Advertisement

Improving Interprofessional Approaches to Physical and Psychiatric Comorbidities Through Simulation

Published:February 22, 2017DOI:https://doi.org/10.1016/j.ecns.2016.12.004

      Highlights

      • Physical and mental comorbidities is a significant concern across health care settings.
      • An interprofessional simulation course was developed to address this area.
      • Knowledge, attitudes, and confidence in care for comorbidities improved significantly.
      • Benefits have been found to interprofessional collaboration, reflection, teamwork, and communication.
      • Simulation can improve professional development and may influence clinical care.

      Abstract

      Background

      Forty-six percent of individuals with mental health conditions have long-term physical illness, while 30% of individuals with long-term physical conditions have a mental illness. Physical and psychiatric comorbidities are of significant concern to medical, psychiatry, and primary care services, with policy, strategy, and literature highlighting the need to better address this interface. Simulation training has been proposed as a tool to improve clinicians' management of physical and psychiatric comorbidities. This study is the first to evaluate interprofessional simulation in improving management of such comorbidity.

      Method

      Participants (n = 63) were doctors and nurses from emergency, medical, psychiatric, and community services across primary and secondary care in South London. Quantitative and qualitative measures were completed before and after a one-day interprofessional simulation course addressing clinical care for physical and psychiatric comorbidities.

      Results

      Knowledge, confidence, and attitudes scores showed statistically significant improvements postcourse with large effect sizes. Thematic analyses highlighted the development of interprofessional working, clinical skills, reflective practice, leadership and teamwork, and communication skills.

      Conclusion

      Simulation training has the potential to improve professional development and clinical practice, with participants reporting increased abilities to provide better care to patients with physical and psychiatric comorbidities, exemplifying the case for increased simulation training in health care education.

