Impact of Bedside Laparotomy Simulation and Microlearning on Trauma Nurse Role Clarity, Knowledge, and Confidence

BACKGROUND

The care of patients undergoing low-volume, high-risk emergency procedures such as bedside laparotomy (BSL) remains a challenge for surgical trauma critical care nurses.

OBJECTIVES

This study evaluates simulation and microlearning on trauma nurse role ambiguity, knowledge, and confidence in caring for patients during emergency BSL.

METHODS

The study is a single-center, prospective pretest-posttest design conducted from September to November 2022 at a Level I trauma center in the Mid-Atlantic United States using simulation and microlearning to evaluate role clarity, knowledge, and confidence among surgical trauma intensive care unit (STICU) nurses. Participants, nurses from a voluntary convenience sample within a STICU, attended a simulation and received three weekly microlearning modules. Instruments measuring role ambiguity, knowledge, and confidence were administered before the simulation, after, and again at 30 days.

RESULTS

From the pretest to the initial posttest, the median (interquartile range [IQR]) Role Ambiguity scores increased by 1.0 (1.13) (p < .001), and at the 30-day posttest, improved by 1.33 (1.5) (p < .001). The median (IQR) knowledge scores at initial posttest improved by 4.0 (2.0) (p < .001) and at the 30-day posttest improved by 3.0 (1.75) (p< .001). The median (IQR) confidence scores at initial posttest increased by 0.08 (0.33) (p = .009) and at the 30-day posttest improved by 0.33 (0.54) (p = .01).

CONCLUSIONS

We found that simulation and microlearning improved trauma nurse role clarity, knowledge, and confidence in caring for patients undergoing emergency BSL.

Nurse Upskilling During Crisis: Collaborating for Continuing Education

BACKGROUND

As rates of coronavirus disease 2019 (COVID-19) reached pandemic levels in early 2020, the need for intensive care unit (ICU) nurses with mechanical ventilator knowledge increased. In response to the pandemic, hospital systems with limited resources reported moving ICU nurse educators to direct patient care roles and reassigning non-ICU nurses to work in the ICU. With fewer resources to educate non-ICU nurses and many newly assigned nurses reporting feeling unprepared for work in the ICU, the need for an accessible and scalable introduction to ICU nursing became clear.

METHOD

Our team responded by creating a free, online, self-paced, asynchronous course introducing the ICU nursing setting.

RESULTS

More than 4,000 learners worldwide have enrolled in the course, with 94% of survey respondents expecting the course to positively impact their institution.

CONCLUSION

Our project shows an approach to effective collaboration among clinical partners, instructional designers, and nursing experts to address critical needs in continuing education in nursing. [J Contin Educ Nurs. 2024;55(5):257-260.].

Time Is Survival: Continuing Education on Sepsis for Neurosurgical Critical Care Nurses

BACKGROUND

Early identification of sepsis among neurosurgical critical care patients is a significant challenge because of the many possible confounding variables that lead to altered mental status in this specific patient population. Nurses' knowledge, attitudes, confidence, and practices related to the early identification and management of sepsis are crucial to patients' survival.

METHOD

This evidence-based intervention project implemented continuing education for neurosurgical critical care nurses on the early signs and symptoms of sepsis and the management of sepsis according to the Surviving Sepsis Campaign (SSC) Guidelines.

RESULTS

Continuing education on sepsis increased neurosurgical critical care nurses' knowledge of the SSC 1-hour sepsis bundle, reported confidence in the management of sepsis, and likelihood of assessing for sepsis.

CONCLUSION

Continuing education for neurosurgical critical care nurses on the signs and symptoms of sepsis and the SSC Guidelines is necessary and may improve patient outcomes. [J Contin Educ Nurs. 2024;55(5):224-230.].

Asynchronous training for ultrasound-guided peripheral IV placement among critical care nurses

OBJECTIVE

Teaching ultrasound (US) guidance for placement of peripheral intravenous (PIV) catheters requires significant time for synchronous didactic and hands-on training. The investigators assessed the feasibility of an asynchronous model for critical care nurses to learn the novel skill of US-guided PIV placement. Secondary outcomes included the percentage of successful attempts and number of sticks per attempt for anatomy versus US-guided approaches.

METHODS

The investigators built a self-contained training cart for learners to practice and record their performance. Training occurred asynchronously. The learners recorded data from PIV attempts. Participants completed pre- and post-training surveys. Data from this prospective observational cohort was analyzed for descriptive and comparative statistics, using Kirkpatrick's Model for evaluation of this educational intervention.

