An Interprofessional Simulation-Based Learning Activity for Nursing and Physiotherapy Students

Advice-giving skills in pre-registration physiotherapy training

BACKGROUND

With increased emphasis on self-management in healthcare, clinicians need outstanding skills in offering advice and empowering patients to attain an optimal outcome.

OBJECTIVES

This study explores how undergraduate physiotherapists acquire knowledge, skills, and confidence to offer advice to patients in clinical practice.

METHODS

Convenience sampling was used to recruit 50 BSc and MSc pre-registration physiotherapy students across all years of study in one university in southern England, UK. Semi-structured interviews were conducted for first year BSc students (n = 13). Six focus groups of mixed BSc and MSc students were conducted, three groups (n = 15 students) were mid-training, and three groups (n = 22 students) were in their final year.

RESULTS

Thematic analysis identified 6 themes: advice content; a patient-centered approach; delivery; acquisitions; perceptions; and uptake of advice. Students placed high value on advice-giving, drawing upon multiple learning opportunities, however they felt under-prepared to deliver this skill in practice. Furthermore, perceptions of their student status, and pressures to perform on graded placements were reported to influence the advice they offered to patients.

CONCLUSIONS

Developing high-level skills in promoting self-management is essential in physiotherapy, this study highlights the challenges for students to develop these skills. Academic and practice educators must explicitly enable and support students to develop the knowledge and skills to confidently offer high-quality advice to patients.

Interprofessional education for healthcare professionals. A BEME realist review of what works, why, for whom and in what circumstances in undergraduate health sciences education: BEME Guide No. 83

AIM

To provide an evidence-informed program theory (PT) for Interprofessional Education (IPE) that adds to the knowledge base of how IPE in undergraduate health sciences education works.

METHODS

We undertook a realist review of the literature and synthesis of the evidence combined with stakeholder experience. Our initial program theory (IPT), built around development, delivery and evaluation of IPE interventions, was tested and refined following an in-depth search of the literature and consultation with stakeholders. The literature (2010-2022) was selected based on the realist criteria of relevance and rigor, as well as on conceptual richness of the studies.

RESULTS

Our PT is built upon 124 CMOs (Context of IPE interventions, Mechanisms that fired within that context, and IPE Outcomes), from 58 studies. Our PT comprises an array of elements found in the Context, including traits and behavioral displays of students and facilitators, and discusses four Mechanisms (feeling responsible, feeling enthusiastic/excited, feeling safe to take risks, and feeling ready), which are likely to lead to outcomes related to the Interprofessional Education Collaborative (sub)competencies.

DISCUSSION

Results were linked to learning theories to further build our understanding. The PT can serve as a guide for the development, delivery, and evaluation of IPE interventions.

Experiences of Boosting Inpatient Exercise After HipFracture Surgery Using An Alternative Workforce - A Qualitative Study

BACKGROUND

Thrice-daily physiotherapy immediately following surgical repair of hip fracture has been shown to be safe and to reduce total hospital length of stay. However, implementing this is challenging with respect to health service funding and staffing. A novel approach may be to utilize an alternative workforce (allied health staff and student physiotherapists) to deliver two of the three daily treatments. However, how patients and staff may view such an approach is unknown. Thus, the aim of this qualitative study was to explore the views of inpatients with surgical repair of a hip fracture, their carers, health care professionals, and physiotherapy students about the implementation and acceptability of thrice-daily physiotherapy, with two sessions delivered by the alternative workforce (the BOOST study).

METHODS

Semi-structured interviews and focus groups with patients, carers, health professionals and physiotherapy students. All interviews were digitally recorded and transcribed via verbatim. The transcripts were coded, and the data analysed via inductive thematic analysis.

RESULTS

A total of 37 interviews (32 one-to-one interviews and five focus group interviews) were analysed. Five main themes were identified: (1) individual perceptions of the intervention: inpatients/carer/staff/student, (2) implementation within the service and organisational context, (3) implementation strategies that were effective, (4) improvements to implementation strategies/barriers to implementation/unsuccessful strategies and (5) future directions of BOOST.

