445CHAPTER 38
Interprofessional End-of-Life Care of a Teenager
A. IMPLEMENTATION OF SIMULATION-BASED PEDAGOGY IN YOUR INDIVIDUALIZED TEACHING AREA
Mary Ann Cordeau, PhD, RN: My focus is on developing simulation-based education (SBE) to meet the outcomes of a senior-level laboratory course offered during the spring semester.
Darlene Rogers, BSN, RN: I am involved in simulation coordination, faculty development, and faculty training for all levels of SBE at Quinnipiac University.
Dennis J. Brown, MPH, PA-C, DFAAPA: My role in the physician assistant (PA) program has been to enhance the usage of simulation in the educational process of the PA students.
Barbara Glynn, DNP, RN-BC: My focus is on interprofessional simulation, which provides the opportunity to learn how to communicate, collaborate, and experience challenging patient situations as a team of multiple disciplines.
RN-BC: My focus is on the final cumulative debriefing wherein students are provided the ability to pull their experiences together, and reflect and compare their perceptions to those of an actual survivor of the same disease.
ARRT: I have developed a variety of formative and summative simulation scenarios for radiographic procedures and the radiation exposure laboratory courses that I teach.
Jennifer L. Herbst, JD, M. Bioethics, LLM: I have worked with faculty colleagues in the law and medical schools and across the schools of nursing and health sciences to reenvision the role of law and lawyers in promoting patient and community health.
PT, DPT: I initiated the use of simulation in the physical therapy (PT) program to introduce and familiarize students with acute care and especially the intensive care unit (ICU) environment.
Meghan A. Lewis, MA, ATC, LAT: My main focus is on incorporating simulation into the emergency management component of the athletic training (AT) profession and to expand into other aspects in the future.
Laura Mutrie, MSW, LCSW: I have worked to incorporate simulated patient experiences into the social work practice curriculum and to develop scenarios for interprofessional and classroom implementation.
FNP-BC, ANP-BC: I am actively involved in interprofessional education (IPE) and working to involve nurse practitioner and nursing students in simulation as a clinically relevant method of education.
Tracy Van Oss, DHSc, MPH, OTR/L, FAOTA: The occupational therapy (OT) department uses simulation as a part of the coursework to teach students to communicate, evaluate, and provide therapeutic interventions.
B. EDUCATIONAL MATERIALS AVAILABLE IN YOUR TEACHING AREA AND RELATED TO YOUR SPECIALITY
The clinical simulation laboratory at Quinnipiac University is a self-contained unit with five acute/chronic/community care rooms, each with a patient and control area separated by one-way glass. The model apartment used in this scenario is a universally designed space for health professionals to learn how an environment can support or inhibit a person of any ability to perform activities of daily living (ADLs). The CT laboratory is a fully energized lab that houses a Toshiba Aquilion 64-slice CT unit. The CT unit is located within a fully shielded room opposite the control room.
C. SPECIFIC OBJECTIVES FOR SIMULATION USAGE WITHIN A SPECIFIC COURSE AND THE OVERALL PROGRAM
At Quinnipiac University, IPE is not attached to a specific course, rather it is currently being offered as a voluntary learning activity for interested students and faculty. IPE began several years ago with the formation of the Interprofessional Simulation Learning and Assessment Committee (ISLAC). This interdisciplinary committee worked collaboratively in the creation of Josh’s Journey. Josh’s Journey, a Sim-IPE, was developed to promote the ability of participants to work as a team to “cooperate, communicate, and share skills and knowledge” to provide safe and holistic care (Decker et al., 2015, p. 293). Faculty from multiple disciplinary and professional areas worked together to create the Sim-IPE based on “interprofessionality” (D’Amour & Oandasan, 2005, p. 10). A committee has been formed to incorporate the use of Sim-IPE across disciplines. Standards I to IX of the INACSL Standards of Best Practice: SimulationSM (International Nursing Association for Clinical Simulation and Learning [INACSL], 2013/2016) were used for guiding the scenario development.