RESULTS

During a 6 month period, 21 nurses completed the asynchronous training, with eight recording their PIV placements. 81.0% of the training occurred outside of a Monday to Friday 9AM-5PM period. There were 64 attempts by anatomy approach and 84 with US-guidance. The anatomic approach was successful in 35.9% of attempts with a mean of 1.5 sticks (SD 1.0, Range 1-5). The US-guided approach had a statistically significant greater rate of success (77.4%; p < 0.001) with a mean of 1.2 sticks (SD 1.2, range 1-2, p < 0.01). Participants reported increased confidence in US-guided PIV placement and enjoyment with this method of learning.

CONCLUSIONS

Asynchronous learning model with cart-based instruction and practice is a feasible means for nurses to learn US-guided PIV placement. Significant outcomes were seen across Kirkpatrick levels I-IV for educational outcome assessment.

The effect of resilience training with mHealth application based on micro-learning method on the stress and anxiety of nurses working in intensive care units: a randomized controlled trial

INTRODUCTION

Nurses in intensive care units (ICUs) face high stress and anxiety, impacting their well-being and productivity. Addressing this, this study evaluated the impact of resilience training via a mHealth application based on micro-learning on ICU nurses' stress and anxiety levels.

MATERIALS AND METHODS

This study, a single-blind randomized controlled trial conducted in 2022-23, involved sixty ICU nurses from two Tehran hospitals. Nurses were chosen through purposive sampling and divided into intervention and control groups by simple randomization. The intervention group was taught resilience via an educational mHealth application based on micro-learning, with data collected using the anxiety and stress subscales of DASS-21.

RESULTS

Before the intervention, there were no significant differences in stress and anxiety scores between the intervention and control groups (P > 0.05). Upon utilizing the mHealth application, the intervention group exhibited significant reductions in stress, from 10.77 ± 3.33 to 9.00 ± 1.66 (P = 0.001), and in anxiety, from 9.43 ± 3.35 to 7.93 ± 0.98 (P < 0.001). In contrast, the control group experienced a slight increase in stress levels, from 10.10 ± 2.19 to 10.73 ± 2.15 (P = 0.002), and in anxiety levels, from 9.10 ± 1.63 to 10.23 ± 1.65 (P < 0.0001).

CONCLUSIONS

The micro-learning-based mHealth application for resilience training significantly reduced ICU nurses' stress and anxiety, recommending its adoption as an innovative educational method.

TRIAL REGISTRATION

The study has been registered in the Iranian Registry of Clinical Trials (No. IRCT20221225056916N1, Date: 04/29/2023).

Learning in intensive care during the COVID-19 pandemic postgraduate critical care nursing students' experiences

OBJECTIVES

This study explored postgraduate critical care nursing students' experiences of learning in the ICU during the COVID-19 pandemic and to understand these experiences in relation to self-directed learning and professional development.

METHODS

An explorative qualitative design was used. Eight postgraduate critical care nursing students from two different universities were interviewed. Questions focused on learning, supervision, ethically difficult situations, issues regarding communication, as well as the impact of the pandemic on students' health. Interviews thematically analyzed, and further analyzed using a theoretical framework focusing self-directed learning and professional development containing the concepts of autonomy, authenticity, and attachment.

RESULTS

The result consists of three themes: 1) Attachment with subthemes Attachment to the patient, Attachment to family and friends, Attachment to the ICU-context, and Attachment to the clinical supervisor.  2) Authenticity with subthemes Experiencing a varying degree of authenticity, Clinical reasoning about how to prioritize care. 3) Autonomy with subthemes Being just a student - with limited responsibility, taking responsibility, and having worries regarding one's professional development. Conclusion: Findings show the need for participation in the ICU community of practice without the demands and responsibility of full participation. Students need to be given the opportunity to form a relationship with practice. For attachment, participation, and consequently professional development to take place, there is need for inviting students to be a part of the team even during such straining circumstances as an ongoing pandemic. These findings can advance the understanding of how to organize clinical education during future crisis such as a new pandemic.

Just-in-Time Orientation of Non-Critical Care Nurses to the Critical Care Environment

During the COVID-19 pandemic, non-critical care nurses assisted in the provision of care to critically ill patients. Just-in-time education was needed for these nurses to effectively assist in the care of these patients. A 12-hour educational program was offered to non-critical care nurses. During this multi-modal program, instructors delivered information to participants through unique didactic classroom learning, simulation engagement, and hands-on experience in a critical care unit. After completing this innovative program, participants demonstrated a significant improvement in knowledge, confidence, and perception of competence in caring for critically ill patients. Participants were highly satisfied with the program. Implementation of a just-in-time, multi-modal critical care nursing program is an effective method of providing non-critical care nurses with basic levels of skills, knowledge, and competency during a crisis to enable them to assist with providing care to critically ill patients. [J Contin Educ Nurs. 2022;53(10):465-472.].

