High Fidelity Simulation Improves Provider Confidence During ACLS Training Even Among Experienced Staff: Are We Missing an Opportunity?
DOI:
https://doi.org/10.17140/EMOJ-2-120Keywords:
Simulation, Confidence, Experience, Advanced Cardiac Life Support (ACLS)Abstract
Background: Advanced Cardiac Life Support (ACLS) resuscitation requires rapid assessment and intervention. It is unclear, however, whether high fidelity simulation improves confidence in providers who are experienced as most simulation training focuses on new graduates or hires. We tested the hypothesis that practicing providers undergoing high-fidelity simulation of cardiopulmonary arrest scenarios will express greater confidence in ACLS skills.
Methods: We conducted a prospective cohort study at an urban level 1 trauma center from January to October, 2011 with a convenience sample of nurses, nurse practitioners, and physicians. They participated in high-fidelity (Laerdal 3G) simulation sessions of cardiopulmonary arrest about 3 months apart. Each session included two scenarios and lasted 30 minutes, including debriefing. We recorded demographics and confidence on a validated 5 point Likert scale confidence measurement tool before and after each session. Responses ranged from not at all confident (1) to very confident (5) in: recognizing signs and symptoms, appropriately intervening, and evaluating intervention effectiveness in cardiac and respiratory arrests. Descriptive statistics, paired t-tests, and ANOVA were used for data analysis. Sensitivity testing evaluated subjects who completed their second session at 6 months rather than 3 months.
Results: Sixty-five subjects completed consent, 35 completed 1 session and 23 completed at least 2 sessions with no missing data. Ninety-two percent were registered nurses, median clinical experience was 11-15 years, and 59% were from an intensive care unit. Provider confidence increased significantly after a single session. There was a trend for further increased confidence with an additional session and the increased confidence was maintained for at least 3-6 months given the sensitivity analysis. The number of cardiopulmonary arrests directly participated in during the past year and the years of clinical experience in their current role did not influence confidence scores.
Conclusion: High fidelity simulation significantly increases provider confidence even among experienced providers. Further
study of the link between provider confidence in ACLS skills and resuscitation quality measures is needed.
References
Neumar RW, Otto CW, Link MS, et al. Part 8: adult advanced cardiovascular life support: 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation. 2010; 122(3): S729-S767. doi: 10.1161/CIRCULATIONAHA.110.970988
Lewis R, Strachan A, Smith MM. Is high fidelity simulation the most effective method for the development of non-technical skills in nursing? A review of the current evidence. Open Nurs J. 2012; 6: 82-89. doi: 10.2174/1874434601206010082
Bruce SA, Scherer YK, Curran CC, Urschel DM, Erdley S, Ball LS. A collaborative exercise between graduate and undergraduate nursing students using a computer-assisted simulator in a mock cardiac arrest. Nurs Educ Perspect. 2009; 30(1): 22-27. doi: 10.1043/1536-5026-030.001.0022
Deutschman CS, Ahrens T, Cairns CB, Sessler CN, Parsons PE. Multisociety task force for critical care research: key issues and recommendations. Am J Crit Care. 2012; 21(1):15-23. doi: 10.4037/ajcc2012632
Corbridge SJ, McLaughlin R, Tiffen J, Wade L, Templin R, Corbridge TC. Using simulation to enhance knowledge and confidence. Nurse Pract. 2008; 33(6):12-13. Web site. http:// journals.lww.com/tnpj/Citation/2008/06000/Using_Simulation_ to_Enhance_Knowledge_and.6.aspx. Accessed March 30, 2016.
