Advertisement

Human patient simulation education in the nursing management of patients requiring mechanical ventilation: A randomized, controlled trial

      Background

      Knowledge among critical care nurses and their adherence to evidence-based guidelines for preventing ventilator-associated pneumonia is reported to be low. The aim of our study was to evaluate the effectiveness of human patient simulation (HPS) education in the nursing management of patients requiring mechanical ventilation.

      Methods

      A prospective, parallel, randomized controlled trial with repeated measurements was conducted in a 22-bed adult mixed medical-surgical intensive care unit in Finland from February-October 2012. Thirty critical care nurses were allocated evenly to intervention and control groups (n = 15 each). The effectiveness of HPS education was evaluated through the validated Ventilator Bundle Questionnaire and Ventilator Bundle Observation Schedule at baseline and repeated twice—after the clinical and simulation settings, respectivley.

      Results

      After HPS education, the average skill scores (Ventilator Bundle Observation Schedule) in the intervention group increased significantly (46.8%-60.0% of the total score) in the final postintervention observation. In the average skill scores, a linear mixed model identified significant time (Pt < .001) and group (Pg = .03) differences and time–group interactions (Pt*g = .02) between the study groups after the HPS education. In contrast, the model did not identify any significant change over time (Pt = .29) or time–group interactions (Pt = .69) between groups in average knowledge scores (Ventilator Bundle Questionnaire).

      Conclusions

      Our study identified significant transfer of learned skills to clinical practice following HPS education but no influence on the level of participants’ factual knowledge.

      Key Words

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to American Journal of Infection Control
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Bouza E.
        • Hortal J.
        • Munoz J.
        • Pascaus J.
        • Perez M.J.
        • Hiesmayr M on behalf of the European Study Group on Nosocomial Infections and the European Workgroup of Cardiothoracic Intensivists
        Postoperative infections after major heart surgery and prevention of ventilator-associated pneumonia: a one-day European prevalence study (ESGNI-008).
        J Hosp Infect. 2006; 64: 224-230
        • Ylipalosaari P.
        • Ala-Kokko T.
        • Laurila J.
        • Ohtonen P.
        • Syrjälä H.
        Epidemiology of intensive care unit (ICU)-acquired infections in a 14-month prospective cohort study in a single mixed Scandinavian university hospital ICU.
        Acta Anaesth Scand. 2006; 50 (1192-7)
        • Klompas M.
        • Magill S.
        • Robicsek A.
        • Strymish J.M.
        • Kleinman K.
        • Evans R.S.
        • et al.
        Objective surveillance definitions for ventilator-associated pneumonia.
        Crit Care Med. 2012; 40: 3154-3161
        • Chen Y.-Y.
        • Wang F.-D.
        • Chou P.
        Incidence rate and variable cost of nosocomial infections in different types of intensive care units.
        Infect Control Hosp Epidemiol. 2009; 30: 39-46
        • Karhu J.
        • Ala-Kokko T.I.
        • Ylipalosaari P.
        • Ohtonen P.
        • Laurila J.J.
        • Syrjälä H.
        Hospital and long-term outcomes of ICU-treated severe community- and hospital-acquired, and ventilator-associated pneumonia patients.
        Acta Anaesth Scand. 2011; 55: 1254-1260
        • Blot S.
        • Labeau S.
        • Vandijck D.
        • Claes B.
        Evidence-based guidelines for the prevention of ventilator-associated pneumonia: results of a knowledge test among intensive care nurses.
        Intensive Care Med. 2007; 33: 1463-1467
        • Labeau S.
        • Vandijck D.
        • Rello J.
        • Adam S.
        • Rosa A.
        • Wenisch C.
        • et al.
        Evidence-based guidelines for prevention of ventilator-associated pneumonia: results of a knowledge test among European intensive care nurses.
        J Hosp Infect. 2008; 70: 180-185
        • El-Khatib M.
        • Zeineldine S.
        • Ayoub C.
        • Husari A.
        • Bou-Khalil P.
        Critical care clinicians’ knowledge of evidence-based guidelines for preventing ventilator-associated pneumonia.
        Am J Crit Care. 2010; 19: 272-277
        • Jansson M.
        • Ala-Kokko T.
        • Ylipalosaari P.
        • Syrjälä H.
        • Kyngäs H.
        Critical care nurses’ knowledge of, adherence to and barriers toward evidence-based guidelines for the prevention of ventilator-associated pneumonia – a survey study.
        Intensive Crit Care Nurs. 2013; 29: 216-227
        • Ricart M.
        • Lorente C.
        • Diaz E.
        • Kollef M.H.
        • Rello J.
        Nursing adherence with evidence-based guidelines for preventing ventilator-associated pneumonia.
        Crit Care Med. 2003; 31: 2693-2696
        • Blackwood B.
        • Albarran J.W.
        • Latour J.M.
        Research priorities of adult intensive care nurses in 20 European countries: a Delphi study.
        J Adv Nurs. 2010; 67: 550-562
      1. Siegel JD, Rhinehart E, Jackson M, Chiarello L, and the Healthcare Infection Control Practices Advisory Committee. 2007 Guideline for isolation precautions: preventing transmission of infectious agents in healthcare settings. Available from: http://www.cdc.gov/ncidod/dhqp/pdf/isolation2007.pdf. Accessed December 31, 2013.