CONCLUSIONS

The qualitative data revealed that higher frequency physiotherapy was well-received by inpatients and that staff/students involved in providing care perceived it as a safe, acceptable and valuable practice. Implementation of higher daily frequency of physiotherapy using an alternative workforce may feasibly be adopted for inpatients following hip fracture surgery.

TRIAL REGISTRATION

This study was approved by the Human Research Ethics Committee (HREC) of the Western Sydney Local Health District (2020/ETH02718). Mutual recognition of approval was subsequently obtained from Northern Sydney Local Health District HREC.

Simulation-based learning in palliative care in postgraduate nursing education: a scoping review

BACKGROUND

Nurses require advanced competence in palliative care, but they face wide variations in education and a shortage in opportunities for clinical placement. Simulation-based learning (SBL) can enable students to develop clinical skills, critical thinking and confidence. No scoping reviews to date have mapped the use of SBL in palliative care within postgraduate nursing education.

METHODS

The aim of this scoping review was to systematically map published studies on the use of SBL in palliative care in postgraduate nursing education. A scoping review was conducted using Arksey and O'Malley's (Int J Soc Res Meth 8(1):19-32, 2005) methodological framework. A systematic and comprehensive search of the Cumulative Index to Nursing and Allied Health Literature (CINAHL), the Education Resources Information Center (ERIC), Ovid MEDLINE, Ovid EMBASE, Allied and Complementary Medicine and PsycINFO was performed for studies published between January 2000 and April 2022. Two authors independently assessed papers for inclusion and extracted data. Reporting followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) checklist. The protocol was registered on the Open Science Framework.

RESULTS

This review includes 10 studies. Three thematic groupings were identified: enhanced understanding of the importance of teamwork, interdisciplinarity and interpersonal skills; preparedness and confidence in one's ability to communicate during emotionally challenging situations; and impact and relevance to one's own clinical practice.

CONCLUSIONS

The use of SBL in palliative care in postgraduate nursing education seems to enhance students' understanding of the importance of teamwork and interdisciplinarity. The review shows contradictory results regarding whether SBL in palliative care increases students' confidence in their communication skills. Postgraduate nursing students experienced personal growth after participating in SBL. Because our findings indicate that limited research has been conducted within this field, future research should (1) explore postgraduate nursing students' experiences with SBL in palliative care with a focus on more practical content such as symptom management, (2) examine the relevance and application of SBL in clinical practice, and (3) be reported in line with recommendations on the reporting of simulation research.

Essential Elements of Preregistration Nursing Interprofessional Simulation Training

BACKGROUND

Internationally, interprofessional simulation (IPS) training increasingly is being included in nursing curricula. This systematic review examined the elements of IPS training that prepare nursing students for clinical practice.

METHOD

Five databases (Cumulative Index to Nursing and Allied Health Literature [CINAHL], ProQuest, PubMed, Scopus, and Google Scholar) were searched for articles published from 2000 through 2020. Search terms included interprofessional, interdisciplinary, collaboration, collaborative care, teamwork, undergraduate nursing, and simulation. Thematic analysis of included studies was conducted using Braun and Clarke's (2006) six-phase approach.

RESULTS

Twenty-one studies were included. Five key themes emerged: (1) foster safe learning spaces, (2) realism matters, (3) effective debriefing is essential, (4) communication and teamwork increase patient safety, and (5) learning about scopes of practice and roles enables better care.

CONCLUSION

IPS training provides nursing students with learning opportunities that can fundamentally shape their capacity to work effectively in interprofessional and multi-disciplinary settings. [J Nurs Educ. 2023;62(1):28-35.].

Interprofessional communication in medical simulation: findings from a scoping review and implications for academic medicine

BACKGROUND

Interprofessional communication is fundamental to the delivery of healthcare and can be taught in medical school and other health professional schools through interprofessional education (IPE) activities. Simulation centers have become a predominant location for simulation IPE activities with infrastructure able to support high fidelity activities in a controlled environment. In this secondary analysis of a scoping review conducted on simulation-based IPE, we describe the characteristics of previously reported simulation IPE activities involving undergraduate medical students in a simulation center focused on interprofessional communication.

