Acute Care Skills Research Articles

Improving pediatric procedural skills and EPA assessments through an acute care procedural skills curriculum.

Acute procedural skill competence is expected by the end of pediatric residency training; however, the extent to which residents are actually competent is not clear. Therefore, a cross-sectional observational study was performed to examine the competency of pediatric residents in acute care procedures in emergency medicine. Pediatric residents underwent didactic/hands-on "Acute Procedure Day" where they performed procedures with direct supervision and received entrustable professional activity (EPA) assessments (scores from 1-5) for each attempt. Procedures included: bag-valve mask (BVM) ventilation, intubation, intraosseous (IO) line insertion, chest tube insertion, and cardiopulmonary resuscitation (CPR) with defibrillation. Demographic information, perceived comfort level, and EPA data were collected. Descriptive statistics and Pearson correlation for postgraduate year (PGY) versus EPA scores were performed. Thirty-six residents participated (24 PGY 1-2, and 12 PGY 3-4). Self-reported prior clinical exposure was lowest for chest tube placement (n = 3, 8.3%), followed by IOs (n = 19, 52.8%). During the sessions, residents showed the highest levels of first attempt proficiency with IO placement (EPA 4-5 in 28 residents/33 who participated) and BVM (EPA 4-5 in 27/33), and the lowest for chest tube placement (EPA 4-5 in 0/35), defibrillation (EPA 4-5 in 5/31 residents) and intubation (EPA 4-5 in 17/31). There was a strong correlation between PGY level and EPA score for intubation, but not for other skills. Entrustability in acute care skills is not achieved with current pediatrics training. Research is needed to explore learning curves for skill acquisition and their relative importance.

Acute Care Interprofessional Event Improved Knowledge, Attitudes, and Practices of Athletic Training and Nurse Practitioner Students

Objective In this study, we sought to assess the changes in the knowledge, attitudes, and practices (KAP) of athletic training program (ATP) and nurse practitioner (NP) graduate students before and after an acute care interprofessional education (IPE) workshop. Design and Setting This was a descriptive KAP survey to be taken by participants before and after the IPE event. This survey was administered using a QR code that participants scanned. The study occurred at the University of Central Florida College of Nursing before and after acute care skills were taught and practiced by each program’s students. Patients or Other Participants A total of 35 students from a professional master’s ATP and an adult gerontology acute care NP program were present at the workshop. Thirty-two students took the preworkshop survey, while 30 students completed the postworkshop survey. Main Outcome Measure(s) In this study, we aimed to measure the change in perceptions about the knowledge, skills, teaching, and IPE understanding of each respective program after the educational workshop. Surveys were distributed before the IPE workshop and then again after the workshop concluded. The survey responses were scored on a 5-point Likert scale. Scores for each section were averaged, and statistical analysis was done using repeated measures analyses of variance for total and subsection scores for both programs. Results A significant increase was found for each group in IPE understanding, knowledge, skills, and teaching scoring (P < .05) with moderate to large effect sizes. Conclusions Participating in this acute care IPE workshop showed significant increases in perceptions of the KAP among ATP and NP students.

