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Implementing Cardiac Surgical Unit-Advanced Life Support Through Simulation-Based Learning: A Quality Improvement
Gregory S Marler1, Margory A Molloy, Jill R Engel
1Gregory S. Marler, DNP, APRN, ACNP-BC, FCCP has nearly 15 years' experience as a nurse practitioner in cardiothoracic surgery and is an assistant professor in the Department of Nursing at Appalachian State University in Boone, North Carolina. He is board certified as an acute care nurse practitioner. Margory A. Molloy, DNP, RN, CNE, CHSE, is the director of the Center for Nursing Discovery at the Duke University School of Nursing, Durham, North Carolina, and actively involved in developing interprofessional collaborative experiences that focus on patient safety, effective teamwork, and communication. Jill R. Engel, DNP, ACNP, FNP, NEA-BC, FAANP, is associate vice president for Heart Services Operations, Nursing, and Patient Care Services for Duke University Hospital System and clinical associate with Duke University School of Nursing in Durham, North Carolina. Gloria Walters, PhD, RN, RN-BC, CCRN-K, is a nurse scientist with Novant Health Forsyth Medical Center in Winston-Salem, North Carolina. Melanie B. Smitherman, BSN, RN-BC, CCRN-CSC, has 10 years' experience in cardiothoracic surgery critical care nursing and is currently pursuing a master of science in nursing degree in adult-gerontology acute care nurse practitioner at Duke University in Durham, North Carolina. Valerie K. Sabol, PhD, ACNP, GNP, ANEF, CNE, CHSE, FAANP, FAAN, is the chair for the Division of Healthcare in Adult Populations at Duke University School of Nursing, Durham, North Carolina. Dr Sabol has more than 25 years of acute and critical care experience and is board certified as an acute care and a gerontology nurse practitioner.
Background:
The European Association for Cardio Thoracic Surgery and the Society of Thoracic Surgeons endorse Cardiac Surgical Unit-Advanced Life Support, a protocol designed specifically for cardiothoracic surgical patients who suffer postoperative cardiac arrests. To enhance patient outcomes and to reduce death rates, cardiothoracic intensive care unit nurses must be able to perform the protocol with confidence, proficiency, and without delays. To this end, simulation-based learning (SBL) is a pedagogical method ideal for optimized learning.
Objectives:
This quality improvement project was designed to implement a post-cardiac surgery resuscitation protocol in a nonacademic, community medical center to enhance nurse knowledge, confidence, and proficiency for optimal patient outcomes.
Methods:
The Cardiac Surgical Unit-Advanced Life Support is an evidence-based resuscitation protocol that was implemented using didactic, hands-on training, and SBL. It was evaluated using knowledge surveys, comparisons in nurse confidence and performance measures, and patient outcomes data.
Results:
Nurses' knowledge gains (ie, mean test scores) on our test were statistically significant between 3 time points (F2,60 = 81.204, P < .001). Knowledge significantly increased from pre-education to immediate post-education (P < .001), but declined from immediate post-education to 3-month post-education assessments (P < .001); however, the 3-month post knowledge mean was still higher than the pre-education knowledge mean (P < .001). Nurses were confident in their ability to apply the protocol, although results failed to show a correlation between confidence and performance ability. Statistical significance for delay in cardiopulmonary resuscitation was found between pre- and post-nursing education patient cardiac arrest events (P = .05).
Conclusions:
Didactic and hands-on learning supported knowledge retention over time for cardiothoracic surgical intensive care unit nurses. Improving self-confidence and the application of an unfamiliar resuscitation protocol through SBL and any impact a training program has on patient outcomes will require ongoing practice and more evaluation.
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