605CHAPTER 51
Professional Integrity in Interdisciplinary Simulation: Creating Workforce Relationships in Occupational Therapy and Nursing
A. IMPLEMENTATION OF SIMULATION-BASED PEDAGOGY IN YOUR INDIVIDUALIZED TEACHING AREA
The Master of Science in Occupational Therapy program at Davenport University in Grand Rapids, Michigan, is a new graduate program for the university. The occupational therapy program achieved initial accreditation from the Accreditation Council for Occupational Therapy Education (ACOTE) in April 2016. The curriculum consists of seven semesters that progress student learning from the basic tenets and theoretical perspectives of occupational therapy to the knowledge, skills, and critical thinking required for managing the complex care of a diverse client base.
The Institute of Medicine (IOM; 2003) identifies five core competencies for the delivery of quality health care that is required of all health care providers. These core competencies serve as an overarching aim for quality health services. Interdisciplinary simulation exercises occur in the first semester of the program involving occupational therapy and nursing students, and were based on two of these competencies.
The first competency is the ability to provide patient centered care. This competency targets specific skills for meeting the needs of patients, including respect for patients’ individual values and preferences, as well as the communication skills required to maintain a therapeutic relationship with patients. The second of the competencies, the ability to work in interdisciplinary teams, requires skills in collaboration as well as effective communication. When stated another way, quality health care is dependent on strong professional relationships. Occupational therapy practitioners connect with nurses in every clinical setting. These professional relationships then, should be forged early in the educational curriculum and fostered throughout a professional program regardless of the discipline. To this end, interdisciplinary simulations with occupational therapy and nursing students begin in the first semester of the Davenport University occupational therapy program.
In the first semester, two courses involve simulations. One course, OCTH 616: Fundamentals and Scope of Occupational Therapy Practice, as the title implies, introduces the fundamentals and scope of occupational therapy practice. In this course, the emphasis is placed on communication with both clients and professional colleagues throughout a person-centered health care relationship. Communication strategies learned in this course include but are not limited to active listening, clear delivery of information, ethical communication, respecting the values and differences 606of others, and collaborative goal setting for occupational therapy interventions. Interdisciplinary simulations were created to apply specific concepts and skills from classroom learning.
The second course in the first semester linked to the simulations was OCTH 621: Acute and Chronic Conditions: Effect on Occupational Performance. This course includes the study of body systems and pathology, and explores the effects of illness and disease on a person’s ability to engage in daily occupations. The student learning outcomes of this course assist the occupational therapy student in anticipating and predicting the effect of disease, illness, and injury on an individual’s functional abilities. The content of this course also assists the student in developing an understanding of the medical environment as well as skills in monitoring and measuring clinical signs of activity intolerance. During the first semester, there are three interdisciplinary simulation exercises. The interdisciplinary simulation that follows focuses on professional communication and is seated within these two courses.
B. EDUCATIONAL MATERIALS AVAILABLE IN YOUR TEACHING AREA AND RELATED TO YOUR SPECIALTY
The simulation met the design concepts established by the International Nursing Association for Clinical Simulation and Learning (INACSL) as outlined in INACSL Standards of Best Practice: SimulationSM (INACSL, 2013/2016). The simulation was directly related to concepts taken from classroom learning activities. Spaces used for the simulation included classroom areas used by the occupational therapy program and modified to best replicate the health care environment in which the scenario might occur that established physical fidelity. The simulation occurred in a large classroom with desks and chairs arranged much like a therapy gym or outpatient setting located in a hospital or rehabilitation facility. Traditionally, in these settings, there are multiple therapists and clients involved in the rehabilitation process at the same time, which can create a high-level of activity and a lack of privacy. In this sense, the simulation environment created high psychological fidelity. At the start of the semester, occupational therapy and nursing faculty collaborated for scheduling, as well as reviewing and modifying the procedures for the simulation. Planning included consideration of the number of students from each discipline, scheduling of the simulation within the semester, timing protocols, use of the physical environment, the equipment needed and faculty supervision needed for each simulation planned for the semester.
C. SPECIFIC OBJECTIVES FOR SIMULATION USAGE WITHIN A SPECIFIC COURSE AND THE OVERALL PROGRAM
The overall objective of the simulation exercise was to meet the 2013 educational standards established by ACOTE (American Occupational Therapy Association [AOTA], 2011). Table 51.1 shows the ACOTE standards addressed by the OCTH 616 and OCTH 621 courses in contrast to the American Association of Colleges of Nursing (AACN) Essentials of Baccalaureate Education for Professional Nursing Practice (AACN, 2008). Specific objectives for the simulation were based on these standards.
D. INTRODUCTION OF SCENARIO
Setting the Scene
The scenario included a list of equipment and supplies needed to replicate the simulation. The supplies and equipment were available in both the occupational therapy and nursing programs.
