Addressing Veterans Needs Through Interprofessional Simulation

1. Addressing Veterans Needs Through Interprofessional Simulation Susan Jones, MSN, RN and Dr. Milena Staykova, Nursing Department Dr. George Steer andDr. Chase Poulsen, Respiratory Therapy Program Dr. Patricia Aireyand Sara Nicely, MPAS Physician Assistant Program Jefferson College of Health Sciences, Roanoke, Virginia David Trinkle, MD and Bruce Johnson, MD Virginia Tech Carilion School of Medicine, Roanoke, Virginia

2. “The warrior ethos includes a promise never to leave a fallen comrade. In that spirit, every clinician can ensure that no veteran is “left behind” without adequate health care” (Johnson, et al., 2013, p. 39).

3. Introduction • The healthcare providers need to understand the impact that military service has on veterans’ health and their families. • Academic institutions are challenged to prepare competent providers addressing the needs of this population. • Two academic institutions collaborated to provide college students with an opportunity to address the needs of veterans and their families though interprofessional (IP) education.

5. Background There are about 23.8 million military veterans (Quinlan et al., 2010). Only 25% of veterans receive healthcare through the U.S. Department of Veterans Affairs (Quinlan et al., 2010). The injuries and illnesses that affect veterans returning from combat are predictable” (Quinlan, 2010, p. 43). Physicians should take active role in the treatment of the American military members in short or long-term care facilities (Quinlan et al., 2010) Providers should screen patients who are returning from combat for depression, PTSD, and suicidal ideation (Quinlan, et al., 2010, p. 43). The White House Joining Forces’ initiative addresses the needs of the past and present military service members and their families (Hamer & Huffman, 2012). Institute of Medicine in the Quality of Health Care in America Report emphasized the need of the healthcare professionals to work in IP teams to improve the quality and safety of patient care. Anthony et al., 2012, “a high-fidelity clinical simulation experience can help prepare nurses to meet the unique health care needs of veterans” (p. 145). Research studies have demonstrated the significance of the IP simulation on competence development (Harder, 2010; Ironside et al., 2009). Students’ clinical skills, self-confidence (Harder, 2010), and patient safety have demonstrated significant improvement after simulation activities (Ironside, Jeffries, & Martin, 2009).

6. Recommendations from the IPEC (Interprofessional Collaborative Practice Council, 2011) Team-Based Competencies: Building a shared foundation for education into clinical practice. Core Competencies Values/Ethics for Interprofessional Practice Roles/Responsibilities for Collaborative Practice Interprofessional Communication Practices Interprofessional Teamwork and Team-based Practice IPEC-Interprofessional Education Collaborative IOM-Institute of Medicine QSEN-Quality & Safety Education for Nurses Jefferson College of Health Science QI-”Work with Me” BSN Essential VI-Interprofessional Communication & Collaboration for Improving Patient Outcomes. Literature Review

7. The Conceptual Framework • Interprofessional Education Model • Simulation in Education Models Medium to high fidelity Human patient simulators • 3D Model of Debriefing (Zigmont, Kappus & Sudikoff, 2011) 1. Defusing 2. Discovering 3. Deepening SWOT Method -Strengths -Weakness -Opportunities -Threats

8. Purpose This research study aims to evaluate interprofessional simulation as learning and teaching strategies to prepare students to care for Military and Veteran patients. The purpose of this study is to evaluate the students perceived confidence level of identifying the special needs and resources for veterans during IP simulation.

9. Research Questions What is the effect of IP simulation on the students’ perceived confidence level of identifying the special needs and resources for veterans?

10. Method and Design An IRB approved mixed method study with a sample of 240 students from 12 programs and over 40 faculty members from 13 disciplines. Students from two colleges: Virginia Tech Carilion School of Medicine (VTC) and Jefferson College of Health Science (JCHS). IP simulation model based on mass causality IP activity. Eighteen evidence-based simulation scenarios: PTSD, Traumatic Brain Injury, Spinal Cord Injury, Sexual Assault, Emergency Delivery, Burns, Amputation, Suicide Attempt, Poly-trauma, and more. The students were divided into IP teams. Debriefing session focused on case presentation, treatment choices based on EBP and patient outcomes, and team collaboration. The instrument, “The Self–Efficacy Measure of Interprofessional Practice Competencies for Students (adapted with permission of the authors- Mann et al. 2012) administered pre-and post-simulation activity. Revised validated tool to include questions measuring the students’ perceived level of confidence to care for veterans during the IP simulation activity.

12. Results Pre-survey means (µ 7.16, SD 1.8) to post-survey means (µ 8.53, SD 1.5), 1.37 difference The t-test statistically significant for the pre-and post-survey means A Chonbach’s alpha-0.909, reliability was established for the new questions

13. Conclusions An increase in the IP confidence level for all students post activity. The thematic analysis of the open-ended questions-congruent with the quantitative aspect of the study. : The interprofessional simulation is an andragogical-strategy leading to increased students’ perceived confidence in identifying the special needs and resource for the veterans. The study results supported the conclusion the students’ confidence in providing care to veterans increase in simulation activity. Veterans’ education should be integrated into interdisciplinary education.

14. Students Testimonials • Peer education definitely effective. Great scenarios especially with veterans. Learned good practical stuff. • Peer education definitely effective. Great scenarios, especially with veterans. • The simulation provided an excellent opportunity for team work and interprofessional problem solving. • It helped to understand how different professions work together for a common goal and how important communication and team work is. • Was fun, confidence building and helpful between professions. • Provided an opportunity to appreciate my fellow healthcare team members. • My team worked effectively and efficiently together, we all played an equally important part to benefit the patient. This process would not have been possible without all team members’ involvement.

16. References Anthony, M., Carter, J., Freundl, M., Nelson, V., & Wadlington, L. (2012). Using simulation to teach veteran center care. Clinical Simulation in Nursing, 8e, 145-150. Harmer, B. M. & Huffman, J. (2012). Answering the joining forces call integrating woman veteran care into nursing simulations. Nurse Educator, 37(6), 237-241. Harder, B. N. (2010). Use of simulation in teaching and learning in health sciences: A systematic review. Journal of Nursing Education, 49(1), 23-28. Ironside, P., Jeffries, P., & Martin, A. (2009). Fostering patient safety competencies using multiple-patient simulation experiences. Nursing Outlook, 57(6), 332-337. Johnson, B. S., Boudiab, L.D., Freundl, M., Anthony, M., Gmerek, G., & Carter, J. (2013, July) Enhancing veteran-centered care. Overview, a guide for nurses in non-VA settings . AJN, 113 (7), 24-39. Mann, K., McFetridge-Durdle, J., Breau, L., Clovis, J., Martin-Misener, R., Matheson, T., Beanlands, H., & Sarria, M. (2012, March). Development of a scale to measure health professions students' self-efficacy beliefs in interprofessional learning. Journal of Interprofessional Care, 26(2), 92-9. Quinlan, J.D., Gauron, M.R., Deshere, D.B., & Stephens, M.B. (2010, July). Care of the returning veteran. American Family Physician, 82 (1), 43-49.

17. Acknowledgement The authors would like to acknowledge the immense contributions of the VTC and JCHS students, Faculty & Staff, and Carilion employees who participated in the simulation activity. Mrs. Dorey Anderson, MSN for coordinating the equipment. Dr. Stuart Tousman & Dr. Milena Staykova for statistic analysis. Most of all, Thank You to our Veterans and their Families for their sacrifices.