Compton Care employs a team of highly skilled nurses on its in-patient unit (IPU).
The complexity of patient needs is increasing. This means it is essential for nurses to manage challenging situations such as:
opioid toxicity
catastrophic bleeds
seizures.
The IPU nurses were keen to refresh their skills and gain confidence in responding to these emergencies.
Using the hospice’s simulation lab, the clinical team developed a simulation training programme with multiple scenarios for the IPU team to practice.
Outcomes
A simulation training session begins with a short briefing to help the participants get used to the environment and demonstrate how the simulation equipment works. Staff are then invited to take part in a scenario, where they need to identify and manage an emergency in real time. Afterwards, there is a debrief where the facilitators help participants to reflect and consolidate their learning.
The simulation sessions are not formally assessed, which means colleagues can work together to solve problems. The key focus is on gaining or consolidating skills in a safe environment. Feedback on the sessions has been positive.
The nurses who have taken part in the sessions say they are benficial for clinical practice. They report feeling more confident to manage acute situations on the IPU. They are more able to:
flag potential concerns
utilise non-technical skills (such as communication and teamwork) when responding to emergencies
question what might happen to a patient out of hours and plan for the necessary support.
Facilitators, challenges and advice
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Key facilitators
Doctors from the IPU medical team developed a training programme that was relevant to the specialty and thought creatively about how the content could be best delivered. The hospice already had a simulation lab which could be used for the sessions.
The team has used a dynamic approach, tailoring sessions to staff needs and adding content as learning needs are identified.
Relationships between the medical and nursing teams have improved as the sessions have been developed, which has had a positive impact on all areas of work. Morale has improved because people can see the hospice is investing in upskilling them.
Challenges
The nurses come from a range of professional backgrounds, which means they are all used to slightly different ways of working. Being able to practice simulations as a team has enabled them to share best practice and learn from each other.
Some team members were nervous to take part because they were unfamiliar with simulation. However the friendly approach of the sessions has encouraged and reassured them. Staff report that the training is more enjoyable than they expected!
The team took an evidence-based approach to develop the sessions, using research on best practice in simulation-based education. Although there is lots of evidence around using simulation in medicine, there is less about nursing education and clinical skills in palliative care.
Tips and advice
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Allocate time for training on the staff rota.
When planning simulation sessions, include plenty of time to debrief as this is essential to maximise learning.
Session facilitators should ensure there is a safe learning environment and help participants reflect on non-technical skills as well as technical ability.
Future development
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The simulation sessions are now being rolled out to IPU and community nurses, doctors and advanced nurse practitioners. The team is looking at other ways to upskill colleagues, for example through bitesize teaching.
The training was proven to improve the confidence and self-reported competence of the nurses, but the team is hoping to gather long-term data to look at whether the sessions objectively improve real-life clinical performance.
