2014 NCSBN Scientific Symposium

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1 2014 NCSBN Scientific Symposium April 2014 Christine Szweda, MS, BSN, RN Senior Director, Operations Office of Nursing Education and Professional Development

2 Objectives Participants can state the rationale for the proposed research study Participants can describe the intervention Participants can identify one area for future study

3 Cleveland Clinic National Recognition U.S. News & World Report - #1 in heart care 19 consecutive years - In top 4 hospitals nationally

4 Integrated Health System serving 5.1 million patients H Euclid Hospital Lakewood Hospital H H Fairview Hospital H Lutheran Hospital H Medina Hospital Cleveland Clinic (main campus) H Marymount Hospital H South Pointe Hospital H Hillcrest Hospital Weston Hospital, Florida H

5 Cleveland Clinic Nursing Total workforce >41,000 Nurses 11, nursing units 4,500 beds 200 operating room settings ER visits (system wide) 440,000

6 Annual RN Hires % New Graduate Nurses Hired into an ICU Setting Types of New Hires 18% % Experienced Inexperienced

7 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?

8 Study Methods Part A - A mixed methods study with doubleblind 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

9 Expectations at Point of Hire Recognition of Problem Recognition of Urgency Expectation of New Graduate Nurses upon entry to CC Health System

10 PBDS Continuum Baseline Assessment Percent of New Graduates in Each Category Unable to recognize change problem or urgency Unable to manage basic med/surg patient problems Acceptable 35%* 54% 11% Unsafe to transition to hospital unit

11 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

12 PBDS Continuum Re-assessment Percent of ICU Nurses in Each Category Percent of Med/ Surg Nurses in Each Category Unable to recognize change problem or urgency Unable to manage patient problems specific to their unit Acceptable 15% 55% 30% 10% 20% 70%

13 Participants Consented intervention group - 25 control group

14 Intervention Control Group - Standard 12 weeks of orientation with a coach/preceptor - Critical care classes scheduled throughout orientation

15 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

16 Day 1 Day 2 Day 3 Day 4 Day 5 Review week Review critical thinking questions Equipment Review Review Scenario SBAR Equipment Review Review Scenario SBAR Equipment Review Review Scenario SBAR Individual HPS Scenarios Review video self assess Practice critical thinking questions with video scenarios Intro to hifidelity simulation HPS Scenario Uncontrolled Pain Debriefing HPS Scenario Hypovolemia Debriefing Equipment Review Review Scenario SBAR HPS Scenario Sepsis Debriefing HPS Scenario Obstucted Airway Debriefing Compare and Contrast with video scenarios and critical thinking questions Debriefing HPS Scenario DKA Debriefing Review Scenario SBAR HPS Scenario Pulmonary Edema Debriefing Present video to cohort and debrief Prioritization exercise (all scenarios from week)

17 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?

18 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?

19 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%

20 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.

21 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

22 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

23 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.

24

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