Transcript Addressing Veterans Needs through Interprofessional Simulation

Addressing Veterans Needs
Through
Interprofessional Simulation
Susan Jones, MSN, RN and Dr. Milena Staykova,
Nursing Department
Dr. George Steer and Dr. Chase Poulsen,
Respiratory Therapy Program
Dr. Patricia Airey and Sara Nicely, MPAS
Physician Assistant Program
Jefferson College of Health Sciences,
Roanoke, Virginia
David Trinkle, MD and Bruce Johnson, MD
Virginia Tech Carilion School of Medicine,
Roanoke, Virginia
“The warrior ethos includes a promise never to
leave a fallen comrade. In that spirit, every
clinician can ensure that no veteran is “left
behind” without adequate health care”
(Johnson, et al., 2013, p. 39).
Introduction
• The healthcare providers need to
understand the impact that military
service has on veterans’ health and their
families.
•
Academic institutions are challenged to
prepare competent providers addressing
the needs of this population.
• Two academic institutions collaborated to
provide college students with an
opportunity to address the needs of
veterans and their families though
interprofessional (IP) education.
Background
There are about 23.8 million military veterans
(Quinlan et al., 2010).
Only 25% of veterans receive healthcare through
the U.S. Department of Veterans Affairs
(Quinlan et al., 2010).
The injuries and illnesses that affect veterans
returning from combat are predictable”
(Quinlan, 2010, p. 43).
Physicians should take active role in the
treatment of the American military
members in short or long-term care
facilities (Quinlan et al., 2010)
Providers should screen patients who are
returning from combat for depression,
PTSD, and suicidal ideation (Quinlan, et al.,
2010, p. 43).
The White House Joining Forces’ initiative
addresses the needs of the past and present
military service members and their families
(Hamer & Huffman, 2012).
Institute of Medicine in the Quality of Health Care
in America Report emphasized the need of the
healthcare professionals to work in IP teams to
improve the quality and safety of patient care.
Anthony et al., 2012, “a high-fidelity clinical
simulation experience can help prepare nurses
to meet the unique health care needs of
veterans” (p. 145).
Research studies have demonstrated the
significance of the IP simulation on competence
development (Harder, 2010; Ironside et al.,
2009).
Students’ clinical skills, self-confidence (Harder,
2010), and patient safety have demonstrated
significant improvement after simulation
activities (Ironside, Jeffries, & Martin, 2009).
Literature Review
IPEC-Interprofessional Education Collaborative
• IOM-Institute of Medicine
• QSEN-Quality & Safety Education for Nurses
• Jefferson College of Health Science QI-”Work with Me”
• BSN Essential VI-Interprofessional Communication &
Collaboration for Improving Patient Outcomes.
Recommendations from the IPEC (Interprofessional Collaborative Practice
Council, 2011)
Team-Based Competencies: Building a shared foundation for education into
clinical practice.
Core Competencies
• Values/Ethics for Interprofessional Practice
• Roles/Responsibilities for Collaborative Practice
• Interprofessional Communication Practices
• Interprofessional Teamwork and Team-based Practice
The Conceptual Framework
• Interprofessional Education Model
• Simulation in Education Models
Medium to high fidelity
Human patient simulators
• 3D Model of Debriefing
(Zigmont, Kappus & Sudikoff, 2011) SWOT Method
-Strengths
1. Defusing
-Weakness
-Opportunities
2. Discovering
-Threats
3. Deepening
Purpose
This research study aims to
evaluate interprofessional
simulation as learning and
teaching strategies to prepare
students to care for Military and
Veteran patients.
The purpose of this study is to
evaluate the students perceived
confidence level of identifying
the special needs and resources
for veterans during IP
simulation.
Research Questions
What is the effect of
IP simulation
on the students’ perceived
confidence level of
identifying the special
needs and resources for
veterans?
An IRB approved mixed method study with a
sample of 240 students from 12 programs
and over 40 faculty members from
13 disciplines.
Students from two colleges:
Virginia Tech Carilion School of Medicine (VTC)
and
Jefferson College of Health Science (JCHS).
IP simulation model based on mass causality
IP activity.
Eighteen evidence-based simulation
scenarios: PTSD, Traumatic Brain Injury,
Spinal Cord Injury, Sexual Assault,
Emergency Delivery, Burns, Amputation,
Suicide Attempt, Poly-trauma, and more.
The students were divided into IP teams.
Debriefing session focused on case
presentation, treatment choices based on
EBP and patient outcomes, and team
collaboration.
