Marie O'Boyle-Duggan Senior Lecturer BCU with Joy Grech Senior
Lecturer and Rebecca Gillett Student LD Nurse
Live Simulati...
What is live simulation?
• It replicates clinical practice and is as near to real
life as possible (Jeffries 2005).
• Use ...
Marie O'Boyle-Duggan Senior Lecturer BCU
with Joy Grech Senior Lecturer and Rebecca
Gillett Student LD Nurse
Why ‘live’ si...
Marie O'Boyle-Duggan Senior Lecturer BCU with Joy Grech Senior
Lecturer and Rebecca Gillett Student LD Nurse
Why live simu...
Nurse Education Simulation
Framework (Jeffries 2005, 2007).
• Clear objectives and information
• Support during the simula...
Simulation activity
Marie O'Boyle-Duggan Senior Lecturer BCU with Joy Grech Senior Lecturer and
Rebecca Gillett Student LD...
Why explore clinical impact?
• Literature suggests that the clinical affect of
the use of simulation in health education i...
Methodology
Mixed Methodology using: -
• National League for Nursing (2005) a
published questionnaire looking at
students’...
Table 1 -Number of Students and Professional Groups
Marie O'Boyle-Duggan Senior Lecturer BCU with Joy Grech Senior Lecture...
Satisfaction with the Simulation
Satisfaction Scores Strongly
Disagree
Disagree Undecided agree Strongly agree
n % n % n %...
Self Confidence following the simulation
Self Confidence Scores Strongly
Disagree
Disagree Undecided agree Strongly agree
...
Student reflections
on day of live simulation
Marie O'Boyle-Duggan Senior Lecturer BCU with Joy Grech Senior Lecturer and
...
Focus groups themes
• Feelings towards patients with learning
disabilities before simulation
• Feelings afterwards
• How s...
Focus Group - ODP Students
Marie O'Boyle-Duggan Senior Lecturer BCU with Joy Grech Senior Lecturer and
Rebecca Gillett Stu...
Focus group ODP
Marie O'Boyle-Duggan Senior Lecturer BCU with Joy Grech Senior Lecturer
and Rebecca Gillett Student LD Nur...
Nursing focus group
Marie O'Boyle-Duggan Senior Lecturer BCU with Joy Grech Senior
Lecturer and Rebecca Gillett Student LD...
Marie O'Boyle-Duggan Senior Lecturer BCU with Joy Grech Senior
Lecturer and Rebecca Gillett Student LD Nurse
“My mentor ex...
Marie O'Boyle-Duggan Senior Lecturer BCU with Joy Grech Senior
Lecturer and Rebecca Gillett Student LD Nurse
“maintaining ...
Conclusions
• Critical issues for people with learning disabilities
exist in modern day health care services
(Emerson et a...
Recommendations
• It is a legal requirement (Equality Act 2010)
that health services make reasonable
adjustments for patie...
Live Simulation LBR Courses
Results and developments post research -
• O’Boyle-Duggan, M, Grech, J, Brandt, R (2012)
Effec...
• The Collaborative projects
objective is to enhance the
learning environment for
students.
• Aims for a inter-disciplinar...
Theory book
• Important part of the project to produce a visual
reference point for people to take away with.
• ‘Guideline...
Student Responses to the IPL
workshop
Really good to work with
different disciplines and
see the differences in our
percep...
Finding ‘comfort cues’ for
the individual was really
good tip.
‘There is not always an
answer for everything.’
Nice sized ...
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Session F - Learning disabilities: Using live simulation to explore challenging behaviour and make reasonable adjustments

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  • marie
  • marie
  • marie
  • Marie - Give example of a scenario
  • marie
  • Joy - Want to ensure we measure clinical impact in some way, thus focus groups post placment, students perception etc..
