Activity: Humanising Technology: the dilemma between privacy and security

Learning outcomes

By the end of the activity, students should be able to:

• Identify the dilemma between patients’ privacy and their security 
• Calm down an anxious patient and generate a relationship of trust and shared decision-making in terms of treatment and other medical procedures
• Work in an interprofessional team and establish a functional and coordinated distribution of roles and responsibilities

As regards transversal skills, students should be able to:

Interpersonal and socio-emotional skills:

• Express ideas clearly and fluently
• Use precise and descriptive/content-specific vocabulary to enhance the topic or message
• Share information in an organised and interesting way
• Share an analysis of the main message to interpret, synthesise and/or evaluate the meaning of the content in order to draw a logical conclusion about the topic
• Show empathy and use non-verbal communication and active listening
• Self-reflect, evaluate one’s own actions and emotions, and take responsibility for own actions
• Perform tasks efficiently and carefully
• Persevere in the face of difficulties
• Develop positive and emotionally safe interaction and develop and co-create teamwork
• Reflect and manage emotional and self-regulation, and show empathy in professional relationships
• Work cooperatively with others
• Develop an empathetic leadership by understanding the needs of others and being aware of their feelings and thoughts, and to facilitate collaborative and participatory problem-solving
• Create a non-discrimination atmosphere
• Facilitate conflict resolution, remain calm under pressure, and control one’s emotions in conflict situations
• Be willing and able to understand people from different backgrounds and embrace diversity

Critical and creative thinking:

• Identify and deal creatively with unexpected, unforeseen, and complex situations that can be exploited, and to evaluate different solutions
• Acquire, process, produce, and evaluate information critically and from the perspectives of different fields and decisions, taking into account both individual and community perspectives
• Question norms, practices, and opinions, and to reflect on own one’s values, perceptions and actions
• Develop innovative solutions to answer different questions and to create new and worthwhile ideas; elaborate and evaluate ideas in order to improve and maximise their creative efforts

 

Brief description of the activity

The activity consists of a simulation wherein an ICU patient, Tina Meyers, wakes up from a one-month coma caused by a car accident. She wakes up slightly disoriented and anxious. The interprofessional team will have to talk to the patient and explain the situation to her while managing altogether the reactions of the patient. During this activity, students will mainly work on their interpersonal and socioemotional skills, but they will also need to think creatively and critically to solve the situation effectively.

 

Activity plan: step by step

 

Before the activity

1. Definition of the case according to the learning outcomes: 

 

The description of the case must include, at least:

(1) Description of the initial scene and clinical features

(2) Challenge posed to the student

(3) Narrative of the simulated character (especially if simulated with actors/actresses)

(4) Key moments that define the course of the case depending on the actions of the student

 

For this activity, the following case is proposed: 

 

Tina Meyers is a 32-year-old woman with no previous illnesses. She had a car accident a month ago and suffered traumatic brain injury. She was admitted to the ICU and has been in a coma ever since. Today, she woke up from her coma. She is slightly disoriented (Glasgow 13/15) but can listen and understand what she is being told. Vital Signs: 

• RF: 19x’
• SatO2: 98% (0.21)
• CF: 97x’
• TA: 102/58 mmHg
• Auscultation: Vesicular murmur preserved. 
• Temperature: 36,5ºC
•  SARS-CoV-2 Test NEGATIVE

 

The patient has difficulty speaking. Shows mild aphonia through the endotracheal tube. She is motionless, she can only move her eyelids and eyes. Anxiety increases heart rate and blood pressure. The patient is covered with a sheet. She carries many catheters. The patient can listen to the nurses, understand them and become aware of everything that happened to her, where she is, etc. Regarding her personal situation: she has a 4-year-old child with a partner from whom she is separated. When she wakes up, she is disoriented and needs to be told where she is and why she has been admitted. 

 

Students are asked to:

 

(a)  check vital signs and patient’s comfort. 

