Feature Article - SKOR | Sentara Knowledge Online Resources
←
→
Page content transcription
If your browser does not render page correctly, please read the page content below
Clinical Nurse SpecialistA Copyright © 2021
Wolters Kluwer Health, Inc. All rights reserved.
Feature Article
Can You Escape Sepsis? Using a Healthcare
Escape Room as an Innovative Approach to
Nursing Education
Adrian P. Dacanay, MSN, RN n Julia Sibrian, MSN, RN, PCCN-K n Colleen Wyllie, MSN, RN, CCRN n
Elizabeth Sorrentino, BSN, RN n Ghada Dunbar, DNP, RN, MHA, NEA-BC, CENP, CNML
Purpose/Objectives: in the feedback and overwhelmingly positive responses received
The purpose of this article is to provide the clinical nurse specialist from participants. The successes of the sepsis escape room have
with an interactive, creative, and fun approach using an escape presented opportunities to continue supporting progressive, fun,
room to increase the retention and application of knowledge and evidence-based learning environments and positively impact
about caring for patients with sepsis and improve patient care both nursing education and patient care outcomes.
outcomes. KEY WORDS:
Description of the Project: adult learning principles, best practices, clinical excellence,
This project involved the design of a healthcare-based escape escape room, innovation, learner engagement, nursing
room, where clinical nurses and interprofessional learners education, nursing retention, nursing satisfaction, patient
engaged in a series of puzzles and problem-solving experiences to care outcomes, sepsis
apply clinical judgment and critical thinking about patient care.
Theory and Frameworks:
T
Knowles' theory of adult learning guided the development of this he importance of ongoing and continuous educa-
gamified learning. tion in healthcare is critical to ensure the delivery
Outcome: of safe, effective, efficient, and high-quality patient
The clinical nurse specialist was critical to the success of the escape care. To meet the ever-changing healthcare demands, hos-
room. The escape room created an innovative learning pitals and healthcare organizations must design education
environment, expanding opportunities to engage staff and using multiple learning modalities to keep clinicians at all
promote high-quality care for best patient outcomes. levels up to date on clinical advances supporting improved
Conclusion: patient care outcomes.1 Clinical nurse specialists (CNS)
The benefits of incorporating adult learning principles with play an important role as facilitator of learning in clinical
gamification-based education as a teaching strategy are evident settings.2 Clinical nurse specialists collaborate with the
healthcare team to ensure the inclusion of adult learning
principles to best meet the learners' needs. This article will
Author Affiliations: Nurse Educator–Critical Care (Mr Dacanay) and Di- discuss the implementation of an escape room to direct
rector of Education (Ms Wyllie), Professional Development & Education
Department, and Charge Nurse, Step-Down Unit (Ms Sorrentino), Kaiser learning in an interactive, creative, and fun approach. An
Permanente South Bay Medical Center, Harbor City, California; and Re- escape room is a team-based game where learners work to-
gional Professional Development and Education Consultant (Ms Sibrian) gether to locate clues and solve puzzles within a specified
and SCAL Regional Director (Dr Dunbar), Kaiser Permanente Southern
California Patient Care Services, Regional Nursing Professional Develop- timeframe. A healthcare-based escape room uses this con-
ment and Education Program, Kaiser Permanente, Southern California Re- cept with the intent to improve clinical knowledge using
gion, Pasadena. evidence-based practice and to provide opportunities to de-
The authors report no conflicts of interest. liver educational excellence for all levels of clinical nurses.
Correspondence: Julia Sibrian, MSN, RN, PCCN-K, Kaiser Permanente This healthcare organization was faced with opportunities
Southern California Patient Care Services, Regional Nursing Professional
Development and Education Program, Kaiser Permanente, 393 E to improve sepsis outcomes in the clinical setting. Recogni-
Walnut Street, Pasadena, CA 91188 (julia.sibrian@kp.org). tion of sepsis was an identified opportunity on the adult in-
DOI: 10.1097/NUR.0000000000000578 patient medical surgical, telemetry, step-down, and critical
Clinical Nurse Specialist A
www.cns-journal.com 65
Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.Feature Article
care units owing to the challenge of clinical nurses recog- sepsis to enhance critical thinking, teamwork, and clinical
nizing sepsis as assessed by the delayed recognition of decision making in the delivery of exceptional nursing care
sepsis for patient who met sepsis criteria. An assessment for patients with sepsis.