81 A Snapshot of Entrustability of Acute Care Procedural Skills in Paediatrics Residents

Abstract Background General paediatricians are expected to be competent in the resuscitation of children and important to this competency is the ability to perform certain acute care procedural skills. Paediatric residents are expected to be competent in these procedural skills by the end of their training as specified by the Royal College (RCPSC). However, the extent to which residents are actually competent is not fully assessed or understood. There are currently no evidence-supported guidelines suggesting the best path toward procedural skills competency for residents, and they are less likely to receive formal training and or supervision for completing procedural skills than their nursing counterparts. They also report feeling inadequately prepared. To address this gap, the Paediatrics program at McMaster University aimed to conduct a longitudinal cross-sectional study examining the competency of their trainees in specific acute care procedures. Objectives The purpose of this first study was to present a cross-sectional observation of the entrustability of paediatric residents in 6 procedural skills. Design/Methods The procedures were bag-valve mask (BVM) ventilation, intubation, intraosseous (IO) line insertion, chest tube insertion, and cardiopulmonary resuscitation (CPR), and defibrillation, which are all requirements of the RCPSC. Paediatric residents attended an “Acute Care Procedure Day” where they performed each procedure with direct observation and feedback. Entrustable professional activity (EPA) scores (from 1 to 5) were recorded for each attempt. Prior, a 1-hour interactive lecture was given that included procedural information and a video demonstration of each procedure. Residents received a copy of the milestones per EPA. Demographic information, self-perceived comfort, and EPA data were collected. Descriptive statistics and Pearson correlation for PGY level versus EPA scores were performed. Results Of the 36 residents who participated, 24(67%) were in postgraduate year (PGY) 1-2, and 12 PGY 3-4(33%). Reported levels of past experience were lowest for placement of chest tubes (n=3, 8.3%), followed by IOs (n=19, 52.8%). During the sessions, residents showed the highest levels of initial entrustment with IO placement (EPA 4-5 in 28/33), BVM skills (EPA 4-5 in 27/33), and CPR (EPA 4-5 in 16/25), and lowest for chest tube placement (EPA 4-5 in 0/35), defibrillation (EPA 4-5 in 5/31 residents) and intubation (EPA 4-5 in 17/31). Despite this, self-reported overall confidence after training for these procedures was moderate to high. There was strong correlation between PGY level and EPA score for intubation, and no correlation for the other procedures. Conclusion Our findings show that entrustability of certain acute care skills is not being obtained (i.e., defibrillation, chest tube placement), and that there were large discrepancies between entrustment scores and perceived comfort among the PGY levels. Further research is needed to characterize the learning curves for these skills, and their relative importance in paediatrics training.

In pursuit of a better transition to selected residencies: a quasi-experimental evaluation of a final year of medical school dedicated to the acute care domain

BackgroundMedical schools seek the best curricular designs for the transition to postgraduate education, such as the Dutch elective-based final, ‘transitional’ year. Most Dutch graduates work a mean of three years as a physician-not-in-training (PNIT) before entering residency training. To ease the transition to selected specialties and to decrease the duration of the PNIT period, UMC Utrecht introduced an optional, thematic variant of the usual transitional year, that enables the development of theme-specific competencies, in addition to physicians’ general competencies.MethodsWe introduced an optional transitional year for interested students around the theme of acute care, called the Acute Care Transitional Year (ACTY). This study aimed to evaluate the ACTY by judging whether graduates meet postgraduate acute care expectations, indicating enhanced learning and preparation for practice.In a comprehensive assessment of acute care knowledge, clinical reasoning, skills, and performance in simulations, we collected data from ACTY students, non-ACTY students interested in acute care, and PNITs with approximately six months of acute care experience.ResultsACTY graduates outperformed non-ACTY graduates on skills and simulations, and had higher odds of coming up to the expectations faculty have of a PNIT, as determined by global ratings. PNITs did better on simulations than ACTY graduates.DiscussionACTY graduates show better resemblance to PNITs than non-ACTY graduates, suggesting better preparation for postgraduate acute care challenges.ConclusionTransitional years, offering multidisciplinary perspectives on a certain theme, can enhance learning and preparedness for entering residency.

349EMF Virtual Reality Simulation to Assess EPA-10 in Fourth-Year Medical Students

Entrustable Professional Activities (EPAs) refers to discrete clinical activities that requires the utilization and integration of various competencies. EPA-10 requires a physician to recognize an unstable patient and initiate evaluation and management. Research has demonstrated that fourth-year medical students are less prepared to manage unstable patients as compared to nonacute conditions. Previous research has demonstrated that simulation-based medical education can improve the acute care skills of medical students and residents.

