Increasing Nursing Confidence Through the Use of a Human Patient Simulator for Advanced Cardiac Life Support (ACLS) Mock Code Drills in the Obstetrical Unit

Monday, 7 July 2008
Susan Faron, RNC, MN, CNS , Labor and Delivery, Antenatal Testing, Triage and PACU, Sharp Mary Birch Hospital for Women, San Diego, CA

Learning Objective 1: The learner will be able to discuss the rationale for providing simulation drills for high risk low frequency events.

Learning Objective 2: The learner will be able to identify three methods for improving nurses' confidence in performance of Advanced Cardiac Life Support.

Throughout the United States, large numbers of obstetrical nurses are certified as Advanced Cardiac Life Support (ACLS) providers as a requisite to being considered qualified to provide Post-anesthesia care in maternity units. Many of them have never had the opportunity to put their advanced training into use because cardiac and respiratory arrest are rare occurrences in obstetrical units. As with other rare occurrences, the anticipation and fear of performing badly can cause stress and anxiety during the actual event.

It has been documented that nurses and medical staff have poor knowledge and skill retention following cardiopulmonary resuscitation training. Medical training utilizing a computerized human patient simulator has been shown to improve competence in a controlled environment. An innovative program was designed to utilize a human patient simulator to increase staff knowledge related to role performance when an obstetrical patient experiences cardiac or respiratory arrest and to improve staff confidence in their ability to recognize cardiac rhythms and initiate appropriate treatment.

A survey was developed to allow nurses to self-report their confidence in their ability to identify members of the code blue team, interpret cardiac rhythms strips, institute medical interventions, locate necessary supplies and equipment, and act as the leader in an Advanced Life Support resuscitation. Pre and post simulation drill training survey responses from a pilot group of fourteen nurses were compared using 2 sample t-test and Wilcoxin's signed-ranks test. Paired samples t-test mean responses increased significantly for each of the 5 survey questions: Question 1, p=.003; Question 2, p=.000; Question 3, p=.000; Question 4, p=.003; Question 5, p=.000. Wilcoxin's signed-ranks test results were similar with statistically significant (p<.05) results for each of the five questions.

These results suggest that use of a human patient simulator for ACLS mock code drills in the obstetrical unit significantly increases self-reported nurse confidence.