1. Self-Reported Gains in Knowledge & Performance by Newly Hired Nurses Completing a Simulation Workshop on Clinical Care Fundamentals Julie Morris, DHEd; Misty Flinchum, BS, RRT; Ashley M. Bossard, BS; Amanda Anderson, BSN, RN, PCCN; Susan Blankenship, BSN, MS, PCCN; Margaret Perry, MSN, RN-BC; David W. Musick, PhD Carilion Clinic and Virginia Tech Carilion School of Medicine Introduction Materials and Methods Results: Nurses’ Self Confidence Ratings References Conclusions & Limitations Contact Information Center for Simulation, Research & Patient Safety (CSRPS) c/o Carilion Roanoke Memorial Hospital 1906 Belleview Avenue SE Roanoke, VA. 24014 (540) 266-5827 Study Objective There is often a “gap” between nursing graduates’ knowledge and skills and the expectations of employers who hire nurses to their first professional positions. A variety of educational teaching and assessment methods may be used to help narrow this “gap” so that newly hired nurses successfully transition to the workplace. 1 The use of simulation-based education (SBE) as a teaching and assessment method within health professions training programs has rapidly expanded during the past decade. 2 A critical component of SBE is guided reflection on the part of the learner, resulting in gradually increasing confidence in one’s own skill set. A growing body of research evidence has documented the utility of SBE for educating health care professionals on a wide variety of topics. 3 The purpose of our study was to analyze the impact of simulation-based education (SBE) in assessing newly hired nurses on selected aspects of fundamental competencies, communication and teamwork skills and escalation of clinical care. Within the first 4 to 6 weeks of being hired, a total of 202 nurses self-assessed their knowledge and clinical care skills before and after a simulation-based educational experience, then provided feedback. Nurses received pre-education on the 10 Signs of Vitality Assessment Process 4 and use of the Situation, Background, Assessment and Recommendation (SBAR) tool. They then completed two separate simulation-based exercises featuring clinical patient care scenarios. During these scenarios they also practiced communication, teamwork and escalation of care skills. A debriefing session followed. A 5-point Likert scale (1=very low to 5=very high) questionnaire asked participants to self-rate confidence and skills before and after the SBE experience. Data analyses were performed using descriptive statistics and the T-test procedure for item means (p ≤.05). Self-reported confidence in all measures increased (see data below; all items statistically significant, p≤.05). Simulation-based education provided newly hired nurses with an opportunity to learn, refine and demonstrate patient assessment skills, communication skills, escalation of care procedures and good teamwork. Limitations to the study include: Small sample size. Lack of long-term follow up on subsequent performance by nurses who completed the workshop. Lack of more objective measures of knowledge and skills needed to escalate care appropriately. Further research: Long-term follow up on retention of gains in knowledge and skills reported by nurses. Include objective measures of nurses’ knowledge & skills, so that self-reported gains can be more firmly established. Cost effectiveness of this type of training. 1 Zigmont J, Wade A, Edwards T, et al. Utilization of Experiential Learning and the Learning Outcomes Model Reduces RN Orientation Time by More than 35%. Clinical Simulation in Nursing 2015; 11: 79-95. 2 Sadideen H, Hamaoui K, Munir S. Simulators & the Simulation Environment: Getting the Balance Right in Simulation-Based Surgical Education. International Journal of Surgery 2012; 10: 458-62. 3 McGaghie WC, Siddall VJ, Mazmanian PE, Myers J. Lessons for Continuing Medical Education From Simulation Research in Undergraduate & Graduate Medical Education. Chest 2009; 135 (3 Supp): 62S-68S. 4 Society of Critical Care Medicine, http://www.sccm.org/Communications/Critical- Connections/Archives/Pages/Taking-Your-Rapid-Response-Team-to-the-Next- Level.aspxhttp://www.sccm.org/Communications/Critical- Connections/Archives/Pages/Taking-Your-Rapid-Response-Team-to-the-Next- Level.aspx The majority of nurses (91%) reported that the simulation based learning experiences were worthwhile, and would be valuable in impacting their daily work with patients. The majority of nurses (86%) reported that course objectives were met. Key theme in course evaluation comments: nurses stated they felt more confident in using the SBAR mnemonic in communicating to a provider in an emergent situation. Results: Nurses’ Feedback on Sessions Mean Before Activity 1= Very Low to 5 = Very High Mean After Activity 3.50Set up/troubleshoot the Alaris IV pump4.00 3.31Assess patient repeatedly4.26 3.31 Describe when to call Rapid Response/Code Team4.26 3.23Demonstrate Working as a Team4.16 3.21Use SBAR4.15 2.96Apply 10 Signs of Vitality3.49 2.87 Relate respiratory depression to over-sedation4.03 2.83Predict Deteriorating Patient3.99 2.76Demonstrate Ability to Escalate4.09 2.65 Find resources for medication information if unfamiliar3.88 Results: How Will Course Impact Your Work? Communication Skill Competence LeadershipTeamworkConfidence 86%48%34%72%69% Results: Feedback on Simulation Experience Need to have lab values available for the "patient" This was a comfortable and supportive learning environment Debrief was awesome, it really helped! Include a little more time for practice of skills Like how they focused on what we did well and did not make us feel bad for things we did not know ED scenarios would be nice Video debriefing was helpful to see what was performed. Being able to diagnose the patients was great practice Very realistic and enjoyable Clear instructions and information. I will use on a daily basis Should be done once a month during orientation This was a good learning experience. Helps with gaining more confidence in situations. Gives you the time to learn from any mistakes if they were made Helpful to require all new graduates to go through top ten most common signs of deteriorating patient; wonderful experience!