Live Simulation

Measuring students satisfaction and confidence in simulation using simulated patients (SPs) and a survey of student personal reflections during simulation Using Focus groups to explore students self reported clinical impact on the care of patients with learning disabilities post clinical placement.

Marie O'Boyle-Duggan Senior Lecturer BCU

What is live simulation?

• It replicates clinical practice and is as near to real life as possible (Jeffries 2005). • Standardised Patients ; not real patients but specifically trained role players, improvising and providing feedback to students in real time simulated clinical encounters (Wiskin 2003) Marie O'Boyle-Duggan Senior Lecturer BCU

Why ‘live’ simulation?

• Students play a major role and are ‘in control’ of the situation deciding in real time appropriate treatment and actions; which enables them to make judgements and learn from their mistakes, (Alinier et al 2006) it increases student self efficacy, (Goldenberg et al 2005). • Teaching strategies employing simulation had a positive impact on students attitudes towards disabled people. (Goddard and Jordan 1998).

Marie O'Boyle-Duggan Senior Lecturer BCU

Simulation and Clinical Issues

• Death by Indifference (Mencap 2007) and later Valuing People Now (2009) highlight how individuals with learning disabilities receive discrimination and neglect in mainstream healthcare • Healthcare for All (2008) recommend that the health needs of people with learning disabilities are included in health education course programmes • People with learning disabilities continue to struggle with poor experiences in hospital settings due to health staff not understanding the individuals needs and more importantly the attitude of health staff towards those individuals with learning disabilities is still very negative (Densmore 2011) • Mencap – 74 Lives and still counting (2012) Marie O'Boyle-Duggan Senior Lecturer BCU

Nurse Education Simulation Framework

This framework consists of five factors. • Clear objectives and information • Support during the simulation • An appropriate problem to solve • Time for feedback and reflection • Fidelity or realism of the experience (Jeffries 2005, 2007).

Marie O'Boyle-Duggan Senior Lecturer BCU

‘Pendleton’s’ Rules’ for Feedback

• • •

The student participating in the role play has the opportunity to talk first and is encouraged to discuss positive points and suggest alternative strategies to improve their performance The observing group are invited to provide feedback but again positive points are required first.

The facilitator and group can provide constructive feedback on the areas identified with care taken to ensure comments are not given in a negative manner. (from Garala et al 2007)

Marie O'Boyle-Duggan Senior Lecturer BCU

Why explore clinical impact?

• Literature suggests that the affect of the use of simulation in health education is still inconclusive (Cioffi, et al 2005). • There appears to be a consensus for a universal outcome measurement (Ravert 2002, Cant and Cooper 2009), Marie O'Boyle-Duggan Senior Lecturer BCU

Methodology

Mixed Methodology Using: • National League for Nursing (2005) a published questionnaire looking at students’ satisfaction and confidence in simulation • Survey of student reflections- day of simulation • Focus Groups - post clinical placement Marie O'Boyle-Duggan Senior Lecturer BCU

Table 1 - Number of Students and Professional Groups Frequency Percent

Child Nursing ODP Adult Nursing Total 65 53 55 173 38 31 32 100 Marie O'Boyle-Duggan Senior Lecturer BCU

Table 2- Satisfaction with the Simulation Satisfaction Scores Strongly Disagree Disagree Undecided agree Strongly agree

n

The teaching methods used in this simulation were helpful and effective The simulation provided me with a variety of materials and activities

1 1

I enjoyed how my instructor taught the simulation

1

The teaching materials used in this simulation were motivating and helped me to learn

1 % n 0.6 0 0.6

1 0.6

0 0.6

1 % 0 n 4 0.6

11 0 1 0.6

3 % 2.3

n 32 6.4

67 0.6

56 1.7

60 % n % 18.5

136 78.6

38.7

94 54.3

32.4

115 66.5

34.7

108 62.4

The way the instructor(s) taught the simulation was suitable to the way I learn

1 0.6

3 1.7

9 Marie O'Boyle-Duggan Senior Lecturer BCU 5.2

54 31.2

106 61.3

Table 3- Self Confidence following the simulation Self Confidence Scores Strongly Disagree Disagree Undecided agree I am confident that I am mastering the content of the simulation.

n 1 % 0.6

n 2 % 1.2

n 6 % 3.5

n 101 % 58 0.6

1 0.6

7 4 95 54.9

I am confident that simulation covered critical content.

1

I am confident that I am developing the skills and knowledge to perform in clinical setting.

1 0.6

1 0.6

2 1.2

95 54.9

Strongly agree

n 63 69 74 % 36.4

39.9

42.8

43.9

34.7

87 101 50.3

58.4

My instructors used helpful resources.

1

It is my responsibility as a student to learn what I need to know from the simulation activity.

