Through the E-Looking Glass
1
Nurses are in ideal positions to provide quality palliative, including end of life (EOL), care to individuals, which requires advance care planning through a series of conversations with loved ones and the healthcare team. Lack of knowledge, discomfort, and system complexity has led to reduced quality EOL care. While not a new phenomenon (Jeffers, 2020), nurses mid- pandemic are caring for dying patients at an alarming rate. The interdisciplinary Palliative Care Simulation Program (PCSP), developed in 2016 to allow licensed nurses to practice discussing palliative care with patients and families, improved nurses’ self-efficacy for palliative care provision (Trovato & Generales, 2019). Suspended in-person meetings became an opportunity to adapt the existing PCSP into a telesimulation experience. Telesimulation allows off-site individuals to use telecommunication to remotely participate in simulation, an approach to learning that creates a safe environment to practice skills, such as crucial conversations (McCoy, Sayegh, Alrabah, & Yarris, 2017; Crider & Smith Glasgow, 2019). CONCLUSIONS Through the E-Looking Glass: Telesimulation as the New Wonderland for Practicing Palliative Conversations Nicole Generales, BSN, RN, CHPN; Gina Petersen, MSN, RN, CHPN, CHSE; Jeffrey Collins BSN, RN,CCRN REFERENCES CAPC. (n.d.). Tools and training for clinicians: Palliative care programs. Retrieved June 1, 2020 from https://www.capc.org/ Crider, M. C., & Smith Glasgow, M. E. (2019). Fostering professional development in simulation. In L. Wilson & R. Wittman-Price (Eds.), Review manual for the Certified Healthcare Simulation Educator™(CHSE™) exam (pp. 267-278). New York, NY: Springer. Ganz, S. (2005, July 1). Hold on. Let go. Retrieved August 10, 2020 from https://www.flickr.com/photos/steveganz/22842423 (Originally photographed 2005, July 1) Jeffers, S. (2020, July 2). Death and dying in a pandemic: Preparing nurses for end-of-life care [Web log post]. Retrieved July 10, 2020, from https://dailynurse.com/death-and-dying- in-a-pandemic-preparing-nurses- for-end-of-life-care/ McCoy, C. E., Sayegh, J.,Alrabah, R., & Yarris, L. M. (2017). Telesimulation: An innovative tool for health professions education. AEM Education and Training, 1(2), 132-136. doi: 10.1002/aet2.10015 Trovato, G., & Generales, N. (2019, October 10). Improving nurse resident palliative care ability through simulation. Podium presentation at ANCC National Magnet Conference in Orlando, Florida. VitalTalk. (2020) COVID collaborative resources. Retrieved June 1, 2020 from https://www.vitaltalk.org/topics/covid-collaborative-resources/ Seven of nine participants (78%) completed the feedback form. Every participant (100%) agreed or strongly agreed that learning objectives were met, rated the course as “Very Good “ or “Excellent,” and agreed or strongly agreed they would use the skills they learned in their clinical practice. Historically used in medical and military education, telesimulation is an emerging approach to learning that is applicable and timely. The Palliative Care Telesimulation Program is an innovative and effective experience that was very well-received by a sample of nurse residents. This novel transformation of an existing innovation is an exemplar of nursing education meeting the ongoing yet immediate needs of new graduate nurses in real-time during the COVID-19 pandemic. Limitations include a small convenience sample, lack of a valid and reliable tool for program evaluation, and technology issues. While access to a telecommunication platform was not a barrier in this pilot, it may be for individuals in different circumstances. Considerations for the near future include inviting interdisciplinary colleagues to join the discussion or participate in role play, adapting role play scenarios to meet needs of future participants, selecting a valid and reliable tool for evaluation, and considering this option when in-person education resumes. INTRODUCTION RESULTS METHODS AIM Based on a needs