revealed the need for further education on the topics of In addition to the clinical focus of the escape room, the
early identification of sepsis and catheter-associated uri- TeamSTEPPS approach was included to improve collabo-
nary tract infection (CAUTI) prevention. The CNS, in part- ration, communication, and performance within the
nership with the professional development and education healthcare system.9 Team failure is one of the most com-
department, used an innovative evidence-based approach mon causes of unexpected outcomes for patients in the
to educate frontline nursing staff on sepsis through the de- acute care setting.9 TeamSTEPPS is an evidenced-based
velopment of an escape room. This offers an interactive, approach to providing healthcare teams with strategies
thought-provoking, and hands-on learning experience. and tools to enhance patient safety.9 TeamSTEPPS compo-
nents were a mandatory element of the escape room learn-
BACKGROUND ing objectives as well as an integral piece to each puzzle,
Meaningful education of nurses is imperative to support supporting patient safety through collaborative team dy-
nursing practice excellence in alignment with Magnet stan- namics, structured communication, effective leadership,
dards and empower nurses in the delivery of high-quality and mutual trust.9
care in accordance with evidence-based practice.3 An op-
portunity to challenge traditional classroom lecture-based METHOD
learning and align with adult learning principles of engag- The development of the sepsis escape room required a
ing learners supported the development of meaningful systematic and organized approach. This approach in-
education. Gamification offers a promising approach to cluded the formation of a multidisciplinary core planning
education by incorporating active learning.1 Active learn- team. Based on available literature, establishment of logis-
ing has been shown to increase knowledge retention and tics, development and design of the escape room, and
application in practice.4 Gaming in education incorporates multiple practice sessions and revisions prior to the imple-
problem-based learning, a tenet of adult learning princi- mentation with the clinical nurses.
ples, and can further stimulate critical thinking while pro-
moting teamwork and collaboration.5 In accordance with Multidisciplinary Team
Knowles Theory of Adult Learning, the escape room was A multidisciplinary team is fundamental to the creative de-
identified as a gamified approach to promote nursing criti- velopment of an escape room to span across all levels of
cal thinking in the care of complex patients and engage nursing. The Director and Assistant Director of Education,
nurses in active learning.6 as team leads, initiated the vision and open collaboration
A healthcare escape room gamifies learning experience for this endeavor. The critical care and maternal-child
by challenging participants to apply clinical knowledge to health educators advanced the delivery of the escape room
solve puzzles and clues within a given scenario to “escape.” through facilitation of innovative adult learning principles
Increased retention of knowledge and subsequent applica- and development of key learning objectives. The team also
tion of the retained information translates into improved engaged the sepsis coordinator and adult CNS to advise on
quality outcomes, particularly within the healthcare field.7 sepsis-related content and quality improvement expertise.
This was evident at 1 medical center, who used a healthcare The CNS, as part of the multidisciplinary team, has a
escape room to address specific quality improvement met- dynamic role in incorporating essential clinical content in
rics related to sepsis outcomes and provide a new learning a gamified approach. With critical care being a key setting,
experience for clinical nurses at all levels. the manager of the intensive care unit (ICU) and
The purpose of this quality improvement project was to step-down unit (SDU) was also essential to the team. In
use an escape room modality to increase the retention and alignment with the andragogical model of adult learning,
application of knowledge about caring for patients with 3 frontline clinical nurses in the SDU and ICU brought an
sepsis and improve patient care outcomes for the provision important perspective on the sepsis workflow in nursing
of safe and quality care. This project involved the design of care.6 Involving learners in educational design aligns with
a healthcare-based escape room with a focus on sepsis and Knowles Theory of Adult Learning to support meaningful
CAUTI prevention, where clinical nurses and interprofes- education.6 The design and development team also in-
sional learners engaged in a series of puzzles and cluded the regional partners in professional development
problem-solving experiences to apply clinical judgment and education.
and critical thinking about patient care.8 By combining Leadership engagement and support were vital to the
these topics in a meaningful approach, the aim was to in- success of the escape room. Administrative leadership
crease knowledge and facilitate application of clinical gave their full support behind the project, providing the
knowledge in the scenario of caring for a patient with team with the time and budget necessary to organize and
66 www.cns-journal.com March/April 2021
Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.execute the escape room. The critical care intensivist and stations. In addition, expired versions of specific medical
hospitalist supported the project as sepsis subject matter supplies supplemented each puzzle design. An inventory
experts and as key partners in developing the concepts of supplies list was kept, helping the team quickly identify
for the escape room. The diverse experiences and profes- the location of supplies when needed. In determining a lo-
sional expertise among the group established a solid foun- cation to execute the escape room, it was important to
dation for the development and implementation of the identify in situ space that was not used for patient care
escape room. and could house the escape room and materials for an ex-
tended period.
