Enhancing Nurse and Physician Collaboration in Clinical Decision Making Through High-fidelity Interdisciplinary Simulation Training

doi:10.4065/mcp.2010.0282

Mayo Clinic Proceedings

Volume 86, Issue 1, January 2011, Pages 31-36

https://doi.org/10.4065/mcp.2010.0282 Get rights and content

OBJECTIVE

To determine whether interdisciplinary simulation team training can positively affect registered nurse and/or physician perceptions of collaboration in clinical decision making.

PARTICIPANTS AND METHODS

Between March 1 and April 21, 2009, a convenience sample of volunteer nurses and physicians was recruited to undergo simulation training consisting of a team response to 3 clinical scenarios. Participants completed the Collaboration and Satisfaction About Care Decisions (CSACD) survey before training and at 2 weeks and 2 months after training. Differences in CSACD summary scores between the time points were assessed with paired t tests.

RESULTS

Twenty-eight health care professionals (19 nurses, 9 physicians) underwent simulation training. Nurses were of similar age to physicians (27.3 vs 34.5 years; p=.82), were more likely to be women (95.0% vs 12.5%; p<.001), and were less likely to have undergone prior simulation training (0% vs 37.5%; p=.02). The pretest showed that physicians were more likely to perceive that open communication exists between nurses and physicians (p=.04) and that both medical and nursing concerns influence the decision-making process (p=.02). Pretest CSACD analysis revealed that most participants were dissatisfied with the decision-making process. The CSACD summary score showed significant improvement from baseline to 2 weeks (4.2 to 5.1; p<.002), a trend that persisted at 2 months (p<.002).

CONCLUSION

Team training using high-fidelity simulation scenarios promoted collaboration between nurses and physicians and enhanced the patient care decision-making process.

Section snippets

PARTICIPANTS AND METHODS

After approval by the Mayo Clinic Institutional Review Board, registered nurses and surgical faculty and surgical residents working together in a dedicated inpatient surgical ward at Mayo Clinic in Rochester, MN, were identified as potential participants. Volunteers were recruited between March 1 and April 21, 2009. Simulation training was conducted at the Mayo Clinic Multidisciplinary Simulation Center in Rochester, MN. The center provides classrooms for prebriefing and debriefing sessions and

RESULTS

Twenty-eight health care professionals, including 19 RNs and 9 physicians (2 surgical faculty, 7 surgical residents), completed the pretest survey and underwent simulation training. Characteristics of participants are summarized in Table 2. Nurses were of similar age to physicians (27.3 vs 34.5 years; p=.82), were more likely to be women (95.0% vs 12.5%; p<.001), and were less likely to have undergone prior simulation training (0% vs 37.5%; p=.02).

Responses to the CSACD surveys at all 3 time

DISCUSSION

This study demonstrated that team training using high-fidelity simulation and debriefing for nurses and physicians promoted collaborative teamwork in a working environment in which dissatisfaction with the existing teamwork approach to patient care was high according to results from Professional Research Consultants (Omaha, NE) surveys and unit-based teamwork surveys. Moreover, after the training experience, participants perceived that significant improvements in the patient care

CONCLUSION

High-fidelity simulation team training can be an effective method to increase awareness of the barriers to good communication among caregivers and improve collaboration in patient care decision-making processes.

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High-fidelity simulation (HFS) can more effectively cultivate knowledge, skills, collaboration, caring, and learning interest of undergraduate nursing students. Since the effect of HFS is equivalent to other teaching methods in cultivating undergraduate nursing students' critical thinking, self-confidence and learning satisfaction, nursing educators can choose the most appropriate methods to achieve the intended learning outcomes according to the actual situation.
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In the current review, educators in half of the studies reported that the length of the debriefing was two to three times longer than length of the simulation. This result corresponds to other educators’ opinions that the ideal length of debriefing is two to four times the length of the simulation (Kolbe et al., 2013; Maxson et al., 2011). However, we could not compare our findings with INACSL standards because there were no criteria about the length of a debriefing.
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¹: Dr Holubar is now with Dartmouth-Hitchcock Medical Center, Lebanon, NH.

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ORIGINAL ARTICLEEnhancing Nurse and Physician Collaboration in Clinical Decision Making Through High-fidelity Interdisciplinary Simulation Training

OBJECTIVE

PARTICIPANTS AND METHODS

RESULTS

CONCLUSION

Section snippets

PARTICIPANTS AND METHODS

RESULTS

DISCUSSION

CONCLUSION

AORN J

J Prof Nurs

Improving Patient Safety Through Simulation Research

Securing “good” nurse/physician relationships

Nurs Manage

Linking the practice environment to nurses' job satisfaction through nurse-physician communication

J Nurs Scholarsh

Excellence through evidence: securing collegial/collaborative nurse-physician relationships, part 1

J Nurs Adm

Discrepant attitudes about teamwork among critical care nurses and physicians

Crit Care Med

Hospital RNs' and CNOs' perceptions of the impact of the nursing shortage on the quality of care

Nurs Econ

Patient safety and errors in medicine: development, prevention and analyses of incidents [in German]

Anasthesiol Intensivmed Notfallmed Schmerzther

Team triage improves emergency department efficiency

Emerg Med J

TeamSTEPPS™: Team Strategies and Tools to Enhance Performance and Patient Safety

ORIGINAL ARTICLE
Enhancing Nurse and Physician Collaboration in Clinical Decision Making Through High-fidelity Interdisciplinary Simulation Training