Table 51.1 Comparison of Professional Program Educational Standards
Accreditation Standards for a Master’s-Degree-Level Educational Program for the Occupational Therapist (AOTA, 2011) | The Essentials of Baccalaureate Education for Professional Nursing Practice (AACN, 2008) |
Effectively communicate and work interprofessionally with those who provide services to individuals, organizations, and/or populations in order to clarify each member’s responsibility in executing an intervention plan. | Demonstrate appropriate team building and collaborative strategies when working with interprofessional teams. |
Explain the role of occupation in the promotion of health and the prevention of disease and disability for the individual family and society. | Contribute the unique nursing perspective to interprofessional teams to optimize patient outcomes. |
Demonstrate knowledge and understanding of the AOTA code of ethics, ethics standards, and standards of practice and use them as a guide for ethical decision making in professional interactions, client interventions, and employment settings. | Demonstrate the professional standards of moral, ethical, and legal conduct. Access interprofessional and intraprofessional resources to resolve ethical and other practice dilemmas. |
Use standardized and nonstandardized screening and assessment tools to determine the need for occupational therapy intervention. Evaluate client’s occupational performance in ADL, IADL, education. Work, play, rest, sleep, leisure, and social participation using standardized and nonstandardized assessment tools. | Conduct comprehensive and focused physical, behavioral, and psychological–spiritual, socioeconomic, and environmental assessment of health and illness parameters in patient using developmentally and culturally appropriate approaches. |
Demonstrate therapeutic use of self, including one’s personality, insights, perceptions and judgments, as part of the therapeutic process in both individual and group interaction. Provide therapeutic use of occupation, exercises and activities. | Engage in caring and healing techniques that promote a therapeutic nurse–patient relationship. |
Source: 2011 Accreditation Council for Occupational Therapy Education (ACOTE®) Standards. Originally published in 2012 in American Journal of Occupational Therapy, 66, S6–S74. http://dx.doi.org/10.5014/ajot.2012.66S6. Copyright© 2012 by the American Occupational Therapy Associated. Used with permission.
ADL, activities of daily living; AOTA, American Occupational Therapy Association; IADL, instrumental activities of daily living.
Technology Used
There is no technology required beyond the physical environment replicating the clinical setting.
Objectives
The student will:
1. Demonstrate therapeutic communication through completion of an occupational profile
2. Demonstrate competency in a selected skill in screening, evaluation, and referral within a scenario
3. Demonstrate understanding of the code of ethics and standards of practice and its use in decision making
608Description of Participants
Participants in the simulation included the occupational therapy students, nursing students, and faculty from both disciplines. Nursing students portrayed a standardized patient in the scenarios. Faculty were present from both disciplines and acted as facilitators. The facilitators were seasoned clinicians with deep knowledge of content and the skill base to be addressed by the simulation.
E. RUNNING OF THE SCENARIO
The scenarios were developed to reinforce the knowledge and skills acquired in classroom learning activities. This simulation exercise lasted approximately 2 hours in length and was strategically positioned in the semester to best match the course content. For example, occupational therapy students learned about therapeutic communication and specific pathologies before the simulation. In additional, occupational therapy students learned standards of practice and the occupational therapy code of ethics. Nursing students had progressed through the nursing program whereby they possessed a good understanding of the diagnoses and conditions portrayed in the standardized patient scenarios.
The path of the session was directed by the occupational therapy student and the responses from the standardized patients during the simulation. Students were provided with performance expectations verbally and in writing 1 week in advance of the simulation. Students were permitted to orient themselves to the simulation environment at their own convenience any time before the day of the simulation if they chose to do so. Students were encouraged to review relevant readings and practice skills that applied to the scenario. Before the start of the simulation, students were reassured that the results of the experience were confidential. However, as the students were in an open space during the simulation, they may have been observed by their peers. They were oriented to the physical space and the location of the equipment likely needed during the simulation verbally and through a visit to the simulation environment at their discretion. Student expectations were stated again immediately before the start of the simulation. The simulation included the element of time pressure and the student was responsible for the flow and pacing of the simulation. Once the simulation had begun, it was allowed to progress without interruption unless a safety concern developed. Otherwise, the facilitator observed the simulated interventions as they unfolded (INACSL, 2013/2016). At the end of the simulation, nursing students stepped out of their role as the standardized patient and provided direct feedback to the occupational therapy students about the effectiveness of communication strategies employed during the session.
F. PRESENTATION OF COMPLETED TEMPLATE
Title
Simulation #1—Occupational Profile
Scenario Level
The level of this scenario is intended for an advanced beginner
Focus Area
Occupational therapy, general practice
609Scenario Description
The occupational therapy scenario replicates an outpatient therapy setting. The patient arrives in the occupational therapy department with a physician referral and is evaluated by the occupational therapist. Occupational therapy and nursing students arrive in the occupational therapy classroom and separate into to their respective roles. Occupational therapy students function as therapists while nursing students function as standardized patients referred to occupational therapy for intervention. The nursing student randomly chooses a patient identity that includes a brief history and specific behavioral characteristics that are portrayed during the interaction. The gender of the standardized patients modified to reflect the gender of the nursing student playing the role of the patient. The patient’s identity and history are withheld from the occupational therapy student. The identities for the standardized patients include:
• A 27-year-old with a history of a traumatic brain injury; the injury is a result of a ride on the back of a four-wheeler that was driven by the spouse
• A 30-year-old single parent with a flexor tendon injury to the dominant hand
• A 65-year-old with the diagnosis of left cerebral vascular accident affecting the dominant upper limb; this patient is new to a long-term care facility and is hoping to be a temporary resident
• A 50-year-old who works in a factory that assembles small parts with electrical wiring and now has an upper limb injury sustained on the job
• A 70-year-old divorced person newly released from the hospital after right-knee replacement with complications; this patient currently lives with his daughter but wants to return to an apartment located on the upper level of an apartment building
Scenario Objectives
1. The occupational therapy student obtains information from the patient through an occupational profile to include the patient’soccupational history and experiences, daily habits and routines, interests, values and current concerns.
2. The occupational therapy student implements therapeutic communication strategies, including interview techniques, to elicit information from the patient necessary to complete the evaluation process.
The scenario reflects the following AOTA (2011) standards:
Standard B.4.0: Screening, Evaluation and Referral
Standard B.5.7: Demonstrate Therapeutic Use of Self
The AACN Essentials of Baccalaureate Education for Professional Nursing Practice (AACN, 2008) reflected in the scenario:
Stay updated, free articles. Join our Telegram channel
Full access? Get Clinical Tree
