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Q&A: Nursing-Simulation Expert Shares an Approach to Minimize Medical Errors

Colette Foisy-Doll, RN, a pioneer of simulation-based learning, pairs it with interprofessional education and an annual event: HELP! Save Stan.

Educator

Colette Foisy-Doll, RN, MSN, CHSE, ANEF

Faculty of Nursing, Program Coordinator, Clinical Simulation Centre, MacEwan University, Edmonton, Alberta, Canada

Certified Healthcare Simulation Educator, Certified Patient Safety Educator, MSN in Leadership in Healthcare, BScN in Nursing, Diploma in Nursing, and member of the Academy of Nurse Educator Fellows of the National League for Nursing

Until recently, it was not common practice for hospital systems to track and openly report human error and mistakes in patient care. “Hospital staff often feared ridicule or being reprimanded for making medical errors so would sometimes fail to disclose,” says Colette Foisy-Doll, RN, of the Faculty of Nursing at MacEwan University in Edmonton, Alberta. “In recent years, patient stories of serious harm and death have been highly publicized by bereaved families. This, along with patient safety advocacy at the institutional level, has resulted in a large-scale outcry for change in the way we teach and train our healthcare professionals.”

Foisy-Doll has been part of that institutional mandate for decades: She spent years advocating for interprofessional education (or IPE, in which students from varied healthcare programs learn about, with, and from each other) and has pioneered, researched, and championed the use of simulation-based learning (in which students participate in hands-on learning activities that mimic those in the healthcare world). It has been well worth the uphill battle, she says. “Nursing regulatory bodies in Canada now require that undergraduate nursing programs feature IPE experiences,” she says. “This practice is also expanding globally and reaching practitioners across all healthcare fields, including medical doctors, physiotherapists, pharmacists, respiratory therapists, medical lab technicians, paramedics, and emergency medical technicians.”

So why did this change in education take so long to become standard protocol? Read on for her interview with Course Hero on this compelling topic—and learn how to promote these new approaches at your own institution or department.

Context

“Simulation-based learning for IPE is a new pedagogical approach where students can come together to learn with and from each other while immersed in the actual care of a simulated patient.”

— Colette Foisy-Doll, RN

The Clinical Simulation Centre (CSC) was first established in 2005, when the Nursing Program opened a 1600-square-foot simulation learning space. Human patient simulation was initially integrated into the bachelor of science University Transfer Program in 2004, but it had been employed for learning by nursing students since 1999. A new 30,000-square-foot, state-of-the-art facility was constructed in the new Robbins Health Learning Centre 2009 and is used by students from many healthcare programs, featuring the use of full-body, computerized, mannequin-based simulation; virtual simulation; and use of hired actors posing as standardized patients, their family members, and other healthcare providers within lifelike simulated scenarios.

See resources shared by Colette Foisy-Doll, RN

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Foisy-Doll’s overview of new pedagogical approaches in nursing

Course Hero asked Foisy-Doll for her insights into interprofessional education and simulation-based learning, how they are being merged in the nursing classroom, and how educators can gain support for IPE and simulation-based learning in their own learning institution. Read on to learn from her years of expertise, beginning with the point at which it became obvious that nursing education needed to make some changes.

Course Hero: What led to the shift in nursing education over the last decade?

Foisy-Doll: If you were to Google “medical error” today, chances are good that an article titled, “Classic Cases Revisited—Death of a Nurse and the Anatomy of Error” from the US National Library of Medicine will be listed near the top of the page. That’s not a mistake. It’s because it was the first time a verdict of “unlawful killing due to a medical error” was recorded in the national record. The patient was a British nurse who died [in 2008] after a postpartum medication was improperly administered. As more cases became known to the public and the media, the pressure was on to find a way to reduce and abolish patient harm.

That was difficult to do [in Canada] because, with the national healthcare system, it is the responsibility of each province to regulate and implement education in healthcare, where health professionals have historically learned in silos with minimal interaction during their programs. Similar situations are common in other countries throughout the world. IPE is a highly complex and enormous undertaking. And it is coupled with much resistance to change. In the last 10 years, there has been a definite shift. We are now graduating nurses and other health professionals that have a better understanding of who is on their team and what their scope of practice is, but we still have a long way to go.

Can you explain simulation-based learning and how it has changed over the years?

Simulation in itself is a beautiful teaching and learning modality—it is a dynamic way to mimic what would happen in a hospital. In simulation-based learning, students participate in patient-care scenarios using a simulated patient. The simulated patient can be a computerized mannequin, otherwise called a human patient simulator, or it can be an avatar that is brought to life in the digital world (and manipulated with computer controls such as a keyboard). Other times, we employ actors as “standardized patients” who are trained to play a certain virtual simulation of symptoms.