(b) explain to the patient what happened to her, when, and where she is now

(c)  explain the possibilities of the intelligent ICU room where she is now: (i) bed moves under verbal order and stores HC information of patients (ii) nurse may be called under verbal order, (iii) there is a tablet with emojis that can be used for non-verbal communication, (iv) the family can be video called if the patient wishes to

(d) ask for the patient’s consent to enter the scientific project where she is involved and the fact that there are cameras monitoring her

 

Narrative of the character and case development: 

 

Tina Meyers has a 4-year-old child, the father of whom she is divorced from. When Tina wakes up, she shows anxiety about the situation of her child. She remembers very vaguely the accident. She quickly asks about her family and the baby girl, and she’s worried if the kid was in the car with her too. When she is told that the daughter was not in the car and that the girl is fine, she calms down, but remains worried about who will take care of her while she is in the hospital. Regarding her family: she divorced from her husband when their kid was still a baby. Her mother died years ago, before her baby girl was born, and her father lives in a village about 50 km from the city and is getting older, showing some difficulty in completing daily activities. She has a neighbour who helps her take care of the girl on late days of work, even though the hospital doesn’t have her contact.

 

In relation to the technological elements present in the ICU, when properly explained, there are things that she likes and accepts, but when she hears that there are cameras and microphones she shows immediate rejection: she does not want these. She is concerned about her privacy and whether her family sees her in this state. How will she know when she is seen and when she is not? What is visible, and what is not visible to others? Who can see it? She is very concerned about her privacy and, above all, about who can access the images. She is anxious and begins to move; she needs to be calmed down so that no tube or catheter is removed. She will only calm down when the cameras are off, or she is empathetically convinced otherwise.

 

2. Preparation of the physical setting

 

Simulation room equipped as an intensive care unit/room with the necessary and typical material for a unit of these characteristics, correctly labelled and ordered. It also can be provided with any other clinical equipment and monitors required for the case resolution. Finally, it must be equipped with a camera and microphone system that allows live broadcasting of the scene to the debriefing room.

Debriefing room separated from the simulation room. It has to be equipped with enough resources to be able to see and hear live what is happening in the simulation room. Likewise, it must allow all participants to be integrated into the conversation, avoiding physical barriers that prevent everyone from seeing each other face to face. 

Simulation control room from which the development of the case is controlled, and the case is broadcast. It is important that the teaching staff or simulation technicians know the computer equipment that is being used. 

3. Definition of the roles of participants

 

Role of the students. Students will be divided into two groups: those who get into the simulation room and try to solve the case (i.e. enact the role of health professional), and those who observe their peers trying to solve the case. All students will participate both in the pre-briefing and debriefing phases of the activity. The group will decide who gets into the simulation room and who stays at the observation room. 

Things to take into account prior to the activity:   Context. You should make sure that the activity is appropriate for the number of students you have, as well as for the learning objectives of the subject in which it will be implemented Materials necessary for its implementation. Make sure that you have a proper primary care simulation room with a proper camera/microphone system. The observation room should have a screen to watch and listen to the development of the case real-time and big spaces to perform the pre- and de-briefing phases. Check whether you have all the consumable and non-consumable materials that will be used during the activity, from printed sheets with the description of the case to the materials of the primary care simulation room. Finally, make sure that you provided students with all the necessary information about the case. Human resources necessary for its implementation. In simulation activities, at least two teachers should be available with knowledge of how to perform simulation activities. You may also need to hire an actress to perform the role of Tina Meyers.

 

During the activity

Step 1. Pre-briefing. The pre-briefing phase is devoted to generating an emotionally-safe space, wherein students feel comfortable to perform the activities they are required without being judged, show their emotions as these emerge, and rely on the group for any source of support. The teacher(s) should be perceived by students as part of the group. To know more information about how to organise this phase, see the Methodological guide. 

Step 2. Case development. For the case development phase, the group will need to choose the students who go into the simulation room and those who stay at the debriefing room. The latter will see their peers trying to solve the case. Before the students enter the simulation room, the case is briefly presented to the whole group. 

Tina Meyers is a 32-year-old woman with no previous illnesses. She had a car accident a week ago and has been admitted to ICU ever since. She has been recovering from an induced coma for 8 hours with a good prognosis. Now she is conscious but slightly disoriented (Glasgow 13/15).

You are working on an intelligent ICU which is included in a European project regarding patients’ security which made it affordable to equip it with the latest technology available: it has cameras and microphones which are switched on 24/7 in order to ensure the best monitoring of the patient situation and early detection of any adverse event. 