D. INTRODUCTION OF SCENARIO
Setting the Scene
This scenario consists of seven scenes involving advanced practice registered nurse (APRN), AT, diagnostic imaging (DI), law, master of social work (MSW), RN, OT, PA, and PT students. Individuals from all professions work together to care for a teenage boy as his illness progresses from a diagnosis of osteosarcoma of the femur discovered after a fall on the basketball court. Josh is a high school student who lives with his parents. Each scene presented is a separate sequential Sim-IPE. Before the start of the Sim-IPE a group prebriefing is held for all participants. The role of each profession is presented. Participants are then assigned to appropriate scenes, which are scheduled over the semester. Participants are engaged in a scenario-related prebriefing and debriefing as well as a culminating debriefing. The entire scenario was filmed and will be used for interdisciplinary educational experiences. Key components of prebriefing stages included learning about end-of-life care, understanding the different interprofessional roles, and feeling comfortable with and safe in the simulation environment.
Technology Used
Depending on the scene, technology used varies and is presented at the beginning of the scene.
447Specific Scenario Objectives
• Participate on a patient-centered health care team to respond to the medical and psychosocial needs of a simulated patient from onset of injury to end of life.
• Develop communication skills appropriate for responding to the needs of the patient, the patient’s family, and other members of the health care team.
• Gain knowledge and insight into the stages of dying and providing end-of-life care.
• Collaborate in critical decision making and creative thinking in devising patient-centered health care team plans of care throughout the course of an illness.
• Introduce nursing/health sciences students to dispute resolution as potential attorney skillset.
Description of Participants
Prelicensure APRN, AT, DI, Law, MSW, PA, PT, OT, and RN students participate in the appropriate scenes. The simulated patient scenes used are live and students received scene-specific training. Scenario role players used in scenes received scene specific training.
E. RUNNING OF THE SCENARIO
Following a prebriefing, the expected run time for each scene is 20 minutes. The expected time for debriefing is 20 to 40 minutes. Each scene is sequential and conducted as a stand-alone Sim-IPE with appropriate participants.
F. PRESENTATION OF COMPLETED TEMPLATE
Title
Interprofessional End-of-Life Care of a Teenager
Scenario Level
Prelicensure students from a variety of disciplines
Focus Area
Field emergency room (ER) care, diagnostic interventions, acute care, home care, hospice care
Scenario Description
Description of Patient
Name: Joshua Williams
Gender: M
Age: 16
Weight: 160 pounds/73 kg
Height: 5 feet, 8 inches/173 cm
Marital status: Single
Religion: Catholic
Major support: Mother and father
Phone: 203-111-1111
Allergies: None
448SCENE ONE: FIELD CARE
Focus Area
This scenario takes place on a basketball court. A simulated patient is laying on the ground moaning in pain.
Patient History
Josh jumped up for the ball, and his opponent crashed into his hip area. As he landed, he heard a sickening crack and felt an extreme pain in his right hip/leg.
Setting the Scene
Equipment Needed
AT kit, vacuum splint bag, an automated external defibrillator (AED), emergency O2 tank, spine board, Gatorade coolers, radio
Resources Needed
No specific resources
Simulator Level
Simulated patient
Participants Needed
Two AT students, two emergency medical technician (EMT) scenario role players, and one team member scenario role player
Scenario Implementation
The scene begins with Josh laying on the ground moaning. The AT responds and emergency medical service (EMS) is called. A fracture of the right femur is suspected. There is diminished circulation, sensation, movement (CSM); posterior tibialis pulse point and dorsal pedal pulse are absent. Josh is complaining of nausea and light-headedness. Vital signs: blood pressure (BP), 90/70 mmHg; pulse, 134 beats/minute—weak and thready; respiratory rate (RR), 22 breaths/minute and shallow, starting to become labored.
Participant Expectations
The AT participant is expected to check the scene for safety to make sure the play has stopped and it is safe to approach the victim; communicate for someone to contact EMS using the radio; determine level of consciousness; establish airway and assess circulation; calm the athlete down while doing a visual inspection; put on protective equipment; obtain baseline vital signs, signal help to acquire vacuum splint, kit, AED, spine board; communicate with the athlete; advise bystanders to greet the EMTs; apply vacuum splint; treat for shock once leg stabilized; transfer to stretcher once EMS arrives, wheel Josh out of the basketball court en route to the ambulance.
