Abstract
Background: Respiratory therapists (RTs) perform terminal extubation without consistent preparation of end-of-life (EOL) competencies including assessment, symptom control, therapeutic communication, and multidisciplinary collaboration. High-fidelity simulation is an experiential tool to enhance technical skill and emotional development through learning. Working in the ICU, RTs participate in EOL care of neonates, pediatrics, victims of trauma, covid-19, and chronically ill patients. The aim of this project is to measure if a simulated learning experience can prepare RT students for competency development as well as process their feelings towards caring for EOL patients.
Methods: Simulated terminal extubation of a lung cancer patient was performed with 11 RT students. Approval was obtained through the Department of Accountability and Research. Qualitative data was collected immediately utilizing questions based on debriefing for meaningful learning with the program director, simulation coordinator and faculty playing the roles of family members. Psychological safety was monitored. Results were coded for similarity. Quantitative data was collected one week post simulation utilizing National League for Nursing effectiveness questionnaires.
Results: Feeling uncomfortable, awkward, and uncertain as what to do post-extubation are the themes generated from this study. Symptoms and technical procedure were adequately managed. A quiet, dim environment felt supportive to the family. Collaboration happened in roles in which they were trained. 10 of the 11 participants (90.9%) responded to the design survey in the reflection phase. 100% agreed or strongly agreed that the simulation was designed to resemble a real-life situation. Students were able to independently solve problems, prioritize care, goal set, and analyze behavior and actions that build knowledge. Eight of the 11 participants (72.7%) responded to the satisfaction and self-confidence in learning survey in the reflection phase of the program. 100% strongly agreed or agreed that the simulation was helpful and effective, provided a variety of activities to learn, built confidence, and developed skills to perform in a clinical setting.
Conclusions: Clinical simulation was an effective training modality for students to learn EOL competencies prior to licensure. Participants safely discussed their feelings in an effort to process the awkwardness they expressed. Ultimately, this will help therapists cope while performing EOL care during their careers.
Pickens Technical College simulation lab set-up for a terminal extubation scenario.
Footnotes
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