Simulation-Based Learning During COVID-19: A Teaching Strategy for Protected Code Blues

In light of the COVID-19 pandemic and uncertainties around risk of transmission, urgent hospital resuscitation (also known as "Code Blue") efforts are needed, pivoting to protect health care workers. This article provides teaching tips for "Protected Code Blues." [J Contin Educ Nurs. 2020;51(9):399-401.].

Nursing students' knowledge, attitude, self-efficacy in blended learning of cardiopulmonary resuscitation: a randomized controlled trial

BACKGROUND

Although various forms of online education are on the rise worldwide, effects of such innovative approach are yet to be validated. This study analyzes whether blended learning cardiopulmonary resuscitation (CPR) education that integrates e-learning and face-to-face education is effective in improving nursing students' knowledge, attitude, and self-efficacy.

METHODS

A randomized controlled design was used. The participants of this study were 120 nursing students randomly assigned to the intervention group (n = 60) or the control (n = 60). The intervention group was trained using a blended learning CPR education program. Self report questionnaires with knoweldge, attitude, and self-efficacy were all used in the pre and post intervention. Differences before and after the education of each group were analyzed with a paired t-test, and the differences between the two groups were analyzed with ANCOVA with knowledge as the covariate.

RESULTS

The findings indicated that the intervention group had significantly higher knowledge scores (intervention: 16.40 ± 1.56, control: 6.46 ± 2, p < .001), and emotional attitude (intervention: 40.85 ± 8.01, control: 36.05 ± 6.87, p = .002) about CPR than the control group, but other outcomes did not differ between groups.

CONCLUSIONS

In this monocentric study, a blended learning CPR program that integrated videos and face to face lecture was found effective in improving nursing students' knowledge and attitudes regarding CPR.

Nursing roles for in-hospital cardiac arrest response: higher versus lower performing hospitals

BACKGROUND

Good outcomes for in-hospital cardiac arrest (IHCA) depend on a skilled resuscitation team, prompt initiation of high-quality cardiopulmonary resuscitation and defibrillation, and organisational structures to support IHCA response. We examined the role of nurses in resuscitation, contrasting higher versus lower performing hospitals in IHCA survival.

METHODS

We conducted a descriptive qualitative study at nine hospitals in the American Heart Association's Get With The Guidelines-Resuscitation registry, purposefully sampling hospitals that varied in geography, academic status, and risk-standardised IHCA survival. We conducted 158 semistructured interviews with nurses, physicians, respiratory therapists, pharmacists, quality improvement staff, and administrators. Qualitative thematic text analysis followed by type-building text analysis identified distinct nursing roles in IHCA care and support for roles.

RESULTS

Nurses played three major roles in IHCA response: bedside first responder, resuscitation team member, and clinical or administrative leader. We found distinctions between higher and lower performing hospitals in support for nurses. Higher performing hospitals emphasised training and competency of nurses at all levels; provided organisational flexibility and responsiveness with nursing roles; and empowered nurses to operate at a higher scope of clinical practice (eg, bedside defibrillation). Higher performing hospitals promoted nurses as leaders-administrators supporting nurses in resuscitation care at the institution, resuscitation team leaders during resuscitation and clinical champions for resuscitation care. Lower performing hospitals had more restrictive nurse roles with less emphasis on systematically identifying improvement needs.

CONCLUSION

Hospitals that excelled in IHCA survival emphasised mentoring and empowering front-line nurses and ensured clinical competency and adequate nursing training for IHCA care. Though not proof of causation, nurses appear to be critical to effective IHCA response, and how to support their role to optimise outcomes warrants further investigation.

Basic life support for the child and infant

The majority of cardiorespiratory arrests in children and infants are caused by respiratory insufficiency rather than cardiac problems; therefore, the order of delivering resuscitation is different to the delivery of basic life support to adults. The Nursing and Midwifery Council has stated that all nurses must be able to provide basic life support. This article will explain the process for recognising the need for, and delivering, basic life support to infants and children.

