West Midlands Centre for Innovation and Training in Elective Care (CITEC) Inter-Professional Clinical Skills Collaboration Simulation Training for Peri-operative Care Student Information and Workbook (PM) Originally developed for CITEC by The University of Birmingham Version 2 (PM) 26 th April, 20
Foreword Hugh Barr President CAIPE* the UK Centre for the Advancement of Inter-Professional Education Integrated care, however well planned, is only as good as the collaboration between the professions who make up the team. Understanding each profession s roles and responsibilities during the day is a start. Be sure to compare too how they relate to the patient. Who finds time to be a good listener - to explain, to reassure and to empower? And how do professions relate to each other? Are some more comfortable together than others? If so, ask yourself why that might be? Look out for signs of misunderstanding or tension, but also examples of good collaboration. Observe carefully, but find opportunities to talk to as many of the workers as you can. Compare notes with fellow students afterwards, teasing out differences in perception which may relate to the way in which your attitudes and values are already being shaped as you enter your chosen professions. There is no better way to begin your inter-professional learning. Have a great day! * CAIPE is a charity and company limited by guarantee and dependent primarily on income from members subscriptions. Founded in 1987, CAIPE is dedicated to the promotion and development of inter-professional education (IPE) with and through its individual and corporate members, in collaboration with like minded organisations in the UK and overseas. 2
Guidelines for Inter-Professional Learning Please follow these guidelines to ensure that you and others have an enjoyable and worthwhile session. Participation The day will allow you to develop your clinical practice in the context of the wider team with whom you will work when you qualify; and in the context of the current changes in patterns of patient care. Much of the success of the day will depend on your contribution please make the most of the opportunity by participating fully in the activities and discussion sessions. Diversity Students taking part in this session come from a wide range of professional and personal backgrounds. To get the most out of the various activities, you will need to be alert to the different perspectives other professionals bring to the discussion and to allow them time and space to share their views and experiences with you. Confidentiality It is essential for the success of the session that participants feel able to take part fully in activities, and to discuss any incidents that may occur freely with other members of the group or with the facilitator. To allow this, please keep all activities and discussions that take place during the session confidential both during the session and subsequently. Mobile phones Please ensure that your mobile phone is switched off for the session. 3
Important Information about Your Session Preparatory Work In order to get the most out of your session, you will need to undertake some preparatory work. Please see page 9 of this booklet for details. Equipment and Dress It is expected that you will come adequately equipped and suitably attired for the simulation session. Please bring whatever equipment that you would normally carry on placement with you to the session (e.g. pen-torch, stethoscope, etc.). You should also wear the clothing / uniform that you would normally wear in clinical areas. Role Players Your session may involve a trained role player from Birmingham University Interactive Skills Unit. Please treat them as you would your patients whilst on a placement. The role player may give you feedback on your work from their perspective as a patient. Health and Safety Your session will start with a compulsory health and safety briefing. You should follow all usual clinical health and safety policies, for example disposal of sharps, safe use of the defibrillators, etc. Facilitator(s) may stop scenarios and prevent students from continuing if they observe unsafe practice during the simulation training. Documentation The scenarios have attempted to provide as much of the usual documentation as may be expected in clinical practice. Inevitably not every single clinical document will be available for all simulations. There should be time to familiarise yourself with the documentation during the session. You will be expected to complete written assessments and forms as you would in clinical practice. No clinical documents should be removed from the clinical skills facility at the end of the session. 4