Method and
Design
The instrument, “The Self–Efficacy
Measure of Interprofessional
Practice Competencies for
Students
(adapted with permission of the
authors- Mann et al. 2012)
administered pre-and postsimulation activity.
Revised validated tool to include
questions measuring the
students’ perceived level of
confidence to care for veterans
during the IP simulation activity.
Participating Programs
Emergency Medical
Service (EMS)
VTC Medical Students
(3rd year)
Physical
Therapy
Assistant
(PTA)
Medical Laboratory
Sciences (MLS),
Masters of
Physician
Occupational Therapy
(MSOT)
Assistant (PA)
Master of Science in
Nursing (MSN)
Occupational Therapy
Assistant (OTA)
Public Health (PH)
Nursing (NSG)
Pharmacy
Respiratory Therapy (RT)
Results
Pre-survey means
(µ 7.16, SD 1.8) to
post-survey means
(µ 8.53, SD 1.5),
1.37 difference
The t-test statistically
significant for the preand post-survey
means
A Chonbach’s alpha0.909, reliability was
established for the
new questions
Comparison of Means and Standard Deviations (SD)
10
Pre-Survey Mean
8
Pre-Survey SD
6
Post-Survey Mean
4
Post-Survey SD
2
0
NSG RT VTC OTA EMS Pharm PTA PH MSOT PA MLS
Pre-Survey Mean 7.7 7.6 6.8 7.7 8.3 9.4 7.4 9.2 8.4 8.2 8.96
Pre-Survey SD
2.4 2.2 2.1 1.7 0.98 0.7 1.9 1.02 1.7 1.2 0.69
Post-Survey Mean 8.7 8.4 7.6 8.3 8.97 9.9 7.96 9.6 8.7 8.5 9.03
Post-Survey SD
1.2 1.8 1.7 1.2 0.8 0.2 1.8 0.6 1.5 1.3 0.9
Conclusions
An increase in the IP confidence level for all students post activity.
The thematic analysis of the open-ended questions-congruent with the
quantitative aspect of the study. :
The interprofessional simulation is an andragogical-strategy leading to
increased students’ perceived confidence in identifying the special
needs and resource for the veterans.
The study results supported the conclusion the students’ confidence in
providing care to veterans increase in simulation activity.
Veterans’ education should be integrated into interdisciplinary
education.
Students Testimonials
• Peer education definitely effective. Great scenarios,
especially with veterans.
• The simulation provided an excellent opportunity
for team work and interprofessional problem
solving.
• It helped to understand how different professions
work together for a common goal and how
important communication and team work is.
• Was fun, confidence building and helpful between
professions.
• Provided an opportunity to appreciate my fellow
healthcare team members.
• My team worked effectively and efficiently
together, we all played an equally important part to
benefit the patient. This process would not have
been possible without all team members’
involvement.
References
Anthony, M., Carter, J., Freundl, M., Nelson, V., & Wadlington, L. (2012). Using simulation
to teach veteran center care. Clinical Simulation in Nursing, 8e, 145-150.
Harmer, B. M. & Huffman, J. (2012). Answering the joining forces call integrating woman
veteran care into nursing simulations. Nurse Educator, 37(6), 237-241.
Harder, B. N. (2010). Use of simulation in teaching and learning in health sciences: A
systematic review. Journal of Nursing Education, 49(1), 23-28.
Ironside, P., Jeffries, P., & Martin, A. (2009). Fostering patient safety competencies using
multiple-patient simulation experiences. Nursing Outlook, 57(6), 332-337.
Johnson, B. S., Boudiab, L.D., Freundl, M., Anthony, M., Gmerek, G., & Carter, J. (2013, July)
Enhancing veteran-centered care. Overview, a guide for nurses in non-VA settings . AJN,
113 (7), 24-39.
Mann, K., McFetridge-Durdle, J., Breau, L., Clovis, J., Martin-Misener, R., Matheson, T.,
Beanlands, H., & Sarria, M. (2012, March). Development of a scale to measure
health professions students' self-efficacy beliefs in interprofessional learning.
Journal of Interprofessional Care, 26(2), 92-9.
Quinlan, J.D., Gauron, M.R., Deshere, D.B., & Stephens, M.B. (2010, July). Care of the
returning veteran. American Family Physician, 82 (1), 43-49.
Acknowledgement
The authors would like to acknowledge
the immense contributions of
the VTC and JCHS students,
Faculty & Staff, and Carilion employees who
participated in the simulation activity.
Mrs. Dorey Anderson, MSN for coordinating
the equipment.
Dr. Stuart Tousman & Dr. Milena Staykova
for statistic analysis.
Most of all, Thank You to our Veterans and
their Families for their sacrifices.