Establishment of a high-dependency unit in Malawi

Adults admitted to hospital with critical illness are vulnerable and at high risk of morbidity and mortality, especially in sub-Saharan African settings where resources are severely limited. As life expectancy increases, patient demographics and healthcare needs are increasingly complex and require integrated approaches. Patient outcomes could be improved by increased critical care provision that standardises healthcare delivery, provides specialist staff and enhanced patient monitoring and facilitates some treatment modalities for organ support. In Malawi, we established a new high-dependency unit within Queen Elizabeth Central Hospital, a tertiary referral centre serving the country's Southern region. This unit was designed in partnership with managers, clinicians, nurses and patients to address their needs. In this practice piece, we describe a participatory approach to design and implement a sustainable high-dependency unit for a low-income sub-Saharan African setting. This included: prospective agreement on remit, alignment with existing services, refurbishment of a dedicated physical space, recruitment and training of specialist nurses, development of context-sensitive clinical standard operating procedures, purchase of appropriate and durable equipment and creation of digital clinical information systems. As the global COVID-19 pandemic unfolded, we accelerated unit opening in anticipation of increased clinical requirement and describe how the high-dependency unit responded to this demand.

Systems Thinking for Managing COVID-19 in Health Care Systems: Seven Key Messages

This article provides the most current guidelines for nurse educators and nurses to use systems thinking to manage COVID-19 in health systems. A working definition of systems thinking is offered, with a review of basic knowledge and care in the context of the system awareness model (SAM). Seven key messages assist nurse educators and nurses in the management of COVID-19 patients culminating in leadership of complex health care systems using systems thinking. [J Contin Educ Nurs. 2020;51(9):402-411.].

An Educational Intervention Incorporating Digital Storytelling to Implement Family Nursing Practice in Acute Care Settings

This project describes implementation of an educational intervention designed to initiate practice changes that support families and nurses during acute illness. An academic-practice partnership and digital storytelling methodology provided a foundation. A quasi-experimental research design included quantitative and qualitative measurement before and after the educational intervention. Themes identified in digital stories of nurse experiences caring for families provided direction for the educational intervention including the digital stories, empirical evidence, and proposed changes in nursing practice focused on families. Nurse participants (n = 160) in the educational intervention reported positive responses on a qualitative questionnaire. Comparing pretest and posttest results of the Family Nurse Practice Scale reflected positive, though not significant change. Family members (n = 49) reported significantly improved perceptions of support on 7 of the 14 items on the Iceland Perceived Family Support Questionnaire. This project highlighted digital storytelling's power to promote family interventions and move family nursing knowledge into practice.

Reducing Digital Storytelling Implementation Barriers in Nursing Education Workshops

Digital stories have the potential to transform health care systems by cultivating understanding and compassion; however, limited research explores the use of this innovative strategy in continuing education. This article describes how a collaborative partnership of an Academic Team and Translational Partners (n = 15) implemented a four-phase study that included a continuing education workshop with digital stories as the central strategy. The study's guiding questions focused on adapting approaches to creating digital stories to reduce logistic concerns and overcome implementation challenges yet empower nurses in their practice with families. Numerical and narrative responses from workshop participant evaluations (n = 160) affirmed storytelling as the most valuable component, and reflection increased understandings to influence their thinking and actions. This study affirms using digital stories as an implementation strategy in health care systems has the potential to transform nursing education, supports the transfer of family nursing practice knowledge, encourages reflection, and develops empathy for families and nurse peers. [J Contin Educ Nurs. 2019;50(9):411-416.].

Impact of a work-based feedback intervention on student performance during clinical placements in acute-care healthcare settings: a quasi-experimental protocol for the REMARK programme

INTRODUCTION

Current perspectives present feedback as a dynamic, dialogic process. It is widely accepted that feedback can have an impact on workplace performance, however, how dialogic feedback is enacted with the learner in authentic healthcare settings is less apparent. This paper seeks to describe the design and development of an implementation study to promote the learner voice in the feedback process and improve feedback encounters between learners and learning partners in healthcare settings.

METHODS AND ANALYSIS

A quasi-experimental study design will be used to evaluate whether implementation of a work-based intervention to improve feedback impacts student performance during clinical placements in healthcare settings. Student performance will be measured at three time points: baseline (pre), mid-placement (post-test 1) and end-placement (post-test 2) in keeping with standard assessment processes of the participating university. The intervention is underpinned by Normalisation Process Theory and involves a layered design that targets learners and learning partners using best-practice education strategies. Data regarding participants' engagement with feedback during clinical placements and participants' level of adoption of the intervention will be collected at the completion of the clinical placement period.

ETHICS AND DISSEMINATION

This study has ethics approval from both Griffith University and Metro South Health Human Research and Ethics committees. Dissemination of results will be local, national and international through forums, seminars, conferences and publications.