Review of Literature
The current available evidence guided the innovative and Development and Design Process
creative development process. The team synthesized the Following logistical considerations, the development and
evidence and examined available baseline knowledge for design of the escape room proved to be a creative and en-
the escape room design. Several sources of scholarly data- joyable process. The CNS elaborated on the design of the
bases were used, including but not limited to the Kaiser escape room using expertise to coach through the full de-
Permanente online database library, California State Uni- velopment. It was helpful to identify the primary education
versity, Fullerton's electronic databases (CINAHL Plus with objectives as a focus for puzzles or stations related to the
Full Text, ScienceDirect, etc), and PubMed. The search terms specific content areas. The specific areas of focus for the
that yielded the most results were “escape room,” “sepsis pre- sepsis escape room were identified as pathophysiology
vention and treatment,” “CAUTI,” and “adult learning princi- of sepsis, signs and symptoms of sepsis (assessment), early
ples.” Other search terms were cross-referenced with these goal-directed therapy (EGDT), and interventions for sep-
specific terms as well, and the team used the Kaiser sis. TeamSTEPPS was identified as the foundation for this
Permanente Librarian service to narrow down results. educational approach to enculturate the principles of
There was an abundance of articles on escape rooms teamwork and collaboration, which has shown to posi-
and escape room development; however, a limited tively impact quality patient care outcomes.9 TeamSTEPPS
amount of information was available specifically on medi- principles support the development of high-performing in-
cal or healthcare-based escape rooms. The few healthcare terprofessional healthcare teams.11 Each puzzle incorpo-
escape rooms found in the literature focused on teaching rated a TeamSTEPPS component the learners must
nursing students or new graduate nurses; there was scarce master before moving on to the next stage of the escape
information on the use of escape rooms in the education of room. The multidisciplinary team used a “divide and con-
experienced nursing staff. There were, however, several quer” approach for puzzle design. The team divided into
guidebooks for educational escape rooms published that subgroups and concentrated on 1 education objective.
served as a starting point for the journey in developing a Each education objective encompassed a station with a se-
sepsis-focused escape room for experienced nurses. ries of interrelated puzzles to engage learners. Each sub-
group focused on the development of 1 station with
Logistics dissemination and feedback from the larger group. Each
The guidebook model chosen to support this escape room station in the escape room built on the previous one, pro-
design was from the University of Kansas Health System.10 viding the team with new information to use to progress
Using this model as a template, the team had a structure forward into the next station. Clear guidelines were devel-
from which to grow sepsis-specific puzzles and storylines. oped for the escape room, to instruct participants in their
Experiences in community escape rooms offered a perspec- roles and expectations of the escape room. These guide-
tive on room design, puzzle options, skill stations, and transi- lines were distributed to the nurses before participating in
tions between puzzles. Notably, although each community the escape room along with a preeducation packet and
escape room design was unique, each engaged their audi- were reiterated before the start of each session. Finally, a
ence with a background storyline that continued throughout debriefing template helped to ensure that key learning ob-
as a frame of reference for the experience. These examples jectives were met, all learner questions could be answered
and experiences supported the structure for a clinical appropriately, and feedback could be captured upon com-
storyline throughout 4 stations with unique sepsis-related pletion of the escape room.
puzzles to create the healthcare-based escape room. A con- A crucial aspect of escape room development was bi-
sistent diagram of escape room helped ensure consistency weekly planning meetings in preparation for implementa-
across each escape room session (Figure 1). tion. During these meetings, each subgroup would share
The next steps were to define a budget as well as a loca- progress, receive feedback, and evaluate each station puz-
tion for the escape room. A budget identified at the con- zle design. This sharing facilitated collaboration between
ception of the development supported the cost-efficient group members, promoted creative ideas, and opened
effort of all supplies purchased to enhance the puzzle new perspectives among the diverse interdisciplinary
Clinical Nurse Specialist A
www.cns-journal.com 67
Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.Feature Article
FIGURE 1. Escape room diagram.
