Increasing Rural Emergency Department Nurses' Confidence in Resuscitation Skills

2.50
Hdl Handle:
http://hdl.handle.net/10755/162645
Type:
Presentation
Title:
Increasing Rural Emergency Department Nurses' Confidence in Resuscitation Skills
Abstract:
Increasing Rural Emergency Department Nurses' Confidence in Resuscitation Skills
Conference Sponsor:Emergency Nurses Association
Conference Year:2007
Author:Albrecht, Luke, MD
P.I. Institution Name:Regions Hospital Emergency Medicine Dept.
Title:Emergency Medicine Resident Physician, PGY-2
Contact Address: 640 Jackson Street, MC11102F, St. Paul, MN, 55101, USA
Contact Telephone:(651) 254-3666
Co-Authors:Beth Elchek LaVelle, PhD, RN, CEN; Jessie G. Nelson, MD, FAAEM
[Clinical Paper Presentation] Clinical Topic: Emergency nurses in rural settings see critically injured patients less frequently than in urban areas with fewer available resources. The Western Wisconsin Regional Trauma Advisory Committee recognized the need for training beyond Advanced Cardiac Life Support and the Trauma Nurse Core Course for experienced rural emergency department (ED) nurses and some basic ED skills for nurses from other units who assist during resuscitations. Emergency care-based educators from the Simulation Center worked with staff from seven rural EDs to design a high-fidelity, simulation-based trauma course emphasizing application of knowledge, skills, and critical thinking without risk to patients.

Implementation: Two customized, interactive, 4-hour workshops were offered to each emergency department and limited to 12 staff per workshop. Requested skills were incorporated into four high-fidelity scenarios: (1) multiple trauma with difficult airway (cervical immobilization, helmet removal, rapid sequence induction, cricoid pressure, laryngeal manipulation, endotracheal tube introducer, intubating laryngeal mask airway, surgical airway, chest tube, autotransfusion); (2) pneumothorax (biphasic positive airway pressure, needle decompression, small-bore chest tubes); (3) burns/fractures secondary to explosion (pain control, intraosseous access, central venous and arterial pressure monitoring); and (4) pediatric trauma. Small teams rotated through scenarios, while remaining staff watched via live feed video. After each scenario, experienced ED faculty (registered nurses, physician, resident, and paramedic) facilitated debriefings focused on learners' concerns and questions, systems issues, evidence-based practices and current controversies. Concerns related to specific psychomotor skills were addressed in advanced, hands-on tutorials using much of their own equipment and part-task trainers.

Outcomes: A convenience sample of 77 staff from six facilities participated in the workshops including 66 RNs (86%). 59% of participants worked in emergency departments. Years of clinical experience ranged from less than one year to 37 years with a wide range of prior experience with resuscitation of critically ill patients (56% less than 10 resuscitations; 7.5% over 70 resuscitations). Baseline comfort with resuscitation: 22% very comfortable, 39% generally comfortable but inexperienced, and 39% uncomfortable (primary reason: lack of familiarity with equipment/procedures). Post-workshop, 99% of respondents reported increased confidence (41% "much more", 58% "somewhat more"), with overall usefulness of the course rated very highly (mean 9.3/10 max, mode 10). Comments were positive: "Acting out a scenario and then discussing what happened and why. I learn better hands on, so that really helped everything 'stick' better". Largest mean increases in comfort were related to respiratory procedures (scale 0 [very uncomfortable] - 10 [very comfortable]): cricothyroidotomy (1.9 pre, 5.2 post), needle jet insufflation (1.8 pre, 4.5 post), and needle thoracostomy (3.4 pre, 6 post).

Recommendations: High-fidelity simulation provides an innovative training model for rural emergency department's interested in enhancing critical thinking skills and increasing exposure to infrequently used equipment. Staff requested additional scenarios and follow-up with simulation in their own emergency departments. Although this workshop occurred in a simulation center, mobile simulation labs or in situ simulation are options. Additional funding through grants will allow the program to continue. Challenges included scheduling (staffing emergency departments while others are at workshops) and time management (debriefing required more time than expected, so the pediatric case was deferred).
Repository Posting Date:
27-Oct-2011
Date of Publication:
17-Oct-2011
Sponsors:
Emergency Nurses Association