Feedback and Video Recording of Simulation Sessions Feedback During the session, you will both take part in the scenario yourself and observe the work of others. Giving and receiving feedback are important aspects of the session and an important part of team working in the clinical environment. You will be expected to give your fellow students feedback on their work, as they will give you feedback on yours. In order to participate effectively in this, it may be helpful to make notes as you watch the scenarios. Successful feedback involves being: Positive; what was done well and why? Specific; focusing only on things that can be changed. This means describing what you see i.e. behaviours, not personality traits or physical attributes. Constructive; would you have done things differently and why? Video Recording All scenarios will be videoed in order to provide you, and your fellow students, with feedback on how you performed/interacted with the patient and each other. Your facilitator may use the video recording to review particular aspects of the scenario, drawing out examples of good practice and discussing with the group areas that may have been handled differently. After the session, individuals taking part in a particular session will be able to view the video recording on the web (further details will be provided in the session). You may wish to use this recording as part of reflective activities with either your teachers / personal mentors. Only those present at a particular session will be able to access the video recording. Downloading and publication of the video recording in any form is not permitted. Any infringement of this will be considered a fitness to practise issue and will be dealt with appropriately by your University. If you have any concerns about any aspect of the video recording, please speak to your facilitator. 5
Programme Timetable 12.30 pm Lunch and Registration 1.00 pm Introductions and Briefing (to include Ice Breaker activity) 1.30 pm Group 1 Pre-Operative Ward 2.10 pm Structured debrief and feedback in the classroom 2.30 pm Group 2 Immediate Post-Op 3.10 pm Structured debrief and feedback in the classroom 3.30 pm Comfort Break 3.50 pm Group 3 Two Days Post-Operatively 4.30 pm Structured debrief and feedback in the classroom 4.50 pm Summary of key points; distribution of evaluation form and directions to access video recordings 5.00 pm Collection of attendance certificates 6
Specific Learning Outcomes Knowledge Understand the special problems of caring for a patient undergoing a major operation Understand why assessment / reassessment and/or continuous monitoring are necessary aspects of caring for peri-operative patients Use a rational system of assessment to manage critically ill patients safely Recognise the circumstances in which additional help is required Clinical Skills Perform a focused clinical assessment of breathless or shocked patients Use airway adjuncts, respiratory support and intravenous treatments in the management of critically ill post-operative patients Act appropriately in an emergency situation, recognising one s limitations Attitudes Understand why team work is essential when dealing with patient pathways Understand why organisational skills are important in managing peri-operative ill patients 7
Generic Learning Outcomes At the end of today s session the student should be able to: Recognise the prime importance of considering patient safety in all clinical activity Describe the patient experience as a continuous journey rather than a series of isolated and disjointed events Incorporate the patient s perspective when considering their care and treatment Work collaboratively with students from other health care professions to complete a given task Apply appropriate clinical skills to ensure successful assessment, planning, implementation and subsequent evaluation of patient care Make decisions relating to patient care as appropriate to your course and year of study Communicate effectively with patients, other health professionals and relatives/carers Recognise the seriously ill patient for whom urgent action is required and act appropriately Acknowledge the limitations of your current level of competence Utilise principles of good record keeping and documentation in order to maximise team communication, patient safety and quality of patient care Use resources appropriately Participate in feedback sessions; giving and receiving feedback from fellow students Reflect on your practice, in order to apply learning to your clinical areas 8
Scenario Brief Mike Field, born 7/01/1946, recently went to see his GP when he experienced some rectal bleeding. Following referral to the local hospital and subsequent tests he was found to have a cancerous mass in his left descending colon. Mr. Field is now being admitted for a left hemi-colectomy. He has already attended a pre-operative admission clinic, and the scenario starts on the morning of the operation. The simulation does not follow the operative procedure, but will go into detail what happens before and after the procedure both immediately in the recovery room and later on the surgical ward. Student Preparation What You Need To Do Prior To The Session For the scenarios you will only be expected to use the knowledge and skills that you have gained so far, from your current time on your course. This particular session fits closely with the peri-operative patient pathway that some students may have already been involved with. However to make the best use of the session you may wish to revise the following topics: Left hemicolectomy - A leaflet explaining the left hemicolectomy procedure is available at the following web address: http://www.birminghamcancer.nhs.uk/viewdoc.ashx?id=moo0bihlxe4qm3aht1ku5g%3d %3D Safe Peri-Operative Care Useful information and videos (including how to put TED stockings on) is available at the following web address: http://www.cetl.org.uk/learning/perioperative-care/data/downloads/perioperative-careprint.pdf Patient assessment (including practical clinical skills e.g. manual blood pressure measurement) Pre-operative preparation; nursing procedures, consent, checklists etc. Anaesthetic recovery room procedures Recognition of unwell patients Effective handover techniques Post-operative management of surgical patients 9