      2. European Union. Council Recommendation of 9 June 2009 on patient safety, including the prevention and control of healthcare associated infections. Official J Eur Union 2009/C 151/1–6. Available from: http://eur-lex.europa.eu/LexUriServ/LexUriServ.do?uri=OJ:C:2009:151:0001:0006:EN:PDF. Accessed December 31, 2013.

        • Lupien A.E.
        High-fidelity patient simulation.
        in: Bradshaw M.J. Lowenstein A.J. Innovative teaching strategies in nursing and related health professions. 4th ed. Jones and Bartlett Learning, Burlington [MA]2007: 197-214
        • Decker S.
        • Sportsman S.
        • Puez L.
        • Billings L.
        The evolution of simulation and its contribution to competency.
        J Contin Educ Nurs. 2008; 39: 74-80
        • Gaba D.M.
        The future vision of simulation in health care.
        Qual Saf Health Care. 2004; 13: i2-i10
        • Jansson M.
        • Kääriäinen M.
        • Kyngäs H.
        Effectiveness of simulation-based education in critical care nurses’ continuing education: a systematic review.
        Clin Simul Nurs. 2013; 9: e355-e360
        • Dine C.J.
        • Gersh R.E.
        • Leary M.
        • Riegel B.J.
        • Bellini L.M.
        • Abella B.S.
        Improving cardiopulmonary resuscitation quality and resuscitation training by combining audiovisual feedback and debriefing.
        Crit Care Med. 2008; 36: 2817-2822
        • Carrigo R.M.
        • Coty M.B.
        • Goss L.K.
        • Lajoie A.S.
        Changing health care worker behavior in relation to respiratory disease transmission with a novel training approach that uses biosimulation.
        Am J Infect Control. 2007; 35: 14-19
        • Ford D.G.
        • Seybert A.L.
        • Smithburger P.L.
        • Kubulinsky L.R.
        • Samosky J.T.
        • Kane-Gil S.L.
        Impact of simulation-based learning on medication error rates in critically ill patients.
        Intensive Care Med. 2010; 36: 1526-1531
        • Pascual J.L.
        • Holena D.N.
        • Vella M.A.
        • Palmieri J.
        • Sicoutris C.
        • Selvan B.
        Short simulation training improves objective skills in established advanced practioners managing emergencies on the ward and surgical intensive care unit.
        J Trauma. 2011; 71: 330-338
        • Jansson M.M.
        • Kyngäs H.A.
        • Kääriäinen M.S.
        Effectiveness of human patient simulation education in improving infection control pracices – a systematic review.
        J Nurs Educ Pract. 2014; 4: 1-6
        • Tablan O.C.
        • Anderson R.B.
        • Besser R.
        • Bridges C.
        • Hajjeh R.
        Centers for Disease Control and Prevention (CDC): guidelines for preventing health-care-associated pneumonia. Recommendations of CDC and the Healthcare Infection Control Practices Advisory Committee. 2003.
        MMWR. 2004; 53: 1-36
        • Berwick D.M.
        • Calkins D.R.
        • McKannon C.J.
        • Nazem A.
        The 100,000 lives campaign: setting a goal and a deadline for improving health care quality. Institute for Healthcare Improvement (IHI).
        JAMA. 2006; 295: 324-327
        • Rello J.
        • Lode H.
        • Cornaglia G.
        • Masterton R.
        A European care bundle for prevention of ventilator-associated pneumonia.
        Intensive Care Med. 2010; 36: 773-780
        • Boutron I.
        • Moher D.
        • Altman D.G.
        • Schulz K.F.
        • Ravaud P.
        Extending the CONSORT Statement to randomized trials of nonpharmacologic treatment: explanation and elaboration.
        Ann Intern Med. 2008; 148: 295-309
        • Jansson M.
        • Ala-Kokko T.
        • Ylipalosaari P.
        • Kyngäs H.
        Evaluation of endotracheal-suctioning practices of critical-care nurses – an observational correlation study.
        J Nurs Educ Pract. 2013; 3: 99-105
        • Polit D.
        • Beck C.
        Nursing research. Generating and assessing evidence for nursing practice.
        9th ed. Lippincott Williams & Wilkins, Philadelphia [PA]2011
      3. Jansson M, Ala-Kokko T, Syrjälä H, Kyngäs H. The development and psychometric testing of ventilator bundle questionnaire and observation schedule. Am J Infect Control. http://dx.doi.org/10.1016/j.ajic.2013.11.007. In press.