METHODS

Electronic searches of PubMed, CINAHL, and ERIC databases in accordance with PRISMA-ScR guidelines were conducted to isolate relevant articles from 2016-2020. In total, 165 peer-reviewed articles met inclusion criteria and data extraction linked to four research questions was applied by one individual and the accuracy was confirmed by a second individual. A secondary analysis was performed to describe what existing approaches for simulation IPE in simulation center settings have been used to explicitly achieve interprofessional communication competencies in undergraduate medical education. A sub-dataset was developed from the original scoping review and identified 21 studies describing simulation IPE activities that took place in dedicated simulation centers, targeted the IPEC interprofessional communication domain, and involved undergraduate medical students.

RESULTS

Though diverse, the majority of simulation IPE activities described high-fidelity approaches involving standardized patients and utilized assessment tools with established validity evidence in IPE activities to measure learning outcomes. A minority of simulation IPE activities were described as hybrid and utilized more than one resource or equipment for the activity and only two were longitudinal in nature. Learning outcomes were focused predominantly on modification of attitudes/perceptions and few targeted higher levels of assessment.

CONCLUSIONS

Educators charged with developing simulation IPE activities for medical students focused on interprofessional communication should incorporate assessment tools that have validity evidence from similar activities, target higher level learning outcomes, and leverage hybrid models to develop longitudinal simulation IPE activities. Though an ideal environment to achieve higher level learning outcomes, simulation centers are not required for meaningful simulation IPE activities.

Simulation in physiotherapy students for clinical decisions during interaction with people with low back pain: randomised controlled trial

BACKGROUND

Low back pain (LBP) is a condition with a high global prevalence, which is getting health professionals' attention, including physiotherapists as they must have the skills to provide treatment that increases the patient's quality of life. Clinical simulations could be a pedagogic strategy that facilitates adequate training for students to acquire skills to improve their professional reasoning in this clinical situation.

OBJECTIVE

This study sought to determine the effects of clinical simulations with simulated patients (SP) on the physiotherapy students' clinical decision-making within a role-playing (RP) scenario while caring of LBP patients.

METHODS

This experimental study included 42 participants from two Colombian universities, randomized into two groups (SP, n = 21; RP, n = 21). The clinical skill of performing the Objective Structured Clinical Examination (OSCE-LBP) was evaluated while students cared for patients with LBP; after that, a pedagogical method was conducted that included clinical simulation and, finally, the OSCE-LBP was applied again to compare both groups.

RESULTS

Changes occurred in the OSCE-LBP among both groups of students: the scores increased (0.66 and 0.59 in RP and SP, respectively), and neither of the two was superior (p value 0.01; 95%CI - 0.21 to 0.23).

CONCLUSION

Both types of simulation favor decision-making in professional reasoning in physiotherapy students during interactions with individuals with LBP. Trial registration https://clinicaltrials.gov/ct2/show/NCT04428892 Identifying number: NCT04428892. It was retrospectively registered.

Exploring the role of simulation to foster interprofessional teamwork among medical and nursing students: A mixed-method pilot investigation in Hong Kong

Effective teamwork is a critical component of maintaining patient safety. However, there is lack of clarity on the best teaching approach to interprofessional teamwork training in medical and nursing curricula. This study aimed to compare the effects of blended classroom plus clinical simulation versus clinical simulation alone on teamwork attitudes, perceptions and performance in medical and nursing students in Hong Kong. This was a pilot study with a mixed-method research design, with both quantitative and qualitative evaluations. Students who studied medicine or nursing courses at a university in Hong Kong were invited to this study. They were assigned into two groups: clinical simulation alone versus blended classroom plus clinical simulation. The primary outcome was attitudinal change related to teamwork behaviours, which was measured using the Human Factors Attitude Survey. The secondary outcomes were perceptions of team-based learning and teamwork performance, which were accessed by the Team-Based Learning Student Assessment Instrument and Ottawa Global Rating Scale, respectively. Four focus group interviews were conducted after the training sessions. Conventional content analysis using inductive coding was performed with the qualitative data. Forty-six students participated in this study. There was a significant increase in the participants' positive attitudes on teamwork for both groups (intervention: MD = 5.36 and control: MD = 3.6, p <.05); however, there was no significant difference on increasing positive attitudes between the groups (estimate = 1.76, 95% CI [-8.59, 5.06], p = .61). Qualitative analysis identified four themes: (1) reconsidering professional roles in managing patients; (2) embodying the experience to share responsibility and complement each other's skills; (3) realizing the importance of trust and communication; and (4) engaging to achieve the mission within a limited time. This pilot study found that a blended classroom did not further improve teamwork attitudes, perceptions and performance in medical and nursing students compared with clinical simulation alone. Qualitative findings showed that students had reconsidered their professional roles in managing patients and realized the importance of teamwork in caring patients.

