Maximizing nursing resources is imperative for hospitals to meet budget. Merging units is often viewed as cost effective. Clinical simulation can be used to both cross-train staff and enhance perceptions of teamwork, thus contributing to patient safety. In the current project, public university school of nursing faculty partnered with a 255-bed regional medical center in the mid-south United States to implement and measure a strategy for training. The university in this project is not affiliated with any one specific medical center, nor is the medical center affiliated with any one single university. This was a true community collaboration that went far above the usual contractual relationship of the university’s nursing students performing clinical rotations with either an instructor or a preceptor, in this hospital. The project provided a professional development opportunity to the hospital nursing staff that was not otherwise possible for the hospital’s staff education department. The project helped stoke other networking and intraprofessional collaborative efforts between the two organizations.
Methods:
Sample: Fifteen nurses and eight nursing assistants underwent simulation as part of this professional development project. Four nurses and four technicians participated in a pre-test/post-test study as part of the project.
Training Methods: Two separate simulation sessions applying different unfolding scenarios (pediatric sepsis and pediatric asthma) were used to assist medical surgical nursing staff in caring for pediatric patients. A Gaumard pediatric simulator was used. This was a life-like, fully responsive wireless simulator. For each 45 minute scenario, one nurse was the patient’s primary nurse; the second nurse was the charge nurse. Project leaders played the roles of people to whom phone calls were placed, such as physician, laboratory, respiratory, and pharmacy. They also changed vital signs and patient outcomes according to the actions taken by the bedside nurses. The nursing assistant played his/her customary role, assisting the nurses, taking vital signs, running to get supplies, etc. The third nurse played a key role as patient’s mother; this person was ‘‘scripted’’ and was intended to challenge and stress the caregivers. Project leaders consisted of two nursing faculty experienced in high-fidelity simulation using unfolding scenarios, the clinical educator for unit, and the director of nursing professional development for the hospital. The director of respiratory therapy also participated with the staff in the scenarios themselves, which promoted interprofessional collaboration.
Study Methods: The 35-item Teamwork Perceptions Questionnaire (TPQ), created as part of the Team Strategies and Tools to Enhance Performance and Patient Safety (TeamSTEPPS) program, was used to measure teamwork. TeamSTEPPS is an evidence-based toolkit developed by the Agency for Healthcare Research and Quality (AHRQ) and the Department of Defense (DOD) in response to the crucial need to develop strategies related to team performance in healthcare. The TPQ is comprised of five constructs: (a) team structure, (b) leadership, (c) situation monitoring, (d) mutual support, and (e) communication.
Results:
Research Data Results: Non-parametric Wilcoxon signed ranks test demonstrated a significant improvement in the TPQ situation monitoring subscale (p < .05, p = .012). Similar research has both supported and not supported these results. The situation monitoring subscale includes:
- Staff effectively anticipate each other’s needs.
- Staff monitor each other’s performance.
- Staff exchange relevant information as it becomes available.
- Staff continuously scan the environment for important information.
- Staff share information regarding potential complications.
- Staff meets to reevaluate patient care goals when aspects of the situation have changed.
- Staff correct each other’s mistakes to ensure that procedures are followed properly.
Clinical Results: Successful simulation training was accomplished. During debriefing of the experience, an additional unexpected benefit of problem-solving transpired. The staff was able to discuss problems encountered on the new unit since it had opened. One example is that the examination room where children were brought for procedures such as a lumbar puncture was not well located or equipped. Together, the group brainstormed on how to resolve several issues. The educator mapped out a plan to address each issue. Additional educational needs were also outlined.
Conclusion:
This project cultivated teamwork among the participating staff, the clinical educator, the director of respiratory therapy, and the director of nursing professional development. Anecdotally, it also engendered a deeper sense of collegiality between the university and the medical center. Other collaborations between the two include: nursing faculty as members of the hospital’s nursing research and evidence-based practice council, partnership in a peri-operative internship supported by a grant, and potential future endeavors.
Implications for practice are that academic and clinical agency partnerships can be mutually beneficial to each organization and more importantly, the community as a whole. Alliances such as this can amplify the reach to accomplish goals and objectives for service excellence.