The Feasibility of Using Simulation to Assess Parent Learning: High Risk Technology Dependent Children

Children dependent upon long term mechanical ventilation post discharge from an acute care center are at high risk for readmissions, morbidity, and mortality directly related to the care they receive in the home environment. Parents are expected to act as caregivers yet are inadequately prepared to provide the level of care needed in the home setting prior to their child’s discharge home. The primary goal of the PAWS (Parental Airway Assessment with Simulation) program was to assess parent learning and confidence in managing these children in the home setting post discharge. The Simulation Model for Improved Learner and Health Outcomes (SMILHO) framed the assessment program’s development, implementation, and evaluation which focused on airway management using an on-site simulation-based assessment focused on observation and evaluation of parental clinical skills. This program implemented a multi-step simulation-based assessment intervention over a 6-8-week period and included a home visit to assess learning in the home environment. Results support that all eight families enrolled in the program demonstrated both an increase in skill acquisition over time as well as increase in self-reported confidence in their ability to care for their child post discharge from the acute care setting.

Over the course of the program, families were exposed to multiple simulation sessions that demonstrated a significant increase in skill level across all content presented with a p value = 0.006. The Pearson correlation value for skill acquisition across all four skills was r = 0.92 indicating a robust positive correlation between parent education, including both existing institutional education programs and focused simulation scenarios, and rigorous debriefing post simulation. Observational changes over time in all eight parent groups additionally included decreased set up time needed for the parents to assemble needed supplies and overall preparation to perform skills. Parents could facilitate skill mechanics with ease over time and were able to manipulate the medical supplies and equipment with greater self-assuredness with each subsequent skill session. Overall, families showed positive increases in all four-skills evaluated.

Post program completion, parents demonstrated a 22% increase in self-reported confidence in caring for their child following discharge using an administered pre-post Family Assessment Survey.