assessment survey completed by nurse residents, the following learning objectives were developed: o Recognize emotions in themselves and others, and navigate conversations using evidence-based communication techniques o Understand palliative care and its relationship to hospice care o Explore goals of care with patients and families for advance care planning o Discuss anticipated end of life symptoms, medications, and services with patients and families The pilot Palliative Care Telesimulation Program was a 4-hour experience using a convenience sample of 9 nurse residents with 1-2 years of acute care experience. Required prework included the Center to Advance Palliative Care (CAPC; n.d.) module, “An In-Depth Look at Pallaitive Care and its Services.” Nurses and facilitators connected via their organizations’ Zoom account. The program began with a mindfulness moment and 1-2 word emotional check-in, followed by a series of Powerpoint slides, live polls, and role plays. Lecture, prebrief, and debrief occurred in the main Zoom room. Role play occurred in four breakout rooms with 2-3 participants each, moderated by facilitators who shared adapted VitalTalk (2020) resources via the chat feature. The program was evaluated using the Yale New Haven Health System (YNHHS) SYN:APSE Simulation Feedback form. “Helpful tips to facilitate palliative care conversations, real-life simulations to facilitate palliative care conversations” “The tools to go back and review afterwards. Also the script for end of life conversation with family was priceless. Will help so much” “Learning tools to help patients and peers understand their feelings and cope with difficult situations” “Simulation role play #2, getting to act as nurse (practice getting comfortable having difficult conversations with family members) and act as significant other (understanding how they family members feels in that situation and understanding what they need)” ACKNOWLEDGEMENTS We would like to thank our colleagues in nursing and simulation education for their gracious and unending support: Barbara Flanagan, MSN, RN, CNL, Education Specialist, YNHH Greenwich Hospital Cheryl Mayeran, MPH, Simulation Consultant, YNHHS “WHAT WERE THE MOST HELPFUL ASPECTS OF THE COURSE?” Screenshot of Role Play #2. Image of hospitalized patient credited to Ganz (2005).
Transcript of Through the E-Looking Glass
Nurses are in ideal positions to provide quality palliative, including end of life(EOL), care to individuals, which requires advance care planning through aseries of conversations with loved ones and the healthcare team. Lack ofknowledge, discomfort, and system complexity has led to reduced qualityEOL care. While not a new phenomenon (Jeffers, 2020), nurses mid-pandemic are caring for dying patients at an alarming rate. Theinterdisciplinary Palliative Care Simulation Program (PCSP), developed in2016 to allow licensed nurses to practice discussing palliative care withpatients and families, improved nurses’ self-efficacy for palliative careprovision (Trovato & Generales, 2019). Suspended in-person meetingsbecame an opportunity to adapt the existing PCSP into a telesimulationexperience. Telesimulation allows off-site individuals to usetelecommunication to remotely participate in simulation, an approach tolearning that creates a safe environment to practice skills, such as crucialconversations (McCoy, Sayegh, Alrabah, & Yarris, 2017; Crider & SmithGlasgow, 2019).
CONCLUSIONS
Through the E-Looking Glass: Telesimulation as the New Wonderland for Practicing Palliative Conversations
Nicole Generales, BSN, RN, CHPN; Gina Petersen, MSN, RN, CHPN, CHSE; Jeffrey Collins BSN, RN,CCRN
REFERENCESCAPC. (n.d.). Tools and training for clinicians: Palliative care programs. Retrieved June 1,
2020 from https://www.capc.org/Crider, M. C., & Smith Glasgow, M. E. (2019). Fostering professional development in
simulation. In L. Wilson & R. Wittman-Price (Eds.), Review manual for the CertifiedHealthcare Simulation Educator™(CHSE™) exam (pp. 267-278). New York, NY:Springer.
