The Effects of Simulated Mock Codes on Nurse Confidence By Roxanne Sabatini, MSN, RN-BC, CCRN

1. The Effects of Simulated Mock Codes on Nurse ConfidenceBy Roxanne Sabatini, MSN, RN-BC, CCRN Insert your logo here

2. Declaration • 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.

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

4. Problem • 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.

5. What is simulation? • 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.”

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

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

8. A Mock Code Session • Introduction • Equipment • Limitations • Assignment of roles • Scenario • History of Patient • Participant action • Debriefing

9. Study Design • 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

10. 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%) Sample/ Demographics

11. Overall Pre-test & Post-test results

12. Group differences based on years of experience for pre simulationitems. (Total Number of Subjects = 153)

13. Group differences based on ACLS certification for pre-simulationitems. (Total Number of Subjects = 153)

14. Group differences based on Previous Mock Code experience for pre-simulationitems. (Total Number of Subjects = 153)

15. Comparison between Critical Care and other units in terms of pre-simulationitems. (Total Number of Subjects = 153)

16. Influences on Confidence • BLS • No statistically significant difference between the groups (BLS<6 months, BLS:7-18 months, 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

17. Limitations/ Barriers • 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

18. Feedback

19. References Abline, C. (2006). Morristown Memorial Hospital CPR Committee Report. 2006. Confidence defined in Wikipedia. Retrieved on September 20, 2007 from http://en.wikipedia.org/wiki/Confidence. 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. 359-369. 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. 200-207. American Heart association.( 2006). Advanced Cardiovascualr Life Support Provider Manual. ISBN 0-87493-496-6. Confidence defined in Wikipedia. Retrieved on September 20, 2007 from http://en.wikipedia.org/wiki/Confidence Confidence defined in Novations.com Retrieved September 20, 2007 from http://www.novations.com/services/efficacy/articles/what-is-confidence,39.html

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21. References Laerdal training manual for Sim man. Retrieved December 15, 2006 from http://laerdal.com. Leontiou, I. (2001). Knowledge, working practices and interventions of nurses in cardiopulmonary resuscitation: a literature review. ICUs and Nursing, 5(2), pp. 1-11. Madden, C. (2006). Undergraduate nursing students’ acquisition and retention of CPR knowledge and skills. Nurse Education Today, 26(30), pp. 218-227. Nurse Educ. 1993 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. 188-198. Simulation defined in Wikipedia. Retrieved October 4, 2007 from http://en.wikipedia.org/wiki/Simulation. Strzyzewski, N. (2006). Common errors made in resuscitation of respiratory and cardiac arrest. Plastic Surgical Nursing, 26(1), pp. 10-16.