Carol Robinson ACF Abstract FY12

"End of Life Simulation of Therapeutic Communication and Care Using Standard Patients and SimMan"

12th Annual International Meeting on Simulation in Healthcare (IMSH)

Clinical simulation of end-of-life (EOL) scenarios can give students the opportunity to learn the vital concepts of EOL care in a safe, non-threatening environment. We have developed and conducted a live simulation of therapeutic communication for EOL discussion with standard patients, and simulation of an actively dying patient, using one standard patient (family member) and SimMan®. The simulations were part of an elective EOL class, consisting of various undergraduate majors. A doctorate of nursing (DNP) student taped an interview of a model patient couple processing the recent bad news of a terminal diagnosis. The video was shown to the class, followed by a live interaction of the students with the model patients as they discussed which communication techniques were helpful versus those that were not. Three weeks later, the patient (now SimMan) was readmitted to our simulation lab with our model patient wife, and students were invited to participate in the care of the patient and his family while he died. Students originally were reticent to volunteer to participate in the death simulation. The faculty proceeded with the simulation, then offered to perform the simulation again with any student volunteers. Two undergraduate nursing students volunteered at that point. During the debriefing, barriers to participating in the simulation, given the safe environment, were discussed. Feedback included discomfort with caring for the dying without more experience. This simulation underscored the need for further education for undergraduate nurses in palliation and EOL care.

RATIONALE:

Practicing nurses report that they have received very little undergraduate or continuing education in palliative and =EOL care. The clinical rotation of many undergraduate nurses is filled with the psychomotor tasks of caring for the living. Rarely does the student have the privilege of caring for someone who is actively dying. Using AACN and ELNEC competencies and course outcomes as a guide, simulations can provide the student insights into elements of care that seem to provide the most emotional distress for students: emotional support to patients who are dying (and their families), physical care, and postmortem care.

SESSION OBJECTIVES:

1. Review seminal literature in EOL simulation

2. Describe process of producing a clinical simulation for EOL using both standard model patients and SimMan®.

3. Discuss debriefing methods/results for students following the scenario

INTENDED DISCUSSION QUESTIONS:

1. What experiences have audience participants had with EOL simulation (non-BLS/ACLS focused)?

2. What barriers stand in your way to produce an EOL simulation in your environment?

PLANNED FORMAT:

Lecture and presentation of video clips from the simulations

Interactive dialogue following presentation

Rationale: Practicing nurses report that they have received very little undergraduate education in palliative and EOL care. Rarely does the student have the privilege of caring for someone who is actively dying. Using AACN and ELNEC competencies and course outcomes as a guide, simulations can provide the student insights into elements of care that seem to provide the most emotional distress for students: emotional support to patients who are dying (and their families), physical care, and postmortem care.