Using Simulation to Evaluate Clinical Performance and Reasoning in Adult-Geriatric Acute Care Nurse Practitioner Students

BACKGROUND

The use of simulation-based learning experiences (SBLE) with nurse practitioner (NP) students is largely unexplored. The purpose of this pilot project was to develop, implement, and evaluate a simulated patient (SP)-SBLE to improve confidence and evaluate clinical performance and reasoning in Adult-Geriatric Acute Care NP (AG-ACNP) students.

METHOD

A mixed-methods design was used to evaluate an SP-SBLE on AG-ACNP student clinical performance and reasoning.

RESULTS

Self-confidence scores and themes from reflections indicated that students perceived this as a valuable experience that enhanced learning and confidence.

CONCLUSION

Results supported the use of SP-SBLEs to improve confidence in clinical performance and reasoning with AG-ACNP students. [J Nurs Educ. 2019;58(10):599-603.].

The Critical Care Nurse Communicator Program: An Integrated Primary Palliative Care Intervention

Twenty percent of Americans die in an intensive care unit (ICU), often incapacitated or requiring assisted decision making. Surrogates are often required to make urgent, complex, high-stakes decisions. Communication among patients, families, and clinicians is often delayed and inefficient with frequent missed opportunities to support the emotional and psychological needs of surrogates, particularly at the end of life. The Critical Care Nurse Communicator program is a nurse-led, primary palliative care intervention designed to improve the quality and consistency of communication in the ICU and address the informational, psychological, and emotional needs of surrogate decision-makers through the shared decision-making process.

Nurses' Perceptions and Practices Related to Alarm Management: A Quality Improvement Initiative

BACKGROUND

The purpose of this quality improvement project was to develop, implement, and assess the effects of an alarm management policy and educational program on nurses' perceptions and practices of alarm management in an acute care hospital.

METHOD

Nurses from an acute care hospital in the southeastern United States attended a mandatory alarm management education program. The hospital implemented the evidence-based alarm management education to achieve the NPSG.06.01.01: Alarm Management. Pre- and posttests were administered to evaluate the education and the changes in nurses' perceptions and practices of clinical alarms.

RESULTS

A total of 417 nurses received the educational intervention. All participants completed the pretest, and 215 (51%) completed the voluntary posttest. Significant improvements were made in alarm perceptions and practices. Nurses suggested unit-specific alarm education, improved staffing, and updated equipment.

CONCLUSION

Findings support the benefits of continued education in alarm management for nurses. Bedside nurses are a critical member of a multidisciplinary alarm management team because they are at the forefront of patient safety and most at risk for experiencing alarm fatigue. J Contin Educ Nurs. 2018;49(5):207-215.

Implementing a Nurse-Driven Protocol to Reduce Catheter-Associated Urinary Tract Infections in a Long-Term Acute Care Hospital

BACKGROUND

Catheter-associated urinary tract infections (CAUTIs) are the second most common health care-associated infection. CAUTIs represent a serious threat to chronic critically ill patients in long-term acute care hospitals (LTACHs). Evidence-based guidelines have been shown to reduce the risk of infection in acute care settings but are not well documented in LTACHs.

METHOD

An evidence-based urinary catheter protocol was developed and implemented across three units in a large LTACH. RNs were oriented to the new protocol through online educational modules. During the evaluation period, 120 patients were admitted with a urinary catheter who qualified for chart review for CAUTI incidence. Overall catheter-days and CAUTI rates were compared, and changes in practice were noted.

RESULTS

After the education intervention, overall urinary catheter-days decreased by 10.1%, and CAUTI incidence decreased by 74% (4.82 CAUTI per 1,000 patient-days to 1.24). The absolute risk reduction was 3.58 infections per 1,000 catheter-days. The findings were statistically significant (z = 1.00, p < .03).

CONCLUSION

Significant reductions were noted in total catheter-days, and CAUTI rates improved after implementation of an education program and an evidence-based urinary catheter protocol in an LTACH. J Contin Educ Nurs. 2018;49(8):372-377.

Outcomes of a Critical Care Hospital-Based Fellowship for Senior Nursing Students

BACKGROUND

A partnership between four academic sites and one practice site was created to address a gap in baccalaureate nursing education resulting from the lack of pediatric and critical clinical experience. Four schools of nursing (SONs) were invited to recruit senior-level nursing students to participate in a critical care fellowship opportunity during their senior synthesis courses.

METHOD

In a mixed-method evaluation, data were collected through three questionnaires.

RESULTS

The findings indicated that the students increased their knowledge and ability in caring for critical pediatric patients. The difference in clinical hours by the SONs did not reveal significant mean differences across measures of self-efficacy, clinical knowledge, or clinical confidence.

CONCLUSION

The critical care hospital-based fellowship can be used as a partnership between a hospital and SONs to expose prelicensure students to clinical experiences and education related to pediatric critical care to decrease nursing shortages in these specialty areas. [J Nurs Educ. 2018;57(8):469-475.].