A qualitative study of perioperative nursing students' experiences of interprofessional simulation-based learning

AIM

To explore perioperative nursing students' experiences of interprofessional simulation-based learning to gain a deeper understanding of how this educational tool can be used to support students' learning and enable them to achieve the intended learning outcomes.

BACKGROUND

Despite extensive research, it remains unclear what and how participants learn from interprofessional simulation-based learning. There is a need to specify how interprofessional simulation-based learning should be organised to support and promote learning processes, especially for postgraduate learners. In particular, there seems to be little evidence in the existing literature in the field of educating perioperative nurses, where advanced technical skills and high-quality nursing care are required.

DESIGN

The study's qualitative and explorative design is reported in accordance with the COREQ guideline.

METHOD

Between May-October 2019, thirty-four perioperative nursing students from four educational institutions participated in six focus group interviews, with four to eight students in each. All participants had previous experience of interprofessional simulation-based learning in acute settings. Data were transcribed verbatim and were then subjected to phenomenological hermeneutical analysis involving three steps: naïve reading, structural analysis and comprehensive understanding.

RESULTS

Three themes were identified the following: customised interprofessional simulation-based learning; reality of the experience of interprofessional simulation-based learning; and preparedness for clinical practice.

CONCLUSION

Customised interprofessional simulation-based learning was found to be of value to the participants and reflected their feeling of mental preparedness entering interprofessional simulation-based learning. Furthermore, participants' experience of reality when using the tool was a key theme that also impacted how prepared participants felt for clinical practice.

RELEVANCE TO CLINICAL PRACTICE

The study findings contribute to the further expansion of interprofessional simulation-based learning in perioperative nursing education as a means of developing students' professional competence. This is essential knowledge, as professional practitioners must reflect on practice to further enhance that practice and patient safety.

Can student-peers teach using simulated-based learning as well as faculty: A non-equivalent posttest-only study

BACKGROUND

Peer-assisted learning has an important place in the delivery of health care education with benefits for both the learners and the peer teachers. Simulation-based learning (SBL) is evolving in healthcare professions training and academic programs as a modality that conveys realism and fidelity through immersion.

OBJECTIVES

The primary aim was to compare physiotherapy student's motivation to learn between a conventional faculty-led SBL activity and the same SBL activity delivered by trained final year physiotherapy peer tutors.

METHODS

Physiotherapy students from two Universities (n = 226) undertook a SBL learning activity (either faculty led or peer led) and completed the Instructional Materials Motivation Scale questionnaire to assess motivation to learn.

RESULTS

There was a high level of learner motivation in all learning groups, with significantly higher learner satisfaction (p < 0.001) and lower attention (p < 0.001) in student-led SBL than faculty-led SBL.

CONCLUSIONS

This study has highlighted the potential to incorporate peer-assisted and simulation-based learning together in the development of future educational activities in health care training.

Recognizing Elder Abuse: An Interprofessional Simulation Experience With Prelicensure Health Care Students

BACKGROUND AND PURPOSE

A common role within all health care professions includes the ability to recognize and report elder abuse. However, teaching the characteristics and assessment of abuse can be difficult. To allow students to engage in a realistic case-based scenario within a health care team, an immersive simulation was developed involving the care of an elderly woman with signs of abuse. The purpose of this quasiexperimental study was to explore the influence of the experience on the participants' perceptions of interprofessional care and their understanding of the assessment of abuse.