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Clinical Simulation In Nursing
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Attoe C.
        • Kowalski C.
        • Fernando A.
        • Cross S.
        Integrating mental health simulation into routine health-care education.
        The Lancet Psychiatry. 2016; 3: 702-703
        • Baker C.
        • Pulling C.
        • McGraw R.
        • Dagnone J.D.
        • Hopkins-Rosseel D.
        • Medves J.
        Simulation in interprofessional education for patient-centred collaborative care.
        Journal of Advanced Nursing. 2008; 64: 372-379
        • Bennett A.J.
        • Arnold L.M.
        • Welge J.A.
        Use of standardized patients during a psychiatry clerkship.
        Academic Psychiatry. 2006; 30: 185-190
        • Birndorf C.A.
        • Kaye M.E.
        Teaching the mental status examination to medical students by using a standardized patient in a large group setting.
        Academic Psychiatry. 2002; 26: 180-183
        • British Medical Association, Science & Education Department and the Board of Science
        Recognising the importance of physical health in mental health and intellectual disability: Achieving parity of outcomes.
        Author, London2014
        • Brown S.A.
        Implementing a brief hallucination simulation as a mental illness stigma reduction strategy.
        Community Mental Health Journal. 2009; 46: 500-504
        • Centre for the Advancement of Interprofessional Education (CAIPE)
        Introducing interprofessional education.
        Author, Fareham2013
        • Cepoiu M.
        • McCusker J.
        • Cole M.G.
        • Sewitch M.
        • Belzile E.
        • Ciampi A.
        Recognition of depression by non-psychiatric physicians: A systematic literature review and meta-analysis.
        Journal of General Internal Medicine. 2008; 23: 25-36
        • Chang C.K.
        • Hayes R.D.
        • Perera G.
        • Broadbent M.T.
        • Fernandes A.C.
        • Lee W.E.
        • Stewart R.
        Life expectancy at birth for people with serious mental illness and other major disorders from a secondary mental health care case register in London.
        PLoS One. 2011; 6: e19590https://doi.org/10.1371/journal.pone.0019590
        • Cohen J.
        Statistical power analysis for the behavioral sciences.
        2nd ed. Lawrence Earlbaum Associates, Hillsdale1988
        • Doherty A.M.
        • Gaughran F.
        The interface of physical and mental health.
        Social Psychiatry and Psychiatric Epidemiology. 2014; 49: 673-682
        • Edward K.
        • Hercelinskyj J.
        • Warelow P.
        • Munro I.
        Simulation to practice: Developing nursing skills in mental health: An Australian perspective.
        International Electronic Journal of Health Education. 2007; 10: 60-64
        • Fichtner C.G.
        • Stout C.E.
        • Dove H.
        • Lardon C.S.
        Psychiatric leadership and the clinical team: Simulated in vivo treatment planning performance as teamwork proxy and learning laboratory.
        Administration and Policy in Mental Health and Mental Health Services Research. 2000; 27: 313-337
        • Frenk J.
        • Chen L.
        • Bhutta Z.A.
        • Cohen J.
        • Crisp N.
        • Evans T.
        • Zurayk H.
        Health professionals for a new century: Transforming education to strengthen health systems in an interdependent world.
        Lancet. 2010; 376: 1923-1958
        • Gough K.
        • Happell B.
        Undergraduate nursing students' attitude to mental health nursing: A cluster analysis approach.
        Journal of Clinical Nursing. 2009; 18: 3155-3164
        • Green J.
        • Thorogood N.
        Qualitative methods for health research.
        SAGE Publications, London2004
        • Groves R.M.
        • Fowler F.J.
        • Couper M.P.
        • Lepkowski J.M.
        • Singer E.
        • Tourangeau R.
        Survey methodology.
        2nd ed. John Wiley & Sons, New Jersey2009
        • Guise V.
        • Chambers M.
        • Valimaki M.
        What can virtual patient simulation offer mental health nursing education?.
        Journal of Psychiatric and Mental Health Nursing. 2012; 19: 410-418
        • Happell B.
        The importance of clinical experience for mental health nursing. Part 1: Undergraduate nursing students' attitudes, preparedness and satisfaction.
        International Journal of Mental Health Nursing. 2008; 17: 326-332
        • Hatcher S.
        • Arroll B.
        Assessment and management of medically unexplained symptoms.
        British Medical Journal. 2008; 336: 1124-1128
        • Jaye P.
        • Thomas L.
        • Reedy G.
        ‘The Diamond’: A structure for simulation debrief.
        Clinical Teacher. 2015; 12: 171-175
        • Katon W.J.
        • Von Korff M.
        • Lin E.H.
        • Simon G.
        • Ludman E.
        • Russo J.
        • Bush T.
        The pathways study: A randomized trial of collaborative care in patients with diabetes and depression.
        Archives of General Psychiatry. 2004; 61: 1042-1049
        • Kirmayer L.
        • Groleau D.
        • Looper K.J.
        • Dao M.D.
        Explaining medically unexplained symptoms.
        Canadian Journal of Psychiatry. 2004; 49: 663-672
        • Kowalski C.
        • Sathanandan S.
        The use of simulation to develop advanced communication skills relevant to psychiatry.
        British Medical Journal Simulation & Technology Enhanced Learning. 2015; 1: 29-32
        • Kulkarni M.
        • Huddlestone L.
        • Taylor A.
        • Sayal K.
        • Ratschen E.
        A cross-sectional survey of mental health clinicians' knowledge, attitudes, and practice relating to tobacco dependence among young people with mental disorders.
        BMC Health Services Research. 2014; 14: 618
        • Lehr S.T.
        • Kaplan B.
        A mental health simulation experience for baccalaureate student nurses.
        Clinical Simulation in Nursing. 2013; 9: 425-431
        • McNaughton N.
        • Ravitz P.
        • Wadell A.
        • Hodges B.D.
        Psychiatric education and simulation: A review of the literature.
        Canadian Journal of Psychiatry. 2008; 53: 85-93
        • Naylor C.
        • Parsonage M.
        • McDaid D.
        • Knapp M.
        • Fossey M.
        • Galea A.
        Long-term conditions and mental health: The cost of co-morbidities.
        The King's Fund, London2012
        • NHS England
        A call to action: Achieving parity of esteem; Transformative ideas for commissioners.
        2014 (Retrieved from)
        • Parsonage M.
        • Fossey M.
        Economic evaluation of a liaison psychiatry service.
        2011 (Retrieved from)
        • Parsonage M.
        • Fossey M.
        • Tutty C.
        Liaison psychiatry in the modern NHS.
        2012 (Retrieved from)
        • Prina A.M.
        • Cosco T.D.
        • Dening T.
        • Beekman A.
        • Brayne C.
        • Huisman M.
        The association between depressive symptoms in the community, non-psychiatric hospital admission and hospital outcomes: A systematic review.
        Journal of Psychosomatic Research. 2015; 78: 25-33
        • Rayner L.
        • Matcham F.
        • Hutton J.
        • Stringer C.
        • Dobson J.
        • Steer S.
        • Hotopf M.
        Embedding integrated mental health assessment and management in general hospital settings: Feasibility, acceptability and the prevalence of common mental disorder.
        General Hospital Psychiatry. 2014; 36: 318-324
        • Ross A.J.
        • Anderson J.E.
        • Kodate N.
        • Thomas L.
        • Thompson K.
        • Thomas B.
        • Jaye P.
        Simulation training for improving the quality of care for older people: An independent evaluation of an innovative programme for inter-professional education.
        British Medical Journal Quality & Safety. 2013; 22: 495-505
        • Rothenhausler H.B.
        Mental disorders in general hospital patients.
        Psychiatria Danubina. 2006; 18: 183-192
        • Salmon P.
        • Peters S.
        • Clifford R.
        • Iredale W.
        • Gask L.
        • Rogers A.
        • Morriss R.
        Why do general practitioners decline training to improve management of medically unexplained symptoms?.
        Journal of General Internal Medicine. 2007; 22: 565-571
        • Sleeper J.A.
        • Thompson C.
        The use of hi fidelity simulation to enhance nursing students' therapeutic communication skills.
        International Journal of Nursing Education Scholarship. 2008; 5: 1-12
        • Thomson A.B.
        • Cross S.
        • Key S.
        • Jaye P.
        • Iversen A.C.
        How we developed an emergency psychiatry training course for new residents using principles of high-fidelity simulation.
        Medical Teacher. 2013; 35: 797-800
        • Tiffen J.
        • Graf N.
        • Corbridge S.
        Effectiveness of a low-fidelity simulation experience in building confidence among advanced practice nursing graduate students.
        Clinical Simulation in Nursing. 2009; 5: 113-117
        • Tiihonen J.
        • Lonnqvist J.
        • Wahlbeck K.
        • Klaukka T.
        • Niskanen L.
        • Tanskanen A.
        • Haukka J.
        11-Year follow-up of mortality in patients with schizophrenia: A population-based cohort study (FIN11 study).
        Lancet. 2009; 374: 620-627
      1. UK Department of Health, No health without mental health: A cross-government mental health outcomes strategy for people of all ages, 2011, Author; London.

        • World Health Organisation
        Framework for action on interprofessional education and collaborative practice.
        Author, Geneva2010
        • Zigman D.
        • Young M.
        • Chalk C.
        Using simulation to train junior psychiatry residents to work with agitated patients: A pilot study.
        Academic Psychiatry. 2013; 37: 38-41