Simulation to Teach Patient Transfers: The Role of Self-Efficacy

Transferring patients is a complex activity that can result in injury to the patient and healthcare professional. There is currently no widespread standard method to teach therapy students patient transfer skills. Simulation is one method to educate students to safely transfer patients, however, research examining the use of simulation to teach and evaluate patient transfer skills is limited. For this study we developed acute care scenarios with embedded critical events to teach transfer skills to occupational therapy students in the context of a medical theatre and with the use of a simulator, SimMan®. Scenarios mimicked common situations encountered when treating a medically complex patient. These situations included management of respiratory equipment, management of external lines, drains and tubes, and management of medical instability during the patient encounter. Performance assessment forms for each scenario provided objective criteria to assess student learning and performance. Using cognitive learning theory, the relationship between active participation and active observation was examined. Knowledge, skill, and safety self-efficacy data were collected. Over time, students with a combination of observation and participation experiences reported no difference in self-efficacy ratings when compared to students with participation experiences only. However, after the second exposure to SimMan®, skills self-efficacy ratings were greater for students who actively participated twice and observed once. Self-efficacy ratings after transfer experiences were not predictive of future performance of transfer tasks. Self-efficacy declined between the classroom and the medical theatre, and increased with repeated exposures to SimMan® scenarios. Ratings for knowledge and skills self-efficacy were closely related to each other over time and across classroom, simulation center and clinical environments. In contrast, safety self-efficacy ratings were more closely associated with environmental changes

Standardized Patients in Occupational Therapy Education

The use of standardized patients (SPs) in occupational therapy (OT) education has greatly increased in recent years; however, there is limited research on the perceptions of student’s clinical readiness utilizing SPs and whether or not the utilization of SPs prepare students for fieldwork. The purpose of this study was to examine the perceptions of SPs in OT education and the perceived clinical readiness of students. The use of SPs has been thoroughly researched in other healthcare related fields. It is important that the same critical attention be given to their use in our own field, which emphasizes the importance of clinical readiness in the development of future professionals. A survey was given to the OT students of Dominican University of California who have had experience with the curriculum, which utilizes SPs. Students were asked to rate their own perceptions of readiness in a number of skills, which were practiced using SPs. Students were also asked to answer qualitative questions regarding their experiences in the simulated environment with SPs. Results indicated that four common themes emerged to the perceptions on the effectiveness of SPs. The use of SPs helped implement observational skills, bring classroom information to practical experience, identified the impact of secondary health conditions/comorbidity, and had effect on student performance due to anxiety. Further studies should be conducted to support this growing area of OT education

Measuring Outcomes in Competence and Confidence in Clinical Skills Through the Use of Standardized Patients

Limited literature is available concerning the use of standardized patients (SPs) in physical therapy education related to outcomes which are assessed. The purpose of our study was to investigate the effects SP implementation had on first year, doctor of physical therapy (DPT) student’s communication and patient interviewing skills and their confidence in those skills. Our study utilized a comparison group, repeated measures design with the collection of four survey instruments at pre-test and two posttest time points. The instruments for our study measured general self-efficacy (GSE), task-specific self-efficacy (Self-Perceived Communication Competence (SPCC) and Froehlich Communication Competence (FroCom) and confidence (Standardized Patient Learning Outcomes Assessment Tool for Confidence (SPLOAT). Both groups completed the survey instrument packet at all three time points, however, only the experimental group received SP encounters prior to the second and final instrument collections. General linear model repeated measures analysis was utilized and the results indicated baseline differences for the GSE, SPCC and FroCom with the experimental group having higher average scores, thus making comparisons of the groups for these measures less meaningful. Significant improvements in average overall confidence scores (SPLOAT) were evident at each collection time point for the experimental group with significant main effects for time and group. Additionally, there was a significant interaction effect between time and group indicating the experimental group increased in their average overall scores ranging from moderate to substantial for all time points. The experimental group performed significantly higher on the second SP encounter compared to the first. The comparison group received no SP encounters throughout the entire study, however also showed significant increases in average overall scores from the pre-test to posttest1 collections but did not indicate significance at the pre-test to posttest2 or for the posttest1 to posttest2 collections. The increases seen in both groups could be attributed to normal maturation through the curriculum and experience over time. SPLOAT score increases were evident in both groups, however only initially for the comparison group. The SP use of the experimental group supports previous research suggesting that multiple exposures to simulation activities, such as SP, aids in the confidence improvements

Accessibility of Health Data Representations for Older Adults: Challenges and Opportunities for Design

