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This speaker does not have any significant financial relationships with (1) the manufacturer(s) of commercial product(s) and/or provider(s) of services discussed in educational presentations, and (2) commercial supporters of this educational activity. This speaker does not intend to discuss any unlabeled use of commercial product, or an investigational application not yet approved for use.

1.Define or describe “Confidence” as related to resuscitation performance 2.What are the predictors or independent variables that effect nurse confidence in assisting in a real code blue situation 3.Describe the effects of simulation on the total group self confidence 4.Compare group mean differences in confidence measures based on education level, area of practice, years of experiences, and recent BLS or ACLS training. 5.Describe how human patient simulation for mock code protocols could be utilized as an evidenced- based teaching modality

Nurse Is often the first responder in a Cardiopulmonary arrest. New Nurses need confidence and competence to assist the team. – “Most nurses do not feel comfortable in codes” (Stryzewski, 2006). At MMH in 2006, MMH had 176 Code blues (40% in MS, 50% ICU) 2009, MMH had 199 code blues (57% ICU) Mock Codes are being practiced in the Bio-skills Lab. It is unclear if simulation training is effective.

To resemble reality “To replicate some or nearly all of a clinical situation so that the situation may be more readily understood and managed when it occurs for real in clinical practice”. “High fidelity simulators are extremely realistic and sophisticated and high level of interactivity.”

Study explored self-reported confidence Self confidence is faith in one’s own abilities (Wikipedia.org). Confidence built upon belief and evidence ( VAS (Visual Analog Scale) 1-5 Confidence Scale (Grundy, 1993)

Confidence Scale Rating (1-5) on 5 subscales 1.I am certain that my performance is correct 2.I feel that I perform the task without hesitation 3.My performance would convince the observer(s) that I’m competent 4.I feel sure of myself as I perform the task 5.I feel satisfied with my performance

Introduction – Equipment – Limitations – Assignment of roles Scenario – History of Patient – Participant action Debriefing

A longitudinal pre-test, post-test repeated measures design Approved by Nursing Research Council & Approved by Institutional Review Board Convenient sample of 157 new nurses entering the hospital utilized Follow surveys sent at 3, 6 & 12 months after Mock Code Session

Total sample 153 RNs in Nursing Orientation 98 (64%) have associate degree or higher 86 (56%) had 2 or more years of nursing experience 48 (31%) had ACLS and no ACLS (105, 69%) RNs who had not had a previous Mock Code (N = 40, 26%) and RNs who had previous Mock Code (N = 113, 74%)

Paired comparison between Pre and post-test measures using the Wilcoxon signed ranks test Pre- simulation Post- simulation P-value ItemN =MeanSDMeanSD< Visual Analog Scale (1-5) < I am certain about my performance < My performance would convince the observer that I’m competent < I feel that I perform the task without hesitation < I feel sure of myself as I perform the task < I feel satisfied with my performance <.001

< 3 Years of experience (N = 74, 48%) 3+ Years (N = 79, 52%) Item (Pre- simulation) MeanSDMedianMeanSDMedian*P Value ( Mann Whitney U Test) 1. VAS < Correct < No Hesitation < Observe < Sure < Satisfied <0.001

No ACLS(N = 105, 69%) ACLS (N = 48, 31%) Item (Pre- simulation) MeanSDMedianMeanSDMedian*P Value ( Mann Whitney U Test) 1. VAS < Correct < No Hesitation < Observe < Sure < Satisfied <0.001

No Mock Code (N = 40, 26%) Previous Mock Code (N = 113, 74%) Item (Pre- simulation) MeanSDMedianMeanSDMedian*P Value ( Mann Whitney U Test) 1. VAS Correct No Hesitation Observe Sure Satisfied

Other (N = 126, 82%)Critical Care (N = 27, 18%) Item (Pre-test) MeanSDMedianMeanSDMedian*P Value ( Mann Whitney U Test) 1. VAS Correct < No Hesitation < Observe Sure < Satisfied

BLS – No statistically significant difference between the groups (BLS 18 months) in terms of any of the pre-simulation items (p>0.05) ACLS – Statistically significant differences (p<0.001) on all pre- simulation measures Previous Mock Code Experience – significant differences (p<0.05) on most measures Nursing Unit – Statistically significant differences (p<0.001) on all pre- simulation measures Years of Nursing – Statistically significant differences (p<0.001) on all pre- simulation measures

Convenient sample – Limited to Magnet designated, teaching hospital – Only new nurses to facility and rehires > 2 years away from hospital Response bias Attrition of longitudinal data

Abline, C. (2006). Morristown Memorial Hospital CPR Committee Report Confidence defined in Wikipedia. Retrieved on September 20, 2007 from Alinier, G. Hunt, B., Gordon, R., Harwood, C. (2006). Effectiveness of intermediate-fidelity simulation training technology in undergraduate nursing education. Journal of Advanced Nursing,54(3), pp Aliner, G., Hunt, W., Gordon, R. (2004). Determining the value of simulation in nurse education: study design and initial results. Nurse Education in Practice, (4),pp American Heart association.( 2006). Advanced Cardiovascualr Life Support Provider Manual. ISBN Confidence defined in Wikipedia. Retrieved on September 20, 2007 from Confidence defined in Novations.com Retrieved September 20, 2007 from

Davies, R. & Perkins, G. (2006). Recall after cardiac arrest scenario testing. Resuscitation, (68), pp DeVita, M.A., Schaefer, J., Lutz, J. Wang, H., Dongilli, T. (2005). Improving medical emergency team performance using a novel curriculum and a computerized human patient simulator. Quality and Safety In Health Care, 14(5), pp Grundy, S. (1993). The Confidence Scale: Development and psychometric charecteristics. Nurse Educator, 18(1), pp.6-9. Hamilton, R. (2005). Nurse’s knowledge and skill retention following cardiopulmonary resuscitation training: a review of the literature. Journal of Advanced Nursing, 51(3), pp Jha, A., Duncan, B.,& Bates, D. (2007). Simulation-based training and patient safety, Chapter 45. Retrieved October 5, 2007 from Jeffries, P. (2007). Simulation In Nursing Education. National League of Nursing: N.Y., N.Y Kim, J., Neilipovitz, D., Cardinal, P., Chiu, M., Clinch, J. (2006). A pilot study using high-fidelity simulation to formally evaluate performance in the resuscitation of critically ill patients: The University of Ottawa Critical Care Medicine, High-Fidelity Simulation, and Crisis Resource Management I study. Critical Care Medicine, 34(8), pp

Laerdal training manual for Sim man. Retrieved December 15, 2006 from Leontiou, I. (2001). Knowledge, working practices and interventions of nurses in cardiopulmonary resuscitation: a literature review. ICUs and Nursing, 5(2), pp Madden, C. (2006). Undergraduate nursing students’ acquisition and retention of CPR knowledge and skills. Nurse Education Today, 26(30), pp Nurse Educ Jan-Feb;18(1):6-9. Corrected and republished from: Nurse Educ 1992 Sep- Oct;17(5):30-3. Parr, M. & Sweeney, N. (2006). Use of Human Patient Simulation in an Undergraduate Critical care Course. Critical Care Nurse Quarterly, 29(3), pp Simulation defined in Wikipedia. Retrieved October 4, 2007 from Strzyzewski, N. (2006). Common errors made in resuscitation of respiratory and cardiac arrest. Plastic Surgical Nursing, 26(1), pp