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Simulation-based nursing education has increased and become a more popular approach for clinicians or educators. It provides a real-life situational experience for students to practice skills, applies critical thinking and makes the decision throughout the simulation. This article is a reflection journal after a simulation for cardiac arrest. Reflection learning has been described as a process of critically reviewing experience from practice so that it may be used to inform and change future practice in a positive way (Bulman, 2008).
In this simulation-based resuscitation reflection, the effectiveness of using of the Situation-Background-Assessment-Recommendation (SBAR) framework during communication between allied health care professionals, teamwork during resuscitation and methods of collecting history from patient and patient will be discussed.
Situation-Background-Assessment-Recommendation (SBAR) framework. In this simulation, the nurse communicated with a physician by using traditional way to report patient’s condition via phone. Physician promoted and obtained information.
SBAR is a communication model which includes Situation, Background, Assessment, and Recommendation. The use of SBAR promotes quality and patient safety by setting shared expectations in terms of what is communicated. SBAR allows for efficient and predictable sharing of information by creating a shared mental model (Shapiro, J. 2017). It has become very popular among healthcare setting, especially between physicians and nurses. It is an effective way of communication for healthcare professionals and allows for transferring of important information.
The SBAR framework is considered by nurses and physicians to be an effective method for organizing the handoff report (Stewart, 2016). A study showed improved perceptions of communication in nurse-to-nurse and nurse-to-physician sceneries by using pre/ post-SBAR implementation questionnaires (Blom, Petersson, Hagell, & Westergren, 2015).
Hailu, Kassahun, & Kerie (2016) founded that communication failure between nurse and physicians was one of the leading causes of preventable patient injuries, complications, death and medical malpractice claim. Use of SBAR framework has been a method which can overcome this communication problem, Thus, using of SBAR framework has two major implication in future.
First, nursing education should include appropriate use of SBAR framework which can be used for effective communication at clinical areas (Stewart, & Hand, 2016). Same education will provide the same perception of SBAR framework and provide better application of this framework.
Second, Stewart and Hand (2016) also suggested that SBAR framework should be applied by nurses as a guideline for all handover communication between nurses and physicians, inter/intra department or institutions. Inpatient safety, effective communication during patient handoffs is the nursing priority (The Joint Commission, 2015).
In this simulation, endotracheal intubation was done in different manners. In the first team, all members did endotracheal intubation and stopped chest compression. In second group one person struggled and did an endotracheal intubation. Teamwork was not done in this simulation. As this procedure should need two persons at least. Teamwork and leadership were lacked.
Resuscitation is a stressful, time-pressured procedure, and unfortunately if often futile. Care of a patient in the emergency setting is particularly prone to errors and adverse events for a variety of reasons. These include the time-pressured decision making, increased rate of patient interventions, and the fact that teams are “assembled” by the emergency call that may have never worked together, or even met each other, before. (Walker, 2013).
Even though there were a well-known cardiopulmonary resuscitation(CPR) algorithms among health care professionals, the results of CPR were remained poor (Hunziker, Johansson, Tschan, Semmer, Rock, Howell, & Marsch, 2011).
Hunziker et al. (2011) indicated some other factors like teamwork and leadership affect the application of CPR algorithm and hence the performance of CPR, besides the technical skills of the resuscitation team members.
Research has shown that teamwork and leadership training has been shown to improve subsequent team performance during resuscitation (Hunziker et al., 2011).
History was taken from a patient in this simulation. The nurse used OLDCART known as O-Onset, L-Location, D-Duration, C-Characteristics, A- Aggravating factors, R-Relieving factors, T-Treatment to obtain a history of present illness from the patient.
Nursing care encompasses knowledge, skill, and competence to enable holistic patient assessment (Office of the Chief Nursing Officer (OCNO) (Ireland), 2016). Professional nursing care involves capturing, analyzing and interpreting patient information (OCNO, 2016), initially through the patient’s health history. Obtaining a detailed clinical history is a core competency of many advanced nursing roles (National Council for the Professional Development of Nursing and Midwifery (NCNM) (Ireland), 2008; Tagney and Younker, 2012; Apau, 2010; Quigley and Martin, 2013), in combination with the advanced physical assessment.
