Simulation training on donning personal protective equipment and performing cardiopulmonary resuscitation for nurses in a geriatric step-down hospital during COVID-19

Le but de cette thèse est de développer des outils statistiques permettant d'initialiser et de calibrer les modèles de microsimulation dynamique stochastique, en partant de l exemple du modèle SimVillages (développé dans le cadre du projet Européen PRIMA). Ce modèle couple des dynamiques démographiques et économiques appliquées à une population de municipalités rurales. Chaque individu de la population, représenté explicitement dans un ménage au sein d une commune, travaille éventuellement dans une autre, et possède sa propre trajectoire de vie. Ainsi, le modèle inclut-il des dynamiques de choix de vie, d étude, de carrière, d union, de naissance, de divorce, de migration et de décès. Nous avons développé, implémenté et testé les modèles et méthodes suivants : 1 / un modèle permettant de générer une population synthétique à partir de données agrégées, où chaque individu est membre d un ménage, vit dans une commune et possède un statut au regard de l emploi. Cette population synthétique est l état initial du modèle. 2 / un modèle permettant de simuler une table d origine-destination des déplacements domicile-travail à partir de données agrégées. 3 / un modèle permettant d estimer le nombre d emplois dans les services de proximité dans une commune donnée en fonction de son nombre d habitants et de son voisinage en termes de service. 4 / une méthode de calibration des paramètres inconnus du modèle SimVillages de manière à satisfaire un ensemble de critères d'erreurs définis sur des sources de données hétérogènes. Cette méthode est fondée sur un nouvel algorithme d échantillonnage séquentiel de type Approximate Bayesian Computation.

Outcome after cardiopulmonary resuscitation (CPR) is influenced by the resuscitation team response. 1–3 Our in-situ simulation training programme aims to improve patient outcome by rehearsing the team response to simulated crises including cardiac arrests. 4 There is a relative paucity of translational research on the impact of simulated team training on real resuscitations. 5 Aims We aimed to assess the impact of simulation training on individual performance, team-working and Crisis Resource Management (CRM) during real cardiopulmonary resuscitations (CPR). Methods Bi-monthly simulation sessions include advocacy-enquiry debriefing and CRM training. Cardiac arrests on PICU requiring at least 2 minutes of CPR were audited (1.5.2014 to 31.5.2015). Following each resuscitation, team members completed anonymous questionnaires scoring team resuscitation performance using the validated TeamMonitor tool 4 and the impact of prior simulation training on self-rated performance. Results 234 resuscitation questionnaires from 36 cardiac arrests were analysed. Prior simulation training was highly significant particularly for improving individual overall CPR performance and assisting early calls for help for the resuscitation (p = 0.001). Prior simulation training improved staff self-rating of performance and confidence during the resuscitation with little variability and strong mean agreement across groups. Consistency of skills during CPR was reported for leadership and role shifting in response to emerging events during the resuscitation (75.92%, n = 180). 36 resuscitation team responses were analysed for consistency of CRM reported by at least 75% of members. Consistent leadership was reported by 21 teams (58.3%). Average team service length did not influence the proportion of teams reporting consistent CRM skills for most dimensions of team-working. Conclusions During real CPR, self-evaluated performance improves significantly with prior simulation training; particularly attendance at more than 3 sessions. Further research is required to assess barriers to consistency of application of CRM during resuscitations and the impact of simulation team training on patient outcome. References Peddy S, Hazinski MF, Laussen PC, et al . CPR: special considerations for infants and children with cardiac disease. Cardiol Young 2007; 17 (Suppl 2):116–126. Abella BS, Alvarado JP, Myklebust H, et al . Quality of CPR during in-hospital cardiac arrest. JAMA 2005; 293 :305–310. Hunt E, Patel S, Vera K, et al . Survey of paediatric resident experiences with resuscitation training and attendance at actual cardiopulmonary arrests. Pediatr Crit Care Med 2009; 10 (1):96–105. Stocker M, Menadue L, Kakat S, et al . Reliability of team-based self-monitoring in critical events: a pilot study. BMC Emerg Med 2013: 13 :22. McGaghie W, Issenberg SB, Barsuk JH, Wayne DB. A critical review of simulation-based mastering learning with translational outcomes. Med Ed 2014; 48 :375–385.

