https://www.infirmiere-canadienne.com/blogs/ic-contenu/2024/08/19/damelioration-de-la-qualite-nicaragua-partie-2
Hospital implements training for advanced CPR
By Milton Valdez, Katherine Garay Alemán, & Michele Trask
August 19, 2024
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The ICU sought to disseminate knowledge through technical training skills, particularly in the practice of advanced cardiopulmonary resuscitation (CPR) under simulation, to empower nurses to offer immediate resolution to intensive care patients.
Editor’s note: This is the second in a three-part series on a Nicaraguan hospital’s quality improvement initiative that began with implementing specialty competencies from the CNA Certification Program. These articles were originally written in Spanish (abstract available below). Part 1 was published on August 12. Part 3 will be published on August 26.
Nursing plays a vital role in the quality and safety standards of patient care. The Hospital Militar Escuela Dr. Alejandro Dávila Bolaños, a military and urban teaching hospital that provides tertiary care, recently implemented a specialist model based on technical competencies to help improve care delivery. The hospital’s initiative aims to cultivate expertise in evidence-based practical theoretical knowledge.
Supplied by Michele Trask
The hospital’s nursing personnel underwent evaluation through an intensive course on CPR, a training program that encompassed all processes based on evidence-based competencies.
The hospital’s intensive care unit (ICU), equipped to handle the most critical patient conditions, identified the need for specialized training in 2016. The objective is to enhance quality standards and provide compassionate care to the Nicaraguan population. In line with the competency-focused culture, a residency model for nursing specialties has been developed to foster the training of specialist nurses, ensuring a high level of specialized and humanized care at all levels.
The ICU sought to disseminate knowledge through technical training skills, particularly in the practice of advanced cardiopulmonary resuscitation (CPR) under simulation, to empower nurses to offer immediate resolution to intensive care patients.
The nursing department comprises 534 professionals with varying levels of education, including those with bachelor’s and master's degrees, specialists and technicians. Continued education based on evidence will enable the identification of potential risk factors, honing of abilities and skills, and the integration of nursing techniques and procedures.
As part of the staff training, Canadian competency skills have been previously adapted and practised (see part 1) in simulators and with actual patients in the ICUs. This approach ensures that nursing staff can effectively recognize abnormal signs and symptoms in severely ill patients.
Objectives
- Encourage the training of specialist nurses at every level, adhering to the principles of international standards for high-quality, safe, specialized and humanized care.
- Emphasize evidence-based practices and the transfer of knowledge for technical skills, particularly in the training of advanced CPR. This training should encompass both simulation scenarios and practical experiences with patients treated at the hospital.
- Equip specialist nurses with the necessary expertise to provide optimal care in a comprehensive and effective manner.
Methods
The hospital’s nursing personnel underwent evaluation through an intensive course on CPR, a training program that encompassed all processes based on evidence-based competencies. This initiative was aimed at standardizing care models within ICUs. The acquisition of knowledge occurred through comprehensive education, hemodynamic workshops, and evaluations, enabling nursing staff to achieve a higher level of practice and enhance the quality of care for patients. This approach also facilitated the development of a personal and professional profile, equipping them to perform their duties more effectively.
The Dreyfus model, inspired by the skill development process, categorizes nursing staff into stages: novice, advanced beginner, competent, proficient and expert (Peña, 2010). The implementation of this model served the purpose of training nursing staff and facilitating the transfer of knowledge to their colleagues. Twelve graduates were selected and assessed based on levels of abilities and skills according to competency standards.
The course provided an opportunity for nursing staff to learn and practise advanced skills through dynamic and proactive practical sessions. This approach aimed to enable the identification of hemodynamic and metabolic changes in patients admitted to intensive care. The course emphasized human development based on levels of abilities and skills, ensuring that each nurse achieves a consistent resolution level.
José Manuel Flores, a nurse and training coordinator, emphasizes the pivotal role of nursing staff as the resource coordinating, directing and monitoring patients throughout their stay in the ICU. This underscores the critical responsibility and expertise required from the nursing team in delivering optimal care.
