In this continuing series on using standardized patients (SPs) in the practice setting, I interviewed Gene Hobbs, BS, Director of Simulation at the University of North Carolina at Chapel Hill School of Medicine and the University of North Carolina at Chapel Hill Department of Pediatrics. Gene is also a Certified Healthcare Simulation Educator and has worked within the healthcare simulation field since 2001. He has extensive experience in simulation-based operations, research, and interprofessional education.
Although the previous several columns have primarily focused on simulation scenarios that involve adult issues and concerns, I took this opportunity to explore with Gene how nursing professional development (NPD) practitioners can use SPs for pediatric-based cases.
MEH: Gene, please share your philosophy on how to conduct simulations related to pediatric issues.
GH: Pediatric simulations can be more challenging than adult scenarios because learner emotions often become very intense. It is important to pay attention to the psychological safety of the learners as they often find taking care of babies and children to be very hard. I have seen learners struggle with their emotions because of the increased stress level they experience while taking care of a sick child. You never know what emotions will get triggered, and facilitators need to be able to appropriately handle the situations that might arise.
MEH: What other aspects of pediatric scenarios are important to emphasize?
GH: I often find that learners need practice with managing the social dynamics of families. For example, simulating a pediatric patient with an entire family in the waiting room can be an effective learning experience. The SP family members can act out a large range of emotions and interactions that the learners must handle, whether it is disagreement about the plan of care or personal conflicts with each other. Communication can get exponentially harder than one-on-one interactions with an adult patient, yet it is very real and something that clinicians need to master.
MEH: Please share how you have integrated simulation technology and SPs into a pediatric scenario.
GH: Using SPs as family members in pediatric simulations can be a great way to enhance fidelity. For example, we run a scenario that involves a father, the SP, who brings his seizing baby into the community hospital emergency department for treatment. The "baby" we use is actually a high-fidelity manikin so that we can simulate seizure activity. The SP father acts out subtle early stages of carbon monoxide (CO) poisoning, such as a dull headache and fatigue. The goal is for the interprofessional team is to arrive at the correct diagnosis, to prepare for an interfacility transfer for a higher level of care, and to recognize that other family members may be exposed.
MEH: Have you experienced doing a scenario that brought about unanticipated results?
GH: Recently, I was preparing for a Pediatric Intensive Care Unit scenario that was to involve the baby's mother and father, yet I only had two female SPs available. So, I used the two female SPs and made them a same-sex couple. I found that the learners recognized a need to practice open and accepting language where parental structures are concerned but had few opportunities prior to this event. We now regularly integrate this same-sex couple aspect to add another dimension to family interactions.
MEH: It is interesting what you can learn when something simple like not having a male SP adds a twist to a scenario. What are your thoughts on pediatric interprofessional simulation scenarios?
GH: Depending on the situation, I might only have learners from one profession, such as pediatric residents. However, I always make sure we have interprofessional facilitators, such as nurses, advanced practice nurses, or pharmacists, who add perspective to the simulation. I also make sure they are integrated into the scenario in a meaningful way. For example, we often run simulations for residents on obtaining informed consent. For an adult patient, that scenario can be rather straightforward. However, there are many factors that can be added for a pediatric case. We can have our SP parents disagree on the plan of care, shut down emotionally with the resident, or exhibit body language to convey that they are confused and do not understand the procedure. As the scenario plays out, the resident might believe they have obtained informed consent from the parents, but the care nurse, played by one of our charge nurses, intervenes and states that the parents expressed privately that they did not understand what they were signing.
MEH: This sounds like an excellent way to involve frontline nurses in the simulations and to help the pediatric residents improve their communication skills.
GH: Absolutely. The charge nurses, essentially acting in an SP role as a clinician, can help the residents see the broader perspective of how obtaining informed consent can be quite extensive. They also have vast experience in dealing with the multitude of family dynamics and pediatric-specific issues that arise and are very willing to share their knowledge broadly.
MEH: How have you used SPs to portray actual pediatric patients and not just adult family members?
GH: Though I have not trained or hired actual child actors, I have worked with children of clinicians to be SPs, which can add a great deal of fidelity to a scenario. One simulation involves treatment of childhood orthopedic injuries. One of my facilitator colleagues has two children, ages 12 and 14, who come in to portray these patients. I have also had children of clinicians help us as anatomy models for ultrasound training.
MEH: What considerations do you need to take into account when working with children?
GH: It is best if the parent is present the entire time. The children need to have a solid level of maturity as well. These two children take their roles seriously and seem to enjoy portraying orthopedic patients.
MEH: Into what other scenarios have you integrated children SPs?
GH: One of my facilitators brought in her 7-year-old son to portray a sepsis patient. We actually put the child into an ambulance and took him to the emergency department. He was then sent to the Pediatric Intensive Care Unit. We were testing hospital systems issues related to sepsis treatment, and I was pleased that the responding teams took everything very seriously! We were able to identify and address several systems issues that day.
MEH: How did the child cope during the simulation?
GH: He did really well. His mother was there the entire time with him. Because he was transferred to several places, there was a significant amount of downtime during the simulation. To prevent boredom, we made sure he had his iPad with him and some other things keep him occupied.
MEH: Is sounds like there are a lot of challenges and opportunities when working with pediatric-focused simulations. Is there anything else you would like NPD practitioners to consider when working with this population?
GH: I find that sometimes clinicians forget that, even though they might be taking care of a pediatric patient, they also need to know how to take care of adults, as adults accompany the children. For example, I will run simulations where the child is coming in for an outpatient visit, but the father goes into cardiac arrest in the waiting room. The learners must be able to effectively handle an adult issue or emergency along with handling a pediatric issue or emergency.
MEH: That is great advice! Thank you so much for sharing your knowledge and experience with us.
My conversation with Gene shed light on the variety of ways NPD practitioners can use SPs in the practice setting to help infuse realism into their pediatric scenarios, particularly when teaching about family dynamics and targeted communication issues. What have you done in the practice environment with SPs and pediatric scenarios? Have you encountered any opportunities or challenges that you would like to share with other NPD practitioners? E-mail me at mailto:[email protected] to continue the conversation.
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