Nursing and social work professions require their workforce to perform myriad complex responsibilities in their professional roles. Social work and nursing departments therefore are obligated to teach and train competent students who are prepared to enter the workforce with competency skills in assessment, intervention, and safety, as well as soft skills such as collaboration. The Institute of Medicine (IOM, 2010) supports interprofessional education (IPE) for a “collaborative practice ready” health care workforce that is prepared to respond to its community's needs.
It is imperative that individual health team members learn to work competently in interprofessional teams where collaborative practice can increase patient safety, promote optimal patient outcomes, decrease fragmented communication, and strengthen health systems (Bolin & Chapman, 2015; Boscart et al., 2017; Costello et al., 2018; IOM, 2010a; Murphy & Nimmagadda, 2015; National Association of Social Workers, 2017; Zhang, Miller, Volkman, Meza, & Jones, 2015). IPE promotes the advancement of collaborative learning experiences in preparing health professionals for team-based care of patients (Council on Social Work Education, 2018). In addition, IPE promotes achievement of the Triple Aim: improving the patient care experience, improving the health of populations, and reducing the cost of health care (Interprofessional Education Collaborative [IPEC], 2016).
The IOM report (2010) The Future of Nursing: Leading Change, Advancing Health recommends interprofessional collaboration as a means to improve quality and safety. The IOM (2010a) defined IPE as a phenomenon “when students from two or more professions learn with, from and about each other to improve collaboration and the quality of care” (p. 7). The Society for Simulation in Healthcare (2014), in conjunction with the National League for Nursing, identified ways to strengthen IPE through simulation. Interprofessional simulation (IPS), the use of simulation across professions, can serve to promote change in communication, collaboration, and professional identity (Murphy & Nimmagadda, 2015; Society for Simulation in Healthcare, 2014). Collaborative processes that are inherent for team member success will not be innate for students if they do not have exposure and practice prior to graduating (Zhang et al., 2015).
Too often, health care professionals have limited knowledge of each other's roles and professional strengths (Leclair et al., 2018). Education of health professionals often can be siloed, and opportunities to develop team skills and dispel misunderstandings regarding roles prior to clinical practice can have an impact on patient safety and quality of care (Costello et al., 2018). As each member of the health care team has a unique contribution to the care of the patient, it is imperative that health care professionals have a broader understanding of other health care disciplines. To maximize quality of care and optimize patient safety, authentic learning environments through IPS, where students can practice skill sets that revolve around real situations, can assist in supporting interprofessional collaboration.
To bridge the gap between education and practice, IPE should be integrated with simulation (Bolin & Chapman, 2015; Murphy & Nimmagadda, 2015; O'Rourke, Horsley, Doolen, Mariani, & Parisault, 2018). In addition, the literature attests to the need for more effective teamwork (Fulmer, 2016). Social work and nursing departments used IPS to demonstrate collaborative practice skills and apply them within a team context. Both professions sought to address nursing and social work students' perceptions of interprofessional collaboration in the context of using high-fidelity (HF) and simulated participant (SP) simulations; HF patients are programmable manikins that exhibit medical symptoms, and SPs are human actors. The Society for Simulation in Healthcare (2016) defined HF simulators as “full-body manikins that have the ability to mimic, at a very high level, human body functions” (p. 14) and an SP as “an individual who is trained to portray a real patient in order to simulate a set of symptoms or problems used for healthcare education, evaluation, and research” (p. 35).
Social work students in their foundation (first) year of a master's degree program and baccalaureate nursing students in their capstone course participated in one collaborative simulation experience that provided care to both HF manikins and SP actors. A total of 24 social work (one man and seven women) and nursing students (two men and 14 women) participated in IPS. Participants ranged in age from 20 to 28 years and represented a mix of racial and ethnic groups (African American, Hispanic, Asian, and Caucasian). The simulation exercise was a requirement for both social work and nursing courses; student performance in the simulation was not graded but was part of course requirements that met course objectives.