Empowering Nurses to Lead Interprofessional Collaborative Practice Environments Through a Nurse Leadership Institute

A year-long Nurse Leadership Institute (NLI) for emerging leaders in primary care clinics and acute care environments was developed, implemented, and evaluated. The NLI's goal was to foster empowerment in interprofessional collaborative practice environments for nurses in the three cohorts of NLIs. The NLI was framed around the Five Leadership Practices of modeling the way, inspiring a shared vision, challenging the process, enabling others to act, and encouraging the heart. To create a professional learning environment, foster community, and enhance leadership skills, the Lean In Circle materials developed by Sandberg were adapted for content reorganization and discussion. Minimal literature exists specifically addressing nursing leadership professionals' development based on Sandberg's Circle materials. The findings of the three NLI cohorts reported in this article begin to fill this existing knowledge gap. Participants reported a significant increase in leadership skills. Recommendations for refinement of future NLI offerings are provided. J Contin Educ Nurs. 2018;49(2):61-71.

Providing psychological support to people in intensive care: development and feasibility study of a nurse-led intervention to prevent acute stress and long-term morbidity

OBJECTIVES

Adverse psychological outcomes, following stressful experiences in critical care, affect up to 50% of patients. We aimed to develop and test the feasibility of a psychological intervention to reduce acute stress and prevent future morbidity.

DESIGN

A mixed-methods intervention development study, using two stages of the UK Medical Research Council framework for developing and testing complex interventions. Stage one (development) involved identifying an evidence base for the intervention, developing a theoretical understanding of likely processes of change and modelling change processes and outcomes. Stage two comprised two linked feasibility studies.

SETTING

Four UK general adult critical care units.

PARTICIPANTS

Stage one: former and current patients, and psychology, nursing and education experts. Stage two: current patients and staff.

OUTCOMES

Feasibility and acceptability to staff and patients of content and delivery of a psychological intervention, assessed using quantitative and qualitative data. Estimated recruitment and retention rates for a clinical trial.

RESULTS

Building on prior work, we standardised the preventative, nurse-led Provision Of Psychological support to People in Intensive Care (POPPI) intervention. We devised courses and materials to train staff to create a therapeutic environment, to identify patients with acute stress and to deliver three stress support sessions and a relaxation and recovery programme to them. 127 awake, orientated patients took part in an intervention feasibility study in two hospitals. Patient and staff data indicated the complex intervention was feasible and acceptable. Feedback was used to refine the intervention. 86 different patients entered a separate trial procedures study in two other hospitals, of which 66 (80% of surviving patients) completed questionnaires on post-traumatic stress, depression and health 5 months after recruitment.

CONCLUSION

The 'POPPI' psychological intervention to reduce acute patient stress in critical care and prevent future psychological morbidity was feasible and acceptable. It was refined for evaluation in a cluster randomised clinical trial.

TRIAL REGISTRATION NUMBER

ISRCTN61088114; Results.

The effect of nurse empowerment educational program on patient safety culture: a randomized controlled trial

BACKGROUND

The complexity of patients' condition and treatment processes in intensive care units (ICUs) predisposes patients to more hazardous events. Effective patient safety culture is related to lowering the rate of patients' complications and fewer adverse events. The present study aimed to determine the effect of empowering nurses and supervisors through an educational program on patient safety culture in adult ICUs.

METHODS

A randomized controlled trial was conducted during April-September 2015 in 6 adult ICUs at Namazi Hospital, Shiraz, Iran. A total of 60 nurses and 20 supervisors were selected through proportional stratified sampling and census, respectively, and randomly assigned to the experimental and control groups. The intervention consisted of a two-day workshop, hanging posters, and distributing pamphlets that covered topics such as patient safety, patient safety culture, speak up about safety issues, and the skills of Team Strategies and Tools to Enhance Performance and Patient Safety. Data were collected through a hospital survey on patient safety culture. Eventually, 61 participants completed the study. Data were analyzed using descriptive statistics, independent-samples t-test, paired-samples t-test, and Chi-square test. P < 0.05 was considered statistically significant.

RESULTS

In the experimental group, the total post-test mean scores of the patient safety culture (3.46 ± 0.26) was significantly higher than that of the control group (2.84 ± 0.37, P < 0.001). It was also higher than that of the pre-test (2.91 ± 0.4, P < 0.001). Additionally, significant improvements were observed in 5 out of 12 dimensions in the experimental group. However, dimensions such as non-punitive response to errors and the events reported did not improve significantly.

CONCLUSION

Empowering nurses and supervisors could improve the overall patient safety culture. Nonetheless, additional actions are required to improve areas such as reporting the events and non-punitive response to errors.

