprof Care 2014; 28:226-31. [PMID: 24559150 DOI: 10.3109/13561820.2014.885003] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
The persistent theory-practice gap shows how challenging it can be for healthcare professionals to keep updating their practices. The continuing education challenges are partly explained by the tremendous stream of new discoveries in health and the epidemic of multi-morbid conditions. Participatory action research (PAR) is used in healthcare as a research approach that capitalizes on people's resources to better understand and enhance their professional practices. PAR thus can consolidate our knowledge on workplace learning in continuing interprofessional education while directly improving quality of care. However, PAR lacks clear scientific criteria to ensure the consistency between the investigators' methodology and philosophy, which jeopardize its credibility. This paper outlines the principles of rigour in PAR and describes the additions of a preliminary planning phase to Kemmis and McTaggart's PAR description as well as the use of the professional co-development group, an action-oriented data collection method. We believe that this will help PAR co-participants achieve improved scientific rigour and encourage more investigators to collaborate through this research approach contributing to the advancement of knowledge on workplace learning in continuing interprofessional education.
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Galbraith A, Harder N, Macomber CA, Roe E, Roethlisberger KS. Design and Implementation of an Interprofessional Death Notification Simulation. Clin Simul Nurs 2014. [DOI: 10.1016/j.ecns.2013.08.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Cooper SJ, Cant RP. Measuring non-technical skills of medical emergency teams: An update on the validity and reliability of the Team Emergency Assessment Measure (TEAM). Resuscitation 2014; 85:31-3. [DOI: 10.1016/j.resuscitation.2013.08.276] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2013] [Revised: 07/25/2013] [Accepted: 08/01/2013] [Indexed: 11/29/2022]
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Wiegers TA, de Borst J. Organisation of emergency transfer in maternity care in the Netherlands. Midwifery 2013; 29:973-80. [DOI: 10.1016/j.midw.2012.12.009] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2011] [Revised: 10/15/2012] [Accepted: 12/17/2012] [Indexed: 11/25/2022]
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Kilday D, Spiva L, Barnett J, Parker C, Hart P. The Effectiveness of Combined Training Modalities on Neonatal Rapid Response Teams. Clin Simul Nurs 2013. [DOI: 10.1016/j.ecns.2012.02.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Smithburger PL, Kane-Gill SL, Kloet MA, Lohr B, Seybert AL. Advancing interprofessional education through the use of high fidelity human patient simulators. Pharm Pract (Granada) 2013; 11:61-5. [PMID: 24155851 PMCID: PMC3798176 DOI: 10.4321/s1886-36552013000200001] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2013] [Accepted: 04/21/2013] [Indexed: 11/11/2022] Open
Abstract
Background Modern medical care increasingly requires coordinated teamwork and
communication between healthcare professionals of different disciplines.
Unfortunately, healthcare professional students are rarely afforded the
opportunity to learn effective methods of interprofessional (IP)
communication and teamwork strategies during their education. The question
of how to best incorporate IP interactions in the curricula of the schools
of health professions remains unanswered. Objective We aim to solve the lack of IP education in the pharmacy curricula through
the use of high fidelity simulation (HFS) to allow teams of medical,
pharmacy, nursing, physician assistant, and social work students to work
together in a controlled environment to solve cases of complex medical and
social issues. Methods Once weekly for a 4-week time period, students worked together to complete
complex simulation scenarios in small IP teams consisting of pharmacy,
medical, nursing, social work, and physician assistant students. Student
perception of the use of HFS was evaluated by a survey given at the
conclusion of the HFS sessions. Team communication was evaluated through the
use of Communication and Teamwork Skills (CATS) Assessment by 2 independent
evaluators external to the project. Results The CATS scores improved from the HFS sessions 1 to 2 (p = 0.01), 2 to 3 (p =
0.035), and overall from 1 to 4 (p = 0.001). The inter-rater reliability
between evaluators was high (0.85, 95% CI 0.71, 0.99). Students perceived
the HFS improved: their ability to communicate with other professionals
(median =4); confidence in patient care in an IP team (median=4). It also
stimulated student interest in IP work (median=4.5), and was an efficient
use of student time (median=4.5) Conclusions The use of HFS improved student teamwork and communication and was an
accepted teaching modality. This method of exposing students of the health
sciences to IP care should be incorporated throughout the curricula.
