Clinical Simulation Learning in Critical Care

Making the Transition: A Critical Care Skills Program to Support Newly Hired Nurses

PURPOSE

This article describes the impact of a hands-on critical care skills day led by clinical nurse specialist (CNS) to enhance junior nurses' clinical skills. Program objectives included providing specialized skills training to meet the needs of high-acuity patient population and reviewing nurse-sensitive indicator-associated care bundles with the goal of increasing compliance.

DESCRIPTION OF THE PROJECT

An 8-hour program of lecture and hands-on skills was developed. Curriculum included nursing-sensitive indicators, sepsis management, complex tubes and drains, airway management, and emergency response. Clinical nurse specialists mentored senior nurses to colead program planning and execution. The program has been offered 9 times. Qualitative and quantitative data were collected on attendees.

OUTCOME

Quantitative data analysis showed that 89% of the assessed components were affected by the program. Medium effect was noted in defibrillator skills, retrieving items from code care, care of suicidal patient, and sepsis screening. Qualitative data based on attendee survey are also presented and analyzed. Decreases in indwelling catheter utilization on select units are discussed.

CONCLUSION

The CNS has the responsibility to ensure nursing practice is reflective of hospital policy and current evidence. This program demonstrates the impact of CNSs in staff education, mentorship, and competency assessment.

Using Critical Care Simulations to Prepare Nursing Students for Capstone Clinical Experiences

The purpose of this innovative learning strategy was to decrease students' fear and anxiety within the critical care environment before the initiation of a critical care capstone clinical experience by enhancing their familiarity of the critical care environment through deliberate practice and experiential learning. This will in turn increase student knowledge and competence in the critical care setting.Critical care units are often used during a capstone clinical experience to enhance critical thinking and clinical reasoning. Student preparation for these rotations, however, is varied and often inadequate. The resulting fear and anxiety impair learning and also contribute to an unsafe environment for this at-risk population.Before the capstone experience, students participated in 3 simulation experiences, each addressing a core concept of critical care nursing. Faculty engaged students during the simulations, while modeling the confidence and critical thinking of a critical care nurse.After both the critical care simulation and the capstone rotation, students stated that the simulation allowed them the time in a safe environment to critically think through the steps to care for critical patients before the capstone rotation. The experience provided them with increased confidence necessary to discharge the responsibilities of a critical care nurse-attention to critical thinking and reasoning.Mindfully constructed simulations with clear objectives help to inoculate the student against fears associated with high-risk patients. This decrease in fear and anxiety before a hands-on clinical experience may improve patient safety. More confident students are also better able to engage in both experiential and deliberate learning, resulting in a more enhanced and meaningful clinical experience.

La formation des nouveaux professionnels arrivants en service de réanimation et en unités de soins continus par la simulation :« Gestion des situations critiques, un enjeu pour la sécurité du patient »

Les professionnels du service de réanimation du centre hospitalier Bretagne-Atlantique et de l’institut de formation des professionnels de santé de Vannes ont réalisé une formation relative à la gestion des situations critiques en réanimation et en unité de soins continus (USC). Cette formation a été construite suite aux constats suivants : 1) d’une part, les infirmières exerçant dans ces services ne bénéficient pas, en France, d’une spécialisation qualifiante ; 2) d’autre part, leur formation initiale ne leur permet pas d’être autonomes dans la gestion de l’imprévu dans ces services de haute technicité ; 3) pour autant, une expertise est nécessaire afin d’être performant dans la gestion des situations d’urgence mettant en jeu le pronostic vital du patient. Au regard de cette problématique, des événements critiques issus de la pratique professionnelle ont été scénarisés pour faire l’objet d’une formation en pratique simulée. Les infirmiers du territoire de santé affectés en réanimation et en USC ont ainsi pu expérimenter les situations à travers la simulation en santé. Cette méthode est particulièrement adaptée en matière de développement de compétences spécifiques dans ce contexte, car elle conjugue analyse de la pratique, réflexion sur l’action, apport de connaissances, mise en oeuvre de bonnes pratiques et coordination des actions. L’expérience de cette action de formation et son bilan sont présentés dans cet article.