Spurred by real-world examples of ICU family meetings where physicians and nurses failed to work in an interdisciplinary format to clearly and sensitively convey crucial information to the families of critically ill patients, this project aims to simulate high-stakes ICU family meetings where nursing students role play as ICU nurses, medical students role play as ICU physicians, chaplaincy residents role play as hospital chaplains, and combinations of students role play as family members. Three scenarios are currently utilized:
A patient with metastatic pancreatic cancer, complicated by a bowel perforation, requiring ICU care whose family must be told that, due to his current severe illness, he no longer can participate in a stage 1 drug trial he was to start
A patient with long-standing metastatic colon cancer with declining quality of life due to pain and foul-smelling fistulas, who suffers a bowel perforation complicated by multi-system organ failure and whose family must decide whether he would want to continue on life support\
A patient with severe H1N1 influenza, multi-system organ failure, and severe ventilator dependence, with no option of lung transplant, whose family must discuss potential withdrawal of life-support
The primary goal of the simulations is to teach how, in these nuanced and difficult conversations, nursing, physician, and chaplaincy colleagues can and must work together to ensure clear, sensitive, and honest communication with families. These ICU situations are particularly challenging as the patient is too ill to participate in the meeting and consequently, discussions must be convened with and decisions made by family members; this adds a layer of complexity and causes us to direct these scenarios at advance level, final year medical and nursing students.
Secondary goals are for students to learn and practice: effective and yet sensitive and empathic communication methods to convey bad news and emotionally laden information; conflict resolution techniques; family meeting-related practical skills (such as introducing meeting participants, active listening, and setting meeting goals); and techniques useful in sensitively dealing with distraught and/or dysfunctional patient families and family members.
Simulations at Hopkins Nursing