PACU Nurse Simulation

Introduction

Simulation session was shown to have better prepared the nursing students in developing communication skills and providing safe care for deteriorating patients (Liaw, Zhou, Lau, Siau, & Chan, 2014). The aim of this paper is to explore areas that will influence nurses’ clinical practice based on reflection of the simulation session. The topic of the simulation session is multidisciplinary teams and the deteriorating patient. The session includes four activities: poison grids game, Lego recreation, ball games, and two clinical case scenarios. Based on reflection of the games, communication is identified as the core factor which affects the achievement of the group activities. Furthermore, facilitation of effective communication

within the team during crisis situations illustrated that timely and appropriate information is critical to patient safety (Blegen, Sehgal, Alldredge, Gearhart, & Wachter, 2009).
This paper will firstly discuss the therapeutic communication, handover communication, and family centred communication based on the reflection, further, the paper will demonstrate the better approach which will be apply into future practice to improve patient’s outcomes.

Simulation session reflection
Therapeutic communication
Closed loop communication is one of the effective therapeutic communication strategies in crisis situations (Jacobsson, Hargestam, Hultin, & Brulin, 2012). During the second half of the ball game, two people were holding balls in their hands, facing against each other and remaining a distance between them, a ball was required to be passed from one person to the other without looking back. Then one of the participant came up with a plan by counting of 3 and threw the ball up highly, finally, the other person caught the ball. This game illustrated that closed loop communication ensures the team members working timely and effectively.
In clinical practice, closed loop communication is also applied to log-rolling the patients. This technique is to ensure all the staff members are on the same page when rolling the patient from one side to the other side (Kolbe & Grande, 2013). A study conducted by Carne, Kennedy, and Gray (2012) also proved that it is an effective tool to ensure the safety of verbal drug administration during resuscitation, as it involves verbal restating of the drug orders to ensure the correct dose and route of administration. Close loop communication ensures that everybody knows what is going on, what needs to be done and what is already done. It reduces the possible errors during medication administration during crisis situation, hence to ensure patient’s safety(Kolbe & Grande, 2013).

Handover
Inadequate handover has been shown to be a common factor of underlying adverse events and causes, with communication failures identified as the root cause in over 70% of adverse hospital events (Liaw et al., 2014; Thompson et al., 2011).

In the case scenario 1, the nurse from post-anesthesia care unit (PACU) transferred a patient who undergone post-operative hip replacement. The PACU nurse didn’t give a proper handover to the ward nurse, as she only did a quick introduction about the patient without checking the orders and charts with ward nurse at patient’s bedside, she then rushed back. Later on, the patient was deteriorating with declined level of consciousness, dropped oxygen saturation. After the primary and head to toe assessment, the nurses identified that patient experienced Morphine overdose, as the order in the medication chart was different compared to the actual rate showed on the patient-controlled analgesia machine. The patient’s deterioration could have been avoided if the PACU nurse could give a structured and detailed handover to the ward nurse at the bedside. The ward nurse could also hold back the PACU nurse and require to check the orders and drug charts at patient’s beside with

her.
In the future practice, a structured handover should be utilised by health care professionals. “ISBAR” framework is the acronym for Identify, Situation, Background, Assessment, and Recommendation (Thompson et al., 2011). It is identified as a systematic, well structured approach to standardized the way of communication within multidisciplinary teams to provide important briefings with less omission of information occurring, and has been shown to reduce rates of adverse events, to ensure patient safety (Nadzam, 2009; Thompson et al., 2011). It is also suggested that a proper handover should be well structured, containing the key elements, and should be conducted at beside (Klim, Kelly, Kerr, Wood, & McCann, 2013).

Family-centred communication
Facilitation of family-centred communication contributes to building successful relationship between the family members and health care professionals.(Thistle & McNaughton, 2015).

In the case scenario 2, the patient’s oxygen saturation dropped to 88% on room air, respiratory rate increased to 30 per minute. The nurse then tried to apply the oxygen mask to the patient. The patient’s daughter was worried about the patient, and kept asking the nurse about the rationale for each intervention. Reflect on the scenario, the nurse did not acknowledge patient’s daughter’s distress, did not provide clear explanations and reassurance to her. This is the reason why the daughter seemed to be anxious and kept asking questions. The nurse should initiate communication with both the patient and her daughter from the beginning, inform the daughter about patient’s condition timely, and articulate rationale for each intervention. Study conducted byMitchell and Chaboyer (2010) highlighted that the challenges issues for nurses during crisis time not only include the multifaceted patient care issue but also the complexity that the patient’s family can add to the

situation.
In the future interaction with families, it is crucial for nurses to acknowledge that rather than having patient as the sole focus of the care, while family members’ needs are also important aspects of the care they deliver, therefore nurses should facilitate family centred communication when delivering the care. Strategies to enhance effective communication with family are concluded as: active listening skills, allowing family to voice concerns, giving timely and clear explanations of treatments and providing reassurance(Westbrook, Grant, Rafalski, & Babakus, 2015). Mitchell and Chaboyer (2010) again supported that effective family centred communication improves patient outcomes.

Conclusion
This paper identified communication as the main aspect through the reflection of simulation activities. Closed loop therapeutic communication, structured “ISBAR” handover communication and family centred communication are demonstrated as the effective communication strategies. Adopting those communication strategies in the future practice could ensure nurses delivering timely, effective and safe care to the patients, hence to improve patients’ outcomes. The building of trust-in therapeutic relationship between family and health care professionals will also promote the cooperation in the future care plan.