The Implementation of a Perianesthesia Nursing Orientation for the Newly Licensed Registered Nurse

<h3>Background Information</h3> Historically, nurses were required to have critical care experience prior to transitioning into the perianesthesia areas of practice. Due to complexity of patient care and critical thinking demands of perianesthesia, new graduates are not often recruited. Throughout the United States, there is limited opportunity for new graduate nurses to work in specialty areas, such as perianesthesia, when there is no formal nursing orientation for the newly licensed registered nurses (NLRNs). Perianesthesia nursing encompasses a unique subset of nursing that combines the acute and critical care skills with a comprehensive surgical and anesthesia knowledge base. A perianesthesia specialty nursing orientation for the newly licensed registered nurse could establish a strong nursing foundation and evolve these novice nurses into competent, perceptive, and collaborative perianesthesia nurses. <h3>Objectives of Project</h3> The objective of this project was to create a perianesthesia nursing orientation for the NLRN. <h3>Process of Implementation</h3> An integrative review of the literature was done to synthesize the evidence and understand the impact of nurse residency programs on healthcare organizations. The project leaders then sought out subject matter experts through ASPAN to gain a better understanding of how to operationalize this project. The project leaders then created an orientation plan and business proposal and submitted it to executive leadership, nursing leadership, and perioperative leadership. The business proposal was accepted and the first perianesthesia nurse residency program was started in January 2021. <h3>Statement of Successful Practice</h3> The first cohort was comprised of 2 NLRNs. The two nurses were selected from a candidate pool of almost 100 applicants. The two NLRNs proceeded through a comprehensive orientation plan for 6 months and successfully finished by July 2021. Due to the success of the pilot group, the project leaders were able to successfully justify and recruit for another group of NLRNs, who started in January 2022. <h3>Implications for Advancing the Practice of Perianesthesia Nursing</h3> The establishment of a specialty nursing orientation for the NLRN now gives new graduate nurses the opportunity to transition successfully into the perianesthesia setting as a new to practice nurse.

Clinical Nurses' Continuing Education Needs in Acute Burn Care.

The purpose of this research was to explore clinical nurses' continuing education needs in caring for patients with acute burns. A descriptive research design was applied. To explore clinical nurses' continuing education needs in caring for patients with acute burns, focus group interviews were conducted. Educational needs assessments in acute burn care knowledge and skills were developed based on a content analysis of the focus group interviews. The participants were clinical nurses at a burn treatment hospital. Collected data were analyzed. The nurses showed a high educational need for nursing knowledge and skills in caring for patients with acute burns. They indicated a need for educational content covering comprehensive nursing knowledge and skills for this care, including emergency treatment and psychosocial nursing care for the physical changes induced by acute burns. A systematic continuing education program needs to be developed for nurses who care for patients with acute burns and delivered using blended learning approaches. [J Contin Educ Nurs. 2022;53(2):77-82.].

Impact of ‘DEALTS2’ education intervention on trainer dementia knowledge and confidence to utilise innovative training approaches: A national pre-test – post-test survey

BackgroundGaps in acute care staff knowledge, skills, and attitudes towards dementia exist. Innovative training approaches that improve the delivery of care for people with dementia are needed. We were commissioned by Health Education England to develop and evaluate a new dementia education intervention ‘Dementia Education And Learning Through Simulation 2’ (DEALTS2), a simulation toolkit to enhance delivery of dementia training nationally across England. ObjectivesEvaluate differences in trainer dementia knowledge scores pre and post training, satisfaction with DEALTS2 Train-The-Trainer (TTT) workshops and simulation toolkit, confidence to use training approaches, and spread of implementation. DesignA questionnaire survey using a pre-test – post-test design with measures completed: before (pre-test); after (T1); and 12 months post training (T2). SettingTwelve one-day DEALTS2 TTT workshops delivered across England in 2017. ParticipantsNational Health Service Trust staff employed in dementia training roles (n = 199 trainers). MethodsTrainers attended DEALTS2 TTT workshops and received the simulation toolkit. Data were collected between 2017 and 2018 using a questionnaire capturing differences in dementia knowledge scores, Likert scales and closed-ended questions measured satisfaction, confidence and implementation. Data were analysed using quantitative methods. ResultsResponse rate was 92% (n = 183) at pre-test/T1 and 26% (n = 51) at T2. Trainer dementia knowledge scores increased from pre-test to T1 (p < 0.001) and were retained after 12 months in 5 of the 6 areas measured (pre-test to T2, p < 0.002); largest gains in ‘humanised approaches to dementia care’. 96% (n = 176/183) were satisfied with DEALTS2 TTT workshops and simulation toolkit; 66.7% (n = 34/51) felt confident to deliver dementia training informed by DEALTS2. Adherence rates were good with 45% (n = 23/51) using the innovative training approaches within twelve months. ConclusionsThe results show DEALTS2 effectively increased trainer dementia knowledge and confidence to utilise innovative dementia training approaches. Implementation of DEALTS2 varied across organisations, therefore further research should explore factors determining successful implementation.