  • Joy
  • Joy
  • Joy- comfort zone issuesThere is a wealth of literature that supports the use of simulation in healthcare, many studies as Coifi et al (2005) suggest never really examining outcome. You can see that students highly rated this simulation and enjoy the activity, therefore the findings and discussion in this research will concentrate on reflections and focus group analysis, which is ultimately what, is being measured. This particular questionnaire does not measure clinical impact, a criticism of research around simulation in health education (Cant and Cooper 2009). The questionnaire does not allow for students to comments on their ratings, for instance where students score ‘disagree’ there is no place for comment to understand why this is the case, in comparing the focus group data with the questionnaire scores some assumptions can be made from comments made by a particular student ODP, this is discussed later in the focus group analysis. It cannot be absolutely clear how students’ measure between their choice between agree and strongly agree for example, we cannot make assumption that they apply equal measure (Coles and McGrath 2010). From my own biased view in terms of needs of patients with learning disabilities (LD) what I really want to find out from the research is potential clinical implications. Furthermore including students self reported reflections of the simulation on the day and post simulation, has allowed for outcome to be measured as Coifi et al (2005) suggest. Not so much whether or not students liked the simulation but how this activity impacted on clinical care to patients with LD. Student Personal reflections in contrast were far more informative as discussed in the next
  • Marie - As well as the rules of reflection and feedback we asked students to reflect at end of session - collated
  • Marie
  • Marie
  • Marie
  • Marie
  • Joy
  • Marie
  • Marie -“Simulation-based education allows trainees to hone their skills in a risk-free environment” (Scalese et al 2007, p1), student feedback shows that this statement is an important theme that runs through the student experience. enabling the students to practice skills safely on simulated patients/role players rather than real service users is as suggested by Henrickson and Patterson (2007) an advantage in terms of “safety of patients” particularly when students are inexperienced and learning new procedures/skills. The literature clearly suggests that outcome measurement of simulation is not evident; this research shows from student reflections that there has been an impact clinically.
  • Marie - This research has shown how this can be done and therefore intends to have an impact on content of pre registration health courses at our university.A workshop incorporating this approach is being developed; in order to offer local clinicians opportunity to explore how they can make a difference with regards to reasonable adjustments.
  • Example slides form Academic and student partnership – collaborative project presentationIPL- LD Live simulation event Becky – Thelast bullet point got me thinking about the live simulations already implemented in our course/uni, how we could develop this – approached Marie who does the simulations with my idea – we applied for funding
  • Advise booklet a bit of a proto type at the moment – awaiting feedback from the students about how helpful it is etc.
  • Explain what I mean by comfort cues.
  • Session F - Learning disabilities: Using live simulation to explore challenging behaviour and make reasonable adjustments

    1. 1. Marie O'Boyle-Duggan Senior Lecturer BCU with Joy Grech Senior Lecturer and Rebecca Gillett Student LD Nurse Live Simulation Exploring students satisfaction and confidence in simulation using simulated patients (SPs) including personal reflections and evidence of clinical impact on the care of patients with learning disabilities.
    2. 2. What is live simulation? • It replicates clinical practice and is as near to real life as possible (Jeffries 2005). • Use of Standardised Patients ; more commonly used in medical education; simulated patients (SPs) as Wiskin (2003) defines are not real patients but specifically trained role players, improvising and providing feedback to students in real time simulated clinical encounters Marie O'Boyle-Duggan Senior Lecturer BCU with Joy Grech Senior Lecturer and Rebecca Gillett Student LD Nurse
    3. 3. Marie O'Boyle-Duggan Senior Lecturer BCU with Joy Grech Senior Lecturer and Rebecca Gillett Student LD Nurse Why ‘live’ simulation? • Students play a major role and are ‘in control’ of the situation deciding in real time appropriate treatment and actions; which enables them to make judgements and learn from their mistakes, (Alinier et al 2006) it increases student self efficacy, (Goldenberg et al 2005). • Teaching strategies employing simulation had a positive impact on students attitudes towards disabled people. (Goddard and Jordan 1998).