IntroductionMost medical schools teach cardiopulmonary resuscitation (CPR) during the final year in course curriculum to prepare students to manage the first minutes of clinical emergencies. Little is known regarding the optimal method of instruction for this critical skill. Simulation has been shown in similar settings to enhance performance and knowledge. We evaluated the comparative effectiveness of high-fidelity simulation training vs. standard manikin training for teaching medical students the American Heart Association (AHA) guidelines for high-quality CPR.MethodsThis was a prospective, randomized, parallel-arm study of 70 fourth-year medical students to either simulation (SIM) or standard training (STD) over an eight-month period. SIM group learned the AHA guidelines for high-quality CPR via an hour session that included a PowerPoint lecture with training on a high-fidelity simulator. STD group learned identical content using a low-fidelity Resusci Anne® CPR manikin. All students managed a simulated cardiac arrest scenario with primary outcome based on the AHA guidelines definition of high-quality CPR (specifies metrics for compression rate, depth, recoil, and compression fraction). Secondary outcome was time to emergency medical services (EMS) activation. We analyzed data via Kruskal-Wallis rank sum test. Outcomes were performed on a simulated cardiac arrest case adapted from the AHA Advanced Cardiac Life Support (ACLS) SimMan® Scenario manual.ResultsStudents in the SIM group performed CPR that more closely adhered to the AHA guidelines of compression depth and compression fraction. Mean compression depth was 4.57 centimeters (cm) (95% confidence interval [CI] [4.30–4.82]) for SIM and 3.89 cm (95% CI [3.50–4.27]) for STD, p=0.02. Mean compression fraction was 0.724 (95% CI [0.699–0.751]) for SIM group and 0.679 (95% CI [0.655–0.702]) for STD, p=0.01. There was no difference for compression rate or recoil between groups. Time to EMS activation was 24.7 seconds (s) (95% CI [15.7–40.8]) for SIM group and 79.5 s (95% CI [44.8–119.6]) for STD group, p=0.007.ConclusionHigh-fidelity simulation training is superior to low-fidelity CPR manikin training for teaching fourth-year medical students implementation of high-quality CPR for chest compression depth and compression fraction.

Ethical conflicts among nurses can undermine nurses’ psychological comfort and compromise the quality of patient care. In the last decade, several empirical studies on the phenomena related to ethical conflicts, such as ethical dilemmas, issues, problems, difficulties, or challenges, have been reported; however, they have not always deeply explored the meaning of ethical conflicts experienced by nurses in geriatric care. This study aims to understand the lived experiences of ethical conflict of nurses in geriatric hospitals in South Korea. A phenomenological study was conducted. In-depth, face-to-face interviews were performed with nine registered nurses who cared for elderly patients in geriatric hospitals in South Korea between August 2015 and January 2016. Three main themes emerged from the analysis: (1) confusing values for good nursing, (2) distress resulting from not taking required action despite knowing about a problem, and (3) avoiding ethical conflicts as a last resort. It was found that for geriatric nurses to cope with ethical conflicts successfully, clear ethical guidance, continuing ethics education to improve ethical knowledge and moral behaviors, and a supportive system or program to resolve ethical conflicts involving nurses should be established.

