In 2016, there were nearly 209,000 incidences of in-hospital cardiac arrest with a survival rate of approximately 24.8% (American Heart Association, 2017b). The in-hospital survival rate of patients in cardiac arrest has been estimated to vary from 11% to 35% (Chan, et. al, 2016). Deficiencies in interprofessional coordination and teamwork have been shown to be a significant source of medical errors that have resulted in fatal consequences (Fung et al., 2015).
Background
There are numerous unexpected situations involving patients requiring immediate medical attention in the clinical setting, and such events can be stressful for those that are not properly trained. In many settings, these circumstances are rare and staff is unaccustomed to efficiently managing patients in crisis. Studies have shown that stress and anxiety can have negative effects on technical and non-technical skills in the clinical environment. The inability to proficiently respond to a crisis situation is often a source of chaos, confusion, and frustration for all parties involved. Delac, Blazier, Daniel, & Wilfong (2013) identified that in nurses alone, the number one fear was not knowing what to do in a crisis event involving patient arrest. In order to optimize outcomes for patients, there must be training to promote a competent multidisciplinary team consisting of nurses, physicians, respiratory therapists, and all other contributing members (American Heart Association [AHA] 2017a).
Significance to Nursing
The importance of effective training is significant for each and every individual involved in resuscitation efforts. When compared to other types of training, simulation has been found to improve staff confidence and performance. Multiple studies have been conducted and provide evidence to support the fact that simulation can improve critical thinking skills and confidence, which in turn decreases anxiety and improves patient care (Adamson, 2015). The importance of effective training is significant for each and every individual involved in resuscitation efforts. When compared to other types of training, simulation has been found to improve staff confidence and performance. Multiple studies have been conducted and provide evidence to support the fact that simulation can improve critical thinking skills and confidence, which in turn decreases anxiety and improves patient care (Adamson, 2015).
Method
The sample for this project was recruited from a hospital setting and included staff members who respond to patients in an emergent situation. The sample consist of at 22 staff members including registered nurses (RNs), licensed practical nurses (LPNs), radiology technicians, physicians, mid-level practioners, and respiratory technicians. The project took place in an 88-bed acute care facility serving South Alabama. Sessions simulating emergent situations which involved participants from multiple disciplines were held to determine the effect of an interdisciplinary training intervention would increase staff confidence levels. The participants were asked to simulate exactly what would be done if this scenario was encountered in real life. Once completed, participants had the chance to discuss the scenario and identify areas that in need of improvement. Surveys (GAD-7) were completed two weeks pre- and post-intervention, and an effectiveness questionnaire (SET) was completed immediately post-intervention.
Results
There were 22 participants who completed the study. The majority of participants strongly agree that the simulation was effective especially with items I feel better prepared to care for real patients (90.9%) and I feel more confident with my decision making skills (96.4%). For the GAD-7, there was an increase in the responses in the not at all category from 27.3-59.1% pre-intervention to 54.5-81.8% post-intervention. The maximum score decreased from 21.0 on the pre-intervention GAD-7 to 13.0 on the post-intervention GAD-7.
Discussion
Interdisciplinary training using simulation in addition to traditional training was perceived by participants as being an effective method of increasing confidence levels of staff. According to pre- and post-intervention surveys, overall anxiety was decreased post-intervention. Expanding on this study could be beneficial in determining the effect of similar interdisciplinary interventions on various variables of performance and patient outcomes.
Limitations
The small sample size (n=22) was a limitation of this study. Staffing limitations and hospital census at the time that the study was implemented may have decreased participation. Also, the familiarity of the PI to the participants could have created bias when the participants were completing the surveys do to feelings of good will towards the PI. Another limitation was the generalization of the GAD-7 in that some participants may have answered the questions based on everyday life instead of how he or she felt while working in the studied session. Implementing the study on a larger scale and evaluating additional variables may be beneficial to future researchers.
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