Board 370 - Research Abstract Research Abstract Noteworthy Connections in the Utilization of Simulation-Based Learning to Improve Knowledge, Clinical Judgment and Patient Outcomes within a Neonatal Environment (Submission #731)

Abstract

Introduction/Background While several factors contribute to healthcare disparities, it is assumed that a strong graduate nursing workforce will affect quality improvements which will impact the cause and effect relationship between quality and health disparities. It is believed that a major contributing factor to infant disparities includes ursing education.1 The NICU Basic Knowledge Assessment Test-Version 3 (BKAT3) was given to identify knowledge gaps among Midwestern Neonatal Intensive Care Unit RNs in the areas of pulmonary, cardiovascular and neurology. Concern for existing clinical judgment of nurses and patient outcome improvement opportunities surfaced. The study’s objective was to provide effective education through simulation to narrow the knowledge gap and improve clinical judgment and patient outcomes. The hypothesis for this research was “Simulation-based education does not have an effect on RN knowledge and clinical judgment nor does it ultimately improve patient outcomes for critically ill infants." Methods The study consisted of a quasi-experimental pre-test/post-test design, utilizing two reliable and validated measurement tools: NICU BKAT-Version 4 (BKAT4) to measure knowledge and the Lasater Clinical Judgment Rubric to measure 11 pre-established clinical judgment dimensions, focused on noticing, interpreting, responding and reflecting2 based on the Tanner Model of Clinical Judgment.3 This voluntary convenience sample included 131 participants over a two year period. The procedure consisted of three simulation-based sessions, each four hours in length, focused on three physiologic systems: pulmonary, cardiovascular, and neurology. Groups of two or three participants were established for each learning session, consisting of simulated scenarios and structured debriefings. Data was collected prior to and after the intervention. Clinical outcome measures dependent upon nursing action were established for pre/post measures: Retinopathy of Prematurity, Intraventricular Hemorrhage (IVH), number of infants discharged on oxygen therapy, selection and initiation of oxygen delivery devices and number of infant resuscitations in the NICU. Results Data analysis from the BKAT4 for knowledge utilized Generalized Estimating Equations (GEE) Methods to examine percentage correct as a binomial outcome and correctly accounted for dependence in the pre and post training scores. Although we could not control for learning that occurs naturally in the setting, overall differences in total scores of pulmonary, cardiovascular and neurology over time were noted: p = 0.0167 (year 1) and p = 0.0021 (year 2). Trend patterns demonstrated improvement over time for clinical judgment (year 2) for both self and evaluator ratings. Shifts in patient clinical outcomes were noted for Intraventricular Hemorrhage (IVH), number of infants discharged on oxygen therapy, and selection and initiation of oxygen delivery devices. Conclusion Pulmonary, cardiovascular and neurologic focused simulation-based learning can impact knowledge and clinical judgment in NICU RNs, as evidenced by significant shifts in pre/post assessment scores and ratings. The Results of simulation-based learning strongly suggest improved patient outcomes, specifically IVH, number of infants discharged on oxygen therapy and selection and initiation of oxygen delivery devices. Further research should focus on simulation impact for other neonatal risks, such as neonatal sepsis, temperature management and medication utilization. Findings also suggest applicability for other professions development of clinical judgment and might well influence interprofessional learning contexts with neonates in both academic and practice settings.