Today, simulation-based learning is being practiced in tandem with interprofessional education. Termed as simulation-enhanced Interprofessional Education (abbreviated Sim-IPE) by the International Association for Clinical Simulation and Learning (INACSL), this new pedagogical approach features hands-on activities where students can come together to learn with and from each other while immersed in the actual care of a simulated patient.

What are some of the unique benefits of Sim-IPE?

It is as real as possible! When grounded using best practices in educational design, a computerized human simulator is a very lifelike experience for students who might otherwise freeze or not know how to ask for help or resources. Imagine looking after a patient who is suffering from a heart attack and you have never had that experience before. Moreover, you have never been an active member of the healthcare team, and now you are faced with managing team communication and critical decisions! As a professional, it takes a lot of commitment to best practices, team excellence, and patient safety to speak up if a doctor or other team member makes a choice you don’t understand or disagree with. By practicing these scenarios with colleagues and a simulated patient, students can rehearse what to say or do, so they will be better prepared when they face similar situations within clinical practicum placements.

How might readers gain support for a simulation program at their school?

One way to gain support to purchase a simulator is to explore other places where education programs have flourished because of simulator use. Today, healthcare education programs have to demonstrate value to students and patients and their families in a way we never had to before. We want people to graduate from our programs proud that they have been educated here. A fear of not being seen as excellent can go a long way. You are basically saying, “If you don’t offer this modality, you will be losing out on dynamic learning for students.” I would also say don’t be afraid to ask administrators for support to implement innovation. You need the support of everyone, including senior leadership and educators to create successful simulation programs.

What do you wish you knew when you started advancing change in nursing education?

Even if we are competing for students or resources, sharing resources and information is the only way to create a community practice.

I was one of an initial group of five partners that came from healthcare education institutions and one hospital from the local health authority who became very interested in bringing IPE to life using simulation. Communicating and collaborating with each other and advancing our ideas was very challenging and often “political” work. I now know that working together across learning and professional practice institutions is crucial to success. For example, in the early days, I clearly remember walking down the hall giving a tour of our simulation unit to someone from a competing learning institution, and my boss—who was not used to this open approach—asked me, “Why are you opening our facility to them and sharing information?” I was steadfast in my belief that institutions must learn and work together for there to be progress in Sim-IPE.

Today we have a formalized consortium of partners, Interprofessional Healthcare Education Partnership (IHEP), that has been doing Sim-IPE for over 11 years across 25 programs, thanks in part to research grants totaling over one million dollars. There are now well over 500 faculty who have been developed as facilitators of Sim-IPE and thousands of students who have participated.

Many of us work together on an annual program called “HELP! Save Stan,” which enables students to participate in interprofessional healthcare simulations using computerized mannequins, standardized patients, and virtual simulation in a safe and realistic environment. Last year, there was an operating committee of 21 members, 47 SIM coordinators, 56 facilitators, and 20 volunteers, and 352 students participating in the event, with guest educators from across Canada.

What happens at this “HELP! Save Stan” program?

The learning event is broken down into more than 20 different simulated situations. For example, some titles are “Can You Handle This?” or “ER Mash-up.” In each scenario, the students participate as members of a health team and must work together to eliminate or reduce harm to the patient. Situations range from a simple home care visit with Stan and his wife to a tricky situation when a patient transfer does not go according to plan. Other simulations might be two professionals collaborating on best practices when doing a narcotic count.

What outcomes have you seen from the “HELP! Save Stan” event?

A crucial question is always: What assumptions do we make about other members of the healthcare team, and how do we get past those stereotypes? At the end of the 2018 event, we asked participants to tell us what they had learned. I think the feedback is very important and could help anyone involved in Sim-IPE. Students said they learned the importance of:

  • Understanding different priorities of different professions in all settings
  • Recognizing that everyone has something important to contribute, no matter the profession
  • Resolving conflict by communicating effectively with team members
  • Applying leadership skills, such as stepping forward and making introductions and interacting with patients
  • Not being afraid to ask questions and to know your own limitations

Some facilitators who observed students also said they learned as much as the students did that day, and both the students and coordinators said they were tired by the end of the day—but happy to have connected. In participant interviews months after the event, students and facilitators noted the long-lasting impact this learning had on them, which we have coined “the HELP! Save Stan afterglow.” It is this type of impactful learning that will change individual and team behaviors in clinical practice and save lives.

Ultimately, meaningful change comes from the cumulative effect of small actions taken by many individuals, which leads to big results. Together, we are the change we want to see in the world.

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