Mental Health simulation scenario at

South West Healthcare, Warrnambool.

Progress against planned activities for the period 1 January – 30 June 2014

(as recorded in Progress Report 1 July - 31 December 2013)

Mental Health Simulation

Medical

In the first six months of 2014, ten 3rd year medical students have participated in a

mental health simulation program developed in conjunction with the mental health

service at South West Healthcare (SWHC), Warrnambool. During their seven week

rotation in mental health, the medical students participated in seven ‘two and a half

hour’ sessions focusing on the following topics:

1. History taking for depressive episode

post-overdose.

2. History taking for an anxiety

presentation and management of a

panic attack.

3. Discuss diagnosis of schizophrenia with

a family member.

4. Mental health review of a patient with

schizophrenia that exhibits early

warning signs indicating ‘thought

broadcasting’; assessment via video conference.

5. Assessing and informing a SP presenting in a manic state that they are to be

admitted to hospital as an involuntary patient.

6. Assessment of a prodromal psychosis with substance abuse.

7. Dealing with a borderline personality disorder that is drug seeking and

becomes confrontational.

Each session focuses on a mental state examination, risk assessment and

management, and the treatment options for each disorder. This has been very well

received and as a result of the medical students promoting the simulation activities

to their fellow students in the IMMERSe program, a full day of simulation training is

scheduled for the IMMERSe medical students in general practice in July.

Nursing

Eighteen nursing students from Australian Catholic University (ACU) Ballarat, Deakin

University in Geelong, and Victoria University have participated in eighteen hours of

simulation training and nine hours of education whilst on their mental health clinical

placement at SWHC.

Deakin University nursing students.

Deakin University, Warrnambool Campus

1st year Bachelor of Nursing students

Simulated Patients (SPs) were incorporated into simulation education sessions for

approximately eighty 1st Year nursing students at Deakin University for the topic

‘Principles of Nursing Care’.

Six local SPs were recruited and trained

in scenarios specifically designed to fit

in with curriculum requirements for the

topic. Sessions were delivered over a

two day period for a five week block

and covered skills such as – general

patient assessment, transfers and

manual handling, falls risk assessments,

hygiene care, mobility and pressure

injury assessment, and patient nutrition

and feeding.

The final week involved the students undertaking a simulated ward ‘shift’ in which

they had to put all the skills they had covered in the previous four weeks into

practice. The sessions were co-facilitated by a GGT HWA clinical educator who also

supported the SPs.

2nd year Bachelor of Nursing students

During this period, it was planned to incorporate simulated patients into the topic

‘Maternal and Child Health’ for 2nd year nursing students. Unfortunately this was not

able to go ahead due to the need for the Deakin University lecturer, who was most

familiar with assisting with recruiting and training SPs, taking unexpected leave, and

the unavailability of a substitute lecturer. There was also some difficulty with the

recruitment of age appropriate SPs.

UniSA, Mount Gambier

Use of Simulated Patients in Practice Based Laboratory sessions

At the UniSA Mount Gambier Campus, simulated patients (SPs) have been

incorporated into practice based laboratory (PBL) sessions in the Bachelor of

Nursing curriculum in conjunction with other modalities, such as role playing

exercises and manikin-based learning.

Two of five manikins were replaced with SPs over an eight week period in the PBL

sessions for ‘Health of Older Adults’. The SPs were trained in scenarios specifically

designed to meet the curriculum requirements with sessions co-facilitated by a GGT

UDRH clinical educator who also supported the SPs.

Throughout the eight weeks, the SPs would portray the same ‘patient’ with scenarios

guiding them through the progression of this patient’s condition. The simulated

patients were trained to present with particular symptoms, ask specific questions and

interact with students to engage them in their learning. Participating students would

rotate between the different ‘patients’ each week and a ‘team nursing approach’

ensured they all had exposure to the SPs.

During the eight weeks, students had to perform clinical skills whilst at the same time

communicate with the SPs. This gave the students experience in dealing with a

variety of different behaviours whilst at the same time practice fundamental skills.

This approach was used to help increase their confidence and better prepare them

for transition into the workforce.

Photo Left - UniSA nursing students PBL sessions with simulated patients.

Photo Right - Nursing students caring for a SP under the guidance of HWA Clinical educator.

