Overcoming Awkward Silences: The Unconventional Use of Simulation to Improve Intimate Partner Screening

Purpose:
This program will assist the learner in identifying how to improve nursing communication and assessment in Intimate Partner Violence screenings as well as other hard-to-teach behavioral competencies in a no-fault simulation environment, with an emphasis on critical thinking skill acquisition.

Relevance/Significance:
Recent statistics indicate that 1 in 4 American women experience IPV during their lifetimes. Although routine IPV screening is completed by nurses, many express discomfort with the process, and opportunities for intervention may be missed without crucial communication abilities. Practicing behavioral scenarios will improve competence, but there are currently few opportunities to safely use these skills in a non-live environment.High-fidelity simulation can be utilized to hone these capabilities.

Strategy and Implementation:
In-situ simulations have been shown to improve clinical skills,create communication standards,and provide no-fault learning environments for healthcare teams.Formal post-simulation debriefing sessions allow participants to enrich the learning experience with shared observations & insight.After identifying IPV screen completion as an area for improvement,nursing leaders from the Fetal Health Center determined that nurses were often unsure how to pursue appropriate avenues of assessment when IPV was suspected but the patient appeared unwilling or unable to answer.The FHC educator collaborated with the simulation team to write an IPV simulation scenario.A professional actor was hired to play the part of the abusive domestic partner, which enhanced the realism of the scenario for the multidisciplinary team of nurses, physicians,social workers,and security. The simulations and debriefings were videotaped so that the teachable moments could be shared with the entire department.

Evaluation:
Post-simulation surveys indicate that 100% of participants feel more comfortable addressing IPV issues and find the material relevant to their daily practice. IPV screening completion rose 17% in the month following the initial simulation, and unit completion rates are now >90%. Confidence in verbal de-escalation techniques, supportive resource availability and communication strategies rose 25%.

Implications for Practice:
Innovation is key to the improvement of quality and safety in healthcare. High fidelity in-situ simulation provides the innovative technology necessary to advance critical thinking skills needed for challenging behavioral competency comprehension in a no-fault learning environment.