Use of High-Fidelity Interprofessional Simulation in Preparing New Graduates for Pediatric End of Life Care

Background: Parents of children who are approaching end of life (EOL) state that interactions with health care providers are the most important factor in their overall appraisal of the child's health care experience. Interprofessional simulation experiences (Sim-IPE) have been shown to enhance health care professionals' knowledge, confidence, and communication during critical scenarios such as the death of a pediatric patient. The use of simulation in new graduate nursing residency programs has been shown to be an effective means for preparing new graduates to handle new and emergent clinical situations. Simulated clinical experiences take place in a safe environment without fear of harming the patient and allow participants to receive feedback in a timely manner. Problem: Despite having some level of formal training or education at the pre-licensure level, new graduate nurses (NGNs) are not receiving suitable training on the care of dying patients as evidenced by a lack of knowledge, skill, and self-confidence to care for pediatric patients at EOL. Methods: Using a descriptive, posttest-only mixed-methods design, NGNs at Rady Children's Hospital in San Diego completed an unfolding high-fidelity Sim-IPE concerning the provision of care for a pediatric patient at EOL alongside a hospital chaplain. Prebriefing and debriefing activities occurred before and after each phase of the simulation. Debriefing was completed using Rudolph's Debriefing with Good Judgment Model. The Simulation Effectiveness Tool -- Modified (SET-M) was used to quantitatively and qualitatively evaluate the participants' perceptions of the outcomes that resulted from the interprofessional simulation. Results: All participants (n = 17) strongly agreed that debriefing was the most effective component of the simulation in terms of learning, clinical judgment, and personal reflection. Prebriefing was the second-most effective component, followed by the confidence and learning that were gained from engaging in the unfolding simulation scenario itself. Qualitative statements supported the results of the quantitative analysis. Conclusions/Implications: This quality improvement project utilized current evidence on the use of interprofessional simulation as an effective experiential learning modality to provide pediatric EOL care training for new graduates. Additionally, the results support the use of Sim-IPE to achieve quality person- and family-centered care during critical clinical situations. [The dissertation citations contained here are published with the permission of ProQuest LLC. Further reproduction is prohibited without permission. Copies of dissertations may be obtained by Telephone (800) 1-800-521-0600. Web page: http://www.proquest.com/en-US/products/dissertations/individuals.shtml.]