Evaluating multisite multiprofessional simulation training for a hyperacute stroke service using the Behaviour Change Wheel

BMC Medical Education

J. Birns⁴  P. Jaye²  A. Roots¹  GB Reedy²  AJ Ross³ 

[1] Friends Stroke Unit, Kings College Hospital, Kings Health Partners, London, UK;Simulation and Interactive Learning (SaIL) Centre, St Thomas’ Hospital, King’s Health Partners, London, UK;Glasgow Dental School, University of Glasgow, 378 Sauchiehall Street, Glasgow G2 3JZ, UK;Department of Ageing & Health, St Thomas’ Hospital, King’s Health Partners, London, UK

关键词: Evaluation;    Education;    Patient simulation;    Stroke;   

Others  :  1224470
DOI  :  10.1186/s12909-015-0423-1

 received in 2014-07-25, accepted in 2015-08-14,  发布年份 2015

【 摘 要 】

Background

Stroke is a clinical priority requiring early specialist assessment and treatment. A London (UK) stroke strategy was introduced in 2010, with Hyper Acute Stroke Units (HASUs) providing specialist and high dependency care. To support increased numbers of specialist staff, innovative multisite multiprofessional simulation training under a standard protocol-based curriculum took place across London.

This paper reports on an independent evaluation of the HASU training programme. The main aim was to evaluate mechanisms for behaviour change within the training design and delivery, and impact upon learners including potential transferability to the clinical environment.

Methods

The evaluation utilised the Behaviour Change Wheel framework. Procedures included: mapping training via the framework; examination of course material; direct and video-recorded observations of courses; pre-post course survey sheet; and follow up in-depth interviews with candidates and faculty.

Results

Patient management skills and trainee confidence were reportedly increased post-course (post-course median 6 [IQ range 5–6.33]; pre-course median 5 [IQ range 4.67–5.83]; z = 6.42, P < .001). Thematic analysis showed that facilitated ‘debrief’ was the key agent in supporting both clinical and non-clinical skills. Follow up interviews in practice showed some sustained effects such as enthusiasm for role, and a focus on situational awareness, prioritization and verbalising thoughts. Challenges in standardising a multi-centre course included provision for local context/identity.

Conclusions

Pan-London simulation training under the London Stroke Model had positive outcomes in terms of self-reported skills and motivation. These effects persisted to an extent in practice, where staff could recount applications of learning. The evaluation demonstrated that a multiple centre simulation programme congruent with clinical practice can provide valuable standard training opportunities that support patient care.

【 授权许可】

   
2015 Ross et al.

【 图 表 】

Fig. 1.

