Providing the opportunity for traditional undergraduate nursing students to participate in simulation and collaboration on interprofessional patient care is nothing short of a scheduling and time management nightmare. The problem is compounded when distance (fully online) undergraduate, baccalaureate nursing completion (BNC) students (LPN to BSN and RN to BSN) are factored into the mix. Thus, a means to offer an opportunity for various tracks of undergraduate nursing students (multi-site) to receive simulation and an interprofessional collaboration experience was requisite. As such, a novel means to equitably facilitate learning gave rise to the use of an Interprofessional Palliative Care Movie Simulation.
“Video-recorded simulation is a teaching technology that allows one to present reality under controlled conditions, both of the environment and the individuals involved, which in turn favors learning” (Cardoso et al., 2011, p. 709). Likewise, video/movie simulation can be accessible via online access as is needed for online students in the BNC program, or as an in class presentation for face-to-face traditional undergraduate nursing students. As palliative care practice readily depicts rich examples of interprofessional team work, a carefully developed movie portraying end of life team care of a patient with amyotrophic lateral sclerosis (ALS) was chosen. This movie had been scripted from audio recordings of students responses during an actual simulation of end-of-life care for a patient with ALS and his husband. The movie was filmed using standardized patient actors playing the patient, husband, sister and the student healthcare providers. The use of standardized patients in simulation “provide rich clinical experiences for undergraduate nursing students” (Sideras, McKenzie, Noone, Markle, Frazier, & Sullivan, 2013, p. 425). The movie is segmented into five scenes; the first four include assessment of patient and family needs by nursing, physical therapy, primary care provider, social work and speech language pathology; the final act is a death scene.
Purpose:
Although evidence supports simulation and the use of video technology, an interconnection of the two and the delivery of complex inter-professional collaborative care content calls for an investigation into the success of these measures to facilitate learning. As such, the purpose of the investigation is to 1) assess student satisfaction and self-confidence in learning using the Interprofessional Palliative Care Movie Simulationand 2) compare online discussion board debriefing with an in person post movie simulation debriefing.
Methods:
The National League for Nursing (NLN) Student Satisfaction and Self-Confidence in Learning survey was utilized for assessment. This 13 item tool utilizes a five point scale. Reliability has been “tested using Cronbach's alpha: satisfaction = 0.94; self-confidence = 0.87” (“Description of Available Instruments,” 2016). Questions from a previously developed tool (University of Vermont) based on the Interprofessional Competency Domains of 1) Values/Ethics, 2) Roles/Responsibilities, 3) Interprofessional Communication, and 4) Teams/Teamwork were also utilized. The tool had been reviewed by faculty in each discipline providing content validity. Reliability of the survey instrument was not tested or established.
The distance students accessed the movie simulation assignment via their online learning platform. The students asychronously viewed the movie simulation and answered debriefing questions via discussion board format. At the close of the discussion board, the students were given access to Qualtrics links for the NLN survey and the IP competency survey. The traditional undergraduate students, participating in person, completed the NLN survey and the IP competency survey after the conclusion of a synchronous movie viewing and debriefing completed in one continuous group session.
Results:
The traditional undergraduate nursing students (n=82) who participated “in person” were 89% female and 11% male, 3% Hispanic, 91% White/Caucasian, 6% Asian and 1% Black/Africian American. The average age was 23 years. The BNC students (n = 25) who participated online were 96% female, 4% male, 76% White/Caucasian, 4% Asian, and 16% Black/African American. The age of these non-traditional students ranged from 24 to 54 years. All students were in their senior year.
Regarding the teaching methods used in this simulation, 94.39% of respondents agreed or strongly agreed that the methods were helpful and effective. When grouped as questions regarding satisfaction in learning, the results of respondents answering agree or strongly agree were 94.54% (RNs), 91.90% (LPNs), and 86.56% for traditional nursing students. Likewise, for questions regarding self confidence in learning, the results of respondents answering agree or strongly agree were 92.05% (RN), 84.17% (LPN), and 79.12% for traditional nursing students.
One question in particular that revealed the most undecidedness or disagreement was: “It is the instructor's responsibility to tell me what I need to learn of the simulation activity content during class time.” The results of respondents answering agree or strongly agree were 54.54% RN, 40% LPN, and 40.74% for traditional nursing students. These results are considerably different from the overall favorable impression of all other survey questions. And, in contrast to this question, students responded positively to a smilar question, “It is my responsibility as the student to learn what I need to know from this simulation activity.” The results of respondents answering agree or strongly agree were 100% RN, 100% LPN, and 89.75% for traditional nursing students.
In regards to self confidence in learning, statements that revealed the most undecided or disagreement were: “I am confident that I am mastering the content of the simulation activity that my instructors presented to me” (UNDECIDED, 20.99% and DISAGREE 3.66% of traditional nursing students only); and “I am confident that this simulation covered critical content necessary for the mastery of medical surgical curriculum” (UNDECIDED, 18.18% RN, 13.33% LPN, 17.28% traditional and DISAGREE, 6.67% LPN, 6.54% traditional).
In regards to the debriefing methods used (face-to-face interaction or online discussion board), the response was extremely favorable and students felt they were able to express their thoughts in a manner conducive to learning. Specifically, in response to the question, “I expressed my knowledge and opinion during the case discussion” results of respondents answering agree or strongly agree were 100% RN, 100% LPN, and 97.53% for traditional nursing students.
Five questions regarding interprofessional collaboration were utilized. Overall 85% of undergraduate nursing students felt they learned about interprofessional team work following the simulation. Students overwhelming indicated that they would forge relationships with other healthcare professionals to improve care for elders with 100% RN, 100% LPN, and 97.56% traditional nursing students responding agree or strongly agree. Likewise students recognized the necessity of utilizing a healthcare team to provide care for patients at the end of life with 100% RN, 93.33% LPN, and 97.53% traditional students responding agree or strongly agree.
Conclusion:
All tracks of undergraduate students reported acceptance of the responsibility for their learning and are comfortable with the use of simulation even when it involves watching a previously recorded simulation. Student responses show that this format is a useful means to allow for online simulation (via a movie) and shows evidence of satisfaction (mode of simulation) and self-confidence in learning and perceived competency in the interprofessional palliative care of a patient. Thus, at least for this pilot survey various tracks of nursing students (multi-site) learning via differing formats (online versus face-to-face) may have direct benefit from this educational modality. This finding is helpful as the logistics for and cost of simulation for large groups of interprofessional students is considerable.
A significant amount of literature supports the use of simulation for enhancing critical thinking. Thus, the development of specific (level appropriate) video case study simulations may broaden the teaching strategies available to bring simulation to students of nursing and other interprofessional disciplines. Thus, the use of a movie simulation (based on health concepts/case scenarios) appropriate to the level of learning can reach a wide audience outside of a simulation lab whether a distance or local student.
Recommendations for Future Research:
As more nursing education is delivered using an online format, innovative online simulation activities which expose students to interprofessional practice must also be continually developed, implemented, and evaluated. The use of faculty developed medical movie simulation scenarios in conjunction with other technological advances such as virtual clinics, video conferencing, and mobile robotic telepresence have and may continue to open up new avenues for interprofessional simulation education albeit, this type of innovative pedagogy must be further evaluated and disseminated. In addition, these modalities can be utilized synchronously or asynchronously whether online distance student or face-to-face campus student. Consistent evaluation of interprofessional practice competency domains must also be included in all educational activities. Likewise continued evaluation of movie simulation as a modality of simulation is recommended in nursing as well as in other disciplines. As an additional measure, multi-site, multi-educational mode (face-to-face and online) comparisons are encouraged.