Interprofessional approach in SOM, SON lays groundwork for effective communication
By Matt Westerfield
It begins with a phone call. A nursing student sees a patient with a violent cough, and she delivers her assessment to a second-year medical student over the phone, weighing different treatment options.
After that, the M2 and the nursing student visit the bedside together, and the patient witnesses an accurate, efficient exchange of information and a teamwork approach to treating his illness.
At least, that's the idea. But on this day, the patient is a simulation manikin, and it's the first time the nursing and medical students have come into contact with each other in a clinical situation.
This month marked the launch of interprofessional education sessions between the Schools of Medicine and Nursing, the result of a concerted effort between Dr. Jimmy Stewart, associate professor of medicine and pediatrics, and Dr. Jan Cooper, associate professor of nursing and director of the Clinical Simulation Center.
"Dr. Stewart and I believed this would be an educational opportunity that would benefit not only our students but have a positive impact on patient care and patient-care outcomes," Cooper said.
"Professional communication and effective teamwork skills require opportunities to practice and develop. We shouldn't expect professions to automatically be able to work together when they've been trained and educated as individual practitioners rather than members of interprofessional teams."
In a series that will continue throughout the semester, senior nursing students and second-year medical students will meet in a variety of simulation scenarios using the SBAR format - situation, background, assessment and recommendation. The goal is to begin building a foundation now for more productive relationships once the two groups of health-care providers are in the workforce.
"This is an opportunity in a low-stress setting for medical students and nursing students to learn to communicate and work together," said Dr. Helen Turner, associate vice chancellor for academic affairs, who participated in the recent sessions. "And the ultimate beneficiary of this will be the patients."
In a Sept. 13 session in the School of Nursing's simulation lab, nursing students practiced interacting with medical students about patient symptoms over the phone and then in person at the manikin's bedside. For the M2s, who have not yet had patient experiences, it amounts to being thrown into the deep end and having to practice face-to-face questioning and on-the-spot treatment planning.
"We want them to be able to communicate efficiently and effectively," Stewart said. "A lot of people assume because you can correctly diagnose a patient that you can effectively communicate that diagnosis to the patient or nurse. So we are emphasizing communication with nurses and patients and trying to find a way to standardize that."
Stewart said he first began thinking about the need to systemize this type of information exchange after following the news coverage of the U.S. Airways jet that crash-landed Jan. 9, 2009, into the Hudson River in New York. All 155 passengers and crewmembers survived the landing, and Stewart attributes that to the jet's pilots using a clear, formalized checklist to communicate with air traffic controllers and emergency responders.
"They were able to communicate effectively in a standardized way to minimize mistakes," he said. "Before this, the first formal interaction (medical students) would have with nurses is when they're an intern. But patient care is a united process, and we're trying to recreate that process with our students."
Effective physician-nurse communication is paramount in the Stewart household: his wife, Mary Ellen, is a registered nurse and nurse educator in the School of Nursing's simulation lab.
"We've been attempting to do this for two or three years, but this school year is the first to actually implement it," said Mary Ellen. "Often, they've never spoken with a physician over the phone because during their clinical training, nurse preceptors have to place those calls. This allows them to get that initial intimidation out of the way before they graduate."
On the other hand, she said, the nursing students might seem to have an advantage because they have worked with real patients by this point.
"But they're both on level ground when it comes to communicating with each other. This is something that can be a tremendous help for them in the clinical setting," she said.
So far, students in both disciplines seem to be enjoying the face time with each other.
"It's very important because we're going to be working with these nursing students when we graduate," said Colette Jackson, M2, whose mother is a nurse. "They're our biggest allies when we get into the clinical setting." Laurie Defoe agreed.
"We need to be working together. It's a good experience," said the senior nursing student. "The more practice you get, the better the nurse you're going to be, so it does help."