【 参考文献 】

• [1]Royal College of Physicians Intercollegiate Stroke Working party: National Clinical Guidelines for stroke. 4th Edition 2012. http://www. rcplondon.ac.uk/sites/default/files/national-clinical-guidelines-for-stroke-fourth-edition.pdf webcite
• [2]Kalra L, Evans A, Perez I, Knapp M, Donaldson N, Swift CG. Alternative strategies for stroke care: a prospective randomised controlled trial. Lancet. 2000; 356(9233):894-9.
• [3]Evans A, Perez I, Harraf F, Melbourn A, Steadman J, Donaldson N et al.. Can differences in management processes explain different outcomes between stroke unit and stroke-team care? Lancet. 2001; 358:1586-92.
• [4]Tissue plasminogen activator for acute ischemic stroke. N Engl J Med. 1995; 333(24):1581-7.
• [5]Stone S. Stroke units. Br Med J. 2002; 325:291-2.
• [6]Harbison J, Hossain O, Jenkinson D, Davis J, Louw SJ, Ford GA. Diagnostic accuracy of stroke referrals from primary care, emergency room physicians, and ambulance staff using the face arm speech test. Stroke. 2003; 34:71-6.
• [7]Nor AM, Davis J, Sen B, Shipsey D, Louw SJ, Dyker AG et al.. The Recognition of Stroke in the Emergency Room (ROSIER) scale: development and validation of a stroke recognition instrument. Lancet Neurol. 2005; 4(11):727-34.
• [8]Healthcare for London. Stroke Strategy for London. http://www. londonhp.nhs.uk/wp-content/uploads/2011/03/London-Stroke-Strategy.pdf webcite
• [9]Hunter RM, Davie C, Rudd A, Thompson A, Walker H, Thomson N et al.. Impact on Clinical and Cost Outcomes of a Centralized Approach to Acute Stroke Care in London: A Comparative Effectiveness Before and After Model. PLoS ONE. 2013; 8(8):e70420.
• [10]Morris S, Hunter RM, Ramsay AIG, Boaden R, McKevitt C, Perry C, et al. Impact of centralising acute stroke services in english metropolitan areas on mortality and length of hospital stay: difference-in-differences analysis. Br Med J. 2002;349:4757. doi:10.1136/bmj.g4757.
• [11]Roots A, Thomas L, Jaye P, Birns J. Simulation training for hyperacute stroke unit nurses. Br J Nurs. 2011; 20(21):1352-1356.
• [12]NHS London Cardiac and Stroke Networks. The London Stroke Model. http://www. slcsn.nhs.uk/uksf/stroke-forum-lsm1.pdf webcite
• [13]Department of Health. Stroke-specific education framework. http://www. weds.wales.nhs.uk/sitesplus/documents/1076/Stroke-Specific_E_Framework.pdf webcite
• [14]Reed K, Wood S, Jacobson L, Chang E, Milzman D. Stroke simulation training: is stroke management missing in residency training? Ann Emerg Med. 2011; 58(4):S284.
• [15]del Moral I, Maestre JM. A view on the practical application of simulation in professional education. Trends in Anaesthesia and Critical Care. 2013; 3(3):146-151.
• [16]Foronda C, Liu S, Bauman EB. Evaluation of simulation in undergraduate nurse education: An integrative review. Clin Sim in Nursing. 2013; 9:e409-e416.
• [17]Ross AJ, Kodate N, Anderson JE, Thomas L, Jaye P. A content analytic mapping of simulation studies in anaesthesia journals, 2001–2010. Brit J Anaesth. 2012; 109(1):99-109.
• [18]Michie S, van Stralen MM, West R. The behaviour change wheel: A new method for characterising and designing behaviour change interventions. Implement Sci. 2011; 6:42. BioMed Central Full Text
• [19]Michie S, Richardson M, Johnston M, Abraham C, Francis J, Hardeman W et al.. The behavior change technique taxonomy (v1) of 93 hierarchically clustered techniques: building an international consensus for the reporting of behavior change interventions. Ann Behav Med. 2013; 46:81-95.
• [20]Patton MQ. Qualitative evaluation and research methods 2nd edition. Sage, Newbury Park CA; 1990.
• [21]Levett-Jones T, McCoy M, Lapkin S, Noble D, Hoffman K, Dempsey J et al.. The development and psychometric testing of the Satisfaction with Simulation Experience Scale. Nurse Educ Today. 2011; 31(7):705-710.
• [22]Jaye P, Thomas L, Reedy G. “The Diamond”: a structure for simulation debrief. Clin Teach. 2015; 12(3):171-5.
• [23]Steinwachs B. How to facilitate a debriefing. Simul Games. 1992; 23:186-92.
• [24]Akhu-Zaheya LM, Gharaibeh MK, Alostaz ZM. Effectiveness of simulation on knowledge acquisition, knowledge retention, and self-efficacy of nursing students in Jordan. Clin Sim in Nursing. 2013; 9(9):e335-e342.
• [25]Paige JT, Garbee DD, Kozmenko V, Yu Q, Kozmenko L, Yang T et al.. Getting a head start: high-fidelity, simulation-based operating room team training of multiprofessional students. J Am Coll Surg. 2014; 218(1):140-149.
• [26]Murin S, Stollenwerk NS. Simulation in procedural training. Chest. 2010; 137(5):1009-11.
• [27]Elfrink VL, Kirkpatrick B, Nininger J, Schubert C. Using learning outcomes to inform teaching practices in human patient simulation. Nurs Educ Perspect. 2010; 31(2):e97-e100.
• [28]McGaghie WC, Draycott TJ, Dunn WF, Lopez CM, Stefanidis D. Evaluating the impact of simulation on translational patient outcomes. Simul Healthc. 2011; 6(7):S42-S47.
• [29]Cant R, Cooper S. Simulation-based learning in nurse education: systematic review. J Adv Nurs. 2010; 66(1):3-15.
• [30]Birns J, Jaye P, Roots A, Reedy G, Ross AJ. A Pan-London simulation training for hyperacute stroke [abstract]. Stroke. 2014; 45:P317.
• [31]Kharasch M, Aitchison P, Ochoa P, Aitchison P, Zhao JC, Kharasch M et al.. Growth of a simulation Lab: Engaging the learner is key to success. Dis Mon. 2011; 57(11):679-690.
• [32]Jordan M, Lanham HJ, Anderson RA, McDaniel RR. Implications of complex adaptive systems theory for interpreting research about health care organizations. J Eval Clin Pract. 2010; 16(1):228-231.
• [33]Stayt LC. Clinical simulation: A sine qua non of nurse education or a white elephant? Nurse Educ Today. 2012; 32(5):e23-e27.
• [34]Cantrell MA. The importance of debriefing in clinical simulations. Clin Sim in Nursing. 2008; 4(2):e19-e23.
• [35]Dreifuerst KT. The essentials of debriefing in simulation learning: a concept analysis. Nurs Educ Perspect. 2009; 30(2):109-114.
• [36]Standard VI: the debriefing process. Clin Sim in Nursing. 2011; 7(4S):s16-s17.
• [37]Paige JB, Morin KH. Simulation fidelity and cueing: A systematic review of the literature. Clin Sim in Nursing. 2013; 9(11):e481-e489.
• [38]Alessi S. Simulation design for training and assessment. Aircrew training and assessment. Edited by O’Neil H, Andrews D. Mahwah, NJ: Lawrence Erlbaum Associates; 2000:197–222.
• [39]Liaw SY, Zhou WT, Lau TC, Siau C, Chan SW. An multiprofessional communication training using simulation to enhance safe care for a deteriorating patient. Nurs Educ Today. 2013; 34(2):259-264.
• [40]Marchal B, Westhorp G, Wong G, Van Belle S, Greenhalgh T, Kegels G et al.. Realist RCTs of complex interventions: An oxymoron. Soc Sci Med. 2013; 94:124-128.