        • Muller M.P.
        • Hansel M.
        • Fitchner A.
        • Hardt F.
        • Weber S.
        • Kirschbaum C.
        • et al.
        Excellence in performance and stress reduction during two different full scale simulator training courses: a pilot study.
        Resuscitation. 2009; 80: 919-924
        • Day T.
        • Iles N.
        • Griffiths P.
        Effect of performance feedback on tracheal suctioning knowledge and skills: randomized controlled trial.
        J Adv Nurs. 2009; 65: 1423-1431
        • Cherry M.G.
        • Brown J.M.
        • Bethell G.S.
        • Neal T.
        • Shaw N.J.
        Features of educational interventions that lead to compliance with hand hygiene in healthcare professionals within a hospital care setting.
        Med Teach. 2012; 34: e406-e420
        • Boyce J.M.
        Measuring healthcare worker hand hygiene activity: current practices and emerging technologies.
        Infect Control Hosp Epidemiol. 2011; 32: 1016-1028
        • WHO guidelines on hand hygiene in health care
        First global patient safety challenge clean care is safer care.
        World Health Organization, Geneva [Switzerland]2009
        • Schweizer M.L.
        • Reisinger H.S.
        • Ohl M.
        • Formanek M.B.
        • Blevins A.
        • Ward M.A.
        • et al.
        Searching for an optimal hand hygiene bundle: a meta-analysis.
        Clin Inf Dis. 2013; 5: 1-12
        • Fulbrook P.
        • Albarran J.W.
        • Baktoft B.
        • Sidebottom B.
        A survey of European intensive care nurses’ knowledge levels.
        Intern J Nurs Stud. 2010; 49: 191-200
        • Burns N.
        • Grove B.
        The practice of nursing research: appraisal, synthesis, and generation of evidence.
        2nd ed. Saunders Elsevier, Philadelphia [PA]2009
        • Gerrish K.
        • Lacey A.
        The research process in nursing.
        6th ed. Wiley-Blackwell, Hoboken [NJ]2010
        • Pogorzelska M.
        • Larson E.
        Assessment of attitudes of intensive care unit staff toward clinical practice guidelines.
        Dimens Crit Care Nurs. 2008; 27: 30-38
        • Feider L.L.
        • Mitchell P.
        • Bridges E.
        Oral care practices for orally intubated critically ill adults.
        Am J Crit Care. 2010; 19: 175-183