MASTERING SIMULATION A HANDBOOK FOR SUCCESS
Ulrich B, Mancini B. Indianapolis, Indiana: Sigma Theta Tau; 2013.
Mastering Simulation is a concise, comprehensive book for those organizations just beginning a simulation program and for those with an existing simulation program. The authors have gathered simulation experts who have contributed their vast knowledge and expertise to this book. Health care leaders (academic and clinical) as well as educators will find this book useful in preparing students to care for patients including clinically complex patients and in developing scenarios for beginning and ongoing competencies with staff development.
Chapter 1 begins with the foundations of simulation factors that contributed to the growth of simulation and the theoretical foundation for the use of simulation. The authors also address factors associated with adult learners. The contributors define many of the definitions associated with simulation. Legal and ethical issues in using simulation are discussed.
Chapter 2 discusses developing clinical competence and confidence using simulation. There are also some techniques to encourage learner motivation.
Chapter 3 discusses creating effective simulation environments, stating that simulation is a teaching strategy. Levels and types of fidelity for simulation are described. The authors supply sample checklist and a scenario template.
Chapter 4 reviews how to create effective and evidence-based scenarios. Scenario development and planning checklist including objectives, supplies, roles, scripts, debriefing, and evaluation are addressed.
Chapter 5 focuses on debriefing and reflective practice and the importance of both.
Chapter 6 describes rationale for evaluating simulation and provides a framework for evaluation.
Chapter 7 discusses the use of simulation with specific learner groups and how simulation can be used to bridge the gap for many clinicians from academia to practice.
Chapter 8 reviews the evolution of simulation to include interprofessional education and practice. Competencies in this area are addressed and include values/ethics, roles/responsibilities, interprofessional communication, and team and teamwork. Challenges and factors that may contribute to positive and negative outcomes are addressed.
Chapter 9 addresses simulation use in academic environments using educational theory to improve learner performance with both content delivery and development of psychomotor skills.
Chapter 10 discusses some of the opportunities and challenges with implementing a simulation program in hospitals and health care systems. The authors go through some of the steps in establishing a program including a leader, initial assessment, program development, purchasing equipment, and staffing a simulation center.
Chapter 11 discusses the use of simulation for risk management and quality improvement. The authors discuss patient, clinician, and environmental safety and how simulation can be used to reduce some of these risks.
Chapter 12 discusses the impact that simulation-based research can have on bedside care. The authors also discuss the design and implantation of simulation-based research.
Chapter 13 describes the roles and skills essential to simulation. Sample position descriptions are given for simulation centers. The authors also include resources and information on certification in simulation for those seeking a career in simulation
Chapter 14 discusses how simulation is being used in credentialing of health care personnel and the importance of certification in simulation. The development of Certified Healthcare Simulator Educator Certification program and the steps involved are given.
Chapter 15 discusses developing and building a simulation center with steps in planning, gathering information, and space requirements, as well as funding and planning resources.
Chapter 16 discusses some of the issues, challenges, and opportunities associated with simulation. With simulation and technology evolving and academic and clinical expectations changing, the use of simulation can provide meaningful experiences for health care providers and help prepare them in a safe environment for complex patient care.
ABOUT THE AUTHOR
Judith Lindsay, RN, MSN, PhD(c), is a nursing program director at Pediatric Research Abstracts, Blackfeet Community College, PO Box 819, 504 S East Boundary St, Browning, MT 59417.
THE NERDY NURSES GUIDE TO TECHNOLOGY
Wilson B. Indianapolis, IN: Sigma Theta Tau International; 2014.
If you are afraid of technology and do not know how to get started, Brittney Wilson has written an upbeat, informational guide for nurses along with relevant and easy-to-follow technology tips included in every chapter. The Nerdy Nurse's Guide to Technology presents technology in a simplified format explaining the basic terms and utility, impressing its value as an essential component of delivering effective nursing care.
Wilson encourages the reader to understand new language and apply new techniques at an individual's own pace. She reminds us that the key to becoming comfortable with technology is finding personal relevance: consider how you use technology every day to communicate with friends and family, find information, and share professional ideas. Competence with technology at a personal level will help you get started toward expanding your proficiency professionally. However, Wilson warns us to take the time to understand technology. Time spent learning the basics will overcome fear and gain confidence, as health care becomes a high-tech environment.
Wilson tells the reader to "ease your way into technology." Technology is constantly changing and as she points out, "everyone struggles with technology on some level...but you owe it to yourself and to your patients to be informed."
The title of her last chapter basically says it all, "Technology Isn't Going Anywhere," and the Health Information Technology for Economic and Clinical Health Act corroborates that fact. Technology is the present and the future of healthcare and is an essential component of Accountable Health Care.
From Google docs to social networking, smartphones, apps, and career advancement, Wilson highlights the very basics of technology to peak your interest and encourage confidence. In the end, she offers a recap of the book and suggests that if readers focused only on chapter 2, they would have a better understanding of approaching technology without fear. Just learning all that Google has to offer will impact your nursing career. Wilson tells us that most people use Google, as a search engine, to find information on the Internet. Finding answers to medical questions from credible medical institutions and authors at the click of a mouse is empowering. She gives a personal example of a clinical assignment when, during her research, she used Google Docs and Google Chrome to present and share information.
As Wilson points out, technology could never replace the personal care a nurse can give, and patients will positively benefit from newfound skills. The electronic health record will help nurses to personalize their patients' experience. No longer will time have to be spent deciphering a nurses' handwritten notes; electronic records save time and reduce errors. Nurses must feel confident using technology, and Wilson's book is a good start for the "shy" nurse!
ABOUT THE AUTHOR
Mary Palombo Werlin, Med, is an Instructional Technology Specialist in Needham, Massachusetts.