Aircrash Disaster Exercise

The Mount Gambier Airport is required to run a training exercise every two years as

part of their accreditation requirements. This year it was led by SA Police and

involved the Civil Aviation Authority, Country Fire Services, Metropolitan Fire Services,

State Emergency Services, Mount Gambier Hospital, SA Ambulance, Flinders

University Rural Clinical School and the GGT UDRH.

GGT UDRH clinical educators recruited and trained simulated patients who would

play the part of victims on the day. The SPs were ‘moulaged’ to reflect injuries and

wounds sustained from the mock crash and then positioned at two plane wrecks at

the airport. Four SPs presented as being dead at the scene, with five critical and five

walking wounded.

The SPs were each trained in a particular scenario to enact out at the disaster site,

en route to hospital, and at the emergency department.

Scenarios used on the day were:

• Casualty with penetrating abdominal wound.

• Casualty with closed head injury.

• Victim with respiratory difficulties, pale and diaphoretic.

• Casualty with burns to torso, face and neck.

• Victim with closed left forearm/deformed right thigh.

• Pregnant female with blunt abdomen trauma.

• Casualty with motor and sensory loss of all limbs.

• Victim with laceration left upper arm, bruising left shoulder.

• Casualty with painful left wrist, grazes to left arm and left face.

• Distressed young female.

• Deceased male inside wreckage.

• Deceased female inside wreckage.

• Deceased female outside of wreckage.

• Deceased young male inside of wreckage.

The benefits for participants and observers were many including:

• the opportunity for hospital staff to practice their code Brown procedure;

• local paramedics and professional entry students could practice patient

extractions and triaging at the scene; and

• professional entry students and staff from nursing, medicine and para

medicine had the opportunity to work side by side under stressful conditions,

in a safe and controlled learning environment.

This is an excellent example of how collaborations with health services and with

community groups can expand learning opportunities for those in the rural

communities. Due to the success of this exercise, a similar training drill is planned for

Portland, Victoria in the second half of the year.

Aircraft Disaster Simulation Exercise March 2014 Mount Gambier

PRCC sessions

Regular simulation sessions were co-facilitated for Flinders University PRCC 3rd Year Medical

Students in Mount Gambier.

Topics covered included chest pain, paediatrics, hypoglycaemia, asthma, trauma, anaphylaxis,

breaking bad news, mental health management, diabetic keto acidosis and management of life

threatening cardiac arrhythmias. Sessions involved several different modalities of simulation -

manikin based (high and low fidelity), simulated patients and hybrid simulation - and consolidated

learnings from their tutorial sessions.

These sessions were developed with an interprofessional focus with participation from nursing and

paramedic undergraduate students on their rural clinical placement.

South Australia Road trip

In February, over an eight day period, the Project Manager and Simulation Coordinator visited

nineteen towns across regional South Australia promoting the GGT UDRH and the simulation

activities. An information flyer and Training Needs Analysis was distributed as well as contact

details of the clinical educator for their area.

Meetings were scheduled with Directors of Nursing, Practice Managers and key staff at district

hospitals, health services and general practice clinics at Mannum, Mount Barker, Gawler, Two

Wells, Balaklava, Clare, Crystal Brook, Port Pirie, Jamestown, Quorn, Port Augusta, Whyalla, Port

Lincoln, Tumby Bay, Cummins, Lock, Wudinna, Wallaroo and Berri.

During this time, introduction and orientation sessions were held with newly employed clinical

educators for Ceduna, Roxby Downs, Port Lincoln, Wallaroo and Berri. Meetings were also

scheduled with existing clinical educators at Gawler, Port Pirie, Port Augusta, and Whyalla. Where

possible, the clinical educators provided a tour of their local hospital and facilities, and went

along to the information sessions.

Photo Left - PRCC 3rd

year medical students with paramedic students performing a log roll on a MVA trauma

simulated patient.

Photo Right - PRCC 3rd

year medical students in a sports related chest trauma scenario.

Additional Simulation Training

AOGP involvement

Late in December 2013, the GGT HWA Project Manager was approached by Dr Tim Kelly (CEO

AOGP) about expanding the simulation activities to include medical and nursing staff and

students of rural general practices.

