Research examining how perceived realism and presence affects participants' learning experiences and outcomes is limited.
A convergent mixed-methods design was used, with quantitative data assigned ...as the primary method. After engaging in a communication training simulation, 141 undergraduate nursing students completed the Concept of Presence, Simulation Design, and the Quality of Discharge Teaching scales. A subsample of 12 participants were interviewed to provide qualitative data, as the secondary method, on their learning experience. Hierarchical multiple regression analysis was performed on the quantitative data and thematic analysis for qualitative data.
Differences in participants' perceived realism and level of presence were not affected by the communication-based learning interventions. A positive, fully mediated relationship between realism, presence, and learning outcomes in discharge communication skills was found. The quality of the simulation experience gave participants the opportunity to reflect on their knowledge and capacity to transfer skills into clinical practice.
The convergence of findings supports the theory that perceived realism and presence positively affected learning outcomes. J Nurs Educ. 2019;58(6):330-338..
As hospital lengths of stay are reduced and patients are organised to return home with the expectation of managing more complex issues, preparing patients and their families for discharge becomes ...more challenging. Patients with chronic health conditions, such as type 2 diabetes typically have poorer health outcomes post discharge and higher readmission rates (Peter et al. 2015). Preparing nurses to perform safe, complex patient discharge will likely lead to improved patient confidence in self-management, and potentially better outcomes.
Based on detailed multi-disciplinary analyses of more than 800 recorded handover interactions, audits of written handover documentation, interviews and survey responses, the contributing authors ...identify features of effective and ineffective clinical handovers in diverse hospital contexts. The authors then translate their descriptive findings into practical protocols, communication strategies and checklists that clinicians, managers and policy makers can apply to improve the safety and quality of clinical handovers. All the contributors are affiliated with the International Research Centre for Communication in Healthcare (IRCCH), an international multidisciplinary organisation of over 90 healthcare professionals from more than 17 countries committed to improving improving communication in healthcare systems around the world. 'The authors have created a new and tightly woven systems safety net that will, if implemented, significantly reduce the occurrence of errors resulting from cumulative communication failures.' -H. Esterbrook Longmaid III, MD, FACR, President of Medical Staff, Beth Israel Deaconess-Milton Hospital, Milton, MA USA 'Uncommonly valuable for the rigorous, original communication research it reports and for the careful translation of the research findings into practical strategies that actually improve clinical handovers in the real world of practice.' -Professor Suzanne Kurtz, Washington State University 'This clear, plain English book is an outstanding resource for the training of all involved in healthcare.' -Elizabeth Trickett, (Former) Director of Safety and Quality, ACT Health, Australia
In the emergency department, communication failures occur in clinical handover due to the urgent, changing and unpredictable nature of care provision. We present a case report of a female patient who ...was assaulted, and identify how various factors interacted to produce communication failures at multiple clinical handovers, leading to a poor patient outcome. Several handovers created many communication failures at diverse time points. The bedside medical handover produced misunderstandings during verbal exchange of information between emergency department consultants and junior doctors, and there was miscommunication involving plastic registrars. There was a failure in adequately informing the general practitioner and the patient relating to follow-up care after discharge. Deficiencies of communication occurred with conveying changes in an investigative report. Communication could be improved by dividing the conduct of handover in a quiet room and at the bedside, ensuring multiple sources of information are used and encouraging role-modelling behaviours for junior clinicians.
Patient Safety emphasizes the reporting, analysis and prevention of medical errors that very often leads to adverse healthcare situations. 1 in 10 patients are impacted by medical errors. The WHO ...calls the patient safety issue an endemic concern. A number of well-known experts of all areas in the medical field have collected very valuable information for a better patient treatment and higher safety culture in all medical disciplines.
Registered nurses are expected to communicate effectively with patients. To improve on this skill education programmes in both hospital and tertiary settings are increasingly turning to simulation ...modalities when training undergraduate and registered nurses. The roles simulated patients (SPs) assume can vary according to training purposes and approach.
The first aim is to analyse how SPs are used in nursing education to develop communication skills. The second aim is to evaluate the evidence that is available to support the efficacy of using SPs for training nurses in communication skills and finally to review the SP recruitment and training procedure.
An Integrative review.
A search was conducted on CINAHL, Psych-info, PubMed, Google Scholar, Scopus, Ovid, Medline, and ProQuest databases. Keywords and inclusion/exclusion criteria were determined and applied to the search strategy.
The integrative review included Nineteen studies from 2006‐2016. Critical Appraisal Skills Program (CASP) method of evaluation was utilised. Emergent themes were extracted with similar and divergent perspectives.
Analysis identified seven clinical contexts for communication skills training (CST) and two SP roles from the eighteen studies. SPs were either directly involved in the teaching of communication (active role) or used in the evaluation of the effectiveness of a communication skills program (passive role). A majority of studies utilised faculty-designed measurement instruments.
The evidence presented in the 19 articles indicates that the use of SPs to teach nurse-patient communication skills targets more challenging clinical interactions. Engaging SPs in both CST program facilitation and course evaluation provides nurse educators with a strong foundation to develop further pedagogical and research capacity. Expanding the utilisation of SPs to augment nurses' communication skills and ability to engage with patients in a broader range of clinical contexts with increased methodological rigor is recommended.
•SPs can partner with educators to enhance nurse's communication skills.•Comprehensive SP training and recruitment protocols should be employed and reported.•SPs can be effectively engaged in program facilitation and evaluation roles.
Aims and objectives
To examine the perspectives of health professionals of different disciplines about clinical handover.