    4. 4. Marie O'Boyle-Duggan Senior Lecturer BCU with Joy Grech Senior Lecturer and Rebecca Gillett Student LD Nurse Why live simulation - clinical issues • Death by Indifference (Mencap 2007) and later Valuing People Now (2009) highlight how individuals with learning disabilities receive discrimination and neglect in mainstream healthcare, 74 deaths and counting (Mencap 2012) • Healthcare for all (2008) recommend that the health needs of people with learning disabilities are included in health education course programmes • People with learning disabilities continue to struggle with poor experiences in hospital settings due to health staff not understanding the individuals needs and more importantly the attitude of health staff towards those individuals with learning disabilities is still very negative (Densmore 2011). Reasonable adjustments are still not being made
    5. 5. Nurse Education Simulation Framework (Jeffries 2005, 2007). • Clear objectives and information • Support during the simulation • An appropriate problem to solve • Fidelity or realism of the experience • Time for feedback and reflection • Rules for feedback Marie O'Boyle-Duggan Senior Lecturer BCU with Joy Grech Senior Lecturer and Rebecca Gillett Student LD Nurse
    6. 6. Simulation activity Marie O'Boyle-Duggan Senior Lecturer BCU with Joy Grech Senior Lecturer and Rebecca Gillett Student LD Nurse Groups of three Three rooms/scenarios with a SP and Facilitator Each student worked with a SP peers observed Feedback/reflect then move to next scenario
    7. 7. Why explore clinical impact? • Literature suggests that the clinical affect of the use of simulation in health education is still inconclusive (Cioffi, et al 2005). • There appears to be a consensus for a universal outcome measurement of clinical impact (Ravert 2002, Cant and Cooper 2009). Marie O'Boyle-Duggan Senior Lecturer BCU with Joy Grech Senior Lecturer and Rebecca Gillett Student LD Nurse
    8. 8. Methodology Mixed Methodology using: - • National League for Nursing (2005) a published questionnaire looking at students’ satisfaction and confidence in simulation • Survey of student reflections- day of simulation • Focus Groups - post clinical placement Marie O'Boyle-Duggan Senior Lecturer BCU with Joy Grech Senior Lecturer and Rebecca Gillett Student LD Nurse
    9. 9. Table 1 -Number of Students and Professional Groups Marie O'Boyle-Duggan Senior Lecturer BCU with Joy Grech Senior Lecturer and Rebecca Gillett Student LD Nurse Frequency Percent Child Nursing ODP Adult Nursing Total 65 53 55 173 38 31 32 100
    10. 10. Satisfaction with the Simulation Satisfaction Scores Strongly Disagree Disagree Undecided agree Strongly agree n % n % n % n % n % The teaching methods used in this simulation were helpful and effective 1 0.6 0 0 4 2.3 32 18.5 136 78.6 The simulation provided me with a variety of materials and activities 1 0.6 1 0.6 11 6.4 67 38.7 94 54.3 I enjoyed how my instructor taught the simulation 1 0.6 0 0 1 0.6 56 32.4 115 66.5 The teaching materials used in this simulation were motivating and helped me to learn 1 0.6 1 0.6 3 1.7 60 34.7 108 62.4 The way the instructor(s) taught the simulation was suitable to the way I learn 1 0.6 3 1.7 9 5.2 54 31.2 106 61.3 Marie O'Boyle-Duggan Senior Lecturer BCU with Joy Grech Senior Lecturer and Rebecca Gillett Student LD Nurse
    11. 11. Self Confidence following the simulation Self Confidence Scores Strongly Disagree Disagree Undecided agree Strongly agree n % n % n % n % n % I am confident that I am mastering the content of the simulation. 1 0.6 2 1.2 6 3.5 101 58 63 36.4 I am confident that simulation covered critical content. 1 0.6 1 0.6 7 4 95 54.9 69 39.9 I am confident that I am developing the skills and knowledge to perform in clinical setting. 1 0.6 1 0.6 2 1.2 95 54.9 74 42.8 My instructors used helpful resources. 1 0.6 1 0.6 8 4.6 76 43.9 87 50.3 It is my responsibility as a student to learn what I need to know from the simulation activity. 1 0.6 2 1.2 9 5.2 60 34.7 101 58.4 I know how to get help when I do not understand the concepts covered . 1 0.6 0 0 22 12.7 87 50.3 63 36.4 I know how to use simulation activities to learn critical aspects of these skills. 1 0.6 1 0.6 11 6.4 99 57.2 61 35.3 It is the instructor’s responsibility to tell me what I need to learn of the simulation activity during class time. 8 4.6 17 9.8 49 28.3 67 38.7 32 18.5 Marie O'Boyle-Duggan Senior Lecturer BCU with Joy Grech Senior Lecturer and Rebecca Gillett Student LD Nurse
