Education Methods for Maintaining Nursing Competency in Low-Volume, High-Risk Procedures in the Rural Setting: Bridging the Theory to Practice Gap

Evaluation of a tracheostomy education programme for speech-language therapists

BACKGROUND

Tracheostomy management is considered an area of advanced practice for speech-language therapists (SLTs) internationally. Infrequent exposure and limited access to specialist SLTs are barriers to competency development.

AIMS

To evaluate the benefits of postgraduate tracheostomy education programme for SLTs working with children and adults.

METHODS & PROCEDURES

A total of 35 SLTs participated in the programme, which included a 1-day tracheostomy simulation-based workshop. Before the workshop, SLTs took an online knowledge quiz and then completed a theory package. The workshop consisted of part-task skill learning and simulated scenarios. Scenarios were video recorded for delayed independent appraisal of participant performance. Manual skills were judged as (1) completed successfully, (2) completed inadequately/needed assistance or (3) lost opportunity. Core non-medical skills required when managing a crisis situation and overall performance were scored using an adapted Ottawa Global Rating Scale (GRS). Feedback from participants was collected and self-perceived confidence rated prior, immediately post and 4 months post-workshop.

OUTCOMES & RESULTS

SLTs successfully performed 94% of manual tasks. Most SLTs (29 of 35) scored > 5 of 7 on all elements of the adapted Ottawa GRS. Workshop feedback was positive with significant increases in confidence ratings post-workshop and maintained at 4 months.

CONCLUSIONS & IMPLICATIONS

Postgraduate tracheostomy education, using a flipped-classroom approach and low- and high-fidelity simulation, is an effective way to increase knowledge, confidence and manual skill performance in SLTs across patient populations. Simulation is a well-received method of learning.

Pulmonary Artery Catheters: Impact of e-Learning on Hemodynamic Assessments

Pulmonary artery catheters (PACs) are invasive devices placed in critically ill patients to monitor hemodynamic data. They are a high-risk, and in some settings a low-volume, medical device due to the complex insertion procedure and potentially lethal complications. Smaller intensive care units (ICUs) have large variances in exposure to PACs, therefore strengthening ICU nurses' belief in their ability to manage these hemodynamic monitoring devices is of utmost importance. The design is a single-group, pre/posttest study conducted on a 15-bed ICU to survey nurses' self-efficacy, knowledge, and satisfaction of an e-learning educational module. Both PAC and noninvasive cardiac output monitor patient application data were collected prior to and following the intervention. Fifteen ICU nurses completed all components of the module. Confidence in ability to accurately interpret hemodynamic data increased from pre- to postintervention (P < .001), and knowledge also increased from pre- to postintervention, albeit not statistically significantly (P = .088). Overall, nurses reported satisfaction with the educational module. With increased self-efficacy, nurses can feel empowered and motivated to further improve patient care management. Thus, workplaces should continue to advocate for additional educational tools for high-risk, low-volume devices.

What factors influence midwives to provide obstetric high dependency care on the delivery suite or request care be escalated away from the obstetric unit? Findings of a focus group study

BACKGROUND

In the United Kingdom, midwives will engage in discussions with the multidisciplinary team as to whether they can provide Obstetric High Dependency Care (OHDC) on the Delivery Suite or whether a woman's care should be escalated to the critical care team. This study aimed to explore the question: What factors influence midwives to provide OHDC or request care be escalated away from the obstetric unit in hospitals remote from tertiary referral centres?

METHODS

Focus groups were undertaken with midwives (n = 34) across three obstetric units in England, with annual birth rates ranging from 1500 to 5000 per annum, in District General Hospitals. Three scenarios in the form of video vignettes of handover were used as triggers for the focus groups. Scenario 1; severe pre-eclampsia, physiologically unstable 2; major postpartum haemorrhage requiring invasive monitoring 3; recent admission of woman with chest pain receiving facial oxygen and requiring continuous electrocardiogram (ECG) monitoring. Two focus groups were conducted in each of the obstetric units with experienced midwives. Data were analysed using a qualitative framework approach.

RESULTS

Factors influencing midwives' care escalation decisions included the care environment, a woman's diagnosis and fetal or neonatal factors. The overall plan of care including the need for ECG and invasive monitoring were also influential factors. Midwives in the smallest obstetric unit did not have access to the facilities for OHDC provision. Midwives in the larger obstetric units provided OHDC but identified varying degrees of skill and sometimes used 'workarounds' to facilitate care provision. Midwifery staffing levels, skill mix and workload were also influential. Some differences of opinion were evident between midwives working in the same obstetric units as to whether OHDC could be provided and the support they would enlist to help them provide it. Reliance on clinical guidelines appeared variable.

CONCLUSIONS

Findings indicate that there may be inequitable OHDC provision at a local level. Organisationally robust systems are required to promote safe, equitable OHDC care including skills development for midwives and precise escalation guidelines to minimise workarounds. Training for midwives must include strategies that prevent skills fade.

Strategies to Prevent Central Line-Associated Bloodstream Infections in Acute Care Hospitals: 2014 Update

Previously published guidelines are available that provide comprehensive recommendations for detecting and preventing healthcare-associated infections (HAIs). The intent of this document is to highlight practical recommendations in a concise format designed to assist acute care hospitals in implementing and prioritizing their central line-associated bloodstream infection (CLABSI) prevention efforts. This document updates “Strategies to Prevent Central Line-Associated Bloodstream Infections in Acute Care Hospitals,” published in 2008. This expert guidance document is sponsored by the Society for Healthcare Epidemiology of America (SHEA) and is the product of a collaborative effort led by SHEA, the Infectious Diseases Society of America (IDSA), the American Hospital Association (AHA), the Association for Professionals in Infection Control and Epidemiology (APIC), and The Joint Commission, with major contributions from representatives of a number of organizations and societies with content expertise. The list of endorsing and supporting organizations is presented in the introduction to the 2014 updates.

Initiation of a neonatal nurse practitioner competency activity in needle thoracostomy

Pneumothorax is a potentially life-threatening condition in a neonate, requiring emergency intervention. The neonatal nurse practitioner (NNP) must be able to respond quickly and competently to prevent significant potential complications or death. The purpose of this practice improvement project was to implement procedure review for NNP competency maintenance in needle thoracostomy for a tension pneumothorax and to evaluate the effectiveness of procedure review on competency through simulation performance. Eighteen NNPs participated (procedure review = 10, no review = 8). Results showed that procedure review had a small impact on total performance score. The simulation performance increased self-efficacy for all participants, and participants supported simulation-based procedural competency maintenance activities.