Health data of consumer off-the-shelf wearable devices is often conveyed to users through visual data representations and analyses. However, this is not always accessible to people with disabilities or older people due to low vision, cognitive impairments or literacy issues. Due to trade-offs between aesthetics predominance or information overload, real-time user feedback may not be conveyed easily from sensor devices through visual cues like graphs and texts. These difficulties may hinder critical data understanding. Additional auditory and tactile feedback can also provide immediate and accessible cues from these wearable devices, but it is necessary to understand existing data representation limitations initially. To avoid higher cognitive and visual overload, auditory and haptic cues can be designed to complement, replace or reinforce visual cues. In this paper, we outline the challenges in existing data representation and the necessary evidence to enhance the accessibility of health information from personal sensing devices used to monitor health parameters such as blood pressure, sleep, activity, heart rate and more. By creating innovative and inclusive user feedback, users will likely want to engage and interact with new devices and their own data

Wheelchair Training Program for New Manual Wheelchair Users

Manual wheelchairs are commonly used for everyday mobility among people with lower limb impairments, including persons with spinal cord injury (SCI). Manual wheelchair users often experience pain and chronic overuse injuries in their upper extremities, limiting their mobility and their ability to complete daily activities. The repetitive trauma of propelling a wheelchair may be a contributing factor to upper extremity pain and injury. The anatomy of the upper extremities is not designed for the number of repetitions and the amount of force involved in everyday wheelchair propulsion. Research has been conducted to identify recommendations for decreasing the number of repetitions and the amount of force involved with manual wheelchair propulsion; however, training on how to use a wheelchair, specifically propulsion training, is often not implemented during rehabilitation. Important steps in identifying strategies for teaching wheelchair propulsion and skills include exploring devices for training, understanding health care professional and wheelchair user perspectives of wheelchair training, and training based on motor learning approaches. Therefore, the overall goal of this project was to further explore methodology for training of new manual wheelchair users. To this end, we conducted three studies (Chapters 2-4). In study 1 (Chapter 2), we tested a wheelchair dynamometer roller system, the WheelMill System (WMS), on its use in simulating different surfaces (i.e., overground and ramps) and assessing propulsion variables that can be used for training new wheelchair users. We identified that the WMS has the ability to accurately simulate flat overground movement; however, the accuracy of the WMS was poor in simulation of ramps. Modifications to the software model and the addition of visual feedback may improve the accuracy of the simulation of ramps. The WMS was accurate in the quantification of biomechanical propulsion variables. In study 2 (Chapter 3), we identified perspectives of health care professionals and manual wheelchair users to assist in prioritizing the focus of wheelchair skills training of new manual wheelchair users. During focus groups, health care professionals and manual wheelchair users discussed if and how wheelchair propulsion biomechanics were taught and important skills that should be included in training. Results indicate that propulsion biomechanics were introduced but not addressed in detail. Important training components discussed include propulsion techniques, transfers in an out of the wheelchair, providing maintenance to the wheelchair, and navigating barriers such as curbs, ramps, and rough terrain. Health care professionals and manual wheelchair users identified many of the same skills as important but ranked them in a different order. In study 3 (Chapter 4), we piloted a wheelchair training program implementing aspects of motor learning for new manual wheelchair users and measured the impact of this program on wheelchair propulsion biomechanics and overall wheelchair skills. Post-training wheelchair biomechanics changed, as well as propulsion performance overground. Wheelchair skills did not change significantly post-training. Wheelchair training has the potential for change; however, there are many challenges associated with implementing training programs for new manual wheelchair users. Together, these results contribute knowledge to evidence-based approaches to teaching new manual wheelchair users with SCI how to efficiently and effectively use their wheelchairs. Specifically, we obtained information about technology for simulating and assessing manual wheelchair propulsion, perspectives of stakeholders with regard to the manual wheelchair training process, and methodology for training new manual wheelchair users

The impact of high-fidelity human patient simulation on clinical judgment of nursing students: A pilot study

The American Association of Colleges of Nursing is encouraging their constituents to increase clinical judgment of nursing students to meet increased workplace demands and higher patient acuity. The literature suggests that human patient simulation (HPS) may be a teaching pedagogy to promote clinical judgment. However, few quantitative studies exist that measure clinical judgment as an outcome of HPS. A pilot study was conducted using a quasi-experimental design that randomly assigned subjects (n = 11) into one of three groups: control, traditional and experimental. Subjects completed pretests for three dimensions of clinical judgment: knowledge, confidence and skill. Following the intervention which consisted of a lecture, and either written or HPS scenarios, the subjects completed posttests for each dimension. Results found that clinical judgment was not increased as a result of HPS. However, subjects in the experimental group following HPS significantly increased the clinical judgment dimension of skill