One social work and two nursing students each delivered domain-specific care for 15 minutes to either an HF manikin or an SP actor; the nursing students initiated patient care and then provided a report to the social work student. Eight 30-minute simulation scenarios were completed throughout the day. The simulation scenario used basic scene development from the Simulated Learning System (Evolve, 2018) simulation scenario; however, portions of the scenario were changed to meet course objectives for both disciplines. All students were provided with the following scenario 24 hours prior to the simulation:
The patient is a 20-year-old woman who had a syncopal episode while attending her college class. Laboratory tests were drawn upon arrival to the emergency department, and the patient was found to be hypokalemic, hypovolemic, and hypotensive. The patient had a history of nausea, vomiting, light headedness, and depression. The patient denied currently taking any medications. After admission, the patient refused any fluid replacements due to fear of weight gain.
Nursing and social work students participated in the prebriefing, which included:
- Introduction to the simulation center.
- Purpose of the simulation.
- Assumptions about the simulation.
- Normalization (e.g., “it is normal to feel anxious and uncomfortable during simulations”).
- A fiction contract (everyone acknowledged that simulation is not real; however, all participants performed in a manner that treated the event as real).
- Audio- and videorecording disclosure.
- Logistics related to equipment.
- Simulation room orientation.
- Patient report.
- Protocol for debriefing process.
- Confidentiality that required students to agree they would not share the simulation experience with classmates who had not yet participated.
Nursing students focused on delivering safe care for a hypokalemic and hypovolemic patient intending to do self-harm. Nursing students then gave a bedside report to social work students using Situation, Background, Assessment, and Recommendation (SBAR) technique. Social work students took report from the nursing students and then performed a psychosocial assessment on the patient. Core competencies for interprofessional collaborative practice through IPEC aligned with the nursing course objectives, which were derived from students' learning outcomes and Quality and Safety Education for Nurses competencies (IPEC, 2016; QSEN, 2018; Council on Social Work Education, 2015), social work competencies, and indicators from the 2015 Educational Policy and Accreditation Standards for baccalaureate and master of social work programs, and with the debriefing questions (Table A; available in the online version of this article).
IPEC Categories and Course Objectives
Twelve students (eight nursing students and four social work students) participated in a debriefing; two debriefings were completed by the end of the day. Questions asked during the debriefing were associated with interprofessional communication, HF versus SP simulation, reflection of the experience, safety, professional standards, and patient care.
Kolb's (1984) experiential learning theory was used as the theoretical framework for this project. Experiential learning is the process whereby students learn through demonstration of their practice skills by “doing” what occurs in real work settings. It is a reciprocal process in which students interact with the learning environment itself and vice versa. There are four stages (Kolb, 1984):
- Concrete experience.
- Reflective observation.
- Abstract conceptualization.
- Active experimentation.
Concrete experience for social work and nursing students consisted of each student's 15-minute patient assessment in a replicated hospital classroom. Reflective observation occurred during debriefing when students and faculty participated in a 45-minute debriefing session that allowed the learners and simulation leaders to reflect on their simulation observations and experience. A structured qualitative dialogue took place with students who verbalized they were frightened presimulation but through abstract conceptualization understood the utility and importance of simulation to help them learn practice skills. Active experimentation allowed students to contemplate how they would change their behavior or actions for an improved simulation experience if given the opportunity, provide suggestions for what might work in the future, and discuss things they could change in their own practice.
IPEC competencies were aligned to nursing course objectives, social work EPAS, and debriefing questions for the simulation scenario (Table A). Students' anecdotal comments from the debriefing reinforced the benefits of interprofessional collaboration in simulation. A summary of comments from 24 nursing and social work students revealed little understanding of a collaborative process for patient care. Students stated they did not know each other's roles and had difficulty knowing what and how much to communicate with each other. Nursing students were familiar with the HF manikins but not with SPs. Social work students had no experiences with any simulation; they were not prepared for the presentation of the manikin and its realistic staging and responses.
Before students started, they stated the 15-minute simulation seemed like an eternity, but after the simulation, the students said they wanted more time. Students communicated they felt more confident and competent and appreciated the value of interprofessional collaboration more than they believed they would. Student comments included “It [was] cool to see from a different perspective and working as a team rather than just the medical side of it,” and “It truly feels good to see that you can work together to help that one patient.”
