‘All Through the Night’ An Inter-Professional Simulation Arlene de la Rocha, RN, MScN, MEd Dana Chorney, RN, MN Leslie Graham, RN, MN, CNCC

We are located….. Partnership – Durham College & The University of Ontario Institute of Technology Collaborative BScN Program Campus Location – Oshawa, Ontario: 40 minutes east of Toronto Both the College and University share the campus space

PURPOSE/BACKGROUND The purpose of this study was to provide members of the inter-professional health care teams (Bachelor of Science in Nursing, Practical Nursing students, Personal Support Worker students, and Paramedic students) the opportunity to experience the nightshift prior to graduation from their respective programs and to collaborate with their inter-professional health colleagues. AND………….

Purpose/Background As nurse educators, we have a mandate and responsibility to educate nursing students on mitigating fatigue when providing patient care as well as and managing fatigue through healthy lifestyle practices when working the nightshift (CNA, 2010).

Method We used a mixed method approach Quantitative data was obtained using a survey via ‘LimeSurvey’ Qualitative data was obtained using open ended questions via LimeSurvey and were analyzed using NVIVO Focus group data was analyzed using NVIVO Sample Convenience sample (32 students) Simulation 17 simulated cases; 5 standardized patients; 5 groups of 5-6 inter- professional team members

Findings- Participants BScN Collaborative Nursing-53.3% Paramedic-21.88% Practical Nursing Program-9.38% Personal Support Worker-9.38% BScN Graduate 3.13%

Questions Addressed 1. How was the high-fidelity scenario helpful or not helpful in reinforcing your knowledge base? 2. How was the high-fidelity scenario effective or not effective in allowing a safe environment to practice? 3. After participating in the high-fidelity scenario, would you feel more confident in a similar situation in the clinical environment? 4. Did the scenario allow you to use your critical thinking and decision making skills? How?

Questions Addressed 5. Did you find it challenging or comfortable working in a team situation? How well did you think the team communicated? Please explain. 6. What did you think your strengths were? Limitations were? 7. What did you find most valuable participating in this 12 hour night high-fidelity scenario? 8. What would you like to see done differently if another high- fidelity scenario were offered?

Findings-Post Simulation Scenarios What did you think your limitations were during the simulation/case scenarios? Fatigue-41.18% Lack of knowledge-38.24% Lack of confidence-32.35% Shyness-32.35% Lack of assertiveness/taking charge-8.82% Forgetfulness-2.94%

Findings-Post Simulation Scenarios After participating in the simulation cases/scenarios, would you feel more confident in a similar situation in the clinical environment? Confident: 84.38% Neither confident nor non-confident: 12.5% Not-confident: 3.13%

Findings-Post Simulation Scenarios Did you find it challenging working in an inter-professional team? Very challenging-12.5% Neither challenging or non- challenging- 43.7% Not challenging- 43.7%

Findings-Post Simulation Scenarios Did you find it challenging to communicate in a team situation? Very challenging-21% Neither challenging or non-challenging- 30% Not challenging- 49%

Findings-Themes that Emerged Preconceived ideas of each professions’ role within the inter-professional team: PSW inquired, “Are we going to just sit and watch?” Paramedics stated, “What are we going to do, it looks like the nurses will have the most to do tonight.” Fatigue and Critical thinking: “Writing things down is very important to prevent forgetting important things needing to be done.” “Critical thinking was off.”

Findings-Themes that Emerged Collaboration: “Team work and collaboration was helpful.” “Simulation should be offered every semester just as it was tonight.” Camaraderie: “Feeling united, feeling vulnerable as tiredness set it.” Confidence: Year three students indicated “We feel more prepared to enter our final year.” New graduates stated “We learned so much and I wish this had been done more often when we were students.”

Future Considerations for ‘All Through the Night’ Simulation Distribute inter-professional health care team members more evenly Reduce number of participants per simulated case scenario Increase participation from discipline specific faculty to facilitate scenario and debriefing Select most appropriate disciplines Faculty PD in delivery of quality simulation Have one designated individual to cover “administrative responsibilities.”

Future Research Utilize a well validated instrument for learner performance Evaluate the learner’s experience using a valid and reliable tool Expand on inter-professional collaboration Further uncover the effects of nurse fatigue on clinical judgment related to patient safety Or simply provide the students the opportunity to experience a 12 hour night shift with no evaluations about their experience and performance.

References Canadian Nurses Association (2010). Nurse fatigue and patient safety. Retrieved from www2.cna- aiic.ca/CNA/documents/pdf/publications/Fatigue_Safety_ 2010_Summary_e.pdfwww2.cna- aiic.ca/CNA/documents/pdf/publications/Fatigue_Safety_ 2010_Summary_e.pdf Geiger-Brown, J., Rogers, V., Trinkoff, A., Kane, R., Barker Bausell, R., & Scharf, S. (2012). Sleep, sleepiness, fatigue, and performance of 12 hour shift nurses. Chronobiology International, 29 (2), doi: / Neill, M. A., & Wotton, K. (2011). High-fidelity simulation debriefing in nursing education: A literature review. Clinical Simulation in Nursing, 7, e161-e168. doi.org/ /j.ecns