roles. This also sparked the development of a “leader board” adult inpatient settings. By incorporating the escape room
for fastest team escape, which added an element of social into an annual skills blitz, the educators were able to ex-
competition to deter learners from sharing escape room– tend to the entire adult inpatient nursing staff. The leader-
specific information with colleagues before participating. board, posted outside the escape room for the staff to
Before implementation, several trials were scheduled view, did indeed promote friendly competition among
where nursing leaders participated in the escape room to staff for fastest escape room completion and facilitated
allow the facilitators to observe the overall flow, assess learner eagerness to participate. The leaderboard com-
the level of complexity of puzzles, establish transitions be- pelled learners to maintain confidentiality with the details
tween the stations, and evaluate the educational value of of the escape room, which promoted critical thinking from
each station. Real-time feedback was collected from each all participants. Ninety-five percent of adult inpatient front-
trial and incorporated into subsequent stations, puzzles, line nursing staff participated in the escape room, with
or escape room mechanics. 100% of teams successfully escaping. The average time to
complete the escape room was 42 minutes, with the fastest
RESULTS team completing it in 27 minutes 5 seconds.
The escape room was initially implemented in the SDU The gamified approach of the escape room showed im-
and ICU settings, with the intention to spread to the other provement in retention and application of knowledge
68 www.cns-journal.com March/April 2021
Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.about caring for patients and patient care outcomes related and used everything I was taught the day before”; “What a
to CAUTI and sepsis. There was a significant reduction in fun way to learn”; “One of my patients presented the
the average incidents of CAUTI from 6 months before EXACT same way that the escape room patient did. I was
and 6 months after the escape room (Figure 2). Following able to get the cultures, antibiotics and fluids to her on
the escape room, there was an increased percentage of time”; and “I am so happy that I was in a team, I could
nurses able to identify patients who met SIRS criteria early not have done this without them.”
and initiate lactic acid blood draw as well as EGDT within
the SEP-1 CMS timeframe (see Figure 3). LEARNINGS, SUCCESSES, CHALLENGES,
OPPORTUNITIES
EVALUATION Creating an escape room was a fun and innovative way to
The escape room, despite its unique nature, borrowed implement educational programs that also achieved sev-
concepts from traditional simulation methodology, includ- eral learning objectives. The escape room featured specific
ing the establishment of learning objectives, use of a sce- puzzles and problems requiring participants to critically
nario to encourage critically thinking, and debriefing at think and synthesize their nursing knowledge on sepsis,
the conclusion of the escape room. Debriefing allows with dedicated time for debriefing. Teamwork and leader-
learners to discuss thoughts and experiences they learned ship were 2 qualities demonstrated by participants at all
from the scenario and identify how to apply their learnings levels of clinical experience. The escape room helped rein-
in real-life situations.12 Debriefing was an integral part of force TeamSTEPPS concepts, such as using SBAR (situa-
the learning process to reinforce learning objectives, dis- tion, background, assessment, recommendation), used
cuss what went well during the experience, recognize clues to encourage critical thinking and assessments, and
areas of opportunity and knowledge gaps, and identify provided opportunities for the learner to analyze and syn-
how to apply concepts into clinical practice. The debriefing thesize evidence presented to them. The development
sessions were lively and interactive, with all participants shar- team used concepts of simulation methodology as well as
ing their learnings and asking clarifying questions. Through application of overarching dynamics of experiential learn-
the debriefing sessions, the team collected real-time staff ing and instituted those components into each puzzle sta-
feedback and testimonials to evaluate the escape room. tion. The escape room created an innovative learning
These qualitative data were incorporated into the escape environment, expanding options for unique educational
room and contributed to the overall success of the pro- opportunities to engage staff and promote high-quality
gram. In addition, comments and feedback from partici- nursing care for best patient care outcomes.
pants were collected during leadership rounding on the
units. Some participant comments and feedback included Challenges
“It was so great that I got to apply my knowledge from sep- As with any major project, the development of the sepsis
sis escape room the next day at work. I had a sepsis patient escape room had its own challenges. The CNS helped
the team to navigate through many of these challenges. Ac-
commodating schedules of people across multiple disci-
plines to meet consistently during the planning stages
proved to be difficult even with the use of online meetings.
Preeducation material, in the form of a 2-page information
packet, was distributed to participants before attending.
However, the learners did not consistently access or re-
view this material before participation.
