Interprofessional simulation training for community mental health teams: Findings from a mixed methods study

ABSTRACT

Community mental health teams (CMHTs) in England face mounting service pressures due to an increased focus on out-of-hospital care. Interprofessional working is essential to providing good mental healthcare in community settings. Simulation training is underused in mental health, despite strong support for its improvement of clinical skills, confidence, teamwork, and interprofessional collaboration in other healthcare settings. This study aims to evaluate the impact of simulation training on community mental health professionals. An interprofessional simulation training course on assessment and team working skills for community mental health professionals was developed and delivered at a time of service reorganisation in South London services, including changes to job roles and responsibilities. In total, 57 course participants completed a survey that measured perceptions of knowledge and confidence, as well as a general view of the course. Eight participants took part in further semi-structured interviews 2–3 months after the course to provide perceptions about this experience’s subsequent impact. There were statistically significant increases in knowledge and confidence scores with large effect sizes. Thematic analyses of open-text survey and interview data identified emergent themes of interprofessional understanding; attitudes in clinical practice; staff well-being; the value of reflection; opportunity for feedback; and fidelity to clinical practice. Simulation training can improve confidence and knowledge in core skills and team working for CMHTs. Participants reported benefits to key areas of community mental healthcare, such as interprofessional collaboration, reflective practice, and staff well-being. Findings represented individual and team learning, as well as subsequent changes to clinical practice, and were related back to the interactive and reflective nature of the simulation. Implications are highlighted concerning the use of interprofessional simulation training in mental health, particularly relating to staff well-being, attitudes, and interprofessional working.     

Improving patient safety by using interprofessional simulation training in health professional education

Modern medicine is complex. Reports and surveys demonstrate that patient safety is a major problem. Health educators focus on professional knowledge and less on how to improve patient care and safety. The ability to act as part of a team, fostering communication, co-operation and leadership is seldom found in health education. This paper reports the findings from pilot testing a simulated training program in interprofessional student teams. Four teams each comprising one medical, nursing, and intensive nursing student (n = 12), were exposed to two simulation scenarios twice. Focus groups were used to evaluate the program. The findings suggest that the students were satisfied with the program, but some of the videos and simulation exercises could be more realistic and more in accordance with each other. Generally they wanted more interprofessional team training, and had learned a lot about their own team performance, personal reactions and lack of certain competencies. Involving students in interprofessional team training seem to be more likely to enhance their learning process. The students' struggles with roles, competence and team skills underline the need for more focus on combining professional knowledge learning with team training.     

Improving patient safety by using interprofessional simulation training in health professional education

Modern medicine is complex. Reports and surveys demonstrate that patient safety is a major problem. Health educators focus on professional knowledge and less on how to improve patient care and safety. The ability to act as part of a team, fostering communication, co-operation and leadership is seldom found in health education. This paper reports the findings from pilot testing a simulated training program in interprofessional student teams. Four teams each comprising one medical, nursing, and intensive nursing student (n = 12), were exposed to two simulation scenarios twice. Focus groups were used to evaluate the program. The findings suggest that the students were satisfied with the program, but some of the videos and simulation exercises could be more realistic and more in accordance with each other. Generally they wanted more interprofessional team training, and had learned a lot about their own team performance, personal reactions and lack of certain competencies. Involving students in interprofessional team training seem to be more likely to enhance their learning process. The students' struggles with roles, competence and team skills underline the need for more focus on combining professional knowledge learning with team training.     

Physical deterioration in an acute mental health unit: A quantitative retrospective analysis of medical emergencies

