Meeting Challenges of Professional Communication Using Live Actors: An Evidence-Based Clinical Project

An essential aspect of the nursing profession is the ability to demonstrate professionalism and be effective and therapeutic in ones’ communication. The academic environment provides curriculum addressing communication however students are often provided limited clinical opportunities to develop their abilities and skills during their clinical experiences. Additionally, the most challenging situations of patient safety initiatives at acute facilities have limited the opportunities for students to experience some of the most challenging communication issues in practice. Conflict management, legal and ethical issues, advocating for a standard of care in sensitive situations such as end-of-life are an element of professional practice yet little specific preparation is done for the “real world of practice”. The possession of effective communication and continued assessment of one’s own communication techniques is essential. Those who do not possess these skills will be challenged in practice, with potential for misunderstandings among patients, families, other members of the interdisciplinary team collaborating to plan and provide quality care. Although the literature contains ample examples of simulation used to teach psychomotor skills, studies involving the use of live actors to teach therapeutic communication remain limited (Webster, 2013).
In an attempt to address the growing concern for how academics prepare both undergraduate and graduate students for their practice role research was done using live actors to address the learning objectives related to communication during academic years 2015-2017. The results indicated the use of live actors was an effective teaching strategy in meeting the learning objectives, engaging the students and leading to a request for additional experiences with live actors. Following the research, ongoing dialogue with graduate students in practice, input from professionals in clinical settings both at the bedside and in leadership and management positions identified situations where communication challenges consistently presented themselves. This led to formal meetings and the development of a proposal for the development of a collaborative evidence-based project to address the communication challenges experienced by professional nurses in their workplace environment using live actors. Little is available to them to address specific self-identified challenges once they are in their practice role. Orientation of new staff might include specific areas of professional communication but limited ongoing resources are available for both new professionals in practice or for those nurses assuming a new practice role. Collaborative relationships were established with health care facilities in the New York City area providing care for patients with high acuity need. The research previously done lead to an evidence-based project mutually constructed by the researchers and members of the professional staff at participating health care institutions.
Overall Purpose of Project: To identify and meet specific self-identified communication challenges experienced in the clinical setting, by professional participants through the use of live actors. This teaching strategy represents an opportunity for immersive, interactive, and reflective simulation experiences to enhance nurses’ clinical practice (Keltner, Grant, McLernon, 2013). Additionally, continued assessment of the effectiveness of the project in fostering communication skills and confidence for professional participants was essential.

Participants in the presentation will be able to:
1.Understand the research findings which was the basis for the development of a collaborative evidence-based strategy using live actors to address communication challenges experienced by professional nurses in practice.
2. Identify the collaborative process used to initiate an evidence-based program addressing professional communication challenges experienced in practice.
3. Identify specific situations which present communication challenges for nurses
4. Know specific elements of selection, scripting and preparation of actors
5. Identify stages and focus of each stage of the simulation experience.
6. Identify challenges experienced in implementing the project and management strategies
7. Understand effects of the project and clinical relevance
Design: Data was collected regarding communication challenges experienced by nurses in the facility. Participants were asked to prepare and submit a brief description of an experience where they had difficulty and challenged their communication abilities. Situations involved communication with patients, families, other members of the interdisciplinary team, as well as with other colleagues in staff as well as leadership and management positions. Scenarios were created according to the identified needs, and reviewed with members of the health care facility responsible for professional development. A regular meeting schedule was created to maintain a collaborative focus and commitment to the strategy. Identification of specific communication goals for each scenario were established, and completion of all elements of the scenario. This also included selection and preparation of the actors. Orientation of the nursing participants to the experience using live actors included communication goal, assignment of roles, rules of behavior, the use of “time outs” debriefing and feedback using a brief evaluation tool submitted electronically upon completion.
Results: Participants’ feedback supported continuation of the project. Feedback also included emotional impact statements, and a number of “Ah Ha Moments” for future consideration and reflection. It was essential that the leader of the experience had expertise in managing unanticipated developments such as a participant’s own lived experience with a loved one during a scenario involving end-of-life family concerns. A number of scenarios had multiple uses as themes presented themselves. Scenarios included general conflict management, legal, ethical concerns, advocacy for patients and self, precepting new staff, collegial conflict, possible breeches in maintaining standards of care, counseling and providing clinical performance reviews. Scheduling and identification of appropriate actors was a specific challenge but was eased through networking and outreach. No pediatric actors participated in this work.
Conclusion: Results of this project confirmed the results of the research which served as the foundation for the project. The use of live actors in simulation for communication challenges experienced by practicing professional nurses remains a viable strategy to promote the continued assessment and development of communication skills necessary to navigate the complexities of health care. This strategy can focus on specific areas and individualized for the setting, participants, and situation. Since communication is essential to providing health care regardless of where it is delivered there are possibilities for replication of this project globally.
Clinical Relevance: This initiative addresses a need identified by professional nurses in practice and their desire to practice at the highest standard possible. There are often limited opportunities to self-evaluate and develop communication skills under the guidance of professionals with specific expertise and in a safe and supportive environment. This project also addresses QSEN competencies: patient-centered care, team work and collaboration, quality improvement and safety. This evidence-based strategy holds great promise whether locally or internationally, and also presents an opportunity to expand the blueprint for this project to interprofessional practice and influence the quality of care where effective communication is essential.