TRIAL REGISTRATION

IRCT2015053122494N1 . Date registered: March 2, 2016.

Impact of a critical care postgraduate certificate course on nurses' self-reported competence and confidence: A quasi-experimental study

BACKGROUND

Postgraduate education is said to support the development of nurses' professional competence and confidence, essential to the delivery of safe and effective care. However, there is a shortness of empirical evidence to demonstrate an increase to nurses' self-reported confidence and competence on completion of critical care postgraduate certificate-level education.

OBJECTIVES

To explore the impact of a critical care postgraduate certificate course on nurses' self-reported competence and confidence. To explore the psychometric properties and performance of the Critical Care Competence and Confidence Questionnaire.

DESIGN

A quasi-experimental pre/post-test design.

PARTICIPANTS

A total population sample of nurses completing a critical care postgraduate certificate course at an Australian University.

METHODS

The Critical Care Competence and Confidence Questionnaire was developed for this study to measure nurses' self-reported competence and confidence at baseline and follow up. Descriptive and inferential statistics were used to explore sample characteristics and changes between baseline and follow-up. Reliability of the questionnaire was explored using Cronbach's Alpha and item-total correlations.

RESULTS

There was a statistically significant increase in competence and confidence between baseline and follow-up across all questionnaire domains. Satisfactory reliability estimates were found for the questionnaire.

CONCLUSIONS

Completion of a critical care postgraduate certificate course significantly increased nurses' perceived competence and confidence. The Critical Care Competence and Confidence Questionnaire was found to be psychometrically sound for measuring nurses' self-reported competence and confidence.

Creation and Efficacy of a Cadaver-Based Prosection Anatomical Course for Critical Care Advanced Practice Providers

OBJECTIVE

Intensive care units (ICUs) increasingly rely on advanced practice providers (APPs) to care for critically ill patients. Our institutional APPs perceived functional anatomical knowledge deficits. To meet this need, a cadaver-based prosection course was developed. The purpose of our study was to describe and evaluate the learner-perceived course efficacy.

DESIGN

A precourse survey collected participant demographics. Precourse and postcourse surveys assessed perceived confidence in 13 anatomical areas. The postcourse survey also evaluated preparedness to perform ICU procedures and to care for postoperative patients, and additionally, gauged participant satisfaction and opinions. Summary statistics and pre-post survey comparisons were performed using Stata 14.0.

PARTICIPANTS

Twenty-five APPs, all Advanced Practice Registered Nurse certified and working within our tertiary care ICUs, completed the course. Participants practiced in a variety of ICUs, inclusive of neurologic/neurosurgical (4.0%), burn (8.0%), medical (12.0%), trauma (28.0%) and surgical (48.0%), and typically held a Masters of Science in Nursing as his/her highest attained degree. Experience levels ranged from 0 to 8 years.

RESULTS

Precourse survey results confirmed perceived anatomical knowledge deficits, noting median APP scores 3.00 or less, correlating to neutral to very little confidence, in all 13 queried anatomical areas. Wilcoxon signed-rank statistical analysis revealed significantly improved confidence level in anatomic knowledge following course completion in all 13 anatomical areas. Aligning with the improved confidence, most participants felt they were better prepared to perform ICU procedures and care for patients following operative intervention.

CONCLUSION

Cadaver-based anatomical training has significant benefit to ICU APPs perceived knowledge and performance.

Assessment of Delirium in Intensive Care Unit Patients: Educational Strategies

BACKGROUND

Delirium is an acute brain dysfunction associated with poor outcomes in intensive care unit (ICU) patients. Critical care nurses play an important role in the prevention, detection, and management of delirium, but they must be able to accurately assess for it. The Confusion Assessment Method for the Intensive Care Unit (CAM-ICU) instrument is a reliable and valid method to assess for delirium, but research reveals most nurses need practice to use it proficiently.

METHOD

A pretest-posttest design was used to evaluate the success of a multimodal educational strategy (i.e., online learning module coupled with standardized patient simulation experience) on critical care nurses' knowledge and confidence to assess and manage delirium using the CAM-ICU.

RESULTS

Participants (N = 34) showed a significant increase (p < .001) in confidence in their ability to assess and manage delirium following the multimodal education. No statistical change in knowledge of delirium existed following the education.

CONCLUSION

A multimodal educational strategy, which included simulation, significantly added confidence in critical care nurses' performance using the CAM-ICU. J Contin Nurs Educ. 2017;48(5):239-244.

Palliative Care Professional Development for Critical Care Nurses: A Multicenter Program

BACKGROUND

Integrating palliative care into intensive care units (ICUs) requires involvement of bedside nurses, who report inadequate education in palliative care.

OBJECTIVE

To implement and evaluate a palliative care professional development program for ICU bedside nurses.

