1. INNOVATIVE, INTERPROFESSIONAL SIMULATION
WORKSHOPS AT THE MENTAL-PHYSICAL INTERFACE
SWAMPI: A novel mixed methods effectiveness study
Dr Asanga Fernando1,2, Chris Attoe1,2, Dr Peter Jaye3, James Pathan1,
Dr Sean Cross1,2 & Professor Simon Wessely2,4
1Maudsley Simulation, South London and Maudsley NHS Foundation trust.2 Institute of Psychiatry, Psychology & Neuroscience, King’s College London. 3Simulation & Interactive learning centre, Guy’s and St Thomas’ NHS Foundation trust. 4 Royal College of Psychiatrists.4
BACKGROUND AND AIMS
46%1 of individuals with mental health conditions have long-term physical illness, while 30%1 of individuals with long-term physical conditions have a mental illness. Physical and psychiatric comorbidity is of significant concern to medical, psychiatry, and primary care services, with policy, strategy, and literature highlighting the need to better address this interface. Simulation training has been proposed as a tool to improve clinicians’ management of physical and psychiatric comorbidities.
This study is the first to evaluate interprofessional simulation in improving management of such comorbidity.
Statistically significant increases in attitudes (paired samples t-tests)
Pre mean
Post mean
p value
Effect size
1. Nature of mental illness
.74
.90
.006*
.13
2. MH and colleagues
.55
.67
.018*
.09
3. Teams and MH
.93
.484
4. Teams and physical health
.81
5. NHS mental health services
.47
1.00
6. Caring for violent patients
.88
.209
7. Violent patients in MH
.85
.024*
Total
5.14
5.73
.001*
.25
Statistically significant increases in confidence (paired samples t-tests)
Pre mean
Post mean
p value
Effect size
1. Risk assess for suicidality
3.20
4.02
.001*
.47
2. Psych to Acute bed transfer
3.39
3.98
.36
3. Patients trying to abscond
3.47
4.20
.55
4. Patients with dementia
3.61
4.07
.30
5. Dementia & physical illness
3.53
3.95
.29
6. Patients refusing treatment
3.48
.28
7. Managing violent patients
3.29
3.88
Total
23.97
28.10
.61
METHODS
Participants (n=63) were doctors and nurses from emergency, medical, psychiatric, and community services across primary and secondary care in South London. Quantitative and qualitative measures on knowledge, confidence and attitudes were completed before and after a one-day interprofessional simulation course addressing clinical care for physical and psychiatric comorbidity.
RESULTS Knowledge, confidence, and attitudes for Doctors and nurses from a range of different backgrounds scores showed statistically significant improvements post-course with large effect sizes. Thematic analyses highlighted the development of interprofessional working, clinical skills, reflective practice, leadership and teamwork, and communication skills, as a result of the course.
Paired samples t-tests assessed the impact of SWAMPI on participants’ knowledge, attitudes, and confidence regarding clinical care at the mental physical interface. There were statistically significant increases in knowledge scores pre (M=2.46, SD=1.26) to post-course (M=4.03, SD=1.53), t(58)=-9.81, p=.001, in positive attitude scores pre (M=5.14, SD=1.41) to post-course (M=5.73, SD=1.17), t(58)=-4.40, p=.001, and in confidence scores pre (M=23.97, SD=4.90) to post-course (M=28.10, SD=3.64), t(58)=-9.54, p=.001. The eta squared statistic indicated large effect sizes, .62, .25 and .61 respectively
Do you believe that today’s course is likely to:
Yes (n=63)
1. Enhance your interprofessional working in your current/future team?
62 (98%)
2. Impact on your clinical practice in the future to benefit patient care?
63 (100%)
3. Impact on your future practice with regard to patient safety?
4. Enhance your communication skills?
61 (97%)
QUALITATIVE FINDINGS - THEMES
Interprofessional working
Clinical skills
Communication
Leadership & teamwork
Reflection
“I now understand more about what mental health nurses and psychiatrists do. This course has helped me realise how we could all work better together for our patients”. – ED nurse
Statistically significant increases in knowledge (paired samples t test)
Pre mean
Post mean
p value
Effect size
1. De-escalating a patient
.71
.92
.001*
.17
2. Capacity assessments
.37
.58
.002*
.15
3. Delirium prevalence
.07
.39
.32
4. Mental Health Act
.29
.73
.38
5. Delirium risk factors
.51
.44
.398
6. Mental illness in Acutes
.34
.024*
.09
7. Physical illness in MH
.64
.28
Total
2.46
4.03
.62
CONCLUSIONS
Innovative, Interprofessional simulation training (SWAMPI) can improve clinical practice and professional development with participants reporting increased ability to provide safer,
higher quality care to patients with physical and
psychiatric comorbidity.
REFERENCES
British Medical Association, Science & Education Department and the Board of Science. Recognising the importance of physical health in mental health and
intellectual disability: Achieving parity of outcomes. London: British Medical Association; 2014.