Mould J, White H, Gallagher R. Evaluation of a critical care simulation series for undergraduate nursing students. Contemp Nurse. 2011; 38(1-2): 180-190. doi: 10.5172/conu.2011.38.1- 2.180
Blum CA, Borglund S, Parcells D. High-fidelity nursing simulation: impact on student self-confidence and clinical competence. Int J Nurs Educ Scholarsh. 2010; 7: 18. doi: 10.2202/1548-923X.2035
Alinier G, Hunt B, Gordon R, Harwood C. Effectiveness of intermediate-fidelity simulation training technology in undergraduate nursing education. J Adv Nurs. 2006; 54(3): 359- 369. doi: 10.1111/j.1365-2648.2006.03810.x
Kim TE, Reibling ET, Denmark KT. Student perception of high fidelity medical simulation for an international trauma life support course. Prehosp Disaster Med. 2012; 27(1): 27-30. doi:
1017/S1049023X11006790 10. Allan CK, Thiagarajan RR, Beke D, et al. Simulation-based training delivered directly to the pediatric cardiac intensive care unit engenders preparedness, comfort, and decreased anxiety among multidisciplinary resuscitation teams. J Thorac Cardiovasc Surg. 2010; 140(3): 646-652. doi: 10.1016/j. jtcvs.2010.04.027
Hunziker S, Buhlmann C, Tschan F, et al. Brief leadership instructions improve cardiopulmonary resuscitation in a high-fidelity simulation: a randomized controlled trial. Crit Care Med. 2010; 38(4): 1086-1091. doi: 10.1097/CCM.0b013e3181cf7383
Yeung JH, Ong GJ, Davies RP, Gao F, Perkins GD. Factors affecting team leadership skills and their relationship with quality of cardiopulmonary resuscitation. Crit Care Med. 2012; 40(9): 2617-2621. doi: 10.1097/CCM.0b013e3182591fda
Wallace SK, Abella BS, Becker LB. Quantifying the effect of cardiopulmonary resuscitation quality on cardiac arrest outcome: a systematic review and meta-analysis. Circ Cardiovasc Qual Outcomes. 2013; 6(2): 148-156. doi: 10.1161/ CIRCOUTCOMES.111.000041
Buckley T, Gordon C. The effectiveness of high fidelity simulation on medical-surgical registered nurses’ ability to recognise and respond to clinical emergencies. Nurse Educ Today. 2011; 31(7): 716-721. doi: 10.1016/j.nedt.2010.04.004
Andreatta P, Saxton E, Thompson M, Annich G. Simulation-based mock codes significantly correlate with improved pediatric patient cardiopulmonary arrest survival rates. Pediatr Crit Care Med. 2011; 12(1): 33-38. doi: 10.1097/PCC.0b013e3181e89270
Hicks FDC, Coke L, Li S. The effect of High-Fidelity Simulation on Nursing Student’s Knowledge and Performance: A Plilot Study. National Council of State Boards of Nursing, Inc (NCSBN) Research Brief 2009; 40. Web site. https://www. ncsbn.org/09_SimulationStudy_Vol40_web_with_cover.pdf. Accessed March 30, 2016.
Hart D, McNeil MA, Griswold-Theodorson S, Bhatia K, Joing S. High fidelity case-based simulation debriefing: everything you need to know. Acad Emerg Med. 2012; 19(9): E1084. doi: 10.1111/j.1553-2712.2012.01423.x
Wang EE, Kharasch M, Kuruna D. Facilitative debriefing techniques for simulation-based learning. Acad Emerg Med. 2011; 18(2): e5. doi: 10.1111/j.1553-2712.2010.01001.x
Dreifuerst KT. The essentials of debriefing in simulation learning: a concept analysis. Nurs Educ Perspect. 2009; 30(2): 109-114. doi: 10.1043/1536-5026-030.002.0109
Benner P. Educating nurses: a call for radical transformation-how far have we come? J Nurs Educ. 2012; 51: 183-184. doi: 10.3928/01484834-20120402-01
Thomas EJ, Williams AL, Reichman EF, Lasky RE, Crandell S, Taggart WR. Team training in the neonatal resuscitation program for interns: teamwork and quality of resuscitations. Pediatrics. 2010; 125(3): 539-546. doi: 10.1542/peds.2009- 1635
Figueroa MI, Sepanski R, Goldberg SP, Shah S. Improving teamwork, confidence, and collaboration among members of a pediatric cardiovascular intensive care unit multidisciplinary team using simulation-based team training. Pediatr Cardiol. 2013; 34(3): 612-619. doi: 10.1007/s00246-012-0506-2
Lee CC, Im M, Kim TM, et al. Comparison of traditional advanced cardiac life support (ACLS) course instruction vs. a scenario-based, performance oriented team instruction (SPOTI) method for Korean paramedic students. J Emerg Med. 2010; 38(1): 89-92. doi: 10.1016/j.jemermed.2007.11.078
Franklin AE, Burns P, Lee CS. Psychometric testing on the NLN student satisfaction and self-confidence in learning, simulation design scale, and educational practices questionnaire using a sample of pre-licensure novice nurses. Nurse Educ Today. 2014; 34(10): 1298-1304. doi: 10.1016/j.nedt.2014.06.011
Levett-Jones T, McCoy M, Lapkin S, et al. The development and psychometric testing of the satisfaction with simulation experience scale. Nurse Educ Today. 2011; 31(7): 705-710. doi: 10.1016/j.nedt.2011.01.004
Downloads
Published
How to Cite
Issue
Section
License
This work is licensed under a Creative Commons Attribution 4.0 International License.
All content published in Emergency Medicine (EM) is licensed under the Creative Commons Attribution 4.0 International License (CC BY 4.0). This license allows anyone to copy, distribute, transmit, and adapt the work — including for commercial purposes — provided appropriate credit is given to the original author(s) and source.