If you wish to prepare in other ways for this session then it is suggested that you revise the assessment and interventions required for pre-operative patients, the specific requirements required when caring for a patient undergoing abdominal surgery, and the common postoperative complications. You may also wish to consider these 20 golden rules of looking after patients in the time around surgery adapted from The Complete Recovery Room Book (4th Edition) by A Hatfield & M Tronson. 1. The confused, restless and agitated patient is hypoxic until proven otherwise 2. Your patient may be hypoxic even though the pulse oximeter reads 98% 3. Never turn your back on a patient 4. The blood pressure does not necessarily fall in haemorrhagic shock 5. Never ignore a tachycardia or a bradycardia; find a cause 6. Post-operative hypertension is dangerous 7. Never use a painful stimulus to rouse your patient 8. Nurse comatose patients on their side in the recovery position 9. If your patient is slow to wake up, or continues to bleed, consider hypothermia 10. Noisy breathing is obstructed breathing, but not all obstructed breathing is noisy 11. Let patients remove their airways when they are ready to 12. Cuddle crying children; hold the hand of crying adults 13. The opioids do not cause hypotension in stable patients 14. When giving drugs to the elderly, start by giving half as much, twice as slowly 15. If you do not know the actions of a drug, then do not give it 16. Treat the patient, not the monitor 17. Cold hands are a sign of a haemodynamically unstable patient 18. Pain prevention is better than pain relief 19. Do not discharge patients from the recovery room until they can maintain a 5-second head lift 20. If confused read rule number 1! 10
Further Reading A list of books you may find useful are shown in the table below: Title Authors Publisher ISBN Number Principles of Peri-operative Practice Martin Hind & Paul Wicker Churchill Livingstone 9780443062513 Advancing Peri-operative Practice Mark Radford, Bernie County & Melanie Oakley Nelson Thornes 9780748753987 Fundamentals of Operating Department Practice Ann Davey & Colin Ince Cambridge University 9780521682862 The Complete Recovery Room Book (4 th Edition) Anthea Hatfield & Michael Tronson Oxford Medical 9780199232680 11
Feedback Discussion Notes Feedback Activity 1: Constructive Critique In the boxes below please indicate what you think about the scenario. This should be a constructive critique sticking to the questions below. You will be asked to list as many points as you can (absolute minimum of 3); but will only have time to feedback a few of these. Ensure that you do these as the scenario unfolds. When considering your critique try to include some elements of how the different student professions communicate and work with each other. What went well in the scenario? What could be done better? 12
Feedback Activity 2: Scenario Discourse Analysis Sheet In the box below please use the following symbols to indicate who talks to whom. Try to indicate whether it was a question (?), an instruction (I), a request (R), an answer (A), a clarification (C) Example (the student in the role of nurse asks the patient a question During the course of the scenario, it is likely that you will draw quite a well filled spiders web of lines. Try on the following table to capture the subject matter of the various interactions. This only has to be on a broad topic heading showing who was involved in the interaction Person 1 Person 2 Person 3 Topic e.g. Doctor Nurse Medications instructions e.g. Radiographer Nurse Patient movement 13
Evaluation and Reflection Evaluation Please take the time to undertake the following activities, which will help us to evaluate your learning experience today: 1. Revisit the short questionnaire that you completed at the beginning of the session, noting down any changes in your views as a result of today s activities. PLEASE REMEMBER TO RECORD ON THE ANALOGUE SCALE YOUR VIEWS NOW YOU HAVE COMPLETED THE SESSION. 2. Complete the general evaluation questionnaire that your facilitator will give to you. Reflection Please revisit the learning outcomes at the front of this workbook and reflect on whether you feel you have achieved them. Reflecting on your learning can help you take an objective view of your progress and see what is going well and what needs working on. Whatever form your reflection takes, it should initially involve you reviewing your experience and examining your feelings about it, then identifying areas to develop and starting to think about ways to do this. To help you with this exercise you will find some prompts for reflection on the next page. Your responses to these questions are for your own use. You do not have to share your thoughts with anyone, but may find it helpful to use them as a starting point for discussion with your tutor or mentor. 14
Prompts for Reflection Identify one thing you have learned about another professional group from today. How did having a mix of professions in your group help you to deal with the day s tasks? What were the challenges of working with a mixed group of professionals? What one skill are you going to attempt to improve, in order to care for patients more effectively? Reflections (What did I learn? How will this influence my practice?) 15