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Affiliation(s)
- Pamela L Smithburger
- Department of Pharmacy and Therapeutics, School of Pharmacy, University of Pittsburgh. Pittsburgh PA ( United States )
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Abstract
Simulation in obstetrics and maternal-fetal medicine is an educational tool that can be employed to address local and national learning objectives for residents and fellows. Simulation may also be incorporated as part of a comprehensive patient safety program to improve maternal and neonatal outcomes. Our objective is to identify steps in designing an effective simulation program, curricula, and scenario using available evidence and drawing on experience. Identification of needs, leadership, and financial and logistic resources is the first step in program design. An appropriate curriculum may be crafted with the intended audience and clear learning objectives in mind. Simulation scenario design is best achieved in a stepwise, layered fashion and must incorporate time for debriefing, feedback, and didactics. Simulation programs of any size, budget, and scope can be successfully implemented at the local, regional, and national levels to enhance education and improve patient safety.
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Affiliation(s)
- Meredith L Birsner
- Division of Maternal-Fetal Medicine, Department of Gynecology and Obstetrics, The Johns Hopkins University School of Medicine, 600 N. Wolfe St, Phipps 228, Baltimore, MD 21287-1228, USA.
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Onishi M, Komi K, Kanda K. Physicians' perceptions of physician–nurse collaboration in Japan: Effects of collaborative experience. J Interprof Care 2012; 27:231-7. [DOI: 10.3109/13561820.2012.736095] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Managing women with acute physiological deterioration: Student midwives performance in a simulated setting. Women Birth 2012; 25:e27-36. [DOI: 10.1016/j.wombi.2011.08.009] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2011] [Revised: 08/22/2011] [Accepted: 08/24/2011] [Indexed: 11/17/2022]
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Vadnais MA, Dodge LE, Awtrey CS, Ricciotti HA, Golen TH, Hacker MR. Assessment of long-term knowledge retention following single-day simulation training for uncommon but critical obstetrical events. J Matern Fetal Neonatal Med 2012; 25:1640-5. [PMID: 22191668 DOI: 10.3109/14767058.2011.648971] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE The objectives were to determine (i) whether simulation training results in short-term and long-term improvement in the management of uncommon but critical obstetrical events and (ii) to determine whether there was additional benefit from annual exposure to the workshop. METHODS Physicians completed a pretest to measure knowledge and confidence in the management of eclampsia, shoulder dystocia, postpartum hemorrhage and vacuum-assisted vaginal delivery. They then attended a simulation workshop and immediately completed a posttest. Residents completed the same posttests 4 and 12 months later, and attending physicians completed the posttest at 12 months. Physicians participated in the same simulation workshop 1 year later and then completed a final posttest. Scores were compared using paired t-tests. RESULTS Physicians demonstrated improved knowledge and comfort immediately after simulation. Residents maintained this improvement at 1 year. Attending physicians remained more comfortable managing these scenarios up to 1 year later; however, knowledge retention diminished with time. Repeating the simulation after 1 year brought additional improvement to physicians. CONCLUSION Simulation training can result in short-term and contribute to long-term improvement in objective measures of knowledge and comfort level in managing uncommon but critical obstetrical events. Repeat exposure to simulation training after 1 year can yield additional benefits.
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Affiliation(s)
- Mary A Vadnais
- Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston, MA, USA.
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Posmontier B, Montgomery K, Smith Glasgow ME, Montgomery OC, Morse K. Transdisciplinary Teamwork Simulation in Obstetrics–Gynecology Health Care Education. J Nurs Educ 2012; 51:176-9. [DOI: 10.3928/01484834-20120127-02] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2011] [Accepted: 11/30/2011] [Indexed: 11/20/2022]
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