Use of simulation training in the intensive care unit.
ABSTRACT With increased patient acuity, nurse educators are faced with the challenge of providing ongoing education and ensuring nurse competency. High-fidelity simulation is an effective teaching modality that can meet the diverse needs of critical care nurses with various backgrounds and levels of experience. The Institute of Medicine recommends the use of simulation and simulators as a best practice tool for an instructional method in healthcare. There is documented support for the integration of simulation in nursing continuing education. Organizations such as the Agency for Healthcare Research and Quality, American College of Surgeons, American Council for Graduate Medical Education, National League for Nursing, American Nursing Association, and American Association of Critical Care Nurses have provided support and encouragement for the use of innovative teaching modalities to create enhanced learning. Along with enhanced learning, simulation plays a role in improving patient safety, recruitment and retention strategies, and addressing quality and risk-management concerns. This article will focus on high-fidelity simulation as it relates to clinical education and nurse competency in the intensive care unit.
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ABSTRACT: Intensive care nursing is carried out in a dynamic environment characterized by the continuous incorporation of new technologies, approaches to care and a request for safety, participation and transparency by the public. Continuing/permanent intensive care nursing training in the acquisition of new competencies is key in this setting. In order to achieve this goal, simulation and problem based learning should be incorporated as essential methodologies to teach these skills. At the same time research should be done on which attitudes, competences, and knowledge are necessary to increase their intellectual knowledge. The core characteristics of ICU and its nursing should allow a deep change in their approach to continuing/permanent nursing education.Enfermería Intensiva 01/2013;
- Nursing Management (Springhouse) 07/2014; 45(7):32-39.
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ABSTRACT: Background: Medical student training and experience in cardiac arrest situations is limited. Traditional Advanced Cardiac Life Support (ACLS) teaching methods are largely unrealistic with rare personal experience as team leader. Yet Postgraduate Year 1 residents may perform this role shortly after graduation. Purposes: We expanded our ACLS teaching to a "Resuscitation Boot Camp" where we taught 2010 ACLS to 19 pregraduation students in didactic (12 hours) and experiential (8 hours) format. Methods: Immediately before the course, we recorded students performing an acute coronary syndrome/ventricular fibrillation (VF) scenario. As a final test, we recorded the same scenario for each student. Primary outcomes were time to cardiopulmonary resuscitation (CPR) and defibrillation (DF). Secondary measures were total scenario score, dangerous actions, proportion of students voicing "ventricular fibrillation," 12-lead ST-elevation myocardial infarction (STEMI) interpretation, and care necessary for return of spontaneous circulation (ROSC). Two expert ACLS instructors scored both performances on a 121-point scale, with each student serving as their own control. We used t tests and McNemar tests for paired data with statistical significance at p <.05. Results: Before instruction, average time from arrest to CPR was 112 seconds and to first DF 3.01 minutes. Students scored 45 ± 9/121 points and 9/19 (49%) performed dangerous actions. After instruction, time to CPR was 12 seconds (p =.004) and to first DF 1.53 minutes (p =.03). Time to DF was delayed as students showed mastery of bag-valve-mask ventilation before DF. After instruction, students scored 97 ± 4/121 points (p <.0001) with no dangerous actions. Before training, only 4 of 19 (21%) students performed both CPR and DF within 2 minutes, and 3 of these had ROSC. After training, 14 of 19 (74%) achieved CPR + DF ≤ 2 minutes (p =.002), and all had ROSC. Before training, 5 of 19 (26%) students said "VF" and 4 of 19 obtained an ECG, but none identified STEMI. After training, corresponding performance was 13 of 19 "VF" (68%, p =.021) and 100% ECG and STEMI identification (p <.05). Conclusions: This course significantly improved knowledge and psychomotor skills. Critical actions required for resuscitation were much more common after training. ACLS training including high-fidelity simulation decreases time to CPR and DF and improves performance during resuscitation.Teaching and Learning in Medicine 07/2014; 26(3):266-273. · 1.12 Impact Factor