METHODS

From May 2013 to January 2015, palliative care advanced practice nurses and nurse educators in 5 academic medical centers completed a 3-day train-the-trainer program followed by 2 years of mentoring to implement the initiative. The program consisted of 8-hour communication workshops for bedside nurses and structured rounds in ICUs, where nurse leaders coached bedside nurses in identifying and addressing palliative care needs. Primary outcomes were nurses' ratings of their palliative care communication skills in surveys, and nurses' identification of palliative care needs during coaching rounds.

RESULTS

Each center held at least 6 workshops, training 428 bedside nurses. Nurses rated their skill level higher after the workshop for 15 tasks (eg, responding to family distress, ensuring families understand information in family meetings, all P < .01 vs preworkshop). Coaching rounds in each ICU took a mean of 3 hours per month. For 82% of 1110 patients discussed in rounds, bedside nurses identified palliative care needs and created plans to address them.

CONCLUSIONS

Communication skills training workshops increased nurses' ratings of their palliative care communication skills. Coaching rounds supported nurses in identifying and addressing palliative care needs.

Video education for critical care nurses to assess pain with a behavioural pain assessment tool: A descriptive comparative study

AIM

To evaluate the impact of video education on critical care nurses' knowledge and skills in using a behavioural pain assessment tool for intensive care patients and to explore the nurses' experiences with video education.

METHODS

Forty-eight nurses in one intensive care unit watched an educational video on the use of the Critical-Care Pain Observation Tool, then assessed pain in two patients with the tool and took a knowledge test. The researcher made parallel pain assessments. Interrater reliability of patients' pain assessment between nurses and the researcher was determined to examine nurses' skills in using the tool after education. Twenty nurses were interviewed about their experiences with the video education. Interviews were analysed with deductive thematic analysis.

RESULTS

The knowledge test scores indicated that the nurses learned the principles of how to use the tool. The interrater reliability of pain assessments reached a moderate level of agreement during the painful procedure, with a weighted kappa coefficient value of 0.48, CL [0.37, 0.58]. The nurses perceived video education positively, but requested additional interaction.

CONCLUSIONS

Video education is useful in teaching the principles of using a pain assessment tool. Additional clinical training is required for nurses to reach adequate skills in using the tool.

'Teaching is incredibly rewarding' Interprofessional education lead Alison Dinning loves how her role feeds in to improving patent safety

After qualifying as a nurse in 1987, Alison Dinning held a variety of clinical roles before taking up a critical care outreach nurse post in 2000.

Knowledge and practice of intensive care nurses for endotracheal suctioning in a teaching hospital in western Turkey

OBJECTIVES

This study was conducted to determine intensive care nurses' knowledge and practice levels regarding open system endotracheal suctioning and to investigate if there is a relationship between nurses' demographic characteristics and their knowledge and practice.

RESEARCH METHODOLOGY/DESIGN

The study was conducted as a cross-sectional and non-participant structured observational design. Data were collected using a 45-item structured and self-administered questionnaire and a 31-item observational checklist. The study sample included 72 nurses.

SETTING

Three adult intensive care units in a teaching hospital.

RESULTS

The nurses' mean scores of knowledge and practice were 23.79±3.83 and 12.88±2.53. Their level of knowledge was very good in 59.7%, good in 34.7%, and the level of practice was fair in 79.2% and good in 18.1%. The relationship between the type of unit and the nurses' knowledge scores was statistically significant (p=0.013). The correlation between the nurses' scores of knowledge and practice was not statistically significant (r=0.220; p=0.063).

CONCLUSION

This study suggests that the knowledge level of most of the nurses was good and their practice level was fair. Intensive care nurses must perform suctioning procedures safely and effectively to ensure delivery of quality of care and eliminate complications.

Precordial electrode placement accuracy by nurses in a large midwestern tertiary care hospital

A quality improvement project to increase the knowledge of nurses and the accuracy of electrocardiogram precordial lead placement among intensive care unit and progressive care unit staff was conducted using a single-group, pretest-posttest preexperimental design. Educational interventions based on the theory of planned behavior were developed from focus group data. A tip card, poster, and video were sequentially presented to more than 1,600 nurses. This resulted in statistically significant gains in both knowledge and accuracy (p < 0.02). This project supports the use of focus groups and the theory of planned behavior to guide education related to quality improvement.

Comparing the effects of problem-based learning and the traditional lecture method on critical thinking skills and metacognitive awareness in nursing students in a critical care nursing course

BACKGROUND

Problem-based learning (PBL) is a method used to develop cognitive and metacognitive skills in nursing students.

OBJECTIVES

The present study was conducted to compare the effects of PBL and the traditional lecture method on critical thinking skills and metacognitive awareness in nursing students in a critical care nursing course.

