New Registered Nurses’ Perception on the effectiveness of Pre-licensure Simulation Training on Readiness to Care for Patients in Cardiac Arrest

Session Disclosure 1) Approval Statement This continuing education activity was approved by the Western Multi-State Division, an accredited approver by the American Nurses Credentialing Center’s Commission on Accreditation. Arizona, Colorado, Idaho, and Utah Nurses Associations are members of the Western Multi-State Division. Approval # 72-17 2) Criteria for Successful Completion To receive contact hours, participants must check-in to the session using the barcode scanner, attend the entire session and then complete both the session evaluation and full conference evaluation by July 31, 2017. 3) Conflicts of Interest This educational activity does not include any content that relates to the products and/or services of a commercial interest that would create a conflict of interest. 4) Commercial Support There is no commercial support being received for this session.

History of the simulated clinical event 2013 Colorado Front Range Flood Flooding impacted 200 miles along the front range, with 17 counties involved. With students commuting from many of the surrounding counties, multiple clinical days were canceled. Creative solutions had to be generated to make up clinical time. The majority of make up time was done in the simulation lab. Students requested a cardiac arrest scenario.

Initial planning A cardiac arrest scenario was written, and students were briefed on ACLS protocols. Faculty volunteered to be part of the core team, or a standardized patient. A date was chosen, supplies were acquired. Training was done with faculty about their roles, and the desired outcome of the scenario. Students were asked to sign up for a two hour time slot. 36 students in groups of six participated.

Simulated clinical event objectives Demonstrate understanding of a typical response to a code in an acute hospital setting Demonstrate understanding of the roles involved in running a code Discuss the following concepts: Communication Oxygenation and perfusion Family presence in CPR Social justice and how it applies to emergency and end of life situations End of life in an emergency setting

The Scenario Three standardized patients present with cardiac symptoms. Each patient is engaged by two students. Students perform initial assessment. NP or MD enters room with reports of ECG showing STEMI, and a troponin of 3.7 on one patient. Scenario is paused; moved to the advanced manikin. Patient continues to decline, and ACLS algorithm is initiated. Patient continues to decline, family arrives, resuscitation is unsuccessful. Family eventually agrees to discontinue CPR and the patient dies.

Debriefing All faculty who perform debriefing have been trained according to policy. A three phase structure is used; reaction, understanding and summary. Emphasis is on communication, roles, interventions, assessment, family presence, end of life and social justice. Debriefing guides are structured to capture cognitive, affective and psychomotor components of the scenario.

Examples of debriefing questions How did the scenario make you feel? Give me an example of how you used closed loop communication. What was the most important intervention; why? How do you feel about family presence in CPR? Compare two patients; one is a homeless man who has had multiple admissions, and a history of alcohol use. The other is a firefighter who was injured saving people in a fire. Do they receive the same treatment and level of respect? How did you feel when the patient died? Discuss the role of a BLS prepared nurse in this situation.

Changes over time The event was made a part of the curriculum and integrated into a course Scenario programmed into CAE software Additional faculty role of anesthesia; intubation added to scenario Use of theater students for standardized patients. Additional simulation driver added so that groups can overlap, shortening the overall day. Upgrade in equipment and supplies to increase realism

Research Study Resulted from feedback from SON Alumni in practice as RNs Alumni (12) contacted faculty after caring for a hospitalized patient who experienced sudden cardiac arrest (SCA) Alumni indicated that the cardiac arrest scenario was highly effective and helped prepare them to manage real patients in SCA

Research Study To explore perceptions on the effectiveness of the simulation a research study was conducted The research question was: What are the perceptions of our alumni on the effectiveness of cardiac arrest simulation training in preparing them to effectively care for patients experiencing cardiac arrest?

Methods Qualitative- phenomenological method of van Manen Interview with open ended questions Cross sectional Interviews were recorded and the audio recordings were be transcribed verbatim

Questions Tell me how you think the simulation prepared you to care for patients in SCA? What was the most effective part of the simulation? What was the least effective part of the simulation? Now that you are in clinical practice what changes would you recommend for the CA simulation?

Sample and Data Collection IRB approved Purposeful sample and Snowball Sample Informants (n=9) were all SON alumni who work in a hospital setting who cared for a patient in SCA. Informants had AHA BLS training, but no ACLS training. Saturation was reached during data collection

Results: Data was reviewed to identify any themes using the phenomenological method of van Manen. Data revealed five major themes: Knowing what to do Empowerment to act Understanding work flow Reduced fear of the unknown Confidence in self

Sample comments from Informants Knowing what to do Empowerment to act Understanding work flow Reduced fear of the unknown Confidence in self

Results: Informants indicated that the simulation was highly valued and helped to prepare them to participate in the care of SCA patients. Informants reported that lack of knowledge about ACLS hindered their learning experience and felt ACLS training would enhance their experience.

Implications: Nurse Educators should consider utilizing simulation to prepare BSN students to care for SCA patients ACLS training should be considered for BSN students to better prepare them to participate in SCA simulation Results of this study should be replicated in other nursing programs and with larger samples

References American Heart Association (AHA), 2015 Heart Disease and Stroke Statistics Update. Retrieved from http://circ.ahajournals.org/content/circulationaha/early/2012/12/12/CIR.0b013e31828124ad.full.pdf. Bogossian, F., Cooper, S., Cant, R., Beauchamp, A., Porter, J., Kain, V., . . . Phillips, N.M. (2014). Undergraduate nursing students’ performance in recognizing and responding to sudden patient deterioration in high psychological fidelity simulated environments: An Australian multi-centre study. Nurse Education Today, 34, 691-696. doi:10.1016/jnedt.2013.09.015 Buckley, T., & Gordon, C. (2011). The effectiveness of high fidelity simulation on medical-surgical registered nurses’ ability to recognize and respond to clinical emergencies. Nurse Education Today, 32, 716-721. doi:10.1016/j.nedt.2010.04.004 Cooper, S., Cant, R., Porter, J., Sellick, K., Somers, G., Kinsman, L., Nestel, D., 2009. Rating medical emergency teamwork performance: development of the team emergency assessment measure (TEAM). Resuscitation 81, 446e452. Endacott, R., Scholes, J., Buykx, P., Cooper, S., Kensman, L., McConnell-Henry, T., 2010. Final-year nursing students’ ability to assess, detect and act on clinical cues of deterioration in a simulated environment. Journal of Advanced Nursing 66 (12), 2722e2731. Gombotz, H., Weh, B., Mitterndorfer, W., Rehak, P. (2006). In-hospital cardiac resuscitation outside the ICU by nursing staff equipped with automated external defibrillators: the first 500 cases. Resuscitation 70, 416e422. International Nursing Association for Clinical Simulation and Learning, 2015 (INACSL). INACSL Standards of Best Practice: SimulationSM Retrieved from http://www.inacsl.org/i4a/pages/index.cfm?pageid=3407 National Patient Safety Agency, 2007. Recognizing and responding appropriately to early signs of deterioration in hospitalized patients. National Patient Safety Agency. [London]. Van Manen, M. (1990). Researching the lived experience. Albany, NY: SUNY Press. Wallin, C., Meurling, L., Hedman, L., Hedegard, J., & Fellander-Tsai, L. (2007). Target-focused medical emergency team training using a human patient simulator: Effects on behavior and attitude. Medical Education, 41(2), 173-180.

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