The Impact of Education and Simulation on Novice Nurse Response and Recognition to Deteriorating Patients

1. The Impact of Education and Simulation on Novice Nurse Response and Recognition to Deteriorating Patients Kristen L. Straka, DNP, RN, CPN Director, Nursing Education, Clinical Practice and Research Marnie Burkett, MSN, RN, CCRN, Michelle Capan, MSN, RN, CPN, Jan Eswein, MSN, RN, CCRN

2. Objectives • Upon completion of the lecture, the learner will: • verbalize significance of failure to recognize symptoms of pediatric deterioration events • State one intervention to improve novice pediatric nurses ability to recognize symptoms during pediatric deterioration • Formulate one implication for nursing realted to the use of high fidelity simulation

3. Purpose and Background • Pediatric clinical experiences decreasing amount of hours/increase the number of rotations • Lack of recognition and intervention (response) to pediatric crisis situation • Lack of comfort ability by staff when responding to a Condition • Next Steps?

4. Review of the Literature • Low survival rate for pediatric patients post arrest • Warning signs often overlooked • Basic training = poor skill recall • High fidelity simulation provides basic assessment skills and opportunity to work through scenarios • Benner – Novice to Expert

5. PICO Question • Does the use of high fidelity for novice pediatric nurses increase their knowledge and ability to recognize and respond to pediatric deteriorating patients?

6. Pediatric Crisis Recognition and Management Course • Design and Intent • 6 months after hire • Graduate Nurses or nurses without prior pediatric experience • Convenience sample – pre/post test design • IRB Approval

7. Website • Pre Test • Demographics • Pediatric Clinical rotation • Questions related to pediatric deterioration and management and response

8. Pediatric Crisis Recognition and Management Course • Core content included lecture on crisis intervention and early detection warning signs • Skills Stations • Push pull fluid resuscitation • Crash cart and med preparation • Defibrillator

9. Pediatric Crisis Recognition and Management Skill Stations Skill Stations

10. Pediatric Crisis Recognition and Management Course Content • Communication Technique • Closed loop • SBAR • Game Show

11. Simulation Scenarios • Three scenarios total • Respiratory – 2 learners • Neurological – 2 learners • Shock – 4 learners

12. Course Implementation • Began May 2011 • Three month trial period • Participants scheduled through Unit Based Nurse Educator

13. Demographics of Pediatric Crisis Recognition and Management Course Participants N= 26 Results at Three Months - Demographics

14. Findings • N=26 • Statistical Significance of knowledge enhancement with an increase from 71.15% to 87.69% on test

15. Statistical Analysis Statistical Significance

16. Percentage of Participants who responded correctly on pre and post assessment. N=26

17. Evaluation from Participants • Fifty-six percent of the participants (n=14) responded when surveyed that the class increased their overall knowledge of recognizing symptoms of the deteriorating patient to a high degree, • 100% of the participants (n=26) felt that they gained confidence in their pediatric nursing skills after participating in simulation to a satisfactory or high degree.

18. Use In Clinical Practice • Six month follow up survey • Have you experienced a crisis? • Knowledge to recognize and respond? • CRM preparation?

19. Results • N=13 • 61.5% experienced a clinical crisis • 100% felt they had the knowledge to respond • 83.3% felt CRM class prepared them

20. Limitations • Sample Size • Annual turnover = 6.8% • Time frame • Lack of standardized testing tool

21. Implications for Nursing Practice • Knowledge gap between school and workplace (novice to expert) • Use of High fidelity simulation

22. Conclusion • Simulation and technology • Lack of traditional pediatric clinical rotation • Bridge the gap • Increase in communication • Decrease in adverse events related to lack of symptom recogntion

23. References • AHRQ Healthcare Innovations Exchange. (2011). Simple scoring system and action algorithm identifies children at risk of deterioration, leading to fewer code and more timely transfer to intensive care unit. Retrieved from http://www.innovations.ahrq.gov/content.aspx?id=2285 • Aiken, L.H., Clarke, S.P., Cheung, R.B., Sloane, D.M., & Silber, J.H. (2003). Educational levels of hospital nurses and surgical patient mortality. JAMA, 290(12), 1617-1623. • 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, 359-369. • American Association of Colleges of Nursing. (2006). The essentials of doctoral education • for advanced nursing practice. Retrieved from http://moodle.chatham.edu/file.php/4816/section08/Essentials.pdf • Benner, P. (1982). From novice to expert. American Journal of Nursing, 82(3), 402-407. • Children’s Hospital of Pittsburgh of UPMC. (2011). About Children’s. Retrieved from http://www.chp.edu/CHP/about%20childrens • Cooper, S., Kinsman, L., Buykx, P., McConnell-Henry, T., Endacott, R., & Scholes, J. (2010). Managing the deteriorating patient in a simulated environment: nursing students’ knowledge skill and situation awareness. Journal of Clinical Nursing, 19, 2309-2318. doi:10.1111/j.1365-2702.2009.03164.x

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