2014 NCSBN Scientific Symposium 2014 NCSBN Scientific Symposium April 2014 Christine Szweda, MS, BSN,

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  • 2014 NCSBN Scientific Symposium

    April 2014

    Christine Szweda, MS, BSN, RN Senior Director, Operations

    Office of Nursing Education and Professional Development

  • Objectives

    •  Participants can state the rationale for the proposed research study

    •  Participants can describe the intervention

    •  Participants can identify one area for future study

  • Cleveland Clinic National Recognition

    •  U.S. News & World Report -  #1 in heart care 19 consecutive years -  In top 4 hospitals nationally

  • H Fairview Hospital

    Lakewood Hospital

    H

    Lutheran Hospital

    H

    Euclid Hospital

    H

    Hillcrest Hospital

    H

    South Pointe Hospital

    H

    Marymount Hospital

    H

    Cleveland Clinic

    (main campus)

    Integrated Health System serving 5.1 million patients

    H Medina Hospital H Weston Hospital,

    Florida

  • •  Total workforce >41,000 •  Nurses 11,000+

    •  154 nursing units •  4,500 beds •  200 operating room settings •  ER visits (system wide) – 440,000

    Cleveland Clinic Nursing

  • Annual RN Hires

    2011

    1750

    2013

    1250

    2012

    1500 Types of New Hires

    18%

    82%

    Experienced Inexperienced

    40% New Graduate Nurses Hired into

    an ICU Setting

  • Study Overview Evaluating the Use of Human Patient Simulation

    (HPS) to Improve Critical Thinking Competencies and Perceived Self-Confidence of New Graduate Nurses in the Intensive Care

    Unit (ICU)

    •  Could an intensive educational program utilizing HPS scenarios significantly improve new

    graduate RN’s critical thinking competencies and perceived self-confidence in managing patient

    problems in the ICU setting?

  • Study Methods

    •  Part A - A mixed methods study with double- blind randomized trial

    •  Part B - A qualitative component utilizing individual interviews

    •  Study Tools -  PBDS© Competency Assessment Tool -  Casey Fink Graduate Nurse Experience

    Survey -  Qualitative Interview Tool

  • Expectations at Point of Hire

    •  Recognition of Problem •  Recognition of Urgency

    Expectation of New Graduate Nurses upon entry to CC Health System

  • PBDS Continuum Baseline Assessment

    Unable to recognize

    change problem or

    urgency

    Unable to manage basic

    med/surg patient

    problems

    Acceptable

    Percent of New Graduates in Each Category

    35%*

    54% 11%

    Unsafe to transition to hospital unit

  • Expectations at End of Orientation

    •  Management of Problem -  Communicate Relevant Info to MD -  Anticipate Orders from MD -  Implement Immediate Nursing

    Interventions Expectation of New Graduate Nurses upon completion of orientation

  • PBDS Continuum Re-assessment

    Unable to recognize

    change problem or

    urgency

    Unable to manage patient

    problems specific to their

    unit

    Acceptable

    Percent of ICU Nurses in Each Category

    15%

    55% 30%

    Percent of Med/ Surg Nurses in Each Category

    10% 20% 70%

  • Participants

    •  Consented 65 -  31 intervention group -  25 control group

  • Intervention

    •  Control Group -  Standard 12 weeks of orientation with

    a coach/preceptor -  Critical care classes scheduled

    throughout orientation

  • Intervention

    •  Experimental Group -  Standard 12 weeks of orientation with

    a coach/preceptor -  Critical care classes scheduled

    throughout orientation •  Five day immersive experience focused

    on ICU problem management

  • Day 1 Day 2 Day 3 Day 4 Day 5 Review week

    Review critical thinking questions

    Practice critical thinking questions with video scenarios

    Intro to hi- fidelity simulation

    HPS Scenario – Uncontrolled Pain

    Debriefing

    Equipment Review

    Review Scenario SBAR

    HPS Scenario – Hypovolemia

    Debriefing

    Equipment Review

    Review Scenario SBAR

    HPS Scenario – Sepsis

    Debriefing

    Equipment Review

    Review Scenario SBAR

    HPS Scenario – Obstucted Airway

    Debriefing

    Compare and Contrast with video scenarios and critical thinking questions

    Debriefing

    Equipment Review

    Review Scenario SBAR

    HPS Scenario – DKA

    Debriefing

    Review Scenario SBAR

    HPS Scenario – Pulmonary Edema

    Debriefing

    Individual HPS Scenarios

    Review video – self assess

    Present video to cohort and debrief

    Prioritization exercise (all scenarios from week)

  • Critical Thinking Questions

    Review SBAR/Receive Handoff Report •  What complications is the patient at risk for? •  How will you know if that complication is occurring? •  What particular components of the assessment are

    you going to focus on?

  • Critical Thinking Questions Assess the patient •  What signs/symptoms do you see? •  What problem/complication do you think is occurring

    and why? •  Does this require any urgent action(s) and why? •  What immediate nursing interventions do I need to

    take and why? •  What information do I need to communicate to the

    physician? •  What orders am I going to anticipate from the

    physician? •  What is the rationale for those orders? •  How will I know the interventions/orders implemented

    have been effective?

  • PBDS Re-assessments Unable to recognize

    change problem or

    urgency

    Unable to manage patient

    problems specific to their unit

    Acceptable

    Pre-Study 15%

    55% 30%

    Control Group 4% 62% 44%

    Experimental/ Intervention Group

    0% 61% 39%

  • Qualitative Findings

    •  Experimental/Intervention group identified 3 themes -  Improved their ability to see the

    entire patient picture -  Taught them to anticipate problems

    and/or complications and know what to expect

    -  Communicate more effectively with the MD and anticipate appropriate orders.

  • Qualitative Findings

    •  Top Lessons Learned -  Improved assessment skills -  Learned the why behind the

    interventions -  Ability to prioritize -  Pattern of critical thinking to use

    when approaching patients

  • Qualitative Interviews

    •  Themes -  Learn best on unit with coach instead of in

    classes -  Time away from unit increased stress in

    some -  Even when practicing independently, did

    not feel confident in understanding the entire patient picture

    -  Coaches who asked questions preferred to those who just showed how things were done

  • Recommendations

    •  Further study on an intervention that allows for time on unit with coach and minimal class content.

    •  Compare relationship between perceived confidence and competency.