International Journal of Healthcare Simulation

Background:

Diagnostic radiography students find working with patients that have suffered trauma or are severely ill, particularly challenging [1]. There is potential for vicarious trauma and poor reactions or behaviours to have a lasting negative impact on the patient. The practice of emotional labour is used to display an organisationally acceptable demeanour; however, this is associated with burnout [2]. This research aimed to evaluate the use of a simulation using moulage in preparing students for these encounters in advance of clinical placement.

Methods:

This research used a longitudinal quasi-experimental design and mixed methods approach. Data collection involved two consecutive first-year cohorts starting in 2018 and 2019. Students (n=97) were randomised into a control and simulation group. The simulation group supported the imaging of a patient who had suffered an open fracture. Quantitative data was collected before and during placement using Visual Analogue Scales (VAS) to measure students’ feelings. Qualitative data was collected at two stages. Firstly, twenty-four small focus groups (n=5) were conducted at the debriefing stage of the simulation and were thematically analysed. Secondly, semi-structured interviews were conducted with students (n=7) following their experience of seeing an open wound in clinical practice. These were analysed using Interpretative Phenomenological Analysis (IPA). All three stems of data collection were triangulated to identify new meta-inferences.

Results:

Statistically significant changes were identified following the simulation, with improved emotional preparedness and a reduction in negatively valenced emotions. Six themes were identified following the simulation: emotion, realistic simulation, pain, difficulty communicating, developing teamwork and patient-centred care. Five superordinate themes emerged from the IPA interviews: experiencing a new environment, navigating new relationships, preparation, engagement with wound, and emotional management. Three meta-inferences were established: simulation to reality, knowledge is power, and emotional support.

Conclusion:

The simulation provided a safe space to encounter an open wound ahead of clinical practice, reducing students’ anxiety and improving their emotional preparedness. The use of moulage enhanced the authenticity of the simulation promoting a similar emotional reaction to those experienced in a real situation. Students gained a better understanding of their role in providing quality patient-centred care, allowing them to consider adjustments to their practice and behaviours before working with real patients. Peer support and teamwork were developed through the simulation, and this was sustained into clinical practice. Evidence indicates the implementation of a simulation using moulage, would have a positive impact on emotional labour, improving the student and patient experience.

References

1. Hyde E, Strudwick R. How prepared are students for the workplace? Imaging Therapy Practice. 2017 September:5–11.

2. Jeung DY, Kim C, Chang SJ. Emotional labor and burnout: A review of the literature. Yonsei medical journal. 2018;59(2):187–193.