Taking a comprehensive health history is a core competency of the advanced nursing role. The purpose of the health history is to source important and intimate knowledge about the patient, their lifestyle, social supports, medical history and health concerns, with the history of presenting illness as the focus and allow the nurse and patient to establish a therapeutic relationship ( Ingram, 2017). At the beginning of history taking, the nurse had established a therapeutic relationship with the patient. During assessing of chest pain, pain score was used to evaluate the severity of pain. This provided a common language between nurses and physicians.
Errors in communication continue to be a contributing factor in adverse patient events in healthcare systems (The Joint Commission, 2015). The systemic nature of the problem of miscommunication between healthcare providers supports the need for a standardized communication method. The SBAR tool is a simple, effective method for communication that operates across disciplines and is well- received by healthcare professionals (Blom et al., 2015; Nagammal et al., 2017). Use of the SBAR tool thus should be implemented systematically to improve healthcare communication and create a safer patient care environment. A study had shown that communication was still affected due to structure absence, loss of information and low adherence after implementation (Ludikhuize, de Jonge, & Goossens, 2011).
As part of professional obligation and for a better outcome of patients, nurses and physician should discuss their communication level while giving care to the patient, communicate openly, in mutual professional respect, and share patient’s information. Moreover, these professional needs play a vital role in creating smooth and a well-defined communication channel (Hailu, Kassahun, & Kerie, 2016).
Teamwork is an essential non-technical skill in the perioperative environment. Along with other key factors, it plays a vital role
in safe and effective practice and should be fostered and encouraged through appropriate training and education. The model of teamwork training best suited to the perioperative environment is less clear. Great care must be taken to ensure that any model used offers the maximum benefit to patients and staff in terms of perioperative safety. Superimposing popular management techniques and training models from other sectors onto this inter-disciplinary, time and safety critical environment may not achieve the desired outcomes or represent the good use of limited resources.
It is clear that more research is required into what is the best model of teamwork training for the perioperative environment. While there have been some controlled studies, a methodology for robust RCTs must be developed in order to bridge the existing knowledge gaps around the clinical effects of teamwork training. Similarly, longer-term effects and the level of need for ongoing training and mentorship must be established.
The key recommendation, however, relates to inter-disciplinary team training at the pre-clinical stage. The evidence set out in this paper suggests that inter-disciplinary training in simulation offers a range of benefits to perioperative staff, particularly in the areas of communication, cooperation, and team building. Similarly, interdisciplinary learning in healthcare education appears to promote collaborative working and greater understanding of professional roles. In the experience of the author, however, medical students do not take part in the simulated perioperative exercises which are a key aspect of the training and education of operating department practitioners. The integration of medical students at this level is something which is highlighted in the literature as potentially important in breaking down stereotypes and challenging the establishment of the medical hierarchy. Introducing interdisciplinary training which includes medical students, nursing students, ODP students and allied healthcare students working together in simulated scenarios, could help to demystify aspects of the perioperative environment and to address barriers to teamwork and communication before they become established.
Further research is required to explore the optimum form and duration of this approach to learning and to establish what if any, effects this has on the future clinical practice of participants. In this respect, the student environment would serve as an excellent testing ground. Roche, F. (2016)
We propose that further studies on the effects of team interactions on the performance of complex medical emergency interventions such as resuscitation are needed. Future efforts to better understand the influence of team factors (e.g., team member status, team hierarchy, handling of human errors), individual factors (e.g., sex differences, perceived stress), and external factors (e.g., equipment, algorithms, institutional characteristics) on team performance in resuscitation situations are critical to improve CPR performance and medical outcomes of patients. (Hunziker et al., 2011).