Another challenge was the amount of resources re-
quired to run an escape room. Initially, the escape room
needed several facilitators: one to control the high-fidelity
simulation mannequin and reset the room after each ses-
sion, one to manage the room flow, provide hints, and de-
brief with participants, and one to function as the
embedded participant. Fortunately, the team was able to
reduce the amount of people needed each time during
the first month of running it. The use of a high-fidelity man-
nequin was not necessary because its interactive function-
ality was not required for the escape room; thus, the team
FIGURE 2. Average CAUTI incidents 6 months pre– and switched to a regular mannequin. The team also realized
post–escape room. that the embedded participant and the facilitator could
Clinical Nurse Specialist A
www.cns-journal.com 69
Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.Feature Article
FIGURE 3. Lactic acid blood draw within the SEP-1 CMS timeframe 5 months before and 3 months after escape room education.
reset the stations as the participants completed them to re- the entire process worked for the escape room concept.
duce the amount of time needed to reset the entire room at The stations and the individual puzzles within each one
the end. Eventually, 2 facilitators were enough to run the needed to teach a specific concept of sepsis care, and each
escape room, reset the stations, and debrief at the end. also had to establish foundation for the next puzzle. The
On certain days, there was only 1 facilitator available to content had to make sense to the nurses clinically so they
run the entire escape room because of conflicting sched- could use that clinical knowledge to solve the puzzles.
ules. Although it was not impossible to run the escape
room with 1 person, it was a challenge to do everything Opportunities
and stay on track with time. There were several opportunities for improvement identi-
Another significant challenge was the development of fied during the process. One was the need to dedicate
the escape room itself. The point of the escape room was more time on the preeducation aspect of the escape room.
not to work through a clinical simulation; it was geared to- This would have ensured that learners had the tools they
ward applying clinical know-how toward solving a puzzle. needed to be successful in the escape room and potentially
Aside from the University of Kansas Health System's guide- increased knowledge retention. Although the preeducation
book, the team did not have previous experience or re- packet was widely distributed to the adult inpatient care
sources in the creation of an escape room. The team had nurses, reinforcement of the written material would have
to pay special attention during the planning and creation been helpful, especially for the nursing units outside the crit-
to avoid making this into a simulation. In addition, it was ical care level. This became clear when learners from less
challenging to embed the educational content into each acute departments outside critical care had difficulty navi-
puzzle in a way that facilitated both achieving the educa- gating the escape room and retaining the material presented
tional objective and linking one puzzle to the next so that on EGDT for the sepsis patient, as this was their first
70 www.cns-journal.com March/April 2021
Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.exposure to the topic. The rounding and discussion with education that provides the learner evidenced-based best
staff to address any uncertainties or questions regarding practice that leads to optimal patient care outcomes.2 The Na-
the material before attendance can be consideration for fu- tional Association of Clinical Nurse Specialists defines the
ture escape room projects. Another area of opportunity CNS role as that of an expert clinician who can work in a va-
was to review the pre– and post–escape room knowledge riety of healthcare settings and has a primary goal of driving
survey questions. The questions formulated were based best practice. They fill a critical role in development of an es-
on the medical center's sepsis protocol and guidelines; cape room as they serve as content expert as well as sea-
however, in the haste of development, the questions were soned educator. The CNS can use the learnings from this
not reflective of new knowledge and application of knowl- escape room to spread across the entire healthcare organiza-
edge. The team discovered that the questions did not ac- tion system to continue supporting a progressive, fun, and
count for how a frontline nurse would interpret the evidence-based learning environment and positively impact
question within the context of their practice. Some ques- both nursing education and patient care outcomes.
tions also ended up being biased or guided. Despite the
challenges, the development team found fulfillment during CONCLUSION
the process. Healthcare escape room is a growing teaching strategy in
nursing education.10 As described in this article, simulation
Joy in Education escape rooms can effectively make learning stick to impact
In the way that gamification brought excitement and en- the delivery of quality care and safe patient outcomes.10
thusiasm to the learner, the development and implementa- The engagement, collaboration, critical thinking, problem
tion of this project brought joy to the educators and solving, and teamwork brought the participants together
facilitators as well. The frontline nursing staff was vital to in a joyful, fun, live-action gaming experience to solve
the interprofessional development team as they brought clues related to sepsis to escape a “locked” room.13 The
a realism to the process. What was really happening at benefits of incorporating adult learning principles with
the bedside? The frontline staff always had this answer, gamification-based education as a teaching strategy are
which made the workflow easier. The team relished the evident in the feedback and overwhelmingly positive
time during multiple meetings to review and dissect the responses received from participants.8 The planning com-
puzzles to ensure that learning objectives were met, com- mittee included a multidisciplinary team of clinicians,
ponents of TeamSTEPPS were integrated into each station, leaders, providers, CNSs, and educators that worked inter-
and evidence-based practice was woven throughout the dependently to support the escape room strategy to pro-
escape room journey. The interprofessional team had the mote active learning and creative thinking to problem
chance to create something new and innovative to accom- solving in nursing education. The successes and positive
plish educational objectives. Finally, the team was espe- outcomes of the sepsis escape room have presented op-
cially grateful for University of Kansas Health System's portunities for the CNS to collaborate with the team on de-
collaborative approach in working with them to create this veloping future projects, such as a stroke escape room and
experiential learning process. spreading the successes to other medical centers.