Background
Ineffective handovers can cause major problems relating to the ...lack of delivery of appropriate care.
Design
A prospective, cross‐sectional design was conducted using a survey about clinical handover practices.
Methods
Health professionals employed in public metropolitan hospitals, public rural hospitals and community health centres were involved. The sample comprised doctors, nurses and allied health professionals, including physiotherapists, social workers, pharmacists, dieticians and midwives employed in Western Australia, New South Wales, South Australia and the Australian Capital Territory. The survey sought information about health professionals' experiences about clinical handover; their perceived effectiveness of clinical handover; involvement of patients and family members; health professionals' ability to confirm understanding and to clarify clinical information; role modelling behaviour of health professionals; training needs; adverse events encountered and possibilities for improvements.
Results
In all, 707 health professionals participated (response rate = 14%). Represented professions were nursing (60%), medicine (22%) and allied health (18%). Many health professionals reported being aware of adverse events where they noticed poor handover was a significant cause. Differences existed between health professions in terms of how effectively they gave handover, perceived effectiveness of bedside handover vs. nonbedside handover, patient and family involvement in handover, respondents' confirmation of understanding handover from their perspective, their observation of senior health professionals giving feedback to junior health professionals, awareness of adverse events and severity of adverse events relating to poor handovers.
Conclusions
Complex barriers impeded the conduct of effective handovers, including insufficient opportunities for training, lack of role modelling, and lack of confidence and understanding about handover processes.
Relevance to clinical practice
Greater focus should be placed on creating opportunities for senior health professionals to act as role models. Sophisticated approaches should be implemented in training and education.
Simulated patients (SPs) are frequently used for training nursing students in communication skills. An acknowledged benefit of using SPs is the opportunity to provide a standardized approach by which ...participants can demonstrate and develop communication skills. However, relatively little evidence is available on how to best facilitate and evaluate the reliability and accuracy of SPs' performances.
The aim of this study is to investigate the effectiveness of an evidenced based SP training framework to ensure standardization of SPs. The training framework was employed to improve inter-rater reliability of SPs.
A quasi-experimental study was employed to assess SP post-training understanding of simulation scenario parameters using inter-rater reliability agreement indices. Two phases of data collection took place. Initially a trial phase including audio-visual (AV) recordings of two undergraduate nursing students completing a simulation scenario is rated by eight SPs using the Interpersonal Communication Assessments Scale (ICAS) and Quality of Discharge Teaching Scale (QDTS). In phase 2, eight SP raters and four nursing faculty raters independently evaluated students' (N=42) communication practices using the QDTS.
Intraclass correlation coefficients (ICC) were >0.80 for both stages of the study in clinical communication skills.
The results support the premise that if trained appropriately, SPs have a high degree of reliability and validity to both facilitate and evaluate student performance in nurse education.
•SPs play a vital role in ensuring an authentic student experience•SPs can provide summative and formative student feedback when trained using an evidence based framework (NHET-Sim).•Further research is required to ensure SPs have capacity to adequately engage in scenario portrayal and provide feedback.
The use of video-assisted reflection as part of the debriefing process is a growing area of interest in simulation-based education. To further develop knowledge in this field, this study explored ...nursing students' reflections on their experience and learning after independently viewing audiovisual recordings of themselves engaging in a patient discharge simulation.
A qualitative study design was used. Students demonstrated their discharge communication skills with simulated patients in three learning intervention groups. Each student privately viewed an audiovisual recording of their simulation session before attending a group debriefing. Audio recordings from 35 debriefing sessions were transcribed for both content analysis and thematic analysis. The sample included 141 nursing students enrolled in a Bachelor of Science (Nursing) program.
Six themes and four subthemes were identified. Themes were realism, nonverbal communication, verbal communication skills, reflective learning, becoming a nurse, and patient needs. Two word clouds using wordcloud.com were generated from the content analysis of students' thoughts and feelings about the simulation experience.
Using simulated patients and video-assisted reflection when teaching communication skills resulted in students reporting a high level of self-awareness, confidence, and a sense of achievement. Students indicated that the process helped to gain a greater understanding of the importance of effective verbal and nonverbal communication skills during interactions with patients. Students reflected on the importance of engaging with patients and considering their postdischarge needs and well-being as part of discharge communication practises.
•Engaging with and reviewing interactions with simulated patients was an effective strategy to teach nursing students' discharge skills and the importance of patient-centred care.•Simulation using video-assisted reflection, while initially confronting, provided students with a unique opportunity to view and critique their communication skills as a nurse.•Watching the audiovisual recording in private supported students' learning needs, reduced their anxiety, and increased their ability to self-reflect.
This study evaluates the effectiveness of information- and interaction-based training interventions to improve nurses' communication skills during the discharge of a patient.
A quasi-experimental ...control group design was applied. Students demonstrated their discharge skills with simulated patients (SPs) in three randomly assigned groups namely control, information-, and interaction-based intervention. An independent group multivariate analyses of variance was used for analysis of both the quality of discharge content and delivery across groups using student, SP, and faculty assessor ratings.
Significant incremental improvements in student communication skills were achieved in the interaction and information groups compared with the control group.
A structured curriculum including high-fidelity simulation, with SPs providing feedback and evaluating students' information- and interaction-based communication skills, is useful in improving student discharge practices and “patients'” understanding of discharge instructions.
•Simulated patients provide an authentic clinical experience, as SPs provide valuable feedback from a patient's perspective.•Offering students an opportunity to apply teach-back with simulated patients can effectively help to teach nursing students efficient communication strategies.•Teach-back can be used to confirm patient knowledge when preparing patients for discharge.
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