Quality improvement for self-confidence, critical-thinking, and psychomotor skills in basic life support of nursing health professionals through case-scenario simulation training

Abstract

Background: Recognition and timely management of medical emergencies in non-critical care units are essential in initiating and delivering high quality care. Simulation training is a constructive tool that can be utilized to refresh and maintain knowledge and skills for staff that may not encounter medical emergencies frequently. This study examined staff that work at the John D. Dingell VA Medical Center Community Living Center (CLC), a subacute and inpatient rehabilitation unit, on their critical thinking skills, knowledge, role responsibilities and confidence levels prior to and after implementation of a mixed intervention of a one-hour webinar didactic and one-hour case-based simulation with debriefing. The purpose of the study was to improve non-critical care staff critical thinking, knowledge and confidence when working with a deteriorating patient.

Methods: A pretest-posttest study design was used to conduct the study.  Pre and post surveys were given to 42 health professionals which included registered nurses (RN), licensed practical nurses (LPN) and nursing aides after participating in a case scenario using a high-fidelity mannequin to simulate a medical emergency. Analyses were performed using the two-tailed t-test with p-value significance of less than .05 using Excel and JMP by SAS.

Results: Among the 42 participants, there was a significant improvement in confidence for recognizing signs of patient deterioration for timely activation of code team (p < .001).  Critical thinking skills and knowledge on appropriate activation of the type of response team based on patients’ speed of deterioration also improved after the intervention (p < .001). Overall, the staff felt more comfortable, confident and knowledgeable concerning their roles and local policy of emergent situations.

Conclusions: A team-based case scenario simulation course may improve non-critical care nursing staff confidence, knowledge and critical thinking as it pertains to activation of code teams and willingness to actively participate in medical emergencies.