Increasing use of an endotracheal intubation safety checklist in the emergency department

The use of non-invasive ventilation by emergency doctors in Johannesburg Academic Hospitals, South Africa - assessing knowledge, attitudes and practices

Introduction

Non-invasive ventilation (NIV) is an alternative ventilatory method to endotracheal intubation and invasive ventilation in patients presenting in acute respiratory failure. Appropriate and timely application of NIV has shown benefits over invasive ventilation. In recent years, there has been an increase in the use of NIV for varying pathologies in response to limited resources.Emergency department doctors' knowledge of NIV, as well as their attitude towards its use can have significant effects on the success of NIV. The aim of this study was to assess emergency doctors' use of NIV in the South African setting.

Methods

This was a multi-centre prospective cross-sectional study that was conducted across three academic emergency departments in Johannesburg, South Africa. Doctors of various grades were included in the study and their responses were analysed according to their level of experience and their job description.

Results

The mean knowledge score of the participants was shown to increase with an increase in job designation (p < 0.001). The doctors' attitude towards NIV was more positive in those with higher knowledge scores (p < 0.001). Participants with previous critical care experience versus those without was associated with a higher average knowledge score (77% vs. 69 %, p = 0.009) as was formal NIV training versus those without (77% vs. 69 %, p = 0.01). The COVID-19 pandemic increased confidence in the use of NIV in 61 % of participants. The majority (69 %) of participants did not use a checklist when administering NIV. Only 53 % used a guideline when initiating a patient on NIV and just 26 % used a locally produced protocol.

Conclusion

Increased clinical experience, critical care exposure and formal NIV training corresponded with higher knowledge scores. Formal NIV training programs, the implementation of a checklist and the development of locally produced protocols are recommended to improve knowledge, attitudes and NIV practice that is in-keeping with international standards.

The impact of rapid cycle simulation deliberate practice on nursing student's resuscitation self-efficacy: A quasi-experimental study

BACKGROUND

Nursing students often report anxiety about the performance of resuscitation in a placement context. Rapid cycle deliberate practice which involves re-running the scenario after de-brief allowing for the correction of errors and improved practice has been widely used to develop skills in resuscitation. Few studies have examined the use of rapid cycle deliberate practice to improve resuscitation confidence and self-efficacy.

OBJECTIVE

to assess if rapid cycle deliberate practice leads to improvements in resuscitation self-efficacy in pre-registration nursing students.

DESIGN

Quasi-experimental pre and post-test design measuring self-efficacy using the Basic Resuscitation Skills - Self Efficacy Scale.

SETTING

University, United Kingdom.

PARTICIPANTS

Students were invited to participate (n = 120) and 106 consented to take part in the study. Participants were in pre-determined practical groups with 56 in the experimental group and 50 in the control group.

METHODS

A pre and post-test of nursing students' self-efficacy during a resuscitation simulation scenario. The scenario will relate to a patient admitted to the emergency room with chest pain who then goes into cardiac arrest. The control group undertake the simulation exercise and then received a de-brief whereas the experimental group participated in a rerun of the scenario following the de-brief (deliberate practice). Both groups completed the Basic Resuscitation Skills Self-efficacy scale pre and post the session. Data were analysed using a paired sample t-test.

RESULTS

Both groups showed improved self-efficacy as a result of the simulation session. The difference in the post-test mean scores between the control and the experimental group was marginal and not statistically significant.

CONCLUSION

rapid cycle deliberate practice simulation does not lead to improved resuscitation self-efficacy amongst pre-registration nursing students when compared with a single session.

ABSTRACT

Nursing students are often anxious about performing resuscitation in practice. Can rapid cycle deliberate practice improve resuscitation self-efficacy? Pre and post-test study (n=106) showed improved self-efficacy with no statistical difference between standard simulation and deliberate practice.