METHODS

This study utilized a mixed-methods research design. A sample of convenience of nursing and physical therapy students (n = 143) from 3 institutions in southwest Virginia was utilized for this study. Participants' perceptions were assessed using the Interprofessional Socialization and Valuing Scale (ISVS) and through focus group interviews.

RESULTS

Students demonstrated a statistically significant improvement based on the Wilcoxon matched pairs test (P < .001) on all 21 questions of the ISVS. A phenomenological study design was employed for qualitative analysis of focus group interviews performed postsimulation to generate information about the students' perceptions of the experience. Two themes emerged from the interviews: (1) communication as a team to provide wholistic patient care and (2) recognition of abuse.

DISCUSSION

The students reported an improved understanding of collaboration on a health care team and how to investigate potential abuse occurring in the home. This further supports research suggesting the importance of interactive learning techniques in teaching health care students to recognize symptoms of elder abuse.

Interprofessional simulation in undergraduate nursing program: An integrative review

OBJECTIVES

Interprofessional (IP) competencies are critical for successful collaborative practice. Nurse education, through interprofessional simulation, plays a critical role in preparing nursing students achieve these competencies. Although considerable research has been conducted on this topic, a broader perspective is lacking. This review systematically appraised and synthesized evidence examining the effects of interprofessional simulation on nursing students' outcomes.

DESIGN

An integrative review method guided this review.

DATA SOURCES

Five databases (Cumulative Index to Nursing and Allied Health Literature, SCOPUS, PubMed, PsychINFO, and MEDLINE) were searched to locate articles published from 2010 onwards. Search and MeSH terms included: interprofessional, interdisciplinary, simulation, nurse education, nursing, and student. Thirty (30) articles were included in this review.

RESULTS

Findings of content analysis revealed five essential themes: interprofessional communication, appreciation of interprofessional team roles, interprofessional teamwork or collaboration, self-confidence or self-efficacy, and positive attitudes or readiness toward interprofessional learning.

CONCLUSIONS

This review provides a current state of knowledge on the efficacy of interprofessional simulation in enhancing interprofessional learning and competencies in nursing students. However, more research should be done utilizing a more robust method of research and reliable assessment methods. Through interprofessional simulation experiences, nurse academe can adequately prepare nursing students for future collaborative practice. Inclusions of interprofessional simulation activities in all clinical nursing courses can help prepare nursing students achieve inter-professional learning.

The influence of a full-time, immersive simulation-based clinical placement on physiotherapy student confidence during the transition to clinical practice

Background

Novice students may have limited learning opportunities during their early exposure to complex clinical environments, due to the priorities of patient care. Immersive, high-fidelity simulation provides an opportunity for physiotherapy students to be exposed to relatively complex scenarios in a safe learning environment before transitioning to the clinical setting. The present study evaluated the influence of immersive simulation on student confidence and competence.

Methods

Sixty penultimate year physiotherapy students completed an 18-day full-time immersive simulation placement. The placement involved students spending 6 days working in each of three core practice areas (cardiopulmonary, musculoskeletal, neurological) in which they interacted with simulated patients portrayed by professional role-play actors. The patient scenarios were developed by groups of expert practitioners and incorporated full documentary and imaging information. Students completed a questionnaire to evaluate their confidence in the clinical environment at the start and completion of each 6-day rotation. Their clinical competence was evaluated at the end of each 6-day rotation using the Assessment of Physiotherapy Practice (APP) tool. In a secondary analysis, the clinical competence of this cohort was evaluated in comparison to a matched cohort of students from the same year group that had not completed an immersive simulation placement.

Results

Student confidence improved significantly in each 6-day rotation (p < 0.001); however, it reduced again at the commencement of the next rotation, and there was no cumulative improvement in confidence over the 18-day placement (p = 0.22). Students who had completed the immersive simulation placement achieved higher APP (p < 0.001) scores in an evaluation of their competence to practice during their subsequent clinical placement.

Conclusion

Immersive simulation provides a beneficial learning environment to enable physiotherapy students to transition from university-based education to working in the clinical environment.

Electronic supplementary material

The online version of this article (10.1186/s41077-018-0062-9) contains supplementary material, which is available to authorized users.