Additional funding from AOGP has enabled four clinical educators to increase their FTE to provide

simulation training to general practice clinics within their area. This has encouraged further

collaborations between local hospitals and rural general practices and is helping promote the use

of simulation within the rural GP community as an additional and effective modality of training

that can be provided ‘in house’.

Mental Health

Pharmacy

Eleven pharmacy students participated in a simulation training day focused on communication

strategies and the management of mental health patients in the pharmacy setting. This proved

very successful and a second day is being planned with nineteen pharmacy students later in the

year.

South West Tafe students

The project Simulation Educator based in Hamilton has been facilitating additional simulation

education to 1st and 2nd year enrolled nursing students at South West TAFE campuses in Hamilton

and Warrnambool. These sessions are primarily delivered prior to the students undertaking their

clinical placements. These sessions involve delivery of scenarios that have been tailored to

consolidate skills which were covered during their tutorials and practice based laboratory sessions.

This gave students the opportunity to practice skills such as ISBAR handover, medication

management, bed making, transferring patients, falls management, identifying the deteriorating

patient, basic life support, obtaining a blood glucose reading, hypoglycaemia management, pre-

operative care and undertaking a full admission assessment. These scenario based sessions used

modalities such as simulated patients, role play, manikins and part task trainers to assist with a

smooth introduction to the clinical environment.

Dan Tehan, Federal Member for Wannon

During a visit to GGT UDRH Hamilton offices, Mr Dan Tehan MP was able to watch clinical

educators deliver a simulation workshop that involved students from various health disciplines in

an inter professional scenario with a SP.

The session was held at the Hamilton Base Hospital, Western District Health Services who are a

supportive partner of the project.

Left to Right - 3rd

yr Monash University pharmacy student, nursing student

from Careers Australia, nursing student from SW Tafe, Simulated Patient, Mr

Dan Tehan MP, 3rd

yr Flinders University PRCC medical student.

Simulation Workshops and Activities

Distribution

Between January to June 2014, 268 workshops were held in 32 towns across regional South

Australia and south west Victoria (refer map below).

2,003 professional entry students and other training recipients from 16 educational bodies and 50

public and private health services, including Aboriginal Cooperatives, received a total of 4,385

training hours.

Educational Bodies represented at workshops

• Adelaide University

• Australian Catholic University

• Careers Australia

• Charles Darwin University

• Charles Sturt University

• Deakin University

• Equals International

• Flinders University Harvard University

• Holmesglen Moorabin

• Latrobe University

• Monash University

• SW Tafe

• TafeSA

• UniSA

• Victoria University

Public and Private Health Services represented at workshops

• Barmera Health Services (1)

• BHP Billiton (2)

• Boandik Lodge, Mount Gambier (5)

• Boneham Cottages, Millicent (5)

• Booleroo Centre District Hospital (8)

• Bordertown Memorial Hospital (5)

• Casterton Hospital (1)

• Ceduna District Health Service (35)

• Cleve Hospital (3)

• Community Health, Naracoorte (11)

• Cowell Hospital (9)

• Cowell SA Ambulance Service (2)

• Gawler Health Service (15)

• Hawkins Medical Clinic (1)

• Heywood Hospital (4)

• Jamestown Health Service (3)

• Kimba Hospital (9)

• Kingston Memorial Hospital (5)

• Longridge Aged Care (9)

• Loxton Hospital (10)

• Mount Gambier District Health Service

(98)

• Moyne Health Services (2)

• Mt Barker Hospital (5)

• Mt Pleasant Hospital (1)

• Murray Bridge Soldiers Memorial

Hospital (25)

• Naracoorte Health Service (18)

• Nerrilda Nursing Home, Port Augusta

(3)

• Orroroo Health Service (12)

• Pika Wiya Health Service, Port Augusta

(3)

• Pinaroo Soldiers Memorial Hospital (1)

• Port Augusta Hospital (7)

• Port Broughton District Hospital (2)

• Port Pirie Regional Health Service (63)

• Portland District Health (76)

• Renmark Paringa District Hospital (1)

• Riverland General Hospital, Berri (4)

• Roxby Downs Health Service (12)

• SA Ambulance (14)

• Snowtown Hospital (10)

• Southern Flinders Health, Laura (6)

• Strathalbyn District Health Service (8)

• Tailem Bend Hospital (2)

• Terang Hospital (2)

• The Oaks, Mount Gambier (6)