449SCENE TWO: EMERGENCY ROOM
Focus Area
Patient assessment and treatment, patient and family teaching and support
Scenario Description
Patient history: During a basketball game, Josh’s femur is fractured. He was treated at the scene by an AT and was transferred to the ER via ambulance.
Setting the Scene
Equipment Needed
Computerized patient simulator dressed in sports clothing, identification bracelet, backboard and collar, hare traction, splint on the right leg, cardiac monitor with automated BP, pulse oximetry, intravenous (IV) equipment, normal C-spine (cervical spine) x-ray, fractured midshaft femur x-ray.
Simulator Level
High-fidelity—computerized patient simulator
Participants Needed
APRN/PA student, two RN students, one AT student, one MSW student, and two EMT scenario role players
Scenario Implementation
The scenario starts with Josh on a stretcher in the ER. On arrival at the ER, the AT communicates the facts of the case with the intake team, consisting of a PA/APRN and two RN students. AT remains on site to ensure that the athlete is stable. Josh is complaining of a level-10 pain in his right leg. He has been transported to the ER in full spinal immobilization via ambulance and is being evaluated by the PA/APRN and two RNs. The MSW student is also on the scene to support the patient and the mother, who arrives a few minutes after the scenario begins.
Participant Expectations
APRN/PA: Obtain a history, including past medical history (PMH), medications allergies, social history (SH), last meal; perform secondary trauma survey; work with the nurses to disrobe patient while maintaining appropriate immobilization; order appropriate diagnostics (x-rays, labs, EKG) and interpret the results; order appropriate medications and therapeutics, including forward thinking of possible progression to operating room (OR), therefore, ensuring nothing by mouth (NPO) status, IV, analgesia, and so on.
MSW: Provide emotional support and empathetic calming to the distressed mother.
RN: Assess vital signs; assist team members with disrobing; discuss findings and treatments with other members of the team; receive and verbalize provider orders; documents injuries, evaluations, medications, interventions; administer IV pain medication and oxygen; communicates holistically with patient and mother.
450SCENE THREE: ILLNESS DISCLOSURE
Scenario Level
Prelicensure APRN, MSW, OT, PT, RN students
Focus Area
Communication, patient and family teaching, patient family support
Scenario Description
This scenario depicts a patient in the orthopedic unit recovering from a surgical repair of a fractured femur. The patient is lying on the hospital bed with his eyes closed. His mother and father are sitting with him at the bedside. The team comes in to speak to the patient and family about the pathology results of the suspicious lesion found during surgery.
Patient history: Josh is a 16-year-old athlete who fractured his femur as a result of an injury on the basketball court. He underwent an open reduction internal fixation (ORIF) of his femur and, during the procedure, the surgeon saw a suspicious lesion, which was biopsied. Josh is currently in the orthopedic unit. The biopsy results have come back and show that Josh has osteosarcoma. The team will be speaking to Josh and his family today about the diagnosis and treatment options.
Setting the Scene
Equipment Needed
Simulated patient wearing a hospital gown; identification bracelet with patient’s name, date of birth, and medical record number. Hospital bed, overbed table, three chairs, call bell, IV pump and 1,000-mL bag of lactated Ringer’s solution, posted crutches, gait belt, and long-handle reacher.
Technology Used
No specific technology is needed
Participants Needed
One simulated patient, one MSW student, one RN student, one APRN student, one PT student, one OT student, mother, and father
Scenario Implementation
The scene opens with PT and OT students actively engaged in caring and patient teaching. Mother and father are sitting at the bedside. APRN, MSW, and RN students arrive to give Josh and his family the news of the pathology report and the presence of a tumor. Parents are very upset; Josh is quiet and withdrawn. The APRN is giving facts about what happens subsequently and the MSW is offering support. PT and OT conclude their session, leaving the rest of the group to continue their discussion. The scene ends with an understanding that the oncologist will be in during the afternoon to discuss treatment options.
Participant Expectations
APRN: Discuss the pathology report and answer any questions the patient and family has.
MSW: Offer patient and family the opportunity to reflect and to focus on the present in response to their needs.
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