Review of effective advanced cardiac life support training using experiential learning

Difficulties of Spanish Primary Health Care nurses to assist emergencies: A cross-sectional study

BACKGROUND

The competence of a Primary Health Care nurse to handle emergency situations depends largely on prior acquisition of theoretical knowledge to make appropriate decisions, combined with the corresponding practical skills to carry out swift and effective interventions.

METHODS

Cross-sectional study conducted in through a survey auto-administered to a simple random sample of 269 nurses (n) with replacement of Asturias, Spain from the total nursing staff of 730 members (N) in Asturias.

RESULTS

In rural areas, the most frequently mentioned reasons were the lack of practical skills (18.9%) and the absence of adequate material (14.4 %). In the semi-urban area, the most common reasons were the lack of practical skills (13.2 %) and the lack of theoretical knowledge (10.3 %). Finally, in the urban area, the main reasons were the lack of practical skills (14.4 %) and the absence of adequate material (7.2 %). The differences were significant (p = 0.025).

CONCLUSIONS

Despite the requirement that they acquire the necessary theoretical and practical skills, not all PHC nurses perceive themselves to be sufficiently prepared. The degree of self-perceived acquisition of this knowledge and skills, which is so important and necessary, is heterogeneous, with clear differences according to the respective field of work.

Transcutaneous cardiac pacing competency among junior residents undergoing an ACLS course: impact of a modified high fidelity manikin

BACKGROUND

Transcutaneous cardiac pacing (TCP) is recommended to treat unstable bradycardia. Simulation might improve familiarity with this low-frequency procedure. Current mannequins fail to reproduce key features of TCP, limiting their usefulness. The objective of this study was to measure the impact of a modified high-fidelity mannequin on the ability of junior residents to achieve six critical tasks for successful TCP.

METHODS

First-year residents from various postgraduate programs taking an advanced cardiovascular life support (ACLS) course were enrolled two consecutive years (2015 and 2016). Both cohorts received the same standardized course content. An ALS simulator® mannequin was used to demonstrate and practice TCP during the bradycardia workshop of the first cohort (control cohort, 2015) and a modified high-fidelity mannequin that reproduces key features of TCP was used for the second cohort (intervention cohort, 2016). Participants were tested after training with a simulation scenario requiring TCP. Performances were graded based on six critical tasks. The primary outcome was the successful use of TCP, defined as having completed all tasks.

RESULTS

Eighteen participants in the intervention cohort completed all tasks during the simulation scenario compared to none in the control cohort (36 vs 0%, p < 0.001). Participants in the intervention cohort were more likely to recognize when pacing was inefficient (86 vs 12%), obtain ventricular capture (48 vs 2%), and check for a pulse rate to confirm capture (48 vs 0%).

CONCLUSIONS

TCP is a difficult skill to master for junior residents. Training using a modified high-fidelity mannequin significantly improved their ability to establish TCP during a simulation scenario.

Integrating simulation based learning into nursing education programs: Hybrid simulation

BACKGROUND

Hybrid simulation can be developed with mannequins of any fidelity and tabletop simulators with a standardized patient to create a complex, high-level learning activity.

OBJECTIVE

The aim of this study is to analyze the effects of a hybrid simulation technique used with nursing students in a scenario about the emergency setting.

METHODS

This one-group pre-test post-test model quasi-experimental study was carried out with 39 students in Ankara, Turkey, from October 2014 to July 2015.

RESULTS

Nearly all participants reported that the simulation improved their critical thinking, decision-making skills, and self-confidence before the clinical activity and that they felt as though they were real nurses during the activity (94.7%, 97.3%, 84.2%, and 92.1%, respectively).

CONCLUSION

The results of this study support the integration of hybrid simulation experiences throughout the nursing curriculum, as evidenced by positive responses from students through the simulation evaluation questionnaire.

Beginning and advanced students' perceptions of the use of low- and high-fidelity mannequins in nursing simulation

BACKGROUND

There is little research evidence that demonstrates the difference between the use of low- and high-fidelity mannequins in assisting students to acquire their skills when students are at different points in their nursing education experience.