Consultation before 'do not attempt resuscitation' orders

Richard Griffith, Senior Lecturer in Health Law at Swansea University, set out the steps nurses must take to ensure that a DNACPR notice is lawful.

Basic life support for the adult

Stuart Barker, Graduate Tutor in Adult Nursing, Northumbria University ( stuart.j.barker@northumbria.ac.uk ), discusses assessing the unresponsive patient and performing cardiopulmonary resuscitation as the crucial first steps in the chain of survival.

Logistical, cultural, and structural barriers to immediate neonatal care and neonatal resuscitation in Bihar, India

BACKGROUND

In India, the neonatal mortality rate is nearly double the Sustainable Development Goal target with more than half of neonatal deaths occurring in only four states, one of which is Bihar. Evaluations of immediate neonatal care and neonatal resuscitation skills in Bihar have demonstrated a need for significant improvement. However, barriers to evidence based practices in clinical care remain incompletely characterized.

METHODS

To better understand such barriers, semi-structured interviews were conducted with 18 nurses who participated as mentors in the AMANAT maternal and child health quality improvement project, implemented by CARE India and the Government of Bihar. Nurse-mentors worked in primary health centers throughout Bihar facilitating PRONTO International emergency obstetric and neonatal simulations for nurse-mentees in addition to providing direct supervision of clinical care. Interviews focused on mentors' perceptions of barriers to evidence based practices in immediate neonatal care and neonatal resuscitation faced by mentees employed at Bihar's rural primary health centers. Data was analyzed using the thematic content approach.

RESULTS

Mentors identified numerous interacting logistical, cultural, and structural barriers to care. Logistical barriers included poor facility layout, supply issues, human resource shortages, and problems with the local referral system. Cultural barriers included norms such as male infant preference, traditional clinical practices, hierarchy in the labor room, and interpersonal relations amongst staff as well as with patients' relatives. Poverty was described as an overarching structural barrier.

CONCLUSION

Interacting logistical, cultural and structural barriers affect all aspects of immediate neonatal care and resuscitation in Bihar. These barriers must be addressed in any intervention focused on improving providers' clinical skills. Strategic local partnerships are vital to addressing such barriers and to contextualizing skills-based trainings developed in Western contexts to achieve the desired impact of reducing neonatal mortality.

[Evolution of the nurse's role in the management of a cardiac arrest]

In France, there are 40 000 sudden deaths each year and the cardiac arrest survival rate is less than 10%. The arrival of extracorporeal cardio pulmonary resuscitation (ECPR) offers hope in the event of refractory cardiac arrest in prehospital care. Extending ECPR programmes requires more scientific evidence, training and an evolution of the role of paramedics.

Management of 'Do Not Attempt Cardiopulmonary Resuscitation' (DNACPR) decisions in the perioperative period

It is increasingly common for patients to be scheduled for anaesthesia and surgery with a 'Do Not Attempt Cardiopulmonary Resuscitation' (DNACPR) decision in place. Updated guidelines for the implementation and management of DNACPR decisions were published jointly by the British Medical Association (BMA), the Resuscitation Council (UK) and the Royal College of Nursing (RCN) in 2014 (BMA, RC(UK), RCN 2014). The Association of Anaesthetists of Great Britain and Ireland (AAGBI) published specific guidelines in 2009 to guide the perioperative management of such patients (AAGBI 2009). In this article, we explain these guidelines with a focus on how DNACPR decisions are made and how they can be modified in order to permit appropriate surgery to take place.

Coming to a theatre near you soon a witnessed CPR event'

A current review of the last thirty years is indicative of improvement in outcome across surgical specialities with the implementation of safer working practices and initiatives in enhanced recovery, preparing patients to be 'fit' for surgery. The focus of training for nurses and operating department practitioners lies with assuring technical competence and the drive is to establish best practice based on evidence. Once qualified, training for professionals within the perioperative environment is developed to enable participation in areas of anaesthesia, surgery and recovery roles. Advanced, intermediate and basic life support as well as advanced scrub practitioner courses are available, further aspects for patient safety have been implemented and pathways developed.