68 General Pediatric Skills – Are we Doing Enough During Training to Prepare Pediatricians for Practice?

Abstract Background Exposure to and training in acute care during pediatrics residency training varies. Furthermore, there is evidence that pediatric and neonatal resuscitative skills, like cardiopulmonary resuscitation, and management of acute care patients is often lacking.1,2 Several studies have shown that only 2.5 of every 1000 pediatric emergency department patients require significant resuscitative efforts3. Thus training for such an event is extremely important because mastering the skills involved are less likely to come with experience. Currently, it is unknown how comfortable community pediatricians feel managing acute care situations, nor if their comfort level changes depending on where they are trained. Objectives Our study aimed to determine if the training general pediatricians receive is sufficient to achieve a high comfort level in acute care that is sustained after 5 years in practice. This study explored pediatricians’ comfort levels with pediatric and neonatal acute care, as set out by the objectives of training in pediatrics from the Royal College of Physicians and Surgeons of Canada. Design/Methods An anonymous cross-sectional survey was piloted to a random sample of pediatricians in the province of Ontario, obtained through the College of Physicians and Surgeons of Ontario. Demographic data regarding practice type and duration was collected as well as training data about courses done in Pediatric Advanced Life Support (PALS) and Neonatal Resuscitation Program (NRP). Using a five-point Likert scale, pediatricians were asked to judge their comfort with different pediatric and neonatal acute care skills and clinical vignettes. Comfort level ranking ranged from 1 (very uncomfortable) to 5 (very comfortable). Skills included are listed in Figure 1. Baseline characteristics were described using frequency measures of proportions and medians and interquartile ranges when appropriate. For general pediatricians and specialists, we used the Mann-Whitney test to determine if there is a difference between the mean sum ranks of comfort level depending on whether the pediatrician was practicing for more or less than 5 years. Results One thousand surveys were mailed, of which 248 were completed (response rate = 24%). Among respondents, 142 (54%) practiced general pediatrics and 68 (32%) were specialists. The majority of respondents practiced in a city, large city or metropolis (84%). In total, 169 (81%) of all survey respondents and 37 (74%) of general pediatricians have been in practice for five years or more. For all respondents, 150 (64%) felt comfortable or very comfortable with neonatal resuscitation team lead. There was no difference in comfort level with leading a neonatal resuscitation team based on years of practice (less than 5 years versus greater than and equal to 5 years) (p=0.69). This result did not change when considering the general pediatrician only (p=0.14). Of all respondents, 113 (48%) felt comfortable or very comfortable with pediatric resuscitation team lead. There was a significant difference in comfort level with leading a pediatric resuscitation team based on years of practice (less than 5 years versus greater than and equal to five years) (p=0.03) with more comfort being seen over time. When analyzing only for general pediatricians, that difference became insignificant (p=0.07). No difference was found in reported comfort in most skills and length of time in practice. However, comfort level is significantly positively correlated with the number of times a skill was performed. Interestingly, a significantly negative correlation was found between comfort level as pediatric resuscitation team lead and number of years in practice (p=0.03). Conclusion The findings of this pilot survey suggest that ensuring competence in acute care in residency training is of utmost importance given that comfort with pediatric and neonatal resuscitation appears to remain static over time. The skills that pediatricians report most discomfort in are a target for continuing professional development or should be revised in the objectives of training of pediatrics.

