Development, implementation, and evaluation of a trauma-informed simulation-based training program for graduate nurses: A single arm feasibility and pilot study.

BACKGROUND: The chance of hospital staff encountering a patient with a trauma history is high. The way health services are offered and carried out are important when engaging with people who have experienced trauma. Implementing training in trauma-informed care (TIC) is part of a cultural change of benefit to both patients and staff. Simulation-based training is a well-accepted method to reduce staff fear and anxiety when working with individuals in distress and to address issues relating to bias and stigma. OBJECTIVES: To provide simulation-based TIC training to graduate nurses. DESIGN: A three-phase process was undertaken to i) create the intervention, ii) determine feasibility, and iii) evaluate the developed training. SETTING: A 600-bed inner-city tertiary hospital in Melbourne, Victoria. PARTICIPANTS: Graduate nurses undertaking their first year of employment (n = 23). METHODS: The content of the training was created using evidence derived from a literature review, a scoping study of available resources, and expert consensus. A pre/post-test within-groups design to assess the safety, acceptability, and effectiveness of the training was undertaken. RESULTS: The Trauma Informed-Simulation Based Training (TI-SBT) aims to increase TIC knowledge and promote TIC behaviours. It is delivered face-to-face over one day and encompasses an education component followed by three immersive patient simulations using professional actors. Analysis found significant improvement in TIC knowledge (p ≤ 0.001, 95% CI = -3.53, -0.47) and behaviours (p = 0.013, 95% CI = -8.88, -5.03). No significant differences were found in measures of anxiety and confidence. Satisfaction with all aspects of the training was high. Qualitatively, participants provided concrete examples of changes to their practice to facilitate TIC. CONCLUSIONS: The developed and novel TI-SBT is a feasible (safe, acceptable, and effective) way of introducing TIC to graduate nurses. These findings provide strong evidence to support a more rigorous evaluation of the training by randomised controlled trial. The TI-SBT has the capacity to not only improve patient care but the experience of hospital staff.

"Unexpected and Distressing": Understanding and Improving the Experience of Transferring Palliative Care Inpatients to Residential Care.

The survival of patients with advanced cancer, coupled with the increased presence of end-stage chronic illnesses in an aging population, is leading to a demand in palliative care. Due to the ongoing need for acute-pain and symptom control in hospice/palliative care units, few are able to offer long-stay admission for those whose symptoms have stabilized. When a patient no longer requires specialist palliative care services, transfer from an inpatient palliative care facility may then be necessary. A core component of the role of palliative-care social workers involves working with patients and their families/carers when the care pathway shifts and the option of residential aged care facility (RACF) needs to be considered. This research explored several issues, including the impact of this transition on the patient and their families and on the interdisciplinary health care team treating the patient. An investigation was undertaken to identify concerns and barriers regarding the transition from hospice care to RACF and opportunities were highlighted to improve clinical practice in this area. A tripartite approach was adopted conducting face-to-face interviews with patients, their families/carers, and health care professionals. Members of the interdisciplinary team were interviewed and social workers working in similar inpatient palliative-care facilities undertook telephone interviews to gauge their experiences. A thematic analysis discerned a number of themes highlighting the impact of this transition on key stakeholders and incorporated recommendations to improve or best manage this process. The research has highlighted the difficulties that patients/families encounter in this transition, as well as the emphases of protecting the integrity of the patient and family. This is achieved by holding open and ongoing dialogue, particularly through family meetings and working in collaboration with the patient, the family, and the team. Understanding the experience and impact of this transition on key stakeholders is helpful in building up a knowledge base and to ensure a more effective relationship occurs. This research incorporated the voices of terminally ill patients, families, and members of the health care team in order to understand their views and recommendations for best managing the transition from a hospice/inpatient palliative-care facility to a RACF. This enables their input to have some real impetus in clinical practice and service delivery.