Assessment of nursing staff's theoretical knowledge of cardiovascular resuscitation in an NHS public hospital

INTRODUCTION

The effective provision of cardiopulmonary resuscitation (CPR) increases patient survival and reduces in-hospital mortality. Nursing staff, as front-line healthcare professionals, are often the first present at cardiovascular arrests and respond by providing CPR. Their training has an impact on the efficiency of CPR and consequently on health outcomes; thus, assessment of their status in that respect may provide useful information for decision making.

METHODS

A cross-sectional study was undertaken in an NHS hospital in Greece to assess the theoretical knowledge of nurses and assistant nurses in relation to CPR. The study population surveyed consisted of nurses and assistant nurses of a specific public hospital.

RESULTS

The study revealed that nursing staff had poor theoretical knowledge, with a mean score for correct answers in the written test of 50.6 ± 25.9% and a mean 4.1 ± 2 correct answers. Fifty-three percent of participants reported taking part in a refresher course after attending a first course, while only 13.2% had participated in a relevant training program during the last 6 months prior to the study. Registered nurses who possessed a university (p=0.016) or a technological institution (p<0.001) diploma, achieved 36.1% and 20.9% higher mean scores, respectively, in the written test in comparison to assistant nurses. The vast majority (91.9%) of the participants expressed their willingness to participate in CPR training courses.

CONCLUSIONS

It is crucial for nursing staff to participate in CPR courses in order to refresh and update their theoretical knowledge and performance skills and consequently to improve the safety and effectiveness of care.

From door to recovery: a collaborative approach to the development of a post-cardiac arrest center

Out-of-hospital cardiac arrest remains common and, despite advances in resuscitation practices, continues to carry a high mortality that may be influenced by several factors, including where a patient is cared for after the cardiac arrest. Implementing a post-cardiac arrest care guideline for survivors of out-of-hospital and in-hospital cardiac arrest involves a multidisciplinary approach with short-term and long-term strategies. Physician and nursing leaders must work in synergy to guide the implementation of an evidence-based plan of care. A collaborative approach was used at a hospital to develop processes, build consensus for protocols, and provide support to staff and teams. A joint approach has allowed the hospital to move from traditional silos of individual departmental care to a continuum of patient-focused management after cardiac arrest. This care coordination is initiated in the emergency department and follows the patient through to discharge.

Parental presence during cardiopulmonary resuscitation of children: the experience, opinions and moral positions of emergency teams in France

OBJECTIVE

To evaluate the experience, opinions and moral positions of French emergency physicians (EP) who had taken a paediatric university course on parental presence during child cardiopulmonary resuscitation (CPR), and to compare it with the responses of nurses on their teams.

METHODS

A questionnaire was sent to 550 EPs who had taken the course during the previous 6 years; the EPs were also asked to give a copy of the questionnaire to nurses on their staff. Data were collected on experience of parental presence during child CPR, opinions on the practice, arguments for and against parental presence, and the moral positions of respondents regarding their perception of life and the sharing of medical/parental power in the decision-making process.

RESULTS

343 responses were analysed, 47% from EPs (29% response rate) and 53% from nurses. 52% of respondents had experienced parental presence during child CPR, but it had been the physician's wish on only 6% of these occasions. Only 17% of respondents favoured parental presence, with EPs (27%) being favourable more often than nurses (12%). The reasons against parental presence were psychological trauma for the parents, risk of interference with medical management, and care team stress. Respondents not in favour of parental presence expressed this view more for medical reasons than for parent-related reasons. The physicians not in favour of parental presence espoused a moral position predicated on medical power.

CONCLUSIONS

A majority of EPs and nurses were reluctant to have parents present during child CPR. Their attitude involved medical paternalism.

