PG61 Breaking bad news, use of actors, immersion suite and ‘in character’ debrief to develop Emergency Nurses

Abstract

Communicating in the Emergency department is challenging, as this is the only part of a hospital that is ‘unbounded’ with a potential unlimited number of presentations. Staff deal with up to 42 communication events per hour, with this time pressure impacting on the effectiveness of communicating with patients, families and colleagues.1 Nurses are frequently in a position to deliver ‘bad news’.2 This is never as common an occurrence as in the domain of Emergency Care. There are many reasons this interaction needs to be done well,3 consensus appears to cite Nurses as lacking confidence in performing this role.4 As part of an innovative Emergency Care module, an educational intervention was designed as follows; a cohort of 30 emergency care staff where taught by an experienced palliative care education lead in a theoretical classroom session on communication theory, with particular focus on the SPIKES model.5 Simulated scenarios then took place in an immersion suite, streamed back into the classroom. Two briefed and experienced simulated patients were used. The candidates from the group were given a ‘handover’ prior to entering the simulation setting. A facilitator was in the classroom keeping focus on observation and note taking. A second facilitator was in the immersion suite (off camera) to ensure technical/pastoral support and time keeping. Upon completion of scenarios, the candidates and actors returned to debrief the scenario with vicarious learning from the ‘audience’. The simulated patients remained in character to provide valuable ‘in role’ feedback. Before subsequently taking part in a broader debrief with the group. Candidate feedback; ‘Gained knowledge of importance of body language and now feel more comfortable handling breaking bad news/difficult conversations’. ‘Knowing models like SPIKE etc will help me structure conversations with patients more effectively and also enable constructive reflection.’ ‘It was excellent - thank you!’ Simulated patient feedback; ‘Everyone seemed invested and it felt really useful to be able to discuss ‘in role’, I felt that there was a lot of positivity. The immersion suite was a really interesting way of facilitating scenarios as it added to the reality and atmosphere for the participant, and preserved the intimacy of the interaction.’ Reference Malone M & Biese K. ( 2018) Care for the older adult in the emergency department, an issue of clinics in geriatric medicine. Elsevier. U.S.A Grudzen C, Richardson L, Johnson P, Hu M, Wang B, Ortiz J, Kistler E, Chen A and Morrison R. Emergency Department-initiated palliative care in advanced cancer: A randomised clinical trial. JAMA Oncology 2016;Vol 1;2 (5):p591598. JAMA Network.