    12. 12. Student reflections on day of live simulation Marie O'Boyle-Duggan Senior Lecturer BCU with Joy Grech Senior Lecturer and Rebecca Gillett Student LD Nurse “people with learning disabilities are also humans with emotions and feeling, but they just portray it differently to main stream normality” (S24/c/T1). “It seems that good communication skills are vital especially in learning disability patients or service users. It reiterates that hands-on practice is the best way of learning and finding mistakes in technique (S60/a/T1/T2/T3) “Opened my eyes to how people with learning disabilities need to be treated” (S53/a/T1/T3). What I did well What were the learning opportunities available to me
    13. 13. Focus groups themes • Feelings towards patients with learning disabilities before simulation • Feelings afterwards • How simulation influenced clinical practice Marie O'Boyle-Duggan Senior Lecturer BCU with Joy Grech Senior Lecturer and Rebecca Gillett Student LD Nurse
    14. 14. Focus Group - ODP Students Marie O'Boyle-Duggan Senior Lecturer BCU with Joy Grech Senior Lecturer and Rebecca Gillett Student LD Nurse “I find it useful in a sense that I pick up on the things that they’ve brought in with them and the things that I say to help the conversations and stuff to progress” (G1/L38/S6/T1) ‘picking up on some of the patient’s personal affects to find the topic for releasing anxiety’ (G1/L44/L48/S5/TT1), and ‘distraction techniques, that’s one thing that you know and that’s one thing that you did learn from the simulation(G1/L49/S1/T1/T3)
    15. 15. Focus group ODP Marie O'Boyle-Duggan Senior Lecturer BCU with Joy Grech Senior Lecturer and Rebecca Gillett Student LD Nurse “nobody’s going to teach us how to behave with people that are – shall we say people that aren’t normal? I don’t know if it’s right for me to say that. But I feel that after that scenario, you know, I feel as I go into different mode, a different programme mode to behave…”(G1/L8/S5/T1), “that’s right. You would then rely on another person to be at hand-holding, with someone who’s not the enemy” (G1/L64- 71/UMS/T1).
    16. 16. Nursing focus group Marie O'Boyle-Duggan Senior Lecturer BCU with Joy Grech Senior Lecturer and Rebecca Gillett Student LD Nurse “I suppose it is the change in attitude, isn’t it really? Instead of saying “oh I’m busy. I’m going to have to write all the notes up.” That really just takes two minutes, just to go and spend a bit of time with someone. And that can mean a lot to somebody”, (G1A/L32/S1/T1). “I worked on an infectious diseases ward and a lady came in and she had learning disabilities. And it was like always, “Oh you can go and feed her,” but actually, I ended up getting on really well with her because I built up a rapport with her. She did trust me and you know. I don’t know. I think nurses, like my mentor, she was a bit ignorant to the fact that she did need more time and you can’t just go in and wham drugs at her and whatever, she wanted to understand” (G1A/L35/S4/T1).
    17. 17. Marie O'Boyle-Duggan Senior Lecturer BCU with Joy Grech Senior Lecturer and Rebecca Gillett Student LD Nurse “My mentor explained it to me and said that, “You missed a really nice one. The child was due for an operation. I don’t know what distressed her.” Our list was a really big list, age 8 to 10. So basically, it’s quick, quick, quick. Everything has to be done on time. So I think the rush that child....and then they said that she ended up crying in the anesthetics room. And she had to be sent back to the ward. And then the next one, the same thing ... I’d probably spend, you know, okay 20 minutes for the patient to talk with them et cetera....... you’ve only got 10 minutes and they’re going to be upset and the whole thing sort of …....snow balls, doesn’t it? I mean, I don’t know how that works for a kid though; to go back to the ward and to come again”.
