Simulation Training to Improve Psychiatric Nurse Practitioner Adherence to Veterans Affairs/Department of Defense Clinical Practice Guidelines for Post-Traumatic Stress Disorder:

Despite the evidence-based clinical practice guidelines created in 2004 by the Department of Veterans Affairs (VA) and the Department of Defense (DoD) for the identification and management of post-traumatic stress disorder (PTSD), studies demonstrate few veterans receive this standard of care. Major disparities in adherence to the evidence-based clinical practice guidelines exist among primary mental health nurse practitioners practicing at an urban VA. This problem is clinically significant as 11% to 30% of veterans are diagnosed with PTSD. PTSD is associated with increased risk of morbidity and mortality. One method used to improve training and to increase adherence to recommended guidelines is simulation-based training. Simulation-based training is successfully utilized in other high-risk industries (e.g. the military and aviation) to increase adherence to recommended guidelines. The implementation of simulation-based training on a clinic level with new mental health nurse practitioners has the potential to improve the training of these clinicians. Ultimately, these clinicians will provide PTSD treatment at the VA. This practice improvement project sought to improve adherence to VA/DoD clinical practice guidelines for PTSD among all mental health nurse practitioners currently working in outpatient mental health at the VA Medical Center. The project was implemented beginning with a PowerPoint presentation in order to provide current VA mental health nurse practitioners with an overview of the VA/DoD PTSD guidelines. Then a simulation-based training using indicated standards was implemented to improve competence and adherence to the clinical guidelines amongst all VA mental health nurse practitioner resident trainees and the mental health nurse practitioner student trainees. After the simulation, the National League for Nursing's (NLN) Educational Practices Questionnaire (EPQ) was administered to the simulation participant to measure the simulation's ability to improve understanding of clinical practice guidelines and importance of adherence. The responses on the EPQ were positive (Figure 1). One hundred percent of trainees and resident participants in the simulation reported they agreed or strongly agreed with all 16 questions regarding simulation activity. Thirteen of the simulation training objectives were considered important to the learners who engaged in the simulation. Approximately 2 questions were listed as neutral in importance to the learners. The majority of learners commented that they enjoyed the teamwork with their peers during the planning and debriefing sessions with peers and facilitators before and after each scene. The learners also commented on how realistically the actor represented the veteran. The NLN educational practices questionnaire results demonstrated this simulation training helps novice mental health nurse practitioners gain awareness and competencies related to the clinical practice guidelines for PTSD and reduces provider adherence barriers. Improving adherence to evidence-based clinical guidelines will improve the quality of mental health care veterans receive by mental health nurse practitioners at the VA. Improving the quality of care for veterans in this large urban VA outpatient mental health clinic will help ameliorate high morbidity and mortality rates of veterans in this region.