IMPLICATIONS FOR NURSING PRACTICE ACKNOWLEDGMENTS
Escape rooms have been linked to experiential learning The authors would like to recognize Lina Najib Kawar, PhD,
environments that lead to increased engagement of the RN, CNS, for her guidance and support through this process.
learner, increased retention of knowledge, and subse-
References
quently improved quality indicators.4 There are many im- 1. Kinio AE, Dufresne L, Brandys T, Jetty P. Break out of the class-
plications for nursing practice whether to enhance the room: the use of escape rooms as an alternative teaching strategy
learning experience, aid in knowledge retention, and appli- in surgical education. J Surg Educ. 2019;76(1):134–139. doi:
cation of that knowledge to provide excellence in nursing 10.1016/j.jsurg.2018.06.030.
2. National Association of Clinical Nurse Specialist. What is a CNS?.
practice in making connections between the learned material https://nacns.org/about-us/what-is-a-cns. Accessed August 14, 2020.
and the real-life, and ultimately improving patient-centered 3. American Nurses Credentialing Center. ANCC Magnet Recognition
care. The goal was to use experiential learning methodology Program. 2020. https://www.nursingworld.org/organizational-
in the acute care setting to provide evidence-based sepsis programs/magnet. Accessed August 14, 2020.
4. Mawhirter D, Garofalo P. Expect the unexpected: simulation
bundle education to the medical center nursing staff to im- games as a teaching strategy. Clin Sim Nurs. 2016;12(4):
prove patient outcomes. The CNS continually coached the 132–136. doi:10.1016/j.ecns.2015.12.009.
learner to use assessments and implementations throughout 5. McEnroe-Petitte D, Farris C. Using gaming as an active teaching
strategy in nursing education. Teach Learn Nurs. 2020;15(1):
the escape room in alignment with evidenced based best
61–65. doi:10.1016/j.teln.2019.09.002.
practice promoting optimal patient care outcomes. The CNS 6. Knowles MS. Andragogy in Action: Applying Modern Principles
plays a vital role in the development and implementation of of Adult Education. San Francisco, CA: Jossey-Bass; 1984.
Clinical Nurse Specialist A
www.cns-journal.com 71
Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.Feature Article
7. The Joint Commission. "Patient Safety Systems" (PS) Chapter. 11. Welsch LA, Hoch J, Poston RD, Parodi VA, Akpinar-Elci M.
https://www.jointcommission.org/standards/patient-safety- Interprofessional education involving didactic TeamSTEPPS®
systems-ps-chapter. Accessed August 14, 2020. and interactive healthcare simulation: a systematic
8. Chan ZC. A systematic review of creative thinking/creativity in review. J Interprof Care. 2018;32(6):657–665. doi:
nursing education. Nurse Educ Today. 2013;33(11):1382–1387. 10.1080/13561820.2018.1472069.
doi:10.1016/j.nedt.2012.09.005. 12. Rudolph JW, Simon R, Rivard P, Dufresne RL, Raemer DB.
9. Agency For Health Research And Quality (AHRQ). Teamstepps®. Debriefing with good judgment: combining rigorous feedback
https://www.ahrq.gov/teamstepps/index.html. Accessed August with genuine inquiry. Anesthesiol Clin. 2007;25(2):361–376.
14, 2020. doi:10.1016/j.anclin.2007.03.007.
10. Adams V, Burger S, Crawford K, Setter R. Can you escape? Creat- 13. Kutzin JM. Escape the room: innovative approaches to interpro-
ing an escape room to facilitate active learning. J Nurses Prof fessional education. J Nurs Educ. 2019;58(8):474–480. doi:
Dev. 2018;34(2):E1–E5. 10.3928/01484834-20190719-07.
72 www.cns-journal.com March/April 2021
Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.You can also read