Social work and nursing students, as well as faculty, realized that strategies used by one discipline may not be familiar to the other discipline. Further information sharing prior to and as part of prebriefing might reconcile this issue. The social work students did not understand the nursing students' use of SBAR and medical terminology. One recommendation is to have social work students take a medical terminology course prior to participation in simulation. The process for bedside report versus outside the door was not agreed on prior to the simulation, and it was assumed students would know how to perform a handoff report. However, during the simulation, students were confused about the process and exhibited discomfort in giving report in front of the patient. Further clarification of respective roles is necessary.
Social work students preferred the SP over the HF manikin. Students also indicated that the utility of substituting a manikin for an actual person has more relevancy in nursing than in social work, as nursing actions may be procedural in nature whereas social work relies on interactive relationships. Future research will examine the relevancy and outcomes related to safety in care for both nursing and social work students. Scheduling issues with the simulation center, nursing students, and social work students was complicated and required detailed planning, arranging, and strategizing to optimize time and rotations through the four simulation rooms.
This collaborative experience was the first attempt in creating IPS between nursing and social work in one college in the western region of the United States. A limitation of the project includes student education levels that ranged from undergraduate to master; however, the educational range of senior-level nursing students and beginning-level master in social work students did not appear to hinder the learning experience. In fact, not all students had prior experience working with HF and SP simulation environments. In addition, lack of faculty experience with IPS also may have affected student success.
Using IPEC (2016) competencies as a guide, a collaborative IPS experience between social work and nursing departments was created to enhance students' understanding of interprofessional communication, roles and responsibilities of other professions, and team-based practice in the context of HF and SP simulation environments. Similar to the literature, students had deficient knowledge of the other profession's roles. Costello et al. (2018) highlighted the benefit of IPS as a way to gain insight into how other professions view a situation and the perspective these other professionals bring to the team. Defining one's own role assists in understanding how another professional's role can contribute toward quality patient care and team dynamics. Some students indicated that their roles were not clear as the handoff was confusing; the simulation team did not specifically indicate what students should do for the handoff as they chose to view students' authentic response to the situation. Despite the fact that the nursing students had more than 500 hours of clinical time, they still did not interact as team players with a common goal for the patient. Fragmented care as a result of not working as a team can have detrimental effects on patient quality and safety (Wilcox, Miller-Cribbs, Kientz, Carlson, & DeShea, 2017).
Communication was an area where both sets of students were conflicted. What to share, how much to share, and the medical language used to share the information was confusing for the students. Boscart et al. (2017) viewed the benefits of information exchange as a way to strengthen interprofessional collaboration and improve patient outcomes. When all team members were informed, treatment plans and processes became clear to everyone. In addition, an appreciation for what every profession brings to the patient's care is discovered and valued. Working in silos does not support an awareness of roles and responsibilities of the other health care team members. Social work and nursing students, although aware of the other discipline during the simulation, made no effort to coordinate care. The SBAR report was given with acronyms and medical information that was foreign to the social work students. Pertinent information regarding patient safety was not the focus of the exchange.
IPEC competencies provide a guide for IPE collaboration and can bridge the gap between the classroom and clinical setting (Dow, DiazGranados, Mazmanian, & Rechin, 2014; Wilcox et al., 2017). Changing the health care culture from independent practice to a team-based approach requires a change in the educational process. IPS is a teaching strategy that engenders a team approach to patient care while supporting professional competencies and safety for all disciplines. Quantitative measurement tools are needed in future research to assess outcomes of educational practice in simulation-based IPE (Wilcox et al., 2017; Zhang et al., 2015). In the future, health care professionals will need to work in teams; early exposure to team-based learning through IPEC competencies and IPS can support collaborative learning and quality patient outcomes.
Individual health team members must learn how to work competently in interprofessional teams where collaborative practice can increase patient safety and promote optimal patient outcomes. Health care professionals may have limited knowledge of each other's roles and professional strengths. In addition, education of health professionals often can be siloed. Simulation-based IPE in conjunction with IPEC competencies supports a collaborative learning environment where all members of the health care team can practice team-based skills prior to clinical practice.