Nursing management of physical deterioration of patients within acute mental health settings is observed, recorded, and actively managed with the use of standardized Adult Deterioration Detection System (ADDS) charts. Patient deterioration may require the urgent assistance of a hospital rapid response or Medical Emergency Team. A five‐and‐a‐half‐year (2011–2016) audit of hospital‐wide Medical Emergency Team attendances was conducted in an acute mental health unit of a single large 250 bed regional hospital in Victoria, Australia. Data were extracted from the hospitals’ quality and patient safety program, RISKMan, and entered into a statistical data program for analysis. A total of 140 patient records were analysed, and the ‘Worried’ category (34%, n = 47) was the principle reason for a Medical Emergency Team call in a mental health ward, followed by hypotension (23%, n = 31) and a low Glasgow Coma Score (16%, n = 22). Upon further investigation of the ‘Worried’ category, the most common conditions recorded were an altered conscious state (22%, n = 9), low oxygen saturation (20%, n = 8), or chest pain (17%, n = 7). Activation of Medical Emergency Team calls predominantly occurred in the daylight morning hours (6am–12md). When data were compared to the general hospital patients, the context of the physiological deterioration of the mental health patients was strikingly similar. Further research is recommended to ascertain the extent and frequency with which staff working in mental health units are performing vital signs monitoring as an essential component of detection of early signs of physiological deterioration.     

Promoting a sustainable mental health nursing workforce: an evaluation of a transition mental health nursing programme

The recruitment and retention of the mental health nursing workforce has been identified as a major issue both nationally and internationally. Transition to practice programmes has been identified as an important strategy in addressing these issues. There is, however, a paucity of literature addressing the potential or effectiveness of transition programmes in achieving these aims. This paper reports the findings of a survey administered to registered nurses at the commencement and completion of the Transition Programme into Mental Health Nursing, in Sydney, Australia. The findings suggest a high level of satisfaction with the programme. The results are directing the ongoing development of clinical placements, clinical supports, education programmes and recruitment and retention initiatives for nurses within the Central Sydney Area Mental Health Service.     

Review article: Managing medical emergencies in rural Australia: A systematic review of the training needs

The aim of the study was to determine the training needs of doctors managing emergencies in rural and remote Australia. A systematic review of Australian articles was performed using MEDLINE (OVID) and INFORMIT online databases from 1990 to 2016. The search terms included ‘Rural Health’, ‘Emergency Medicine’, ‘Emergency Medical Services’, ‘Education, Medical, Continuing’ and ‘Family Practice’. Only peer-reviewed articles, available in full-text that focussed on the training needs of rural doctors were reviewed. Data was extracted using pre-defined fields such as date of data collection, number of participants, characteristics of participants, location and study findings. A total of eight studies published from 1998 to 2006 were found to be suitable for inclusion in the analysis. Six studies cited the results of self-reported questionnaires and surveys, one used a telephone questionnaire on a hypothetical patient and one utilised a theoretical examination. The studies found a significant proportion of participants wanted more emergency training. Junior rural doctors were found to have deficiencies in knowledge about stroke. Emergency skills doctors wanted more training including: emergency ultrasound, paediatric/neonatal procedures and cricothyroidotomy. However, many of the studies were performed by training providers that may benefit from deficient results. Given that the data was over 10 years old and that advances have been made in knowledge, training opportunities and technology, the implications for current training needs of rural doctors in Australia could not be accurately assessed. Thus there is a need for further research to identify current training needs.     

Violence in mental health settings: A systematic review

The introduction of smoke‐free policies is increasingly common in mental health settings, to improve health. However, a barrier to implementing smoke‐free polices is staff concern that violence will increase. We conducted a systematic review comparing the rates of violence before and after the introduction of smoke‐free policies in mental health settings. Two authors searched major electronic databases. We included studies reporting the prevalence of violence (verbal and/or physical or combined) before and after the introduction of a smoke‐free policy in a mental health, forensic, or addiction setting. We included 11 studies in the review. A narrative synthesis was used to describe the key results of each study. Six studies measured physical violence specifically; four reported a decrease or no change and two reported a short‐term increase. Five of these six studies also measured verbal violence; two found an increase, with one of the studies reporting that this increase was temporary. Three reported a decrease in verbal violence. A further five studies evaluated the rate of combined verbal and physical violence; four reported a decrease or no change and the other an increase. We conclude that the introduction of smoke‐free policies generally does not lead to an increase in violence. There is a need for more robust studies to support this finding. However, the conclusions from this review may be a step in reducing staff concerns.     