Background There is little published work regarding simulation training in end of life care for registered nurses. Simulation training offers the opportunity to learn in a safe environment, without compromising patient safety. Methods Each simulation day covered five scenarios, written by Specialist Palliative Care Clinical Nurse Specialists (SPC CNS), based on real cases that ward nurses had reported difficulty in managing. Scenarios included seizures, pain, breathlessness, care planning in last days of life, breaking bad news on the telephone, and dealing with distressed relatives. In each scenario there was an HCA in the room and a doctor available for telephone advice. The patient and relative were either played by the actor or the ‘SimMan’. The candidates participated in pairs and the remaining candidates observed via video-link. The subsequent debrief utilising ‘The Diamond’ model was led by a Palliative Medicine Consultant and SPC CNS. This model encourages description, analysis and application of learning in a non-judgemental way. Results Pre and post-simulation day feedback was collected via a 1 - 5 scale and revealed: confidence to manage physical symptoms increased (3.15 vs 4.25) confidence in communication increased (3.3 vs 4.24) candidates learnt something new from the day (free text) scenarios were rated as useful/very useful confidence with simulation training was unchanged (3 vs 3) Conclusion High fidelity simulation training for registered nurses in an acute hospital is an effective way to teach palliative/end of life care skills. Registered nurses are keen for simulation training to be integrated into end of life care education.