OBJECTIVES

Our study examined differences between the use of low- and high-fidelity mannequins on student outcomes with both beginner and advanced students.

DESIGN

A quasi-experimental investigation.

SETTINGS

Participants performed two simulations, one simulation using a low-fidelity mannequin and the other simulation using a high-fidelity mannequin.

PARTICIPANTS

First and fourth semester pre-licensure students from a Bachelor of Science in Nursing program and an accelerated nursing entry program participated in this study.

METHODS

A Students' Satisfaction and Self-confidence Scale and Simulation Design Scale were used to obtain data. Statistical analysis was performed using the Statistical Package for the Social Sciences for Windows version 17.0. The results obtained from scales were compared using Wilcoxon sign test and Mann-Whitney U test. A p value of <0.05 was considered statistically significant.

RESULTS

The student satisfaction score of the students in the low-fidelity mannequin group was 3.62±1.01, while that of the students in the high-fidelity mannequin group was 4.67±0.44'dir (p=0.01). The total score of the simulation design scale in the low-fidelity mannequin group was 4.15±0.63, while it was 4.73±0.33 in the high-fidelity mannequin group (p=0.01).

CONCLUSIONS

Students' perceptions of simulation experiences using high-fidelity mannequins were found to be higher in contrast to their perceptions of experiences using low-fidelity mannequins.

Impact of levels of simulation fidelity on training of interns in ACLS

AIM

Identifying the modality and fidelity of simulation that offers the greatest benefit to the learner is critical to Advanced Cardiac Life Support (ACLS) training. Our hypothesis is that participants who receive ACLS training on high-fidelity mannequins will perform better than those trained on low-fidelity mannequins.

METHODS

The study was performed in the context of an ACLS Initial Provider course for new postgraduate year 1 residents and involved 3 training arms: (1) low-fidelity, (2) mid-fidelity, and (3) high-fidelity. Educational outcomes were evaluated by written scores, student evaluations of the course, and expert rater reviews of megacode performance.

RESULTS

A convenience sample of 54 subjects was randomized to 1 of the 3 training arms. All 3 groups significantly improved based on written posttest scores (P < 0.0001); however, pretest to posttest improvement among the 3 training arms was not significantly different: low-fidelity = 42.3 (95% CI, 35.7-48.9); mid-fidelity = 41.3 (95% CI, 34.7-47.9); high-fidelity = 40.8 (95% CI, 34.3-47.5; P = 0.95). All participants felt the simulator environment was realistic regardless of level of fidelity. Participants in the high-fidelity group were less likely to feel comfortable in the simulator environment (P = 0.0045). Clinical performance as assessed by expert raters' megacode scores was better for high-fidelity (66.3) than mid-fidelity (60.1) (P = 0.04).

CONCLUSION

Overall, there was no difference among the 3 groups in test scores or perceived instructor or course quality; however, subjects trained on high-fidelity mannequins performed better than those trained on mid-fidelity with respect to megacode performance.

Institutional resuscitation protocols: do they affect cardiopulmonary resuscitation outcomes? A 6-year study in a single tertiary-care centre

PURPOSE

Despite advances in cardiopulmonary resuscitation and widespread life-support trainings, the outcomes of resuscitation are variable. There is a definitive need for organizational inputs to strengthen the resuscitation process. Our hospital authorities introduced certain changes at the organizational level in our in-house resuscitation protocol. We aimed to study the impact of these changes on the outcomes of resuscitation.

METHODS

The hospital code blue committee decided to reformulate the resuscitation protocols and reframe the code blue team. Various initiatives were taken in the form of infrastructural changes, procurement of equipment, organising certified training programs, conduct of mock code and simulation drills etc. A prospective and retrospective observational study was made over 6 years: a pre-intervention period, which included all cardiac arrests from January 2007 to December 2009, before the implementation of the program, and a post-intervention period from January 2010 to December 2012, after the implementation of the program. The outcomes of interest were response time, immediate survival, day/night survival and survival to discharge ratio.