DESIGN

The present study was conducted with a quasi-experimental, single group, pretest-posttest design.

METHODS

A group of third-year nursing students (n=40) were recruited from Khorramabad School of Nursing and Midwifery in the west of Iran. The lecture method was used in one group over the first eight weeks of the first semester and PBL was adopted in the second eight weeks. Standardized self-report questionnaires including The California Critical Thinking Skills Test-B (CCTST-B) and the Metacognitive Awareness Inventory (MAI) were administered before and after the use of each of the instruction methods. Data were analyzed in SPSS using the paired t-test.

FINDINGS

No significant changes were observed in the students' critical thinking skills and metacognitive awareness after performing the lecture method. However, a significant increase was observed in the overall critical thinking score (P<0.01) and its sub-scales of evaluation and deduction (P<0.05) and in the overall metacognitive awareness score (P<0.001) after performing the PBL method.

PEER REVIEWED BASED ASSESSMENT IN POST GRADUATE EDUCATION

Students have a propensity to focus their learning aligned to the assessment items established within the units of study, rather than acknowledging the broader need to learn and apply the content taught. This approach to education stifles students' learning and their ability to apply knowledge, and as a result, essential content can be poorly retained.

The effectiveness of education in the recognition and management of deteriorating patients: A systematic review

BACKGROUND

Survival from in-hospital cardiac arrest is poor. Clinical features, including abnormal vital signs, often indicate patient deterioration prior to severe adverse events. Early warning systems and rapid response teams are commonly used to assist the health profession in the identification and management of the deteriorating patient. Education programs are widely used in the implementation of these systems. The effectiveness of the education is unknown.

AIM

The aims of this study were to identify: (i) the evidence supporting educational effectiveness in the recognition and management of the deteriorating patient and (ii) outcome measures used to evaluate educational effectiveness.

METHODS

A mixed methods systematic review of the literature was conducted using studies published between 2002 and 2014. Included studies were assessed for quality and data were synthesized thematically, while original data are presented in tabular form.

RESULTS

Twenty-three studies were included in the review. Most educational programs were found to be effective reporting significant positive impacts upon learners, patient outcomes and organisational systems. Outcome measures related to: i learners, for example knowledge and performance, ii systems, including activation and responses of rapid response teams, and iii patients, including patient length of stay and adverse events. All but one of the programs used blended teaching with >87% including medium to high fidelity simulation. In situ simulation was employed in two of the interventions. The median program time was eight hours. The longest program lasted 44h however one of the most educationally effective programs was based upon a 40min simulation program.

CONCLUSION

Educational interventions designed to improve the recognition and management of patient deterioration can improve learner outcomes when they incorporate medium to high-fidelity simulation. High-fidelity simulation has demonstrated effectiveness when delivered in brief sessions lasting only forty minutes. In situ simulation has demonstrated sustained positive impact upon the real world implementation of rapid response systems. Outcome measures should include knowledge and skill developments but there are important benefits in understanding patient outcomes.

Influence of patient and provider factors on the workload of on-call physicians: A general internal medicine cohort observational study

Factors associated with the physician workload are scarcely reported. The study aims to investigate the associated factors of on-call physician workload based on a published conceptual framework.The study was conducted in a general internal medicine unit of National Taiwan University Hospital. On-call physician workloads were recorded on a shift basis from 1198 hospitalized patients between May 2010 and April 2011. The proxy of on-call workloads included night calls, bedside evaluation/management (E/M), and performing clinical procedures in a shift. Multivariable logistic and negative binomial regression models were used to determine the factors associated with the workloads of on-call physicians.During the study period, 378 (31.6%) of patients had night calls with related workloads. Multivariate analysis showed that the number of patients with unstable conditions in a shift (odds ratio [OR] 1.89 and 1.66, respectively) and the intensive care unit (ICU) training of the nurse leader (OR 2.87 and 3.08, respectively) resulted in higher likelihood of night calls to and bedside E/M visits by the on-call physician. However, ICU training of nurses (OR = 0.37, 95% confidence interval: 0.16-0.86) decreased the demand of performing clinical procedures by the on-call physician. Moreover, number of patients with unstable conditions (risk ratio [RR] 1.52 and 1.55, respectively) had significantly increased the number of night calls and bedside E/M by on-call physicians by around 50%. Nurses with N1 level (RR 2.16 and 2.71, respectively) were more likely to place night calls and facilitate bedside E/M by the on-call physician compared to nurses with N0 level. In addition, the nurse leaders with ICU training (RR 1.72 and 3.07, respectively) had significant increases in night calls and bedside E/M by the on-call physician compared to those without ICU training.On-call physician workload is associated with patient factors and the training of nurses. Number of unstable patients in a shift may be considered in predicting workload. The training of nurses may improve patient safety and decrease demand for clinical procedure.