Family presence at resuscitation attempts

UK resuscitation guidelines suggest that parents and carers should be allowed to be present during a resuscitation attempt in hospital but no guidance is available regarding family presence when resuscitation takes place out of hospital. A new research study has suggested that relatives who were offered the opportunity to witness resuscitation were less likely to develop symptoms of post-traumatic stress disorder than those who were not given the chance. This article summarises the results of this study and provides an expert commentary on its conclusions.

The effects of simulation-based resuscitation training on nurses' self-efficacy and satisfaction

BACKGROUND

Nurses are often the first responders in clinical emergencies that require effective training to ensure high-quality resuscitation and patient safety. The aim of the study was to evaluate the efficacy of simulation-based resuscitation training by assessing two different training modalities (computer-based simulation versus mannequin-based simulation) with practicing nurses.

METHOD

The study used a comparative study design with random assignment to two simulation-based training modalities. A total of 38 nurses participated in the study: 18 nurses with computer-based simulation, and 20 nurses with mannequin-based simulation. Participants rated their self-efficacy and satisfaction after participating in a simulated scenario involving managing a cardiac arrest patient.

RESULTS

On a 10-point scale, the participants' overall self-efficacy rating was 6.50 (SD=1.66), and satisfaction rating was 7.53 (SD=1.20) for both groups. There were no significant differences between the groups. The computer-based simulation group had significant higher satisfaction ratings in 'Setting priorities for nursing intervention' and 'Implementing nursing skills as protocol' compared to the mannequin-based simulation group. Most nurses felt the simulation experience was useful for future performance in their workplace, but rated realism of simulation as unsatisfactory.

CONCLUSION

The introduction of simulation-based resuscitation training as an active-learning format was positively embraced by nurses. Computer-based simulation might be beneficial for acquiring nursing skills and decision making skills in resuscitation. Further study is needed to verify the effects of simulation-based resuscitation training with more rigorous outcomes.

Web-based video and feedback in the teaching of cardiopulmonary resuscitation

Knowledge and skills relating to cardiopulmonary resuscitation tend to be lost over time. The combination of simulation sessions with online video records and online feedback allows for an enduring record of skills sessions to assist students in retaining and revising their learning. This paper reports a qualitative evaluation of such a combination used in inter-disciplinary sessions for volunteer nursing and medical students. Methods included focus groups and free text questionnaires; data were gathered from fourteen students and three teachers. Students had used the online material in a variety of personal ways, and found that the addition to their learning was significant. Their memories of the simulation sessions and of the feedback received immediately afterwards were incomplete, and repeated viewing enabled them to identify good and poor practice with more confidence, and to reflect more carefully on their own and others' practice. Teachers found it easier to give more detailed feedback when given the chance to watch the video than immediately after the session. All felt that the sessions would ideally be embedded in the curriculum.

Tracheostomy in infants: parent education for home care

Children with tracheostomies are increasingly discharged home for continued care by their parents. Nurses are responsible for providing these parents with the extensive education required for a smooth and successful transition to home care. This article is intended to help neonatal and pediatric nurses to effectively prepare the parents of an infant with a tracheostomy to provide safe, quality care to their child after being discharged from an acute care setting to their home. This article discusses the knowledge, attitudes, and skills the parents are required to acquire prior to the infant's discharge. Home ventilation, airway management, suctioning, tracheostomy care, emergency management, safe home environment, equipment for continuous or intermittent ventilation, and supplies necessary for care are some of the topics discussed.

[The family's place in intensive care departments]

The presence of the family in an intensive care department calls for collaboration between the nursing team and the patient's family. The nurse's role is important. She must use all her nursing skills to act as an effective intermediary between the family and the doctor, to ensure in particular that everyone can understand the information being conveyed.

Immersive virtual reality simulations in nursing education

This article explores immersive virtual reality as a potential educational strategy for nursing education and describes an immersive learning experience now being developed for nurses. This pioneering project is a virtual reality application targeting speed and accuracy of nurse response in emergency situations requiring cardiopulmonary resuscitation. Other potential uses and implications for the development of virtual reality learning programs are discussed.