• Tumby Bay Hospital (6)

• Waikerie Health Service (13)

• Western District Health Service,

Hamilton (13)

• Whyalla Hospital & Health Service

(108)

• Woomera Hospital (4)

• Wudinna Hospital (8)

Listing of simulation activities and training workshops that have been delivered

Mental Health

• Anxiety & Schizophrenia

• Bipolar recommendations

• Depression assessment

• Interprofessional communication skills

& managing aggressive behaviour

• Mental Health borderline personality

disorder

• Mental State examination, risk

assessment & management

• Morphine OD treatment

• Post-natal depression

• Psychological First Aid

• Psychosis

• Schizophrenia education

Paediatrics

• Aboriginal maternal & infant care

• CPR on a child

• Emergency presentation of paediatric meningococcal diseases

• Paediatric Basic Life Support

• Paediatric focus simulation session

• Sick baby

Surgical Management

• 12 lead ECG interpretation, blood

results

• Appendicitis education &

management

• Arterial lines & chest drains

• Aseptic technique and post-operative

wounds

• Blood transfusions

• Compression bandaging

• Drips & drains • Post-operative care

• Pre-operative assessment

• Prioritising workload

Aged Care Management

• Acute pain in the older adult

• ADL's/ Nutrition

• Consent in the elderly

• CVA and falls management

• Dysphagia screening

• Health of Older Adults - Palliative care

• Health of Older Adults (ECGs, Infusions)

• Health of Older Adults (IM Injections,

mini mentals, IVT assessments)

• Health of Older Adults (IV fluids, wound

cleaning & dressings, mobilising)

• Health of Older Adults (IVT therapy,

IDUC, documentation, listening to

chest sounds, airway suction, O2

admin, medication)

• Health of Older Adults (medication

admin, documentation & hygiene

• Health of Older Adults (PEG feeds,

BGL, IVT & S/C & IM injections)

• Health of Older Adults (PEG feeds,

BGL, IVT therapy, aseptic techniques)

• IV pumps, enteral feeding, syringe

drivers

• Medication administration, bed

making

• Neurological assessment

• Patient handover & transfer - falls risk

assessment

• Patient health assessment

• PEG feeding & care

• Physical assessments

• Pressure injury

• Swallow assessment

• Vital signs, communication and

urinalysis

Medical Management

• Aseptic technique & wound dressing

• Atrial fibrillation

• Bed bath

• Blood safety

• Clinical handover - ISBAR

• Detection & treatment of changes in

an asthmatic patient

• Documentation education

• Falls risk assessment

• Interpreting blood results

• Management of a diabetic patient

• Manual handling

• Preparing thickened fluids

• Rehabilitation admission

• Simple dressings & managing the

diabetic patient

• Simulated shift

• Slide sheet & nursing assessments

• Transition to professional practice

• Vital signs

• Vital signs & patient positioning

• Workplace health & wellness

• Wound management

Obstetrics

• Basic Life Support in pregnancy

• Breastfeeding

• Breech birth

• Emergency birth & neo-natal

resuscitation

• Mid for non-midwives

• Neo-natal simulation

• Newborn resuscitation

• Obstetric emergencies

• Post-natal block

• Post-partum haemorrhage

• Pre-eclampsia simulation • Shoulder dystocia

Clinical Skills

• Catheter management

• Chest drain management • Donning & doffing PPE

• Female catheterisation

• Intraosseous access

• IV cannulation

• Male catheterisation

• Preparation & administration of

medication with aseptic technique

• Simple ECG interpretation & rhythm

recognition - lead placement

• Urinary catheter care

• Vascular access & anaphylaxis

• Venepuncture

Emergency Management

• Advanced Life Support skills • Airway management

• ALS algorhythm

• Anaphylaxis management

• Basic Life Support

• Burns

• Cardiac arrest

• Cardiac pharmacology

• Chest pain

• Code Blue cardiac arrest

• CPR & Post-Op

• Deteriorating patient

• ECG – life threatening arrhythmias

• Emergency scenarios

• Emergency, trauma & midwifery

presentations

• Exercise Head On - Mock Aircraft

disaster

• External cardiac pacing

• Hypoglycaemia

• Management of chest pain scenario

• Managing the emergency trolley

• Oxylog portable ventilator

• Primary & Secondary survey

• The Unwell Patient - emergency

presentations

• Triage & airway assessment

Simulation Workshop Delivery

Workshops delivered have involved sessions in practice-based scenarios and clinical

skills that were targeted at health professional entry students on placement and on

campus, and for staff in the local workforce.