Address correspondence and reprint requests to: Mary Palombo Werlin, Med, 20 Winslow Rd. Winchester, MA 01890 (mailto:[email protected]).
WIHI: SITUATION-BACKGROUND-ASSESSMENT-RECOMMENDATION: STRUCTURED COMMUNICATION AND PSYCHOLOGICAL SAFETY IN HEALTH CARE
Original presentation: January 30, 2014.
Currently available at http://www.ihi.org/resources/Pages/AudioandVideo/WIHISBARStructuredCommunication.
Presenters:
* Michael Leonard, MD, Safe & Reliable Healthcare LLC; adjunct professor of medicine, Duke University School of Medicine
* Audrey Lyndon, PhD, RNC, CNS-BC, FAAN, associate professor, University of California, San Francisco, School of Nursing
* Jill Morgan, BSN, MBA, NE-BC, nurse manager, intensive care unit, UnityPoint Health-St. Luke's Hospital
* Ansley Stone, OB quality coordinator, Carolinas HealthCare System
WIHI is the Institute for Healthcare Improvement's free "talk show" program. The format was developed to help healthcare improvers keep up with current and robust thinking and strategies for improving patient care. Live attendance is possible when the hour-long webinar is premiered, but participants may access the program later, listen to the audio and download the transcript of the chat, slides, and resources. Participants may also choose to do any of these things individually. I decided to listen to the audio first, and later, when I returned to my computer, I opened the slides and resources to follow up on some of the materials referred to during the presentation.
Identify situation-background-assessment-recommendation (ISBAR) is widely used, but some other frameworks are now being discussed. I was curious to hear what other multidisciplinary teams were using.
The presentation first explained that SBAR was derived from the Navy and adapted to healthcare by Kaiser Permanente's Doug Bonacum and Suzanne Graham, along with Dr Michael Leonard. The structured communication framework migrated into the world of healthcare more than a decade ago. The initial format, SBAR, is a way for professionals to succinctly convey critical information to each other in a safe and effective way. More recently, the "I" was added to improve identification issues.
Although SBAR is widely used in emergency and critical care, presenters Jill Morgan and Ansley Stone are nursing leaders who explained how they use SBAR in ensuring safe care for pregnant women undergoing labor and delivery and in drawing attention to any patient or staff situation that requires immediate attention and decision making.
Live conversations with thoughtful questions continued throughout the 1-hour session. Participants and presenters agreed that communication is a social agreement in which we must provide psychological safety. Encouraging team members to speak up, in a respectful and professional manner, may require some training, practice, and mentoring. The discussion provided suggestions to help providers step back from previous issues and relationships and focus on the delivery of clear communication. All presenters agreed that improving communication between team members is key to improving safety.
Throughout the webinar, participants suggested resources such as Web links and books, while offering advice from personal experiences. Suggestions for further reading and information about guidelines were included verbally and in the written chat. For example, they offered directions for anyone interested in looking at a complete package of communication tool developed by the airline and military professionals. It was helpful to hear that SBAR is a tool, whereas TeamSTEPPS is a structured framework for moving to a culture of safety.
A direct link was provided to check out the Agency for Healthcare Research and Quality's (AHRQ's) TeamSTEPPS, which includes SBAR, at http://teamstepps.ahrq.gov/. Following this link brought me to additional resources and an invitation for an upcoming webinar hosted by AHRQ on how to use AHRQ's Hospital Survey on Patient Safety Culture to evaluate the impact of teamwork training on changes in patient safety.
It was interesting to hear how hospitals, schools of nursing, and medicine are using SBAR. Some introduce it in hospital orientation for all staff, whereas in the intensive care unit, all nurses are mentored using SBAR. Nursing and medical students use it in simulated experiences, learning it as a framework for team communication. For many, it has become part of the culture. The accompanying slides provided examples of computerized communication tools and formats using SBAR in hospitals that have merged the framework into the electronic medical record.
I was very interested in the discussion about using SBAR for listening. Strategies to include teaching active listening explained how SBAR formats make listening easier.
This led to a discussion about the importance of knowing to whom you are speaking and how to identify your role in the patient's care. Presenters explained how the acronym was updated to ISBAR to include identity. Links to YouTube videos were provided to illustrate this point.
Poll questions were sent out early in the presentation and included questions such as "What are your challenges in communication?" It was interesting to hear different perspectives as live webinars encourage participants to work like a think-tank: asking questions that encourage critical thinking and discussion. We were encouraged to ask ourselves questions, such as the following: What's your experience with SBAR? How might it be strengthened for safety work over the next 10 years? How can SBAR become a solid communication tool for improved handoffs or enhance newer processes, such as daily safety huddles, to achieve what Michael Leonard calls "psychological safety" among all staff?
It was clear that high-performing cultures with high accountability are very clear about how they talk to each other. In this discussion, I learned about a book entitled Helping: How to Offer, Give, and Receive Help by Edgar H. Schein. In this book, Schein teaches that to change behavior, we need to communicate respect, and if you want someone to do something differently, you must be explicit about behaviors you want to see. The author tells you to think out loud and invite others into the conversation.
As I become more comfortable with technology, I will listen to more webinars, in my car, on walks, or at home. I like the many options that this format offers and the flexibility to find the one that best fits my schedule.
The authors have disclosed that they have no significant relationship with, or financial interest in, any commercial companies pertaining to this article.
ABOUT THE AUTHOR
Kathleen Ahern Gould, PhD, RN, is an adjunct professor at Boston College, William F. Connell School of Nursing, in Chestnut Hill, Massachusetts. She is the editor-in-chief of Dimensions of Critical Care Nursing.