Six people stand in a small room around a "patient" — a lifelike, high-tech simulator — laying in a hospital bed.
The tension in the air is palpable as so many people are working to care for the patient: a Union nursing student is checking vitals. A pharmacy student is asking the patient's upset "caregivers" (portrayed by Union faculty and staff) questions about medication, and a social work master's student is trying to assess the patient's and the family's needs. A medical resident from the University of Tennessee Family Medicine Center enters as a doctor to check on the patient and give out instructions. Instructors watch their students and take notes as the situation unfolds.
The scenario may be fake, but the stress in the room is real as the Union students and the medical residents and medical students from UT work together to try care for the ill patient during this interprofessional experience simulation in Providence Hall's Simulation Labs.
Interprofessional experience (IPE)
simulations like this one from November
2019 demonstrate the value of collaboration
to the participating students, and they show
the value of different academic disciplines
across the university cooperating to provide
a rich learning experience. Although the
COVID-19 pandemic affected the ability to
pull all of these departments together for
a similar "mega" simulation in the fall of
2020, they plan to restart the large IPE sims
in the fall of 2021.
HOW IT STARTED
In the fall of 2016, senior nursing students began having interprofessional experiences with other disciplines in simulation labs, said Renee Anderson, director for simulation and interprofessional development. Anderson has been at Union for nearly 13 years, has taught in simulation for nine years and was made director of simulation in August 2018.
The College of Nursing partnered with the School of Social Work, namely Theresa Blakley, professor of social work, and Nita Mehr, associate dean for the School of Social Work. Each fall, senior nursing students and MSW students participate in a simulation experience that focuses on the community aspect of nursing.
Beginning in 2017, the College of Nursing and the College of Pharmacy partnered to offer a large IPE simulation in the fall and the spring. This included third-year pharmacy students, senior nursing students and Master of Social Work students. In 2018, to meet pharmacy accreditation requirements, they began to include medical students and medical residents from the University of Tennessee Family Medicine Center in Jackson. This is the largest IPE simulation that nursing, pharmacy, social work and the UT Family Medicine Center offer.
"The thing with the interprofessional simulation, it is interprofessional — no one department can do it alone," Anderson said. "Back in 2016, when we decided we needed to do this, it was realizing that if we're not careful, the student who is going to someday be the professional will see themselves as a silo, and that's not how we are. So, we wanted to have practice-ready professionals that knew how to communicate and collaborate with other disciplines to meet the needs of the patient."
In the fall of 2018, an IPE sim began with junior nursing students and second-year pharmacy students. That same fall, the College of Nursing partnered with the School of Theology and Missions to offer an IPE simulation twice a year for junior nursing students and Christian studies students that focuses on ethical situations.
Kim Lindsey-Goodrich, director for interprofessional education and professor of pharmacy practice, said the IPE sims are not only a way for pharmacy students to use their clinical knowledge and skills, but also to recognize the roles and responsibilities of everyone on the health care team to optimize patient care.
"From that interprofessional standpoint, it's an opportunity for them to learn how to work with others and even work with the simulated patients, too, because the patient is part of the health care team, as well," Lindsey- Goodrich said. "We just try to provide as many opportunities as we can work in to give them those opportunities to work with others. And, if they do it on a simulated basis, then hopefully they're going to be more comfortable when they get out in practice doing their rotations, and then ultimately when they're licensed pharmacists working with other licensed practitioners."
Although junior and senior nursing students participate in regular nursing simulation labs — a total of 17 over their time as traditional undergraduate students — they are different than the interprofessional experiences. For their day-to-day sims, Anderson said, they only include nursing students, and they know what the "patient's" diagnosis will be. For the IPEs, however, the students are not aware of the scenario beforehand. Traditional students will participate in four IPEs during their time as students.
"I see [students] from their very first one to their very last one, and I'm able to see that fantastic growth that occurs in their ability to provide that patient-centered care," Anderson said.
Anderson said she does not know of
any other university in the area that does
as many interprofessional experiences as
Union. According to Anderson's research,
Union offers more and longer simulation
experiences in comparison with other
schools. Union University is ranked the No.
1 best college for nursing in Tennessee for
2021 by Niche.com. Union's 2020 College
of Pharmacy graduates scored a pass
rate of 98 percent on the North American
Pharmacist Licensure Examination, the
top performance in Tennessee and the
eighth highest in the nation.
TEAMWORK MAKES IT HAPPEN
To plan a large IPE sim like the one that took place in November 2019 and included nursing, pharmacy, social work and the UT Family Practice Center, the different disciplines meet together multiple times beforehand to develop the scenario "in such a way that it provides that communication collaboration between all the disciplines," Anderson said.
The professors involved also find actors to participate in the simulation, which often includes Union faculty and staff such as Jay Bernheisel, professor of engineering, and Greg Bohner, director of disability services. Sherrie Turner, simulation specialist, is also a vital part of simulation labs, Anderson said. Turner sets up the rooms, gets paperwork ready and prepares the simulated "patients" with clothing and moulage (makeup) for the scenario.
During the simulation, each discipline's professors observe how their students provide patient care, communicate and collaborate. After the sim is over, students and professors participate in a debriefing session where they have an opportunity to discuss the experience, verbalize challenges and review how they were able to demonstrate Christ's love in the scenario. The sims are built to be a safe environment for students to learn, Anderson said.
Mehr, who also serves as director for MSW programs and as professor of social work, said the IPE sims push social work students out of their comfort zones within the safety of a classroom setting with their peers.
"The shift into the sim lab offered a setting like internships in which students move from passive to active learning," Mehr said. "It also required that social work students learn the delicate balance of interacting with other professionals in multidisciplinary practice. Students learned to work in parallel lanes as they singularly focused on patient care."
At the end of every simulation experience, students in every participating discipline also fill out an evaluation form to provide feedback about the learning experience.
Alli Herring was a Union nursing student who graduated in the spring of 2020 and now works as a nurse on the acute care floor at Vanderbilt's Monroe Carell Jr. Children's Hospital in Nashville, Tennessee. Herring participated in the November 2019 "mega sim" experience and said her simulation lab experiences at Union helped her learn how to collaborate well with others and handle stress in preparation for her 海角乱伦社区.
"We're all learning together," Herring
said. "There's less pressure and more
being able to be willing to work together
and figure out what each other is
thinking, and working and building off
each other's ideas."
CHRIST-CENTERED SIMULATIONS
Another unique aspect of Union's simulation lab experiences is that professors and students can talk about the Lord in everything they do, Anderson said. In every simulation, the professors put an emphasis on Christian worldview — it is always Anderson's intention and the students' goal to demonstrate their love of Christ as they care for the simulated patient. Anderson hopes that in their years at Union, the students will develop in their own faith.
"We are blessed at Union University to be able to integrate faith in our classes with students," Mehr said.
Demonstrating Christ's love to patients is immersed through every course they teach, Anderson said. Professors are able to share about their own life experiences and how they have integrated faith in the hospital and clinical setting. Students are taught to listen to key cues from the patient.
"Our instructors put an emphasis on making sure you're providing holistic care," Herring said of her time as a student. "While that doesn't always necessarily mean the patient is going to be spiritually involved or want that in their care, you're always available to give it and you want to support the patient emotionally and spiritually, no matter what their religion may be. I think that does prepare us for the real world, as well, because our instructors are always encouraging that and reminding us of the importance of the spiritual side of care, as well as the obvious patient care."
