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By Kate Hunger

An interprofessional intensive care unit simulation activity this spring was timed just right for the 118 physical therapy, occupational therapy and nursing students who participated.

Held in April before doctoral PT and OT students began clinical rotations and the 4th-year Bachelor of Science in Nursing students graduated, the activity gave students the opportunity to learn firsthand about the roles of other health professions in the ICU — and to practice their own skills.

Embracing an interprofessional approach

“The idea is to work collaboratively with other programs in the university,” said Bobby Belarmino, PT, DPT, PhD, CCS, and assistant professor of physical therapy. “We no longer work in silos in the clinic. We should start training the future clinicians of tomorrow to work collaboratively with other clinicians.”

The activity is also a research study, Enhancing Perceived Confidence, Communication, and Teamwork Collaboration of Allied Health and Nursing Students Using Interprofessional Critical Care Simulation Experience, that will expand next year to include respiratory care students, said Dr. Belarmino, who is the project’s principal investigator.

The idea for providing a simulation experience to students came from the notion of how to better prepare students for acute care or ICU rotations. Providing care to patients in this complex and demanding ICU environment is often intimidating to novice clinicians — and  especially to students, Dr. Belarmino said. Many studies show that the use of simulation experiences affords students a better understanding of their respective roles and responsibilities in the clinical environment. Such experiences can allow students to develop an appreciation of the value of an interdisciplinary team approach in providing care, he said.

“We are trying to mimic what an interprofessional team looks like in the real world,” he said. “I wish I had this when I was a student. I remember the first time I went to the ICU, I was so intimidated, I didn’t even want to move the patients.”

During the activity, interprofessional teams of students practiced a simulated case involving a 74-year-old open-heart bypass patient with complications of pleural effusions, delirium and chest pain and a complicated medical history. The patients, played by OT and PT students, were connected to multiple lines, tubes and drains. Students were required to complete tasks with the simulated patient: PT students mobilized them, OT students performed evaluations and self-care activities, and nursing students handled medication administration and assessment of pain and patient condition.

The ICU simulation study has received a LINC Seed Grant which will fund next year’s simulation activity. Faculty collaborators include Isabell Stoltz, DNP, MN, RN, CCNS, assistant professor/clinical and Kevin Voelker, JD, MN, RN, assistant professor/clinical, both in the School of Nursing; Autumn Clegg, EdD, OTR, associate professor/clinical and academic fieldwork coordinator and Mei-Ling Lin, PhD, OTR, assistant professor, both in the Department of Occupational Therapy, and Tabatha Dragonberry, DHSc, MBA-H, MEd, RRT-NPS, RRT-ACCS, AE-C, CPFT, C-NPT, assistant professor and director of online learning in the Division of Respiratory Care.

The research team hopes to determine whether and how much the interprofessional simulation experience benefits students when they begin practice with patients in the ICU. Pre- and post-briefings will seek to determine how much the activity affected students’ perceived confidence, communication and teamwork in the ICU. This year’s activity was the first with three programs. The previous year, OT and PT students served as the trial run for the project concept.

Students appreciate the interprofessional experience

The activity was designed to be a one-time, 2.5-hour session for each student. This year’s critical care simulation activity was offered on two dates in April at the Center for Simulation Innovation at the School of Nursing. Participating were 51 OT students, 43 PT students and 24 nursing students. Students report learning a lot from the activity.

“I loved this simulation,” said Jami Timmons, BSN, who was in the last semester of nursing school when she participated in the simulation. “You are never alone in the hospital. It’s not just going to be you.”

The simulation allowed the nursing students to be at the center of patient care, and they demonstrated their mastery of the skills and teamwork necessary to practice in the complex environment of the ICU, Dr. Stoltz said.

“The nurses are the leader at the bedside and can direct care by collaborating with PT and OT,” she said. “The collaboration with other disciplines runs deep and is essential to patient safety, which we were able to practice during simulation.”

The OT students learned about the various lines and drains from the nursing students and found the IPE experience helpful, said Dr. Clegg.

“It gave them some confidence about going to their Level II fieldwork the following month,” she said.

Physical therapy student JJ Jumamil was nervous before the activity but was happy to share her knowledge of physical therapy and appreciated learning about OT and nursing in the ICU.

“I felt overall it was a very open and safe environment for us to both learn from each other and also to teach each other,” Jumamil said.