P094: Use of high fidelity simulation to improve quality of care within Correction Canada's maximum security facilities: A Canada's first

Innovation Concept: Nurses working in corrections facilities are routinely faced with acute care scenarios requiring skilled management. There are also increasing numbers of inmates with chronic health conditions and acute exacerbations. Correctional Service Canada (CSC) has partnered with the Clinical Simulation Lab at Queen's University to develop a simulation-based training program aimed at improving acute care skills of Corrections nurses and staff. This novel quality improvement program encompasses a range of presentations that commonly occur in correctional environments. Methods: The program consisted of two laboratory sessions focused on acute care and trauma followed by an in-situ simulation session. The sessions were organized around the 4-component instructional design that enhances complex learning. Both lab sessions began with scaffolded part-task training (IV insertion, ECG interpretation, airway, circulatory support, etc) and then progressed to six team-based high-fidelity simulations that covered cardiac arrhythmias, hypoglycemia, agitated delirium, drug overdoses, and immediate trauma management. Participants rated the effectiveness of each session. Lastly, an in-situ session was conducted at the Millhaven maximum security facility for nursing and correctional staff. It comprised of five scenarios that incorporated actors, a high-fidelity manikin, and simulated security issues. Participants completed a validated self-assessment before and after the session grading themselves on aspects of acute care. Curriculum, Tool, or Material: Our multi-modal simulation curriculum enhanced self-assessed knowledge of CSC learners. Of 71 attendees in the acute care skills session, 70 agreed or strongly agreed that the exercise enhanced their knowledge, satisfied their expectations, and conveyed information applicable to their practice. All 13 participants in the trauma session agreed or strongly agreed to these sentiments. We used Wilcox signed rank test item by item on the in-situ questionnaire. There was significant improvement in majority of skills sampled: airway management, O2 delivery, team organization and assessment/treatment of cardiac arrest. Conclusion: This initiative is the first time high-fidelity simulation training has been used with Corrections nurses and the first in-situ simulation in a maximum security institution in Canada. The sessions were well-liked by participants and were assessed as very effective, validating the demand for further implementation of clinical simulation in correctional facilities.

"Nightmares-Family Medicine" Course Is an Effective Acute Care Teaching Tool for Family Medicine Residents.

Simulation is an effective method for teaching acute care skills but has not been comprehensively evaluated with family medicine (FM) residents. We developed a comprehensive simulation-based approach for teaching acute care skills to FM residents and assessed it for effectiveness. We compared the effectiveness of our standard acute care simulation training [Acute Care Rounds (ACR)] to a more comprehensive simulation-based acute care program, Nightmares-Family Medicine (NM). We used a self-reported comfort scale as well as video-captured performance on an acute care Objective Structured Clinical Examination (OSCE). Seventy-seven of our FM residents in their postgraduate year 1 between July 2012 and June 2015 participated in the study. Wilcoxon matched pairs and one-tailed t tests analysis was used for analyzing the comfort scale, Whitney-Mann, and χ for the OSCE performance. Nightmares-Family Medicine's initial 2-day session significantly improved the resident's self-assessment scores on all 20 items of the questionnaire (P < 0.05). Time-matched ACR improved 11 of 20 items (P < 0.05) level. Follow-up NM sessions improved 5 to 8 of 20 items (P < 0.05). Follow-up ACR sessions improved 1 to 5 of 20 items (P < 0.05). The means taken at the end of postgraduate year 1 year were higher for 13 of 20 items in the NM group (P < 0.05) as compared with ACR group. The NM group scored significantly higher on both the mean scores of OSCE individual categories (P < 0.01) and the Global Assessment Score (P < 0.05). Significantly less NM residents failed the OSCE (n = 1/30, 3.3% vs n = 8/37, 21.6%, P < 0.05). "Nightmares-Family Medicine" course is very effective at teaching acute care skills to FM residents and more so than our previous curriculum.