RESULTS

2,164 in-hospital cardiac arrests were included in the study, 1,042 during the pre-intervention period and 1,122 during the post-intervention period. The survival percentage increased from 26.7 to 40.8 % (p < 0.05), and the survival to discharge ratio increased from 23.4 to 66.6 % (p < 0.05). Both day- and night-time survival improved (p < 0.05) and response time improved from 4 to 1.5 min.

CONCLUSIONS

A strong hospital-based resuscitation policy with well-defined protocols and infrastructure has potential synergistic effect and plays a big role in improving the outcomes of resuscitation.

High fidelity simulation based team training in urology: a preliminary interdisciplinary study of technical and nontechnical skills in laparoscopic complications management

PURPOSE

Simulation based team training provides an opportunity to develop interdisciplinary communication skills and address potential medical errors in a high fidelity, low stakes environment. We evaluated the implementation of a novel simulation based team training scenario and assessed the technical and nontechnical performance of urology and anesthesiology residents.

MATERIALS AND METHODS

Urology residents were randomly paired with anesthesiology residents to participate in a simulation based team training scenario involving the management of 2 scripted critical events during laparoscopic radical nephrectomy, including the vasovagal response to pneumoperitoneum and renal vein injury during hilar dissection. A novel kidney surgical model and a high fidelity mannequin simulator were used for the simulation. A debriefing session followed each simulation based team training scenario. Assessments of technical and nontechnical performance were made using task specific checklists and global rating scales.

RESULTS

A total of 16 residents participated, of whom 94% rated the simulation based team training scenario as useful for communication skill training. Also, 88% of urology residents believed that the kidney surgical model was useful for technical skill training. Urology resident training level correlated with technical performance (p=0.004) and blood loss during renal vein injury management (p=0.022) but not with nontechnical performance. Anesthesia resident training level correlated with nontechnical performance (p=0.036). Urology residents consistently rated themselves higher on nontechnical performance than did faculty (p=0.033). Anesthesia residents did not differ in the self-assessment of nontechnical performance compared to faculty assessments.

CONCLUSIONS

Residents rated the simulation based team training scenario as useful for interdisciplinary communication skill training. Urology resident training level correlated with technical performance but not with nontechnical performance. Urology residents consistently overestimated their nontechnical performance.

Advanced cardiac life support instruction: do we know tomorrow what we know today?

This study compared two instructional and evaluation methods for teaching advanced cardiac life support (ACLS) to health care professionals who were taking the ACLS course for the first time. Outcomes of the instruction were measured on completion of the course and at 3 months and 6 months postinstruction to identify differences in participants' knowledge retention, skills competency, and self-efficacy in performing ACLS. In addition, satisfaction with the teaching method was evaluated. The two methods of teaching and evaluating competencies for ACLS were (1) traditional classroom instruction plus practice and evaluation with monitors (low-fidelity simulation); and (2) classroom instruction plus practice with high-fidelity patient simulators. Participants in the study were 148 health care professionals or health care students who were novices in ACLS preparation. Participants were recruited from a large Midwest school of nursing and school of medicine, a Midwest physicians' assistant program, and a not-for-profit hospital. The findings showed no significant differences in ACLS knowledge, skills, self-efficacy, or learner satisfaction immediately after instruction or at 3 to 9 months posttraining. Retention of ACLS knowledge and skills competency over time was low in both groups; recommendations and interventions are discussed based on the study results.

Can learning to sustain life be BASIC? Teaching for the initial management of the critically ill in Australia and New Zealand