Full metadata record

DC FieldValue Language
dc.typePresentationen_GB
dc.titleIncreasing Rural Emergency Department Nurses' Confidence in Resuscitation Skillsen_GB
dc.identifier.urihttp://hdl.handle.net/10755/162645-
dc.description.abstract<table><tr><td colspan="2" class="item-title">Increasing Rural Emergency Department Nurses' Confidence in Resuscitation Skills</td></tr><tr class="item-sponsor"><td class="label">Conference Sponsor:</td><td class="value">Emergency Nurses Association</td></tr><tr class="item-year"><td class="label">Conference Year:</td><td class="value">2007</td></tr><tr class="item-author"><td class="label">Author:</td><td class="value">Albrecht, Luke, MD</td></tr><tr class="item-institute"><td class="label">P.I. Institution Name:</td><td class="value">Regions Hospital Emergency Medicine Dept.</td></tr><tr class="item-author-title"><td class="label">Title:</td><td class="value">Emergency Medicine Resident Physician, PGY-2</td></tr><tr class="item-address"><td class="label">Contact Address:</td><td class="value"> 640 Jackson Street, MC11102F, St. Paul, MN, 55101, USA</td></tr><tr class="item-phone"><td class="label">Contact Telephone:</td><td class="value">(651) 254-3666</td></tr><tr class="item-email"><td class="label">Email:</td><td class="value">luke.w.albrecht@healthpartners.com</td></tr><tr class="item-co-authors"><td class="label">Co-Authors:</td><td class="value">Beth Elchek LaVelle, PhD, RN, CEN; Jessie G. Nelson, MD, FAAEM</td></tr><tr><td colspan="2" class="item-abstract">[Clinical Paper Presentation] Clinical Topic: Emergency nurses in rural settings see critically injured patients less frequently than in urban areas with fewer available resources. The Western Wisconsin Regional Trauma Advisory Committee recognized the need for training beyond Advanced Cardiac Life Support and the Trauma Nurse Core Course for experienced rural emergency department (ED) nurses and some basic ED skills for nurses from other units who assist during resuscitations. Emergency care-based educators from the Simulation Center worked with staff from seven rural EDs to design a high-fidelity, simulation-based trauma course emphasizing application of knowledge, skills, and critical thinking without risk to patients.<br/><br/>Implementation: Two customized, interactive, 4-hour workshops were offered to each emergency department and limited to 12 staff per workshop. Requested skills were incorporated into four high-fidelity scenarios: (1) multiple trauma with difficult airway (cervical immobilization, helmet removal, rapid sequence induction, cricoid pressure, laryngeal manipulation, endotracheal tube introducer, intubating laryngeal mask airway, surgical airway, chest tube, autotransfusion); (2) pneumothorax (biphasic positive airway pressure, needle decompression, small-bore chest tubes); (3) burns/fractures secondary to explosion (pain control, intraosseous access, central venous and arterial pressure monitoring); and (4) pediatric trauma. Small teams rotated through scenarios, while remaining staff watched via live feed video. After each scenario, experienced ED faculty (registered nurses, physician, resident, and paramedic) facilitated debriefings focused on learners' concerns and questions, systems issues, evidence-based practices and current controversies. Concerns related to specific psychomotor skills were addressed in advanced, hands-on tutorials using much of their own equipment and part-task trainers.<br/><br/>Outcomes: A convenience sample of 77 staff from six facilities participated in the workshops including 66 RNs (86%). 59% of participants worked in emergency departments. Years of clinical experience ranged from less than one year to 37 years with a wide range of prior experience with resuscitation of critically ill patients (56% less than 10 resuscitations; 7.5% over 70 resuscitations). Baseline comfort with resuscitation: 22% very comfortable, 39% generally comfortable but inexperienced, and 39% uncomfortable (primary reason: lack of familiarity with equipment/procedures). Post-workshop, 99% of respondents reported increased confidence (41% &quot;much more&quot;, 58% &quot;somewhat more&quot;), with overall usefulness of the course rated very highly (mean 9.3/10 max, mode 10). Comments were positive: &quot;Acting out a scenario and then discussing what happened and why. I learn better hands on, so that really helped everything 'stick' better&quot;. Largest mean increases in comfort were related to respiratory procedures (scale 0 [very uncomfortable] - 10 [very comfortable]): cricothyroidotomy (1.9 pre, 5.2 post), needle jet insufflation (1.8 pre, 4.5 post), and needle thoracostomy (3.4 pre, 6 post).<br/><br/>Recommendations: High-fidelity simulation provides an innovative training model for rural emergency department's interested in enhancing critical thinking skills and increasing exposure to infrequently used equipment. Staff requested additional scenarios and follow-up with simulation in their own emergency departments. Although this workshop occurred in a simulation center, mobile simulation labs or in situ simulation are options. Additional funding through grants will allow the program to continue. Challenges included scheduling (staffing emergency departments while others are at workshops) and time management (debriefing required more time than expected, so the pediatric case was deferred).</td></tr></table>en_GB
dc.date.available2011-10-27T10:31:43Z-
dc.date.issued2011-10-17en_GB
dc.date.accessioned2011-10-27T10:31:43Z-
dc.description.sponsorshipEmergency Nurses Associationen_GB
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