Donna Proulx, RN, MS, CCRN-CSC

1. Can The Use of High-Fidelity Simulation Increase Participant’s Self-Perceived Confidence and Technical Proficiency When Used as a Teaching Tool During a Critical Care Course? Donna Proulx, RN, MS, CCRN-CSC

2. Conflict of Interest • I do not have any professional, personal or financial, bias, inclination, obligation or loyalty which may in any way affect my objectivity, independence or impartiality in delivering this presentation.

3. Study Purpose • To explore alternative methods of teaching critical care content to graduate nurses and inexperienced critical care registered nurses enrolled in a 12 week critical care course. • To evaluate HF simulation as an effective tool to decrease the knowledge gap between the classroom and the clinical environment. • To discover new knowledge as it relates to the use of high-fidelity simulation and student confidence and technical proficiency.

4. Inclusion Criteria • This study used a convenience sample of registered nurses enrolled in a 12 week critical care course at Catholic Medical Center between March 2010 and March 2012: 6 courses total. • Course participants were registered nurses hired to work on monitored units: PACU, ICU, Emergency Room, Medical Telemetry, Surgical Telemetry. • Inclusion criteria: Participant must attend full 12 week course. • Study approval obtained from the Catholic Medical Center (IRB) Review Board.

5. Methodology • Instrument was designed and validated for use in this study. • Participants were given the opportunity to participate in a pre/post test 5-point Likert scale asking them to rank their self-perceived level of confidence as it relates to the subject at hand. • Participation was voluntary; survey instrument was placed in an 8.5 X 11 envelope with a #2 pencil. Consent was implied if instrument was completed. • Facilitator was not present in room while time was allowed for completion of survey tool.

6. Three Sim Lab Sessions • Non-Lethal CardiacAtrial Fib / amiodaroneSVT / adenosineSympt bradyc w/TVPHeart block /ext. pacingInternal pacer FTC • RespiratoryResp decline w/pneumoniaAcidotic s/p extubationApnicPneumo s/p central lineCalc P/F RatioRMS intubation • Lethal CardiacVentr Tach/Vfib arrestTorsades de Pointe/Low KVagal s/p sheath removalUnstab SVT/A-fibr cardiovPEA s/p epic wires rem

7. Survey Tool: Quantitative & Qualitative Questions asked participant to rank: (I am…..) • Confidence when caring for a patient with** • Anxiety when caring for a patient with** • Can recognize clinical signs of a patient deteriorating with** • Communicating with my patient whom has** • Communicating with a patients prescriber regarding condition r/t** • Confident I possess the technical hand-on skills I need to safely care for a patient with** _____________________________________________________ Qualitative Feedback: • The MOST helpful to my learning experience for this session was: • The LEAST helpful to my learning experience for this session was: • This simulation experience has helped me to:

8. Results Total Surveys Returned: • Non-Lethal Sessions: 42 • Respiratory Sessions: 40 • Lethal Cardiac Sessions: 39 Experience Level: • Graduate Nurse or < One Year: 72% • 1-5 Years Experience as RN: 15% • Over 5 Years Experience as RN: 11% Missing Data • 2 incomplete data points on scale • 14 missing experience level

9. Results • Statistical Analysis SPSS 19.0/ Paired-sample t-Test/ 95% CI • Statistical significance was noted with a p value <0.05 5-strongly disagree 4-somewhat disagree3-neutral2-somewhat agree1-strongly agree

10. Qualitative: Most Helpful Most Helpful • Learn how to use co-workers to collaborate ideas. • Realize you are not as rushed as you think/feel. • Watching others to see what they would do. • Receiving feedback in different situations. • Discussing what we would have done differently after. • To have a patient and not worry about harm. • Working with actual pacemaker and defibrillator. • Put a clinical picture to something I have not experienced yet. • Realize how much I really know. • Knowing I could make a mistake and not be judged. • Learn how I should respond in an emergency. • Less likely to freeze up when the real time comes. • Know what my options are when a patient is deteriorating. • To formulate a process when evaluating a patient in distress. • Learn about PEA and know to do CPR and no shock if there is an organized heart activity and no pulse. • Know what equipment is available and have confidence to use it.

11. Qualitative: Least Helpful Least Helpful • Going first. • I feel I am more stressed in Sim Lab. • I feel rushed. • The audience. • I would have preferred a second run-through with the same scenario to get it right. • 3-4 more scenarios would have been better.

12. Discussion • Results are limited to those participants that attend didactic lecture prior to attending simulation session. • Strengths of this study include control over standardization of scenarios used throughout entire study; same equipment (pacemakers, defibrillators, IV pumps), as well as same lab set-up. • Department directors dedicated to giving new staff time out of floor scheduling to attend critical care course and simulation sessions. • Simulation used in this setting with new graduate nurses is helpful to reinforce the expected practice of having current patient lab data & assessment available when phoning a prescriber with a change in patient condition, as well as reinforcing the use patient rescue programs, such as the rapid response team.