1 0.6

0.6

1 2 0.6

1.2

8 9 4.6

5.2

76 60

I know how to get help when I do not understand the concepts covered .

It is the instructor’s responsibility to tell me what I need to learn of the simulation activity during class time.

1

I know how to use simulation activities to learn critical aspects of these skills.

1 0.6

0.6

0 1 0 0.6

22 11 12.7

6.4

8 4.6

17 9.8

49 Marie O'Boyle-Duggan Senior Lecturer BCU 28.3

87 99 67 50.3

63 57.2

61 38.7

32 36.4

35.3

18.5

Student Reflections - Day of simulation “

Kiss keep it short and simple. Talk more slowly” (S2/c/T1), “people with learning disabilities are also humans with emotions and feeling, but they just portray it differently to main stream normality” (S24/c/T1).

“

It seems that good communication skills are vital especially in learning disability patients or service users. It reiterates that hands-on practice is the best way of learning and finding mistakes in technique (S60/a/T1/T2/T3) “Opened my eyes to how people with learning disabilities need to be treated” (S53/a/T1/T3). Not all children with learning disabilities have challenging behaviour” (S17/c/T1).

Marie O'Boyle-Duggan Senior Lecturer BCU

Student Reflections

•

“That even though each patient is an individual and should be treated the same, it is alright to make allowances and to take your time” (S28/c/T1), “It has also shown me that just taking time and making the patient feel relaxed is very important” (S39/a/T1), “Thinking about finding out childs interests in order to talk to them first and gain their trust” (S14/c/T1).

Marie O'Boyle-Duggan Senior Lecturer BCU

Focus Groups - ODP Students

• • •

“I find it useful in a sense that I pick up on the things that they’ve brought in with them and the things that I say to help the conversations and stuff to progress” (G1/L38/S6/T1) and ‘distraction techniques, that’s one thing that you know and that’s one thing that you did learn from the simulation(G1/L49/S1/T1/T3).

‘picking up on some of the patient’s personal affects to find the topic for releasing anxiety’ (G1/L44/L48/S5/TT1),

Marie O'Boyle-Duggan Senior Lecturer BCU

Focus Groups – ODP Students

• “n

obody’s going to teach us how to behave with people that are – shall we say people that aren’t normal? I don’t know if it’s right for me to say that. But I feel that after that scenario, you know, I feel as I go into different mode, a different programme mode to behave…”(G1/L8/S5/T1), “that’s right. You would then rely on another person to be at hand holding, with someone who’s not the enemy” (G1/L64-71/UMS/T1).

Marie O'Boyle-Duggan Senior Lecturer BCU

Focus Groups –Nursing Students

•

“I suppose it is the change in attitude, isn’t it really? Instead of saying “oh I’m busy. I’m going to have to write all the notes up.” That really just takes two minutes, just to go and spend a bit of time with someone. And that can mean a lot to somebody”, (G1A/L32/S1/T1).

• “

I worked on an infectious diseases ward and a lady came in and she had learning disabilities. And it was like always, “Oh you can go and feed her,” but actually, I ended up getting on really well with her because I built up a rapport with her. She did trust me and you know. I don’t know. I think nurses, like my mentor, she was a bit ignorant to the fact that she did need more time and you can’t just go in and wham drugs at her and whatever, she wanted to understand” (G1A/L35/S4/T1).

Marie O'Boyle-Duggan Senior Lecturer BCU

Focus Group Nursing Students

• • “

maintaining eye contact and staying calm, being patient and not standing above people was a big one that we learned. I think getting down to the same level as them. Yeah, just general body language and being calm I guess” (G1a/L8/S2/T1/T2/T3).

“Big thing from the workshops that I took, onto the wards, I mean all three of them, steve with a magazine, mary and penguin, and Janet Eastenders. You know getting their attention away from something humanized, normal, you know, a TV programme. And so I talk about that and they open up and that’s essentially a way into them. I used it so many times on the next ward and placement”. (G1a/L51/S3/T1/T2/T3).

Marie O'Boyle-Duggan Senior Lecturer BCU

Conclusions

• Critical issues for people with learning disabilities exist in modern day health care services (Emerson et al 2011); the overall aim of this research is to have an impact on some of these issues.

• Overwhelmingly the findings have been very positive, students felt confident and satisfied with the simulation activity • Simulation had an impact on patient care when on clinical placements Marie O'Boyle-Duggan Senior Lecturer BCU

Recommendations

• It is a legal requirement (Equality Act 2010) that health services make reasonable adjustments for patients with learning disabilities • Healthcare for All (DH 2008) suggests that Higher Education Authorities provide education regarding the needs of people with learning disabilities to all health professional groups on undergraduate courses. • Mencap Report – Death by Indifference - 74 lives and still counting (2012) • Workshop for local clinicians Marie O'Boyle-Duggan Senior Lecturer BCU