Going home with baby: innovative and comprehensive support for new mothers.

Shorter length of stay for postpartum mothers and their newborns necessitates careful community follow-up after hospital discharge. The vast amount of information given during the initial postpartum period can be overwhelming. New parents often need considerable support to understand the nuances of newborn care including newborn feeding. Primary health care and community services need to ensure there is a seamless continuum of care to support, empower, and educate new mothers and their families to prevent unnecessary hospital readmission and other negative health outcomes. The Healthy & Home postpartum community nursing program provides clinical communication and supports to bridge the gap between acute hospital and community follow-up care through home visits, a primary health care clinic, a breastfeeding center, a breastfeeding café, a postpartum anxiety and depression support group, bereavement support, and involvement in a Baby-Friendly Initiative™ coalition. Nurses working in the program have the acute care skills and resources to complete required health care assessments and screening tests. They are also international board-certified lactation consultants able to provide expert breastfeeding and lactation care. This paper describes how the Healthy & Home program has evolved over the past 25 years and offers suggestions to other organizations wanting to develop a postpartum program to meet the physical and mental health needs of postpartum families to promote maternal and infant wellbeing.

A Teaching Simulation is Effective in Improving Athletic Training Students' Football Helmet Facemask Removal Clinical Skills and Confidence

Context: Patient encounters related to acute care skills rarely occur in clinical education, leaving a potential gap in students' skills and confidence. Objective: Investigate the effects of an acute care simulation requiring football helmet facemask removal on clinical skill application and confidence in athletic training students. Design: Cross-sectional. Patients or Other Participants: Forty-four students (16 male, 28 female; age = 20.9 ± 1.12 years) enrolled in 2 accredited professional athletic training programs. Intervention(s): Participants completed a confidence assessment survey and were pretested on football helmet facemask removal skills. Pairs of participants engaged in a simulation where they evaluated and managed a football player who required facemask removal, followed by a debriefing session. Participants repeated the confidence assessment survey and were posttested to evaluate skills. Main Outcome Measure(s): Dependent variables were clinical skills scores and confidence, as measured by a confidence assessment survey. Simulation served as the independent variable. Paired samples t test determined changes in clinical skills scores. Wilcoxson Signed-Rank Test determined changes in confidence. Results: Paired samples t test revealed a significant increase in performance on the posttest, including: primary survey (t43 = 4.13, P &amp;lt; .001), facemask removal (t43 = 4.00, P &amp;lt; .001), vital signs assessment (t43 = 5.57, P &amp;lt; .001), and secondary survey (t43 = 8.85, P &amp;lt; .001). Wilcoxon Signed-Rank Test revealed increased confidence in participants' recognition of (Z = 4.96, n = 44, P &amp;lt; .001), knowledge of (Z = 5.03, n = 44, P &amp;lt; .001), and skills (Z = 4.78, n = 43, P &amp;lt; .001) needed for football helmet facemask removal. Conclusions: With the inability to ensure students have authentic, real-time evaluation of acute care skills during clinical experiences, a simulation can assist in acquisition of skills, while also improving confidence in managing acute care conditions.

Closing the theory to practice gap for newly qualified doctors: evaluation of a peer-delivered practical skills training course for newly qualified doctors in preparation for clinical practice

PurposeThe Good Intern Programme (GIP) in Sri Lanka has been implemented to bridge the ’theory to practice gap’ of doctors preparing for their internship. This paper evaluates the impact of...

A Retrospective Study of Physiological Observation-reporting Practices and the Recognition, Response, and Outcomes Following Cardiopulmonary Arrest in a Low-to-middle-income Country.

