Interprofessional education (IPE) is required in the advanced nursing practice curriculum to promote communication and collaboration between health care professionals. The American Association of Colleges of Nursing and the National Organization of Nurse Practitioner Faculties have established competencies related to interprofessional collaboration. Awareness of the roles of other health care disciplines facilitates effective communication and mutual respect and may lead to improved quality of care (Poore et al., 2019).
Geographical location often presents a barrier to integrating IPE in an academic setting (Poore et al., 2019) as other health care disciplines may not be located within the same school. Virtual simulation can be used to overcome this barrier. Simulation using telehealth, which increases access to care, may offer health care students opportunities to interact despite their being in different locations (Rutledge et al., 2021). Nurse practitioner students require exposure to telehealth experiences to gain competency in its utilization. However, despite competency recommendations and its increased use, there is limited training in telehealth for nurse practitioner students (Rutledge et al., 2021). As an opportunity to integrate IPE at our college of nursing, family nurse practitioner (FNP) students engaged with pharmacy students from a different university in an Objective Structured Clinical Examination (OSCE) telehealth simulation.
TELEHEALTH INTERPROFESSIONAL EXPERIENCE
Faculty from both universities met virtually to discuss the objectives and possible case scenarios to achieve mutual benefit for both FNP and pharmacy students. The simulation was a formative educational experience in which a participation grade was awarded for successful completion. The International Nursing Association for Clinical Simulation and Learning (INACSL) standards of best practice (INACSL Standards Committee, 2016), along with the Eppich and Cheng (2015) promoting excellence and reflective learning in simulation framework, were used to guide the development and implementation of the simulation.
The first step in developing the simulation was to determine the desired student learning objectives and performance measures. Next, the scenario was developed, requiring students to perform a follow-up evaluation on a patient who had previously been diagnosed and treated for depression at a different clinic. The scenario used guidelines from the Institute for Clinical Systems Improvement to support evidence-based practice in primary care (Trangle et al., 2016). A simulation objective map was completed outlining the course objectives, prebriefing requirements, learning assignments, performance measures, and points for debriefing. The simulation objective map helped ensure that faculty were familiar with the desired objectives and performance measures, which provided students with a consistent experience.
Two weeks prior to the scheduled event, faculty, staff, and standardized patients (SPs) took part in a trial run via the Zoom meeting platform to evaluate the simulation for quality. A nursing faculty member portrayed the FNP student, and a pharmacy faculty member portrayed the pharmacy student. Other faculty observed to identify problems with the scenario or gaps in learning. Staff from the College of Nursing Learning and Technology Resource Center (LTRC) developed a schedule for student participation; students were given the schedule and log-in instructions one week prior to the event, along with supplemental resources on conducting a telehealth visit, depression treatment guidelines, and information about IPE. A recorded prebriefing was provided via the learning management system (LMS); it provided details necessary for successful participation, including review of the Zoom breakout room format, learning objectives, and the availability of a pharmacist for assistance if needed. Students were told they could consult the pharmacy if needed by verbalizing the need to consult or call the pharmacy but suggestions regarding utilization of the pharmacist's expertise were not reviewed.
Five faculty members, five SPs, 70 FNP students, and six pharmacy students took part in the simulation. There were five breakout rooms, with a faculty member and an SP in each room. The faculty member was hidden from view until the debriefing, and pharmacy students waited for the FNP student to request a consultation. Students were scheduled in 20-minute time slots: a five-minute prebriefing in the waiting room, a 10-minute patient encounter, and a five-minute one-on-one debriefing. The debriefing discussion was available in the LMS at the end of the day to allow students to self-reflect on their learning experience.
As students logged into the video conference waiting room, they were greeted by an LTRC staff member who provided the prebriefing, which included event details related to the breakout room format and a "doorway sheet." This contained basic information including vital signs, chief complaint, pertinent history, and laboratory results. Pharmacy students were given a similar doorway sheet, with the patient's current medication, dosage, and prescription fill dates. The FNP student was then sent to a breakout room where the SP was waiting. According to the OSCE script, the SP did not remember the dosage of a previously prescribed medication, and the FNP student recognized the need for a pharmacy consult to verify the current medication and dosage. From the waiting room, an LTRC staff member served as Zoom facilitator; the faculty member in the breakout room notified the Zoom facilitator, who then sent the pharmacy student to join the breakout room. The FNP student had the opportunity to utilize the pharmacist's expertise regarding medication, dosing, and treatment options.
Students were provided with immediate individual feedback during debriefing. After all students participated in the simulation, faculty discussed common student errors and technology issues as well as thoughts for success and future improvements. The discussion points were communicated to the students via the LMS. The students were instructed to use self-reflection for further debriefing and reinforcement of learning objectives.
DISCUSSION
IPE experiences are important to encourage students to utilize the knowledge and skills of other health professionals and work together to improve patient outcomes. IPE has the potential to foster teamwork and positively impact clinical practice (Poore et al., 2019). This OSCE was innovative because faculty from different universities participated virtually, eliminating a common geographic barrier to IPE. Overall outcomes were positive. Student clinical performance was consistent with their level of education, OSCE performance measures, and the objectives of the course. Most students felt the OSCE provided a valuable opportunity for interprofessional collaboration.
All FNP students consulted the pharmacy concerning the patient's current medication and dosage. However, approximately 30 percent neglected to utilize the pharmacist to determine an appropriate treatment plan. Faculty observed this omission and addressed the qualifications and roles of a pharmacist during the debriefing. The debriefing discussion enabled faculty to emphasize the importance of utilizing the pharmacist's expertise and knowledge to formulate an optimal treatment plan. Students often commented that they were unaware they could ask a pharmacist about appropriate dosing or treatment recommendations. In the prebriefing, students were told they could consult a pharmacist if needed, but suggestions regarding potential utilization of the pharmacist's expertise were not reviewed.
It is important to not disclose too much information during the prebriefing to prevent alteration in student behavior. However, it is essential that students have sufficient information to participate effectively (INACSL Standards Committee, 2016). As broad objectives should be clear to promote an optimal learning experience, faculty felt that to enhance the IPE component in the future, prebriefing for the scenario would need to include more details about the pharmacist's role. A team-based approach to patient care is a critical aspect of any IPE, and the role of each health care member involved in the scenario should be explained during the prebriefing. Incorporating these changes in the future may help ensure that both disciplines gain valuable learning experiences.
CONCLUSION
Creating IPE opportunities for FNP students can seem like an arduous endeavor, especially when locations and the establishment of mutual goals are barriers to overcome. Virtual IPE simulations eliminate geographic barriers and offer increased accessibility. Utilizing virtual modalities such as videoconferencing, academic institutions may incorporate IPE experiences more consistently. A telehealth visit is an appropriate and feasible option to consider when programs are looking to incorporate IPE opportunities. Utilizing this approach addresses multiple competencies in one OSCE simulation experience. Academic institutions should prioritize collaborating on the development of virtual IPE simulation experiences to ensure clinical competency and foster teamwork among health care professionals.
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