Multi-Method Critical Care Orientation Improves Critical Thinking, Skills and Confidence

Background: Traditional didactic educational strategies have not been efficient or effective in preparing critical care nurses to care for moderately complex patients with confidence and competence.

Objective: Utilize an evidence-based, multi-method approach that is individualized and flexible to improve the knowledge, skills, critical thinking and confidence of critical care nurses in a large academic medical center.

Methods: More than 300 nurses attended the re-designed Critical Care Orientation (CCO), including nurses from adult and pediatric intensive care units, emergency and telemetry units. Multiple tools were used to provide education: The American Association of Critical-Care Nurses ECCO on-line modules¹, on-line programming, didactic presentations, case studies, skills lab, and simulation. Pre- and post-tests measured knowledge acquisition using the Basic Knowledge Assessment Tool (BKAT)². Competency was assessed based on skills lab performance, case study analyses, and simulation performance. Post-education surveys measured participants’ confidence and perceptions of the program. Data was collated and reviewed by a central committee, resulting in ongoing improvements in the CCO program and support from leadership.

Results: The overall mean of the BKAT scores increased from 71.80 to 84.42 (p <.000) following CCO.  Approximately 70% of the participants stated that the teaching methods were effective and created a positive learning environment. More than 92% reported the online modules were useful. Similarly, participants found that the skills lab (91-99%) and simulation (87-98%) were useful. The six-month follow-up survey showed greater than 70% were confident in mastering the content presented during the orientation. All of the participants (100%) were confident that they were developing the knowledge and skills required to provide care for moderately complex patients in the clinical setting. Furthermore, 100% of participants revealed that they were confident that they could assess the needs of their patients, interpret the findings, develop a care plan, and have the skills to deliver the planned care. More than 95% were confident that they could communicate their patient’s needs to others on the healthcare team and collaborate with the team. Lastly, orientation was completed on time by 93.3% of participants.

Conclusion: The re-designed Critical Care Orientation is both efficient and effective in preparing nurses to provide excellent care to moderately complex patients. Utilizing a multi-method, flexible approach to learning accommodated individual participant’s learning style and needs. Nurses were given the opportunity to assess their learning needs, to develop knowledge, skills and confidence through various methods, and to evaluate competency in a simulated and clinical setting.  Participants increased their knowledge, skills, and confidence through the evidence-based orientation.