Background and Aims:In Sri Lanka, as in most low-to-middle-income countries (LMICs), early warning systems (EWSs) are not in use. Understanding observation-reporting practices and response to deterioration is a necessary step in evaluating the feasibility of EWS implementation in a LMIC setting. This study describes the practices of observation reporting and the recognition and response to presumed cardiopulmonary arrest in a LMIC.Patients and Methods:This retrospective study was carried out at District General Hospital Monaragala, Sri Lanka. One hundred and fifty adult patients who had cardiac arrests and were reported to a nurse responder were included in the study.Results:Availability of six parameters (excluding mentation) was significantly higher at admission (P < 0.05) than at 24 and 48 h prior to cardiac arrest. Patients had a 49.3% immediate return of spontaneous circulation (ROSC) and 35.3% survival to hospital discharge. Nearly 48.6% of patients who had ROSC did not receive postarrest intensive care. Intubation was performed in 46 (62.2%) patients who went on to have ROSC compared with 28 (36.8%) with no ROSC (P < 0.05). Defibrillation, performed in eight (10.8%) patients who had ROSC and eight (10.5%) in whom did not, was statistically insignificant (P = 0.995).Conclusions:Observations commonly used to detect deterioration are poorly reported, and reporting practices would need to be improved prior to EWS implementation. These findings reinforce the need for training in acute care and resuscitation skills for health-care teams in LMIC settings as part of a program of improving recognition and response to acute deterioration.

Using High-Fidelity Simulators to Teach Acute Care Skills

Using High-Fidelity Simulators to Teach Acute Care Skills

Satisfaction and self-confidence with nursing clinical simulation: Novice learners, medium-fidelity, and community settings

BackgroundSimulation is fast becoming a normative pedagogy for a portion of clinical time in undergraduate nursing programs in the U.S. Studies have shown positive outcomes in increasing self-confidence and satisfaction with simulation. The questions remain as to which fidelity of simulation best matches which learners, how early can simulation begin with novice students, and in which contexts can simulation be best used for these early learners. This study was undertaken to find out if novice students were able to demonstrate increased satisfaction and self-confidence with medium fidelity simulation in community based roles, as these students have no knowledge of acute care skills at this point in their learning. ObjectivesThe purpose of this study was to evaluate the use of medium fidelity simulation by measuring self-confidence and satisfaction among novice learners and to demonstrate the feasibility of using community based scenarios in simulation. MethodA quasi-experimental design using 61 undergraduate nursing students at a Midwestern college. Data was collected using three NLN simulation instruments known as the Educational Practices Questionnaire, Self-Confidence in Learning Questionnaire, and Simulation Design Scale (Jeffries and Rizzolo, 2006) following a five-week pediatric community-based simulation course. Students were concurrently enrolled in pediatric theory courses and their first acute care clinical course and skills lab while completing this community-based simulation course. ResultsThe results revealed that students were satisfied and self-confident following their simulation experience. They also reported high levels of satisfaction with the fidelity of the simulation experience. ConclusionMedium fidelity community based pediatric simulation can be used effectively among novice nursing students. This pedagogy is an effective way to bridge theory instruction with clinical instruction while providing students with necessary community experiences.

Athletic Training Students Demonstrate Airway Management Skill Decay, but Retain Knowledge over 6 Months

