"Mock Herniations" to Assess Nurses' Response Times and Accuracy in Setting Up Ventriculostomies in the Pediatric Intensive Care Unit
ABSTRACT When an emergent ventriculostomy is required for relief of increased intracranial pressure, it is critical that participating physicians and nurses work as an efficient team for optimal outcomes. From our experience, problems in ventriculostomy insertion have occurred because of delays in obtaining correct supplies and lack of skill in assembling the drainage system. The goals of this study were to (a) decrease the response time and (b) increase competency for successful insertion and setup of a ventriculostomy by using a "mock herniation" scenario. Three different nursing shifts in the pediatric intensive care unit at the University of Missouri Health Care were presented with a mock scenario of a child with increased intracranial pressure and impending herniation. Each group was timed on its ability to gather the correct supplies and scored on accuracy in setting up the drainage system. Subsequently, all pediatric intensive care unit nurses underwent skills laboratory training on correct assembly of the drainage system. After training, three different groups of nurses were tested again using the mock herniation scenario. This time, there was improvement in all areas tested, particularly in the mean time taken for accurate assembly and setup of the emergency ventriculostomy drainage system. We conclude that skills laboratory training reinforced by periodic mock herniations significantly decreases response time and increases accuracy of assembling supplies and setting up the drainage system for ventriculostomy insertion.
SourceAvailable from: Marek Czosnyka[Show abstract] [Hide abstract]
ABSTRACT: Intracranial pressure (ICP) is derived from cerebral blood and cerebrospinal fluid (CSF) circulatory dynamics and can be affected in the course of many diseases of the central nervous system. Monitoring of ICP requires an invasive transducer, although some attempts have been made to measure it non-invasively. Because of its dynamic nature, instant CSF pressure measurement using the height of a fluid column via lumbar puncture may be misleading. An averaging over 30 minutes should be the minimum, with a period of overnight monitoring in conscious patients providing the optimal standard. Computer-aided recording with online waveform analysis of ICP is very helpful. Although there is no "Class I" evidence, ICP monitoring is useful, if not essential, in head injury, poor grade subarachnoid haemorrhage, stroke, intracerebral haematoma, meningitis, acute liver failure, hydrocephalus, benign intracranial hypertension, craniosynostosis etc. Information which can be derived from ICP and its waveforms includes cerebral perfusion pressure (CPP), regulation of cerebral blood flow and volume, CSF absorption capacity, brain compensatory reserve, and content of vasogenic events. Some of these parameters allow prediction of prognosis of survival following head injury and optimisation of "CPP-guided therapy". In hydrocephalus CSF dynamic tests aid diagnosis and subsequent monitoring of shunt function.Journal of Neurology Neurosurgery & Psychiatry 07/2004; 75(6):813-21. DOI:10.1136/jnnp.2003.033126 · 5.58 Impact Factor
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ABSTRACT: Across the healthcare system, staff development specialists and nurse leaders have been challenged with the development, implementation, and evaluation of processes by which clinical nursing staff demonstrate competence in an efficient and effective manner. The purpose of this article is to describe one approach used in an acute care setting. Staff development specialists and nurse leaders played key roles in assessing, developing, and evaluating a nursing competency validation fair.Journal for nurses in staff development: JNSD: official journal of the National Nursing Staff Development Organization 01/2008; 24(3):124-8. DOI:10.1097/01.NND.0000300881.48802.b7
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ABSTRACT: Incorporating play into formal teaching strategies was introduced in theory over 75 years ago by John Dewey and the Gestalt theorists. Play, in the form of simulations, has had a significant role in contemporary nursing education. Simulations can teach more than a skill or an idea, since they can be designed to teach the complexification of ideas. The author explores the theoretical and historical development, the advantages and disadvantages, and future uses of simulations.Nurse Educator 01/1991; 16(2):28-31. DOI:10.1097/00006223-199103000-00012 · 0.67 Impact Factor