An evaluation of an interprofessional master's level programme in children's palliative care: The students' evaluation

In 2010/12 an innovative children's palliative care interprofessional educational project funded by the Irish Hospice Foundation was undertaken in a University faculty (Trinity College Dublin). This initiative responded to international educational recommendations to meet the palliative care needs of children. The project involved the development and delivery of 3 standalone modules at Master's level and a substantive research evaluation of the project to examine stakeholders and students perspectives to provide an insight into their experiences and to gather data for future developments. The research evaluation was conducted in two parts, part one sought students' evaluation and part two sought stakeholders', curriculum developers and lecturers' feedback.This paper reports the students' evaluation. Findings indicate that students perceived undertaking the modules provided them with the opportunity for improved interprofessional learning and they found modular content and assessment challenging. They also found the modules met their educational needs and also promoted an awareness of interprofessional education and the collaborative teamwork involved in children's palliative care. These students already experienced in children's palliative care indicated that those teaching on programmes at this level need expertise and programme time needs to be available for sharing experiences and for consolidation of learning.     

Towards interprofessional family-oriented teamwork in primary services: the evaluation of an education programme

A 2-year interprofessional family-oriented training programme for professionals working in the field of primary services (e.g. health care, social welfare, schools, day care) started in Oulu Province, Finland, in 2000. It aimed to provide the trainees with skills to work with families in interprofessional teams, to support them to cope better and to encourage them to develop new models for helping clients. Seventy-six trainees from 13 professions participated. This paper describes the structure, methods and the content of the programme and evaluates its success. Material was content analysed from participants' evaluations at the end of the programme and discussion during a focus group in which three trainees and three trainers participated. During the programme trainees' working methods moved from being detached experts towards client and family-orientation. Job satisfaction also improved. They began to appreciate interprofessional teamwork and found that client and family-oriented working methods supported families in using their own resources in solving problems. The study indicated that the sufficiently long process of education where the interprofessional collaboration has been put in practice already during the education is needed to change the theoretical framework and practical working methods of the trainees.     

Multidisciplinary evaluation of an emergency department nurse navigator role: A mixed methods study

Aim

To utilise multidisciplinary staff feedback to assess their perceptions of a novel emergency department nurse navigator role and to understand the impact of the role on the department.

Debating evidence-based health policy in an interprofessional classroom: an exploratory study

ABSTRACT

Model United Nations (MUN) debates enable students to engage in policy debate in simulated UN councils, and are regularly held in schools and colleges, globally. In developing countries where leadership and teamwork in ‘evidence-based policy and practice’ is needed to overcome health inequities and strengthen health systems, few curricula teach these skills using simulation-based, participatory learning approaches. Do MUN debates have something to offer for health professions education in low-resource settings? Since MUN debates are novel in health profession education, we aimed to identify the skill domains for selection of outcome measures in future evaluations. We employed an exploratory, qualitative approach to identify relevant competency domains. The 8 students (4 medical, 1 dental, and 3 pre-med) who volunteered to participate in the MedMUN initiative were interviewed, responses were thematically analyzed and a conceptual framework was developed. Leadership (subthemes: confidence and public-speaking), teamwork (subthemes: student integration and interprofessional education), and social responsibility (subthemes: democracy and a global outlook) were dominant themes. MUN debates are useful, interprofessional simulation exercises for providing students a window into global health policy, while engendering leadership and teamwork skills.     

Reconstructing professional identity for professional and interprofessional practice: A mixed methods study of joint training programmes in learning disability nursing and social work

This article draws on the findings from a mixed methods study with practitioners who qualified from joint training programmes in learning disability nursing and social work and explores the impact on professional identity of such programmes. Although several joint programmes are well established, very little research has been carried out with those who have qualified from them. These practitioners have experienced a kind of training quite unlike that offered by singular education programmes, incorporating a dual socialisation process, which has been neither analysed nor theorised. The study reported in this article comprised a postal survey to graduates from five programmes followed by in depth semi-structured interviews. Survey data were analysed by use of SPSS, while the interviews were analysed by use of a content analysis approach. The article discusses findings in relation to theoretical conceptions of professional status, boundaries and identity and relates these to the perceptions of respondents about their professional identities. It explores the ambiguities and uncertainties inherent in this type of professional training programme and argues that these reflect aspects of the current context of professions as a whole. The article concludes that a new professional identity is emerging in learning disability practice, generated by such programmes.