The following piece is by guest writer Nicole Sneath NNP at the University of Manitoba. I am delighted to have her write on the use of simulation in the NICU and encourage you to watch the video she made for a recent charitable luncheon for the Children’s Hospital Foundation of Manitoba.
Practice makes perfect. This is something we’ve all heard at one point or another. Whether it was when we were learning how to ride a bike without training wheels, or print our name, or pitch that perfect strike. It seems a basic lesson, common sense, but do we practice what we preach?
In health care we deal with stressful situations, complex syntheses of information and multiple unique interactions. For the most part, we work in interprofessional teams, each one responsible for some part of care to our patients and each one dependant on the other whether we like to admit it or not. Our groups are varied, ranging from hands on direct care providers, to consultants, support staff, administrators and maintenance workers. Each one plays a unique role complementing the other. Sounds like the perfect set up. In practice however, do we really complement each other? Do we communicate effectively? How often do things fall through the cracks? Do we use our skills and strengths to everyone’s advantage? Is this diverse system a well-oiled machine working together and collaborating to provide optimal patient care? I would guess if you looked at your organization critically you may not be happy with all the answers.
Most of us trained and practiced with members of our own profession, doctors with doctors, nurses with nurses and so on. We were hired into our jobs and again did our orientation and continuing education within our own groups. In the everyday workplace however we are all blended together, modeling those that have practiced before us. Sometimes we work together well, seamlessly collaborating for a common goal. When we don’t, who pays the price? Perhaps it’s the patient with an untoward outcome, perhaps its the administrator with a complaint on their desk, perhaps its the consultant frustrated by the miscommunications or perhaps it’s the staff member not satisfied or content with their work.
Training programs have started to recognize that collaboration needs to start at the beginning. Waiting to introduce these concepts until arrival into the workplace is too late. Interprofessional learning is defined as learning with, from and about each other and this should happen at all levels of education and training. Teams function well not only by practicing together, but by creating environments where teams can get to know each other. Creating a relationship, no matter how small, can go a long way when stress increases and trust is needed.
It’s been shown that errors are often caused by breakdowns in communication. Maybe the nurse that administered the wrong dose of medication just didn’t know the dosing for that particular medication? Solving the problem could be teaching the proper dose and voila, problem solved. Or was the problem that they didn’t know where to find the information, weren’t comfortable asking for help, or didn’t want to question the doctor that ordered it? When the surgeon amputates the wrong leg is it because that one surgeon just isn’t that bright? Or could it be that no one else in the operating room double-checked, no one spoke up when they thought-wait, was it the left or the right, each one assumed that someone else must know best? Speculations abound for what goes on in critical incidents such as these. A common thread in preventing many critical incidents is the need for improved communication. Closed-loop communication, a shared mental model, role identification and clear leadership are integral to good communication in stressful situations. These concepts are best taught through experience rather than didactic lectures alone. So how do we go about teaching these skills?
Practice. Practice in an environment that is like the real thing, but lacks the risk to patients. Gone is the see one, do one, teach one mantra but it is replaced by see many, simulate even more, then do. Simulation allows us to breakdown specific skills and practice them over and over until we master them. We can practice individually or to harvest the greater benefit we can bring our interprofessional groups together and practice the skills that can’t be taught by reading a book. We can video record the sessions and debrief them afterwards. Instead of debriefing by giving a reassuring pat on the back or a not helpful shaming, perhaps we should try the “debriefing with good judgement” method and gain insight into the frames that guide individuals behaviour and actions. We can stop asking “dirty questions”-you know, the questions that we ask when we already know the answer, the “guess what I’m thinking” questions. Instead we can develop true curiosity into what individuals are thinking and then be able to change behaviour and facilitate critical thinking and problem solving.
We all come to work and want to do a good job. We want to be told that we made a difference, that something we did during the day has made a positive contribution to someone’s life. If this doesn’t resonate then perhaps a change in occupation is in order. If we critically examine our own practice, we would find areas that we could improve, skills we wish were a little more precise, or areas of specialty that we wish we knew a little more about. Traditional responses would be to dust off an old textbook or perform a literature search and get the information we need. Is this manner of learning effective? Does this address all the skills and knowledge we are seeking? Do we really know our areas of weakness? Do we want to?
1. There’s no such thing as “nonjudgemental” debriefing: a theory and method for debriefing with good judgement. http://www.ncbi.nlm.nih.gov/pubmed/19088574
2. Debriefing with good judgement: combining rigorous feedback with genuine inquiry.