CARDIOPULMONARY emergencies are high-risk, low-incidence events in long-term care (LTC) units. Many nurses find responding to a cardiac arrest a stressful experience that invokes insecurity and fear. We were concerned that nurses at the Community Living Center (CLC), an LTC unit for veterans located next to the main hospital, weren't confident in their skills due to the low incidence of cardiopulmonary arrests in LTC settings compared with the main hospital. The CLC is a homelike facility where veterans receive short- or long-term rehab, help with activities of daily living, and skilled nursing and medical care. We were concerned that RNs, LPNs, and unlicensed assistive personnel (UAP) at the CLC didn't meet the skills and competency expectations in a code blue. Because the CLC is a brisk 6- to 10-minute walk from the main hospital, responders to code blue situations and members of the critical care committee decided to assess the confidence of the CLC staff in code blue situations through simulation-based mock code drills. We implemented a two-phase educational program based on the latest evidence-based guidelines to improve nurses' responses to code blue situations and patient safety. We also extended simulation training to resident physicians and interns in the ICU who are part of the cardiac arrest team. Guidelines and training The American Heart Association last updated the CPR and emergency cardiovascular care guidelines in 2010 based on the evidence evaluation process. These guidelines continue to emphasize the importance of high-quality, effective chest compressions and early defibrillation.1 Studies of in-hospital staff performance show that retention of CPR skills is poor; as a result, training every 2 years is recommended.1 As with any skill, basic life support (BLS) and advanced cardiovascular life support (ACLS) skills require practice to ensure competence. When the quality of education is increased and training is more frequent, we believe CPR skills become natural and instinctive and resuscitation efforts are more effective, especially for frontline patient-care providers. The ICU nurse of the cardiac arrest team from the adjoining hospital usually arrives first and can assess how the first responder, and in this case the CLC staff, performs BLS. The staff in the CLC is expected to provide BLS, and although they're trained in BLS, manikin training isn't quite the same as a real-life situation. They tended to stay in the background and watch the code blue due to a lack of confidence. Starting with a survey In December 2011, members of the critical care committee sent an online survey to 120 CLC nursing staff to find out the following: Do they understand their role in a code blue? Do they know how to operate the automated external defibrillator (AED)/defibrillator before the cardiac arrest team arrives? Do they believe that BLS training is sufficient to enable them to -effectively and correctly participate during a code blue? There were 96 respondents. (See Comparing results before and after education.) RNs, LPNs, and UAP were unsure of their role before the arrival of the cardiac arrest team, felt uncertain about operating the portable AED/defibrillator, and believed BLS training wasn't sufficient to boost their confidence. These survey results led us to the following questions: Does BLS provider training adequately prepare nurses to respond to a code blue? Does BLS training increase confidence in their ability to participate in a code? Would increasing the frequency of BLS training from annually to quarterly improve retention of skills and competency? Starting a program In response to the survey, a simulation-based mock code program was developed. Its goals were to improve patient outcomes and increase healthcare team members' knowledge, competence, and confidence in emergency situations. Review of the literature and the use of simulation to reinforce healthcare members' roles and responsibilities in cardiac arrest and rapid response team situations supported the first-phase training.2,3 This phase covered BLS skills and competency and emphasized first and second responder roles. The simulation program was conducted in two phases. The main focus of the first phase was the "First 5 Minutes," the key component for improved patient outcomes: high-quality, effective CPR. It also focused on nurses' roles as first and second responders. Second-phase training covered practicing mock codes. For the training to be successful, realism is the key; the situation must closely mimic a real code blue. Honing the details Prescheduled training was coordinated with one or more nurse managers so it wouldn't involve staff overtime. Because small groups were found to be more effective, interactive, and informal, classes were arranged for groups of four or five participants. First-phase training. The goal for this phase was to provide training for 100% of frontline direct patient-care providers. Two instructors were present. To accommodate staff on all shifts, training was provided at various times when unit activities were usually less hectic. The training location was a hospital bed in an unoccupied patient room with a training crash cart, defibrillator, and a low-fidelity manikin. All participants got an opportunity to operate the equipment. They were encouraged to open crash cart drawers and supplies, put things together, and check equipment for proper functioning. For real-time cardiac monitoring, a volunteer was connected to the monitor so responders could practice correct electrode placement and troubleshooting equipment. Defibrillator pads were applied to a manikin. For chest compressions, "push hard, push fast" was emphasized by review and a return demonstration. First-phase training was completed with 90% staff participation. At the end of each education session, a case scenario was provided and participants were encouraged to critique each other's performance. Participants could identify what went well and what needed improvement.Figure: Comparing results before and after educationDiscussion among participants of the simulation activity as well as a posteducation survey showed that staff appreciated the hands-on training and gained confidence in operating the equipment and in performing as first and second responders. They've also acknowledged that the "First 5 Minutes" training classes helped them feel better prepared and more confident about actively participating during a code blue. Second-phase training. The goal for this phase was to evaluate staff knowledge, skills, competency, and implementation of their roles and responsibilities as first and second responders. Two trainers coordinated with the nurse managers in CLC to make sure an empty room would be available for a mock code conducted on their units. They also collaborated with the hospital switchboard operator to announce a code blue overhead so that the cardiac arrest team located in the adjacent hospital could respond. Once the hospital cardiac arrest team arrived at the scene, they were informed that it was a mock code. The CLC staff then proceeded with the mock code. After each mock code, debriefing was conducted. For subsequent mock codes, the overhead page for the cardiac arrest team wasn't activated so as not to interrupt patient care. Encouraging outcomes Both phases were completed within 1 year. A follow-up survey using the same questions revealed that mock codes improved staff's perceived performance and that nurses believed that the mock codes were helpful. They felt more confident in their roles and demonstrated increased comfort with the equipment. About 4 months after the completion of training, an actual code blue was called in CLC. The responding cardiac arrest team from the adjacent hospital applauded the CLC staff's effort and efficiency, and this was reflected in the debriefing. The first and second responders performed exactly what was expected of them when the cardiac arrest team arrived at the scene. A mock code is now conducted quarterly in CLC. Expanding the program Having seen the successful outcome of simulated training, the trainers began to look internally to the cardiac arrest team in the adjacent hospital. Resident physicians and interns in the ICU rotate monthly. They're part of the cardiac arrest team if they're on-call for the day. Although they're required to complete ACLS training, most of them haven't assumed the team leader role in a real code blue. In response, the trainers also began to conduct simulated code training for physicians rotating to the ICUs monthly, focusing on their roles and responsibilities when a code blue is called. They assume the roles of team leader, airway management, or chest compressor and are asked to perform each role during the simulation. Postcode debriefing quarterly reviews showed that after the code blue simulation training, actual code blue situations were conducted more efficiently with less confusion with role designation and improved communication among members of the cardiac arrest team.

