Improving Collaboration among Social Work and Nursing Students through Interprofessional Simulation

Background

Nursing faculty have led simulation with nursing students for more than 10 years, most recently implementing interprofessional simulation at a small liberal arts college in the Midwestern United States. Objectives for this interprofessional simulation were based on the IPEC (2011) panel's Core Competencies for Interprofessional Collaborative Practice, specifically Domain 2 (roles/responsibilities), and Domain 3 (interprofessional communication). After contacting social work faculty to determine interest, planning occurred to facilitate this learning experience, determining the steps needed to create a simulation with nursing and social work students collaborating as a team. A team of nursing and social work faculty worked cooperatively to adapt an Advancing Care Excellence for Seniors National League for Nursing scenario to simulate collaboration and communication among these two professions.

This simulation was a required course activity for senior nursing and social work students. Institutional review board approval was received to collect and use student reflections about the interprofessional simulation. This interactive experience was the first opportunity for students from these two professions to work collaboratively. To ease possible anxiety related to the simulation, students were given the following resources prior to the event:

Method

On the day of the simulation, students were oriented to the simulation environment (social work students were new to simulation), introduced to the role players (a nursing alumna and a retired nursing faculty member), shown a short video to learn about the patient, and given their roles. The scenario focused on a newly admitted 84-year-old woman with a urinary tract infection, dehydration, and confusion. The simulation unfolds over three scenarios emphasizing assessment, conflict between the patient and her daughter about living arrangements, discharge teaching, and initiating appropriate referrals. The experience was adapted so that nursing and social work students would need to collaborate and communicate with each other as well as with the patient and her daughter.

The pilot project included 26 students (16 nursing and 10 social work). Three 20-minute scenarios focused on the following:

Throughout the simulation, conflict between family members forced students to demonstrate an understanding of effective communication skills with difficult family dynamics.

Eight nursing students and five social work students participated in each of three 1-hour simulations. Six nursing students were the primary or secondary nurse in one of the three scenarios; the last two nursing students were observers, recorders, or safety sentinels. The scenario was adapted to allow the social work students to observe the first scenario (new to simulation) and participate in the second and third scenarios. Nursing students were encouraged to consult with the social work students in the care of this patient and family to achieve the outcome of discharge to the most suitable living arrangement with the necessary resources.

A 30- to 40-minute debriefing occurred after each scenario. Student reflections indicated that debriefing sessions after each scenario facilitated learning.

Following the simulation, nursing and social work students ‘perceptions of the interprofessional simulation were captured through three open-ended questions:

The purpose of this descriptive study was to begin to understand the experience and impact of interprofessional simulation with nursing and social work students.

Results

Researchers coded the open response comments from the nursing students to identify emerging themes. See themes from nursing student reflections in Table 1.

OPEN IN VIEWER

Table 1

Sample Reflection Responses From Nursing Students

Theme	Student Responses
Collaboration	The combined knowledge of the nurse and the social worker provide for the best patient outcomes.
	I think a lot can be learned from this collaboration.
	This simulation really helped to drive home the necessity of teamwork among all members of the health care team.
	More confident interacting with other disciplines.
	We pulled together and got the job done to care for the patient.
	Nurses need social workers on their teams!
	They were able to answer questions that I was not able to answer.
	I learned how important communication is between the nurse and social worker.
	The communication between social workers and nurses is very important.
Understanding roles	I am still wondering about how extensive the services are that social workers have.
	I wonder what the various roles of a social worker are.
	I am curious as to where else social workers provide their expertise.
	I wish I had a little more information about what the exact role of social workers was before the simulation.
	I was wondering how patients would find out about these resources (social work).
	I am curious what processes the social worker is involved in.
	I would have liked to know more of what the social workers actually do.
	To improve it (simulation), the instructor can give more background information about each profession.
	I had a limited idea of how to use a social worker until this scenario.
More opportunity	I would like more opportunities … to practice communicating with social workers.
	It was great having another part of the health care team there, but each session felt too short.
	It would be a great opportunity to involve even more students with other hospital potential jobs.
	I think this simulation was very helpful. To make it better, I think there should be more time.
	I hope that we can have this kind of simulation more in the future, because I can see it is really helpful.

Data analysis revealed learner value for the interprofessional simulation. Both nursing and social work students reported gaining understanding of the need to collaborate with other health care team members. Students suggested including preparation prior to the simulation to enhance understanding of the scope of practice of nurses and social workers, which would increase the value of this learning experience and enhance collaboration. The study participants also expressed desire for an increase in collaborative learning experiences.

Social Work Reflection

Social work students were asked to provide general reflections about their experience with the simulated learning activity. They reported multiple positive outcomes from the simulation experience. They reported a lack of understanding of the role of professional nurses and that having a better understanding of nurses ‘scope of practice would facilitate increased collaboration. Social work students also expressed some surprise at the nurses ‘ability to address patients ‘holistic needs while providing immediate physical care, and reported seeing an overlap between themselves and the nurses in some of the engagement skills used with patients and their families.

Students also reported ways that simulation built on their developing social work skills. Several mentioned learning to adapt patient needs (e.g., a patient- or nurse-reported concern or a family conflict) rather than rigidly sticking to their own agendas for the simulation. For example, students saw conflict issues requiring immediate mediation arising between the mother and daughter in the simulation and reported setting aside their assessment questions to mediate the conflict. Social work students also reported enjoying the opportunity to practice their general social work skills such as engagement, empathic responding, and assessment. They valued the opportunity to receive immediate feedback and to apply those skills for holistic care in acute care. The social work students found the dual nature of the feedback (assessment of both the skills used and how their work fed into the interprofessional work) helpful.

Discussion

The identified need for IPE, with a focus on teamwork, was a precursor to this experience. Faculty from two disciplines came together to prompt collaboration between students of the two professions in the care of an 84-year-old woman.

Reflections were gathered from both nursing and social work students to understand the experience of simulation-enhanced IPE. Students identified the opportunity to collaborate between professions as instructive learning, which facilitated collaboration among interprofessional team members. To facilitate increased collaboration of the interprofessional team, both social work and nursing students identified the need for increased understanding and information about the role and scope of practice of other health care professionals.

In summary, simulation-enhanced IPE may be a promising addition for health care educators. Improvement in attitudes related to collaboration as members of an interprofessional team were reported in the reflections after this simulated exercise. Additional education prior to the simulated exercise on the scope of practice of other health care professionals would be even more beneficial.