Commonly in Australia and New Zealand, initial intensive care support of critically ill patients is by non-intensive care trained medical and nursing staff Basic Assessment and Support in Intensive Care (BASIC) is an internationally run short course to assist practitioners to gain knowledge and skills to manage the early hours of critical illness. The aim of this study was to assess the performance and acceptance of the BASIC course as conducted in an Australian metropolitan teaching hospital and a major regional centre in New Zealand. Performance on pre- and post-course multiple choice examinations and the overall course assessment by all participants attending between 2005 and 2009 was analysed. Of 796 participants, 338 (42%) were in Australia and 458 (58%) in New Zealand. Compared to New Zealand, Australian non-intensive care consultants and junior medical staff attended more commonly at 9% vs 4% and 62% vs 42% respectively, while nurses more frequently attended in New Zealand (47% compared to 12%, P < 0.001). The pre-course open book examination result averaged 79% (95% confidence interval 78 to 80) and the post-course closed book examination was 64% (95% confidence interval 63 to 65). The post-course examination score was predicted by pre-course examination score (beta = 0.22, 95% confidence interval 0.17 to 0.27), nursing occupation, (beta = -3.96, 95% confidence interval -5.03 to -2.90) and the availability of a scenario-based simulation module (beta = 0.22, 95% confidence interval 0.17 to 0.27, R2 = 0.38, P < 0.001). Participants generally found they had learned a great deal from the program and that the course material was of an appropriate level. The BASIC course was found to be a positive learning experience for health care practitioners inexperienced in the management of the critically ill.

Critical action procedures testing: a novel method for test-enhanced learning

CONTEXT

Human error is a leading cause of adverse events in anaesthesia. Residents' knowledge of how to respond to rare, yet potentially life-threatening events has been shown to deteriorate over time and thus cost-effective educational interventions are indicated. Previous research has shown that test-enhanced learning has the potential to strengthen both clinical knowledge and performance. We hypothesised that critical action procedures (CAPs) tests, similar to those employed by high-performance aircraft pilots, would help improve resident knowledge about how to respond to rare and potentially catastrophic events encountered during the perioperative period.

METHODS

Knowledge assessments were administered to 29 first-year anaesthesiology residents over the course of 9 months. Five-minute closed-book tests were administered with fill-in-the-blank questions regarding the American Society of Anesthesiologists' difficult airway guideline, advanced cardiac life support protocols, an institutional airway fire protocol and drug dosing for malignant hyperthermia. Inter-group comparisons were evaluated using the Kruskal-Wallis test. The difference between the pre-test and final test scores for each subsection was determined with the Mann-Whitney U-test for independent samples.

RESULTS

Composite subtest scores, when compared with baseline pre-test scores and subsequent scores, and when adjusted for attrition, significantly improved over the course of 9 months (20.5% versus 80%; P < or = 0.001). Likert-based survey data indicated a positive report for attainment of knowledge.

CONCLUSIONS

In this longitudinal observational study of first-year anaesthesiology residents, CAPs testing helped improve knowledge about critical events. Although the study was limited by its small number of subjects, a significant attrition rate and the lack of a control group, it demonstrates a cost-effective educational intervention that improved resident knowledge. This intervention may enable residents to transfer learned skills from theoretical testing situations to real-life scenarios. We propose the use and further study of CAPs testing as a cost-effective modality to augment both simulated and actual experiential learning.

Comparison of medical student responses and course achievement according to different types of patient simulations in an introductory advanced life support course

PURPOSE

The optimal type of patient simulation for different levels of learners has not been extensively studied. The purpose of the study was to compare preclerkship medical student responses and course achievement according to different types of patient simulations in an introductory advanced life support (IALS) course.

METHODS

A full-day, simulation-based IALS course was developed for preclerkship medical students who attended a four-week introduction to a clinical medicine program. One hundred eighteen students were trained in three days. Onsite interactive simulation with verbal debriefing (interactive type) was applied on the first day, and full-mission, realistic simulation with video-assisted debriefing (realistic type) was applied on the second and third days. At the end of course, students evaluated the course and their simulation experiences and completed a written post-test.

RESULTS

Student responses to the course and patient simulations were very positive. Students who experienced the realistic type of patient simulations more highly rated in realistic experiences, such as patient care, than the interactive type group (3.83+/-0.88 vs. 3.41+/-0.84, p=0.018). Values for team communication training were more highly rated by students in the interactive type group than the realistic type (4.69+/-0.52 vs. 4.39+/-0.86, p=0.022). There was no significant difference in post-test scores between the two groups (realistic, 67.63+/-10.80; interactive, 66.73+/-9.93, p=0.654).

CONCLUSION

Both types of patient simulation provide valuable learning experiences to preclerkship medical students, with their own advantages in an IALS course. Onsite interactive simulation with verbal debriefing may be more cost-effective tool for preclerkship medical students.