Cardiac Clinical Educator Children's Healthcare of Atlanta Buford, Georgia, United States
Abstract: Introduction In the CICU at Children's Healthcare of Atlanta (CHOA) a bedside nurse progresses through a tiered advancement structure based upon patient acuity, surgical repair, and previous training. With improvements in surgical techniques and medical technology, the population of patients requiring delayed sternal closure (DSC) has decreased in the past decade. This change in population presents a challenge to ensure the advancing bedside nurse is adequately trained for a patient requiring DSC. To address this concern, a simulation class was created.
Methods Previously a nurse was required to have 3 bedside orientation shifts paired with a preceptor before they could care for the patient with DSC independently. To accelerate the orientation process and fill in potential knowledge gaps, the orientation requirement changed to 1 bedside orientation shift as well as attending a 2-hour simulation class. The objectives of the simulation class address basic assessment skills of DSC and required documentation; as well as reviewing common surgical repairs and teaching identification of potential patient emergencies with their respected treatments. Two simulation scenarios were developed to provide an interactive learning experience where nurses can critically think through processes and apply interventions based on policy and procedure in a safe learning environment. Debriefing is a critical element of each scenario, which provides the nurse an opportunity to discuss concepts they experienced in the simulation or in real life. At the conclusion of the class, participants were asked to complete a survey that utilized a 5-point Likert scale to self-report changes in knowledge and confidence level from before taking the class and after participating in the simulation class.
Results At the completion of the simulation class, participants self-reported an overall increase in confidence and knowledge in all categories. Survey results showed a 37% increase in knowledge of assessing an open chest patient. For the objective covering an emergency situation of cardiac tamponade, participants reported a 20% increase in identifying signs and symptoms of cardiac tamponade and a 25% increase in knowledge for treating cardiac tamponade. For the objective covering the emergency situation of a BTTS occlusion, participants reported a 21% increase in knowledge level for identifying signs and symptoms of BTTS occlusion and a 21% increase in knowledge of treating a BTTS occlusion. Participants reported a 48% increase in knowledge level for the objective that covers the 3 emergency blood pathways available at our institution. At the completion of the class, participants reported a 37% in confidence level for caring for a patient with a delayed sternal closure. Conclusions The reduction in bedside orientation shifts paired with a simulation course to train staff nurses to be competent in caring for a patient with DSC and higher acuity patients was successful in the CICU at CHOA. The simulation class has also shown to be a good point in a nurse’s development through our tiered advancement structure to have an opportunity for continuing education about more complex patient populations and preparing them to being an instrumental resource nurse to the unit.