Context: Airway management (AM) knowledge and skills are taught in all athletic training programs; however, research suggests that skill decay occurs with acute care skills as length of nonpractice increases. Objective: Evaluate retention of AM knowledge and skills, specifically oropharyngeal airway (OPA) and nasopharyngeal airway (NPA) use, in athletic training students. Design: Cross-sectional study. Patients or Other Participants: Twenty-five students (8 males, 17 females; age = 21.12 ± 1.42 years) enrolled in Commission on Accreditation of Athletic Training Education–accredited professional athletic training programs. Intervention(s): Participants' AM knowledge and skills were assessed 5 times (baseline–T4). The baseline assessment was followed by an educational review session. Participants were reassessed (T1) before being randomly assigned to 2 groups. The experimental group's AM knowledge and skills were reevaluated at 1 month (T2), 3 months (T3), and 6 months (T4), and the control group's at 6 months (T4). Main Outcome Measure(s): Dependent variables of AM knowledge and skills scores. Groups served as the independent variable. Repeated-measures analysis of variance with between-participants and within-participants effects assessed changes in knowledge skills scores. Results: Testing revealed no significant differences between the groups on knowledge (F2.00,46.00 = 0.37, P = .70) and overall clinical skills (F1.57,36.17 = 0.09, P = .87). A significant main effect for time on knowledge (F2.00,46.00 = 28.44, P &amp;lt; .001) found baseline scores were different from scores at T1 and T4. A significant main effect for time on OPA skills (F1.50,34.60 = 65.02, P &amp;lt; .001) and NPA skills (F1.62,37.31 = 106.46, P &amp;lt; .001) found baseline scores were different from scores at T1 and T4 and T1 score was different from T4 score. Conclusions: Both groups retained AM knowledge over a 6-month period, whereas OPA and NPA skills decayed from review session to 6-month follow-up. The lack of significant differences between the groups suggests that subsequent testing may not affect retention of AM knowledge and skills.

P046: The “Nightmares-FM” course: an effective simulation-based acute care training method for family medicine residents

Introduction / Innovation Concept: Acute care skills are difficult to teach but can be improved using high-fidelity simulation training. We developed a comprehensive acute care “Nightmares-FM” simulation course (NM) for our Family Medicine residents and compared it to our standard simulation teaching- episodic Acute Care Rounds (ACR). Methods: NM course consisted of an initial 2 day session followed by 3 follow-on sessions interspersed throughout the PGY-1 year. ACR participants got access to 3 sessions interspersed throughout the PGY-1 year, each focusing on a different aspect of acute care. Both groups got access to the NM manual which covered the relevant topics: shock, arrhythmias, shortness of breath, altered level of consciousness and myocardial infarction. The manual is physiology-based and written specifically at the level that an average Family Medicine resident would be expected to perform at during on-call crises or emergency medicine rotations. 12 residents participating in the NM and 12 residents in time-matched ACR filled out questionnaires asking them to rate their level of knowledge of various aspects of acute care. Self-reported changes before and after each session, and at the end of the year, were analyzed using Wilcoxon matched pairs test. End of the year mean scores were compared using a two sided t-test. Finally, we developed a high-complexity acute care Objective Structured Clinical Examination (OSCE): COPD exacerbation with septic shock requiring use of positive pressure ventilation, fluids and vasopressors. The groups participated in the OSCE in February of their PGY-2 year and were graded using a validated scoring sheet marked by two independent expert video reviewers. Curriculum, Tool, or Material: NM initial 2-day session significantly improved the resident’s self-assessment scores on all 20 items of the questionnaire (p&lt;0.05). Time matched ACR improved 11 out of 20 items (p&lt;0.05) level. Follow-up NM sessions improved 5-8 out of 20 items, (p&lt;0.05). Follow-up ACR sessions improved 1-5 out of 20 items, (p&lt;0.05). End of the year means were higher for 13/20 items in the NM group (p&gt;0.05) The NM group scored significantly higher on both the mean scores of OSCE individual categories: Initial assessment, Diagnostic workup, Therapeutic interventions and Communication and teamwork (p&lt;0.05) and the Global Assessment Score (p&lt;0.026). Conclusion: “Nightmares-FM” course is more effective than our standard curriculum at teaching acute care skills to Family Medicine residents.

A collaborative approach to training ward nurses in acute care skills in resource limited settings: the nursing intensive care skills training (nicts) project

Early recognition and prevention of deterioration of ward patients can improve patient outcomes and reduce critical care admissions [1]. In low and middle income countries (LMICs), with often minimal access to critical care therapies, the benefit may be even greater. However training to assist ward nurses develop acute care skills remains limited in such settings. As part of the NICST portfolio of acute care training, the Sri Lankan nursing faculty sought assistance to deliver a 2 day course for ward nurses [2].