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- Costello, M., Prelack, K., Faller, J., Huddleston, J., Adly, S. & Doolin, J. (2018). Student experiences of interprofessional simulation: Findings from a qualitative study. Journal of Interprofessional Care, 32, 95–97.
- Council on Social Work Education. (2015). Educational policy and accreditation standards for baccalaureate and master's of social work programs. Retrieved from https://www.cswe.org/getattachment/Accreditation/Accreditation-Process/2015-EPAS/2015EPAS_Web_FINAL.pdf.aspx.
- Council on Social Work Education. (2018). Mission. Retrieved from https://www.cswe.org/About-CSWE.
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- Kolb, D.A. (1984). Experiential learning: Experience as the source of learning and development. Upper Saddle River, NJ: Prentice Hall.
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IPEC Categories and Course Objectives
|IPEC||Nursing Course Objectives||Social Work Objectives||Debrief Questions|
|Choose effective communication tools and techniques, including information systems and communication technologies, to facilitate discussions and interactions that enhance team function||Use a variety of communication techniques to resolve conflict and manage group dynamics as methods of developing positive working relationships||Competency 8
Indicator C: use interprofessional collaboration as appropriate to achieve beneficial practice outcomes
Indicator E: facilitate effective transitions and endings that advance mutually agreed-on goals.
|What are your thoughts about the “handoff/referral/conversation” to the nursing/social work student?|
|Communicate one's roles and responsibilities clearly to patients, families, community members, and other professionals||Compare the education, roles, and perspectives of the nursing profession with other members of the health care team||Competency 6
Indicator A: apply knowledge of human behavior and the social environment, person-inenvironment, and other multidisciplinary theoretical frameworks to engage with clients and constituencies
|What do you think the patient's perspective was of you? What are reasons you feel this way?|
|Use the full scope of knowledge, skills, and abilities of professionals from health and other fields to provide care that is safe, timely, efficient, effective, and equitable||Integrate evidence, clinical judgment, interprofessional perspectives, and patient preferences in planning, implementing, and evaluating outcomes of care across the life span||Competency 8
Indicator A: critically choose and implement interventions to achieve practice goals and enhance capacities of clients and constituencies
|How prepared to complete the psychosocial assessment did you (social work student) feel after learning about the client's medical (and mental health) condition? Did you feel you provided safe care to your client? Why or why not? What steps did you employ to provide safe care?|
|Communicate with team members to clarify each member's responsibility in executing components of a treatment plan or public health intervention||Use a variety of communication techniques to resolve conflict and manage group dynamics as methods of developing positive working relationships||Competency 8
Indicator C: use interprofessional collaboration as appropriate to achieve beneficial practice outcomes
Indicator D: negotiate, mediate, and advocate with and on behalf of diverse clients and constituencies
|Was there a referral that was made? Did the social work and nursing student have a conversation?|
|Forge interdependent relationships with other professions within and outside of the health system to improve care and advance learning||Function effectively within nursing and interprofessional teams, fostering open communication, mutual respect, and shared decision making to achieve quality patient care||Competency 8
Indicator C: use interprofessional collaboration as appropriate to achieve beneficial practice outcomes
|What was your perception regarding interdisciplinary collaboration?|
|Engage in continuous professional and interprofessional development to enhance team performance and collaboration||Function effectively within nursing and intraprofessional teams, fostering open communication, mutual respect, negotiation, and shared decision making to achieve quality nursing care||What was the context/content of the nursing and social work conversation?|
|Maintain competence in one's own profession appropriate to scope of practice||Use clinical reasoning and judgment to evaluate and adapt nursing care for diverse populations facing complex health problems||Competency 1
Indicator A: make ethical decisions by applying the standards of the NASW Code of Ethics, relevant laws and regulations, models for ethical decision making, ethical conduct of research, and additional codes of ethics as appropriate to context
|How and in what ways did use of manikins and actors influence your performance in simulation?|