Workshops were tailored to suit the requirements of the health services and

educational institutions. In some cases, the sessions in hospitals were kept

reasonably short. This was to ensure students did not lose valuable clinical

placement time, and yet still had opportunities to practice important clinical skills.

Meanwhile, it allowed staff to access training without having extended times off the

ward. Other workshops were also held late in the afternoons, or on weekends, to

cater for those that have difficulty attending during normal working hours.

Workshops activities can be skills-

focused or scenario-based and

designed to support curriculum

requirements and meet competency

levels.

Workshops delivered to medical and

nursing students on campus have

had content designed to fit in with

curriculum requirements after

consultation with University

educators.

Workshop activities have been able

to meet curricula elements closely

aligned with clinical placement

objectives. They have covered

behavioural skills areas such as

communication and teamwork that

have been identified as components

that span all professions and are

written in the report “Use of Simulated

Learning Environments in Professional

Entry Level Curricula of Selected

Professions in Australia’.

Photo Above - Medical Interns in a simulated

scenario with a manikin.

Photo Above - Nursing students from Deakin

University and UniSA in a simulation workshop.

Workshop activities aimed at medical students have enabled further training in skills

to meet their competency level, as listed in the ‘Medical Graduate Competency

Framework report’ of 2012.

For nursing students, workshop activities

aim to cover all ten of the most

commonly identified skills which could

meet competency standards, as listed

in the Health Workforce Australia report

‘Use of Simulated Learning

Environments in Nursing Curricula’.

Simulation Equipment

Workshops delivered by clinical

educators are supported and

enhanced by the use of simulation

equipment listed on the asset register,

which was purchased specifically to

assist with meeting the training needs

and requirements of professional entry

students and staff. Clinical educators

regularly incorporate a wide variety of

simulation modalities into their sessions,

ranging from low, medium and high

tech simulation equipment to trained

simulated patients (SPs), or a

combination of both. Equipment is often shared amongst the educators to ensure a

wide variety of training options are available to participants.

Using trained SPs in scenario-based activities has given rural health students

opportunities to experience patient interaction and practice a variety of

communication techniques. This has been especially relevant in the area of mental

health where SPs have been incorporated in scenarios in workshops specifically

tailored for medical students on their mental health rotation. Students are able to

practice communication and consultation skills in a mistake-forgiving environment,

which in turn allows them to make, recognise, and correct errors in a supportive and

non-threatening environment.

The integration of SPs into Bachelor of Nursing sessions enabled nursing students to

critically analyse and reflect on their performance enabling them to adjust

behaviours and experiment with different techniques to ‘test’ their effectiveness.

Examples of the same procedure being

practiced using two different training

modalities.

UniSA nursing students with simulated

patients during their PBL sessions.

The opportunities associated with

undergraduates practicing techniques

such as information gathering,

appropriate questioning styles, eye

contact, body posture, active listening,

empathy and rapport building, will

hopefully assist with reducing anxieties

when providing care for real patients.

This training should also reduce the

occurrence of real patients from

encountering an inexperienced or

inadequate communicator and

practitioner.

Project Summary

Simulated Learning Environments funding from HWA has enabled the GGT UDRH to

effectively distribute simulation based education and training to rural and remote

health professionals and undergraduates throughout rural south west Victoria and

regional South Australia.

Workshop activities in clinical skills and ‘in situ’ scenarios relevant to the workplace or

study program are being provided to health professionals and students on clinical

placement, on rural campuses or in the workforce. This has resulted in a significant

increase in participation of simulation activities for those in country areas and is

encouraging a crossover between public and private services, between hospitals

and general practices, and between medical, nursing and allied health disciplines.

Networks and collaborations have been established with health care services,

universities and regional training providers to allow for the coordination and delivery

of regular simulation workshops. Project partnerships with CHSA LHN and AOGP has

significantly increased opportunities for those in rural areas to experience inter

professional, multidisciplinary and discipline specific activities.

Both photos show Flinders University medical students and UniSA nursing students working together

in inter professional scenarios with simulated patients.