Since she woke up recently, you are asked to enter the room to explore how Tina is doing and ask her for consent to use the technological equipment (cameras and microphones).

After the case is presented, the selected students are accompanied to the simulation room. 

While the case is developing, there are two key moments to which you should pay special attention: 

(a)   The student explains to the patient what happened to her and why she is in an ICU room.

(b)   The student describes the technological possibilities of the room. The patient rejects the situation and shows anxiety and discomfort. 

 

The students will have to communicate empathetically with the patient and be able to calm her down whenever she reacts anxiously. They will also have to communicate with each other effectively and without the patient noticing that there are things that they don’t know. You will need to pre-define the maximum duration of the case and find a realistic way to stop the case in the event that the students are not able to solve it (see above).

 

Step 3. Debriefing. In the debriefing phase, the students that were in the simulation room get back to the debriefing room with their peers and facilitator(s)/teacher(s). This is a moment for common reflection in which performing students offer an internal point of view of the simulation and observing students offer an external point of view of what happened and what could have been done differently. Therefore, it will probably be the phase that lasts the most. Topics that should be addressed are: 

(a)   emotions appeared during the case

(b)  investigation of the reasons that have led to the decision-making: whether, why and how performing students asked for help to other professionals;  how they redirected the patient; how they described the technological possibilities of the room and how the patient reacted to it

(c ) transfer of learning to professional reality

 

After the activity

After the debriefing, it’s time for evaluation. Below, you can find a rubric to evaluate their socioemotional and interpersonal skills (both of students that performed in the simulation and those who observed it). You can also give it to them for self-evaluation in order to stimulate self-reflection.

 

Role of teacher(s)

The teacher(s) will facilitate the pre-briefing and debriefing activity. In both parts of the activity, an emotionally-safe space should be guaranteed. They will not get into the simulation room unless they play a role in which they make the simulation end realistically (e.g., the unit coordinator gets into the room for a check-in with the patient and offers to solve the situation).

Following the recommendations made by studies in simulation methodology, it is preferable to have two teachers in this type of simulation. One of them, the “instructor” and who will have accomplished a specific training in simulation methodology, will take the role of moderating and facilitating the session and debriefing, while the other, an expert in the content of the cases, will handle content clarification and questions.

Evaluation tool

Transversal skills are difficult to evaluate, particularly among big groups of students. Therefore, in this section we propose a tool for students to self-assess the development of these skills. The tool is divided into three dimensions: suitability of the learning activity, level of achievement of learning outcomes, and transferability to professional settings. You can adapt the dimensions and/or indicators that you use according to your teaching-learning context and needs. 

 

Evaluation tool to self-assess the development of skills during the activity

For each of the following statements, select the best answer on a scale from 1 to 4, where 1 means “Not at all” and 4 indicates “Yes, totally”. N/A means “not applicable”.

	1	2	3	4	N/A
DIMENSION 1. Suitability of the learning activity
I found this learning activity adequate in terms of time
I found this learning activity adequate in terms of resources (material resources, physical space, etc.)
I found this learning activity adequate in terms of content
I found this learning activity engaging
I found this learning activity challenging
I found this learning activity disruptive in comparison with other learning methodologies
I found this learning activity useful to learn [add the subject]
I found this learning activity useful to retain knowledge
This learning activity motivated me to deepen my knowledge of [add subject or hard skill]
This learning activity allowed me to feel emotions that would be rather difficult to experience with other learning methodologies
I would recommend this learning activity to others
DIMENSION 2. Level of achievement of learning outcomes
This learning activity helped me to improve…
…my ability to [add a row for each learning outcome of the activity that you performed, both related to hard and transversal skills]
DIMENSION 3. Transferability to professional settings
After this learning activity…
…I will be better able to apply what I learned to my reality (everyday life, classroom, professional life)
…I feel more capable to perform in a professional setting
…I feel I can make better choices regarding professional situations
…I feel more prepared and self-confident to address professional situations
OPEN QUESTION – Use this space to explain whatever you think is remarkable from the learning activity, including strengths, weaknesses, improvements, potential uses, feelings or dilemmas you encountered during the activity.

 

Download evaluation tool in pdf here.