Results
The training in managing cardiac arrhythmias during resuscitation resulted in four nurses achieving level 3 of advanced beginner competence, whereas two nurses demonstrated a higher proficiency level, reaching level 4 competence.
A comprehensive assessment of nursing competence levels was conducted through a bibliographic review. Various parameters, including the need to respond quickly to changing level of acuity, activation of the rapid response system, airway control, preparation for endotracheal intubation, and immediate post-intubation assessments and interventions, as well as patient monitoring, were considered for evaluating nursing abilities across categories. (Contact author Michele Trask for a copy of the competency-based assessment tool.)
The evaluation of nursing staff’s practice, incorporating knowledge, attitudes and skills, indicates the need for additional competency-based training to advance them to an expert level. The proposed plan to address this involves continued interprofessional training for nursing staff every six months using the hospital’s simulator centre. This approach aims to consistently enhance the proficiency of nursing staff in handling cardiac arrhythmias and other critical scenarios.
Conclusion
The quality improvement intervention featured a prospective analysis that enabled nurses to undergo competence-based training tailored to their levels. The training enabled nursing staff to independently execute actions that were categorized as competent, advanced beginner or proficient. This was a significant increase in the scope of practice for nurses compared to the assessments and skills they were responsible for prior to the education. The goal is to build on this to eventually support nurses to achieve an expert level. Hence, it is proposed to conduct the advanced CPR course every six months.
A thorough follow-up for nursing staff is necessary. One nurse brought forward the suggestion of appointing a trainer in the ICU. This would allow nurses to enhance skills and dexterity, particularly in the advanced management of airways and addressing arrhythmias during CPR.
The clinical skills of the nursing staff underwent evaluation across all phases of CPR, emphasizing the integration of a rapid response team and an interprofessional approach involving both medical and nursing staff in education-based practices. The educational intervention was so successful that another cohort is planned to spread this knowledge across all nurses working in a critical care environment.
RESUMEN
Objetivo
Promover la formación de enfermeras especialistas en todos los niveles bajo los principios de las metas internacionales de calidad, seguridad, atención especializada y humanizada basada en la evidencia y la transferencia de conocimientos para la capacitación de habilidades técnicas en la práctica de la reanimación cardiopulmonar avanzada, bajo simulación y pacientes atendidos en el Hospital Militar Escuela Dr. Alejandro Dávila Bolaños.
Método de estudio
El método de estudio fue prospectivo, para la evaluación de criterios de competencias técnicas que fueron posibles de abordar durante la investigación, se evaluaron 12 egresados de enfermería de unidades de cuidados intensivos adultos y se incorporó el modelo de S. Deyfus para el desarrollo de habilidades y criterios de competencia bajo estándares internacionales para la estandarización de procesos de atención de enfermería basados en la evidencia y la transferencia de conocimientos teóricos y prácticos. Los datos fueron recolectados por medio de 2 talleres simulados y evaluación de los lineamientos de la especialidad de enfermería basados en: conocimientos, actitudes y prácticas en que hacer de enfermería.
Conclusiones
Se identificó que el personal de enfermería desarrolló habilidades y destrezas en el curso de reanimación cardiopulmonar avanzada, especialmente para identificar posibles factores de riesgo condicionantes en el paciente crítico.
Reference
Peña, A. (2010). The Dreyfus model of clinical problem-solving skills acquisition: A critical perspective. Medical Education Online, 15(1), 4846. doi:10.3402/meo.v15i0.4846
Capt. Milton Valdez, MD, is director of intensive care at the Hospital Militar Escuela Dr. Alejandro Dávila Bolaños.
Katherine Garay Alemán, MHA, BN, has a postgraduate certificate in adult intensive care nursing and is head nurse at the Hospital Militar Escuela Dr. Alejandro Dávila Bolaños.
Michele Trask, BSN, MIPH, RN, FCAN, CHE, EDAC, is an adjunct professor at the University of British Columbia’s School of Nursing.
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