This study aims to evaluate the effectiveness of simulation training (ST) in improving nurses' knowledge and practice, which is essential in the nursing field, particularly among nurses in Jordanian hospitals. ST has the potential to significantly enhance patient care outcomes. A Randomized Control Trial was conducted in five hospitals in Jordan, using three repeated measurement tests: a pre-test, an immediate post-test after the intervention, and a post-test three months later. The nonparametric Mann-Whitney statistical test showed that the control and experimental groups were similar, with no significant differences in the participants' demographic characteristics. The Independent T-test confirmed the similarity of the pre-test results in the control group's knowledge and practice and the intervention group's mean scores. The simulation intervention proved to be highly effective in enhancing Basic Life Support (BLS) knowledge and practice among nurses. It nearly doubled the knowledge pre-test percentage from 40% to 75.35% in the immediate post-test, improving the scores from poor in the pre-test to excellent in the post-test. This significant improvement highlights the importance of simulation training in enhancing nurses' knowledge and practice. Similarly, ST significantly increased the average practice score percentage from 47.5% to 70% after the intervention, demonstrating its substantial impact. In conclusion, BLS simulation is a highly efficient educational method that helps participants acquire knowledge and skills. Simulation training prepares learners to activate cardiopulmonary resuscitation (CPR) quickly and correctly in case of cardiopulmonary arrest. Therefore, simulation in training should be expanded in the nursing curriculum.

Objective To evaluate the application effect of high-fidelity human patient simulation in cardiopulmonary resuscitation (CPR) training in emergency medicine course. Method All of the 84medical freshmen in the academic year of 2008, who studied emergency medicine course, were chosen as the study object. The students were randomly divided into high-fidelity simulator (SimMan) training group(EG) and ordinary training group (CG), when they finished the course. Two groups accepted training for the same time, and then examined the CPR performing by the system of advanced cardiovascular life support (ACLS) simulator, and make data-analysis with the software of SPSS 11.5. Result The students in EG group have higher total mean score than CG ( P ＜ 0.05). However, in the aspects of survival ratio,performing time and chest compression quality, EG has higher score than CG, but there is no significant statistical difference ( P ＞ 0.05 ). Conclusion This study demonstrates that high-fidelity human patient simulation can simulate many common symptoms of emergency patients, it has great effect on helping medical students to improve the quality of doing CPR, but the training results is not as good as the author expected compared with the ordinary training. So the training method in the application of high-fidelity human patient simulation should be improved. Key words: Simulate training; High-fidelity human patient simulation; Emergency medicine; Cardiopulmonary resuscitation(CPR); Medical student

Methods of simulation training and quality assessment during obstetric emergencies are still ambiguous. The aim of this study was to evaluate the effectiveness of anaesthesiologists' simulation training for emergency situations in obstetrics. We conducted a prospective, descriptive, and comparative study to evaluate the anaesthesiologists' simulation training effectiveness during obstetrical emergencies. Data of 109 obstetrical anaesthesiologists trained over two years for invasive procedures and cardiopulmonary resuscitation, high-fidelity scenarios and medical personnel teamwork included were analyzed. We used the two-sided t-test (p < 0.05 considered significant). We noted during the fifth training sessions, the anaesthesiologists had a significant manipulation time decrease for all skills compared to the ones assessed during their first training session (p < 0.01). The 100-grade scale scores for all invasive techniques significantly improved during the anaesthesiologists' training (p < 0.01). Cardiopulmonary resuscitation effectiveness and team work also improved significantly during the fifth session (p < 0.01). As a result of simulation training, significant improvement of speed and quality indicators, for invasive techniques in obstetrical emergency states treatment, was noted. For the fifth training sessions, there was a decrease in the practical skills execution time. The overall effectiveness and teamwork quality for cardiopulmonary resuscitation showed significant improvement.

Geriatric Hospital Nurses' Perceived Barriers to Research Utilization and Empowerment

Time-to-Task in Interval Simulated Cardiopulmonary Resuscitation Training: A Method for Maintaining Resuscitation Skills

Rapid implementation of COVID-19 tracheostomy simulation training to increase surgeon safety and confidence.