[Nursing education for the management of cardiocirculatory emergency in a hospital environment]

The aim of the study is to evaluate how nurses are trained to deal with in-hospital emergencies . Cardiocirculatory arrest represents the epitome of extreme emergency since lack of perfusion to vital organs can cause death in a few minutes and immediate life-saving measures are necessary. Hence, all health workers , and nurses in particular , must be specifically trained. The study was performed in a central Italian hospital to assess the level of knowledge regarding these techniques, the relative equipment and their practical application.

An exploration of student nurses' thoughts and experiences of using a video-recording to assess their performance of cardiopulmonary resuscitation (CPR) during a mock objective structured clinical examination (OSCE)

Cardiopulmonary resuscitation (CPR) is an essential skill taught within undergraduate nursing programmes. At the author's institution, students must pass the CPR objective structured clinical examination (OSCE) before progressing to second year. However, some students have difficulties developing competence in CPR and evidence suggests that resuscitation skills may only be retained for several months. This has implications for practice as nurses are required to be competent in CPR. Therefore, further opportunities for students to develop these skills are necessary. An action research project was conducted with six students who were assessed by an examiner at a video-recorded mock OSCE. Students self-assessed their skills using the video and a checklist. Semi-structured interviews were conducted to compare checklist scores, and explore students' thoughts and experiences of the OSCE. The findings indicate that students may need to repeat this exercise by comparing their previous and current performances to develop both their self-assessment and CPR skills. Although there were some differences between the examiner's and student's checklist scores, all students reported the benefits of participating in this project, e.g. discussion and identification of knowledge and skills deficits, thus emphasising the benefits of formative assessments to prepare students for summative assessments and ultimately clinical practice.

Training nurses for CPR: support for the problem-based approach

AIM

To assess whether problem-based learning (PBL) is more effective over conventional teaching methods by comparing final resuscitation exam results of nursing students who received cardiopulmonary resuscitation (CPR) training either by traditional or by a PBL approach.

METHODS

A retrospective and comparative research design was implemented. Data on final CPR exam grades, collected both from PBL and traditionally trained students, were obtained for a total of 1775 students between 2000 and 2007 in three major schools of health sciences in Hungary. Comparison between PBL and traditional teaching methods as well as across schools was made.

RESULTS

t-tests on means yielded significant differences (t=3.569; p<0.001) between PBL and conventional training favoring PBL instructed students. Students who received PBL training had better final CPR exam grades than traditionally trained peers. The only significant difference among schools was found for PBL training. There was no difference across schools in final CPR grades when traditional training was concerned.

CONCLUSION

PBL was a superior instruction method for CPR training. Students who attended PBL classes achieved greater theoretical knowledge and demonstrated better resuscitation skills when tested. Whether or not PBL is superior in real-life application of CPR practice is yet to be confirmed.

Parental presence in pediatric trauma resuscitation: one hospital's experience

Although parental presence during medical resuscitation of children has been a common practice for years, the same opportunity has rarely been available for families in pediatric trauma resuscitation. Blank Children's Hospital is an exception; for three years, the hospital has had a successful program for family presence in pediatric trauma resuscitation. Beginning with the efforts of one nurse, a task force was established that developed guidelines for this practice in conjunction with nursing and allied health staff, as well as trauma surgeons. Chaplains were approached and then trained to serve as family support persons during trauma resuscitation. Families have been receptive to and pleased with the opportunity to be present during trauma resuscitation of their children.

Code blue: what to do?

Cardiac arrest may occur intraoperatively at any time. The purpose of this article is to help the reader recognize and assist in the management of an intraoperative cardiac arrest. Patients who are at risk for cardiac arrest in the OR are identified and different types of pulseless arrythmias are identified. Roles of perioperative personnel are suggested and documentation during the code is discussed.