Background Evidence shows patient dissatisfaction regarding healthcare professionals’ discussions of DNACPR (Do Not Attempt Cardio-pulmonary Resuscitation) and Ceilings of Treatment. Often the reality is that healthcare professionals are having to broach these conversations in less than ideal circumstances. Increasingly, the responsibility falls on nurses and new trainees with no opportunity to get feedback on the impact on patients and to learn in a constructive way from experience. We used hospice volunteers to take part in training two different groups (a) Hospice Community Clinical Nurse Specialists (CNSs) and (b) Foundation Year (FY) Doctors. The volunteers took part as simulated patients/relatives and provided feedback.
Aims The aim was to increase the confidence levels of the FY Doctors and CNSs through conducting DNACPR and Ceilings of Treatment discussions in a safe environment. For CNSs, there was an additional aim – to evaluate competency using simulation after a simulated practice session.
Methods Bespoke scenarios were written for each of the two groups, tailored to the likely clinical circumstances in which they would be having these discussions. Volunteers were recruited from the existing pool of hospice volunteers. The volunteers were briefed and shown the Simulation Suite in advance. Confidence levels were completed by participants pre- and post each session. A competency framework was written against which to evaluate the CNSs’ performance.
Results In both groups, 100% of the participants stated that their confidence levels increased. Both groups commented on the usefulness of feedback from the volunteers. 100% of the CNSs achieved the required competency after the practice session.
Conclusion Simulation is an effective way of improving the confidence levels of healthcare professionals in conducting DNACPR and Ceilings of Treatment discussions. Simulation can be used to conduct evaluation of competency. Hospice volunteers are a useful resource in educational initiatives using simulation and can provide dynamic feedback for healthcare professionals to aid reflective learning.
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