Gaming: Occupation-Based NBCOT Exam Preparation

The purpose of this scholarly project was to create a novel, unique, and effective preparation tool for the National Board for Certification in Occupational Therapy (NBCOT) certification examination. A literature review of 40 evidence-based journal articles addressed adult learning principles; guidelines for facilitating learning; types of, advantages, and disadvantages of using gaming in higher education; and preparation methods for high-stakes examinations. Information reviewed also included current preparation tools; exam blueprint; and domain, task, and knowledge statements ofthe NBCOT certification examination. An Open Book: NBCOT Exam Prep Game is a board game that can be used as a supplementary preparation tool for candidates who are preparing for the NBCOT certification examination. A board game was chosen for its ability to reduce anxiety, increase motivation to study, allow test takers to learn perspectives from one another, and increase confidence for taking an exam. An Open Book: NBCOT Exam Prep Game is designed to use group discussion, simulated exercise, problem-solving activities, case methods, and peer-helping activities to stimulate learning and provide the opportunity to apply knowledge required for passing the certification exam. Adult learning principles and concepts from the Occupational Adaptation model provide the foundation for the project design. The design of the game board and questions were developed with the blueprint of the NBCOT examination and the validated domain, task, and knowledge statements as foundational information. Evidence in the literature supports the use of games in higher education to reduce anxiety, increase motivation to study, allow test takers to learn perspectives from one another, and increase confidence for taking an exam. The product of this scholarly project presents a social learning tool in the form of a board game that incorporates adult learning principles, concepts of the Occupational Adaptation model, and the NBCOT blueprint and domain, task, and knowledge statements reflecting current practice in occupational therapy. An Open Book: NBCOT Exam Prep Game is designed to supplement current preparation tools

ENVIRONMENTAL INFLUENCES ON OCCUPATIONAL THERAPY PRACTICE

Rehabilitation hospitals serve to foster a client’s independence in preparation to return home after an injury or insult. Having space in rehabilitation environments that is home-like and supportive for each client can facilitate participation in occupations and assist in learning and practicing the skills needed to transition to home. Yet, typically occupational therapists provide interventions to clients in therapy gyms with exercise and impairment based equipment. Currently the stroke population is changing and identifying the optimal rehabilitation environment is imperative to guide occupational therapy practice. This dissertation contains three studies relating to the rehabilitation environment and occupational therapy interventions. The first study focused on the perceptions of occupational therapists regarding their optimal rehabilitation environment, identifying that they would prefer to offer their clients a variety of rehabilitation environments and that there is a relationship between the environment and the type of intervention provided. A second study examined the effects of occupation-based interventions provided in a home-like environment to an individual recovering from chronic stroke with the results indicating enhanced occupational performance, resumed competence in desired roles, improvement in affected upper extremity function, and notable neuroplastic change. The final study investigated how the rehabilitation environment influenced the interventions used by the occupational therapists. The findings supported the relationship between the therapy environment and a specific intervention; working in the therapy gym with preparatory methods and being in a home-like space using occupation-based interventions. The environment influenced occupational therapy interventions and it is recommended that the occupational therapist match the client’s goals to the ideal environment for optimal intervention

DEVELOPMENT OF AN OPTIMAL PATIENT TRANSFER TASK SET AND SIMULATION-BASED INTERVENTION TO REDUCE MUSCULOSKELETAL INJURY IN HEALTHCARE WORKERS

Introduction: Occupational injury is recognized as a key attrition factor in nursing with musculoskeletal injury the most common cause. Nurses, nurse aides and orderly injury rates are consistently listed in the top ten US occupations in terms of total numbers of injuries with patient transfer a primary etiologic factor. Patient transfer education for trainees as well as employees remains inconsistent and non-standardized. Legislative and policy efforts have not been effective.Methods: Two methods are combined in this paper to approach the problem: hierarchical task analysis and a simulation educational intervention. Hierarchical task analysis has been used to solve industrial process problems for more than three decades and simulation education methods have been used in aviation since the 1920's. The hierarchical task analysis process is used to develop an optimal task set which was used to frame and implement a healthcare simulationtraining intervention.Results: Performance evaluation tools for patient transfer were developed based on the optimum task set. Transfer of simulation training outcomes to the clinical setting was demonstrated on pilot study intervention and control units. The program was implemented in a community hospital with sustained improvement in transfer skill and reduction of injury rates and lost work days.Conclusion: Because patient safety and improved outcomes are linked to adequate levels of nurse staffing, the public health implications of this project are significant. If nursing injury can be avoided using these methods then true progress can be made in arresting the injury epidemic with resultant reduction of nursing workforce losses with consequent healthcare system benefits