Ganz, S. (2005, July 1). Hold on. Let go. Retrieved August 10, 2020 fromhttps://www.flickr.com/photos/steveganz/22842423 (Originally photographed 2005, July 1)
Jeffers, S. (2020, July 2). Death and dying in a pandemic: Preparing nurses for end-of-lifecare [Web log post]. Retrieved July 10, 2020, from https://dailynurse.com/death-and-dying-in-a-pandemic-preparing-nurses- for-end-of-life-care/
McCoy, C. E., Sayegh, J., Alrabah, R., & Yarris, L. M. (2017). Telesimulation: An innovativetool for health professions education. AEM Education and Training, 1(2), 132-136. doi:10.1002/aet2.10015
Trovato, G., & Generales, N. (2019, October 10). Improving nurse resident palliative careability through simulation. Podium presentation at ANCC National Magnet Conferencein Orlando, Florida.
VitalTalk. (2020) COVID collaborative resources. Retrieved June 1, 2020 fromhttps://www.vitaltalk.org/topics/covid-collaborative-resources/
Seven of nine participants (78%) completed the feedback form. Every participant (100%) agreed or strongly agreed that learning objectives were met, ratedthe course as “Very Good “ or “Excellent,” and agreed or strongly agreed they would use the skills they learned in their clinical practice.
Historically used in medical and military education, telesimulation is anemerging approach to learning that is applicable and timely.
The Palliative Care Telesimulation Program is an innovative and effectiveexperience that was very well-received by a sample of nurse residents. Thisnovel transformation of an existing innovation is an exemplar of nursingeducation meeting the ongoing yet immediate needs of new graduate nursesin real-time during the COVID-19 pandemic.
Limitations include a small convenience sample, lack of a valid and reliabletool for program evaluation, and technology issues. While access to atelecommunication platform was not a barrier in this pilot, it may be forindividuals in different circumstances.
Considerations for the near future include inviting interdisciplinary colleaguesto join the discussion or participate in role play, adapting role play scenariosto meet needs of future participants, selecting a valid and reliable tool forevaluation, and considering this option when in-person education resumes.
INTRODUCTION RESULTS
METHODS
AIMBased on a needs assessment survey completed by nurse residents, thefollowing learning objectives were developed:
o Recognize emotions in themselves and others, and navigateconversations using evidence-based communication techniques
o Understand palliative care and its relationship to hospice careo Explore goals of care with patients and families for advance care
planningo Discuss anticipated end of life symptoms, medications, and services
with patients and families
The pilot Palliative Care Telesimulation Program was a 4-hour experienceusing a convenience sample of 9 nurse residents with 1-2 years of acute careexperience. Required prework included the Center to Advance Palliative Care(CAPC; n.d.) module, “An In-Depth Look at Pallaitive Care and its Services.”
Nurses and facilitators connected via their organizations’ Zoom account. Theprogram began with a mindfulness moment and 1-2 word emotional check-in,followed by a series of Powerpoint slides, live polls, and role plays. Lecture,prebrief, and debrief occurred in the main Zoom room. Role play occurred infour breakout rooms with 2-3 participants each, moderated by facilitators whoshared adapted VitalTalk (2020) resources via the chat feature.
The program was evaluated using the Yale New Haven Health System(YNHHS) SYN:APSE Simulation Feedback form.
“Helpful tips to facilitate palliative care conversations, real-life
simulations to facilitate palliative care conversations”
“The tools to go back and review afterwards. Also the script for end of life conversation with family was priceless.
Will help so much”
“Learning tools to help patients and peers understand their feelings and
cope with difficult situations”
“Simulation role play #2, getting to act as nurse (practice getting comfortable having difficult
conversations with family members) and act as significant other (understanding how they family
members feels in that situation and understanding what they need)”
ACKNOWLEDGEMENTSWe would like to thank our colleagues in nursing and simulation education for
their gracious and unending support: Barbara Flanagan, MSN, RN, CNL, Education Specialist, YNHH Greenwich
HospitalCheryl Mayeran, MPH, Simulation Consultant, YNHHS
“WHAT WERE THE MOST HELPFUL ASPECTS OF THE COURSE?”Screenshot of Role Play #2. Image of hospitalized patient credited to Ganz (2005).