The current study addresses the persistent challenge of cardiopulmonary arrest and the critical need for prompt responses by healthcare providers (HCPs). Basic Life Support (BLS) training is vital for equipping HCPs with the skills necessary for cardiopulmonary resuscitation (CPR). Simulation training, an increasingly integral element of nursing education, offers an effective means of enhancing participants’ confidence. This study aims to develop and validate a simulation training module in BLS and evaluate its effectiveness in improving confidence levels among newly employed nurses (NEN) in Jordanian government hospitals. This study introduces the Simulation in Basic Life Support Training (SBLST) module, which was developed in alignment with current BLS guidelines and educational theories. Through content and face validity, this study validates the efficacy of the module. In a randomised controlled trial involving 102 NEN, the intervention group underwent a full day of SBLST, while the control group received standard brochure-based training. Statistical analysis revealed a significant increase in confidence levels among the intervention group following the training (F-statistic = 37.969, p &lt; 0.001). The findings underscore the effectiveness of the SBLST module in enhancing nurses’ confidence in performing CPR. By integrating simulation and theoretical frameworks, this study advances the goal of enhancing BLS training in nursing education.

AimsThe study examined self‐reported job‐related stressors induced by the COVID‐19 pandemic and psychological distress among hospital nurses and physicians. In addition, we explored the role of negative affect (NA) and background variables in relation to COVID‐19‐related job stressors and psychological distress.BackgroundDuring COVID‐19 pandemic, hospital nurses and physicians were exposed to highly enduring occupational stress, that stem from subjective appraisal of inadequate job resources (i.e., personal protection equipment, information on how to manage safely in the ongoing work and organizational attention to the needs arising from the ongoing work).DesignCross‐sectional design.MethodsBetween May and July 2020, 172 nurses and physicians working at a medical centre in Israel filled in self‐report questionnaires about sociodemographic data, COVID‐19‐related job stressors, psychological distress and NA.ResultsOur results confirmed the positive direct link between perceived COVID‐19‐related job stressors and psychological distress among hospital nurses and physicians. NA was found to serve as a mediator in this association (indirect link). Furthermore, nurses and physicians' seniority was related positively to psychological distress and also played a moderator role in the indirect link.ConclusionWe recommend to monitor the mental health of hospital nurses and physicians and to provide a platform to address their job stressor concerns related to COVID‐19, and share helpful coping strategies.Impact statementDuring the abrupt COVID‐19 outbreak, hospital nurses and physicians face challenges that might raise NA and psychological distress. Our study revealed that among hospital nurses and physicians, COVID‐19‐related perceived job stressors and psychological distress were positively linked, and NA plays a mediating role in this association. Among nurses and physicians with moderate or high years of seniority (>11 years), higher COVID‐19‐related perceived job stressors associated with higher NA, which in turn was associated with greater psychological distress. Policymakers would be wise to provide a platform to address hospital nurses and physicians' mental health.

The use of different educational methods and programs, such as simulation and virtual training, plays an important role in effective Cardiopulmonary Resuscitation (CPR) learning for nursing students. This study was conducted with the aim of comparing mannequin-based simulation training with virtual training on CPR learning among nursing students. This parallel randomized controlled trial was conducted in 2022. We selected 73 nursing undergraduate students and randomly assigned them to two groups: mannequin-based simulation and virtual training groups. The knowledge, attitude, and performance of CPR in both groups were evaluated and compared before, immediately after, and 1 month after the intervention. Data analysis was performed using independent t-test and the repeated-measure analysis of variance (ANOVA) using the Statistical Package for Social Sciences (SPSS) software. Within-group differences were significant in both mannequin-based simulation and virtual training groups in terms of knowledge, attitude, and CPR performance before and after training, as well as between before and 1 month after training (p < 0.001). In addition, the mean performance of simulation group students was significantly higher than the virtual group (p < 0.001), but no significant difference was observed between the two groups in terms of knowledge and attitude dimensions before training, after training, and 1 month after training. Both mannequin-based simulation and virtual training methods increase CPR learning. Considering that students' knowledge and attitude increase significantly using both training methods and the performance of students in the simulation group is better than in the virtual group, the use of a multimodal approach is recommended for CPR training of nursing students.