Unit-based Simulation for the Bedside Registered Nurse

Jocelyn Disher, BSN, MSN, RN

Anisha Desai, BSN, RN

Angela Burgum, RN

Cynthia Fallon, BSN, RN, ONC

Patricia Hart, PhD, RN

Kathie Aduddell, EdD, RN

Lanell Bellury, PhD, RN, AOCNS

BACKGROUND & LITERATURE REVIEW

SJHA RRT data Literature review showed HFS was mainly used in:

Academic setting Lab setting Military setting Aviation industry Space program

HFS was rarely reported in a healthcare setting at the unit based level

PROBLEM STATEMENT

Early identification of the deteriorating patient is a significant nursing function.

Rapid Response Team data identified cardiovascular step-down units as having the largest number of transfers to a higher level of care (ICU).

Are nursing staff appropriately identifying the early stages of patient deterioration?

PURPOSE & OBJECTIVES The purpose of this study was to examine the effect of

using unit-based High Fidelity Simulation (HFS) to improve bedside registered nurses’ identification of deteriorating patients on step-down cardiovascular units by assessing their knowledge and self-confidence levels.

Objectives:

To review the feasibility and benefit of using high fidelity simulation in an acute care nursing unit environment.

To describe the effect of high fidelity simulation on knowledge and self-confidence scores.

RESEARCH QUESTIONS 1. What is the effect of using unit-based HFS as an educational tool on professional RNs’ knowledge levels in acute respiratory deteriorating patients on step-down cardiovascular units in a community hospital?

2. What is the effect of using unit-based HFS as an educational tool on professional RNs’ self-confidence levels in handling acute deteriorating patients on step-down cardiovascular units in a community hospital?

METHOD A pilot study using a quasi-experimental design with an

interventional pre-post method

Convenience sample of nurses working on 2 step-down cardiovascular units

HFS was conducted on an empty nursing unit

The intervention consisted of a HFS scenario depicting a chronic Obstructive Pulmonary Disease (COPD) patient in respiratory distress

Approved by Saint Joseph’s Institutional Review Board

INTERVENTION Intervention packet provided to participants

Scripted orientation to the simulation experience

Participants given the simulation patient information card

Simulation scenario

Scripted debriefing

Post-assessment instruments

$10 gift card for participation

DATA COLLECTION Instruments:

Demographic questionnaire

Knowledge instrument

Self-confidence scale (Dr. Hicks)

RESULTS: SAMPLE (n = 23)

Demographic Characteristic Mean (range) Number (%)

Nursing experience in years 11.88(1-34)

Baccalaureate prepared RNs 14 (60.9)

Certified RNs 12 (52.2)

Professional organization members 13 (56.5)

RESULTS: SCORES ON KNOWLEDGE TEST AND SELF-CONFIDENCE TOOL

p< .01 p< .01

LIMITATIONS Limited sample size

Findings may not represent the general population of acute care nurses

Possibility of discussion between the participants about the scenarios and test questions

Hawthorn Effect

Knowledge and self-confidence levels being measured immediately after the HFS intervention

IMPLICATIONS FOR STAFF DEVELOPMENT Studying a larger pool of RN’s

Although the unit based HFS seemed to be a favorable means, further comparative studies needed

HFS could be tailored to:

Unit specific educational needs

Competencies for RN’s

Increase knowledge and self-confidence levels post-intervention could have a positive impact on preventing further patient deterioration

CONCLUSION HFS could be beneficial in clinical training

Use of HFS with RN’s in the acute care environment is:

Feasible

Effective way of increasing knowledge and self-confidence in acute patient deterioration events

A special thanks to: Dr. Lanell Bellury-Research Coordinator at SJHA

Dr. Kathy Aduddell

Dr. Patricia Hart

John Somerville-(Sim-man Expert at Mercer University)

Dr. Hicks- (for letting us use the self-confidence scale)

Risa Benoit-Critical care CNS for helping us develop knowledge questionnaires

Our participants-CV-Stepdown RN’s

Susan Beard -Education Coordinator CNS (Sim-man Expert at SJHA)

Study Investigators’ managers- for allowing us 12 hours/month to work on our research project

SJHA RRT team

SJHA Nurse Research scholar program

Acknowledgment

Questions

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