    18. 18. Marie O'Boyle-Duggan Senior Lecturer BCU with Joy Grech Senior Lecturer and Rebecca Gillett Student LD Nurse “maintaining eye contact and staying calm, being patient and not standing above people was a big one that we learned. I think getting down to the same level as them. Yeah, just general body language and being calm I guess” (G1a/L8/S2/T1/T2/T3). “Big thing from the workshops that I took, onto the wards, I mean all three of them, steve with a magazine, mary and penguin, and Janet Eastenders. You know getting their attention away from - something humanized, normal, you know, a TV programme. And so I talk about that and they open up and that’s essentially a way into them. I used it so many times on the next ward and placement”. (G1a/L51/S3/T1/T2/T3).
    19. 19. Conclusions • Critical issues for people with learning disabilities exist in modern day health care services (Emerson et al 2011); the overall aim of this research is to have an impact on some of these issues. • Overwhelmingly the findings have been very positive, students felt confident and satisfied with the simulation activity. It is also clear that students reflected that skills explored and practiced during simulation had an impact on patient care when on clinical placements Marie O'Boyle-Duggan Senior Lecturer BCU with Joy Grech Senior Lecturer and Rebecca Gillett Student LD Nurse
    20. 20. Recommendations • It is a legal requirement (Equality Act 2010) that health services make reasonable adjustments for patients with learning disabilities • Healthcare for All (DH 2008) suggests that Higher Education Authorities provide education regarding the needs of people with learning disabilities to all health professional groups on undergraduate courses. • Workshop for local clinicians Marie O'Boyle-Duggan Senior Lecturer BCU with Joy Grech Senior Lecturer and Rebecca Gillett Student LD Nurse
    21. 21. Live Simulation LBR Courses Results and developments post research - • O’Boyle-Duggan, M, Grech, J, Brandt, R (2012) Effectiveness of Live Simulation of Patients With Intellectual Disabilities Journal of Nursing Education, June 2012 - Volume 51, 6: 334-342 Contract with Children’s Hosp – LD live simulation workshop for clinical staff Nursing, ODP, Social work, IPL collaborative project all receiving Live simulation workshop Marie O'Boyle-Duggan Senior Lecturer BCU with Joy Grech Senior Lecturer and Rebecca Gillett Student LD Nurse
    22. 22. • The Collaborative projects objective is to enhance the learning environment for students. • Aims for a inter-disciplinary partnership between students and staff, to achieve a more ‘hands on’ role for student contribution to their education. • Favours projects that reinforce theoretical knowledge by developing and applying student skills into real life situation. Marie O'Boyle-Duggan Senior Lecturer BCU with Joy Grech Senior Lecturer and Rebecca Gillett Student LD Nurse
    23. 23. Theory book • Important part of the project to produce a visual reference point for people to take away with. • ‘Guidelines’ aimed to be easy to read, and a back up to what they learnt from the simulation workshop. • Included in the book – communication tips, laws & policy such as ‘making reasonable adjustments,’ reports highlighted that show a need for mainstream health care to be more knowledgeable on the needs of pwld. Marie O'Boyle-Duggan Senior Lecturer BCU with Joy Grech Senior Lecturer and Rebecca Gillett Student LD Nurse
    24. 24. Student Responses to the IPL workshop Really good to work with different disciplines and see the differences in our perceptions. Hearing how patient felt in the situation was so useful,this is often overlooked in practice! The workshop was structured really well, feedback structure was consistent. Being given feedback with tips on new skills I can use is so helpful for the future. Marie O'Boyle-Duggan Senior Lecturer BCU with Joy Grech Senior Lecturer and Rebecca Gillett Student LD Nurse
    25. 25. Finding ‘comfort cues’ for the individual was really good tip. ‘There is not always an answer for everything.’ Nice sized groups – smaller is better as it feels less like you are ‘performing.’ ‘Time outs’ were so comforting to get suggestions from your peers. Marie O'Boyle-Duggan Senior Lecturer BCU with Joy Grech Senior Lecturer and Rebecca Gillett Student LD Nurse

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