The Effects of Simulated Mock Codes on Nurse Confidence

By Roxanne Sabatini, MSN, RN-BC, CCRN

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Declaration

• This speaker does not have any significant financial relationships with (1) the manufacturer(s) of commercial product(s) and/or provider(s) of services discussed in educational presentations, and (2) commercial supporters of this educational activity.

• This speaker does not intend to discuss any unlabeled use of commercial product, or an investigational application not yet approved for use.

 

Objectives

1. Define or describe “Confidence” as related to resuscitation performance

2. What are the predictors or independent variables that effect nurse confidence in assisting in a real code blue situation

3. Describe the effects of simulation on the total group self confidence

4. Compare group mean differences in confidence measures based on education level, area of practice, years of experiences, and recent BLS or ACLS training.

5. Describe how human patient simulation for mock code protocols could be utilized as an evidenced-based teaching modality

Problem• Nurse Is often the first responder in a

Cardiopulmonary arrest.• New Nurses need confidence and competence to

assist the team.– “Most nurses do not feel comfortable in codes”

(Stryzewski, 2006).• At MMH in 2006, MMH had 176 Code blues (40% in MS, 50% ICU)• 2009, MMH had 199 code blues (57% ICU)

• Mock Codes are being practiced in the Bio-skills Lab.

• It is unclear if simulation training is effective.

What is simulation?

• To resemble reality• “To replicate some or nearly all of a clinical situation so that the

situation may be more readily understood and managed when it occurs for real in clinical practice”.

• “High fidelity simulators are extremely realistic and sophisticated and high level of interactivity.”

What is Confidence?

• Study explored self-reported confidence• Self confidence is faith in one’s own abilities

(Wikipedia.org).• Confidence built upon belief and evidence (

www.novations.com).

VAS (Visual Analog Scale) 1-5

Confidence Scale (Grundy, 1993)

Confidence Rating Tools

Confidence Scale Rating (1-5) on 5 subscales

1. I am certain that my performance is correct2. I feel that I perform the task without

hesitation3. My performance would convince the

observer(s) that I’m competent4. I feel sure of myself as I perform the task5. I feel satisfied with my performance

A Mock Code Session

• Introduction– Equipment– Limitations– Assignment of roles

• Scenario– History of Patient– Participant action

• Debriefing

Study Design

• A longitudinal pre-test, post-test repeated measures design

• Approved by Nursing Research Council & Approved by Institutional Review Board

• Convenient sample of 157 new nurses entering the hospital utilized

• Follow surveys sent at 3, 6 & 12 months after Mock Code Session

Sample/ Demographics

Total sample 153 RNs in Nursing Orientation

• 98 (64%) have associate degree or higher

• 86 (56%) had 2 or more years of nursing experience

• 48 (31%) had ACLS and no ACLS (105, 69%)

• RNs who had not had a previous Mock Code (N = 40, 26%) and RNs who had previous Mock Code (N = 113, 74%) 0

0.050.1

0.150.2

0.250.3

0.350.4

0.450.5

1st Qtr

Med/Surg

Tele

CriticalCareMaternity

Peds

ER

Psych

Rehab

Hemo

Overall Pre-test & Post-test results

Paired comparison between Pre and post-test measures using the Wilcoxon signed ranks test

Pre-simulation

Post-simulation

P-value

Item N = Mean SD Mean SD < .001

1. Visual Analog Scale (1-5)

118 2.7 1.1 3.3 1.0 < .001

2. I am certain about my performance. 149 2.7 1.0 3.4 0.9 < .001

3. My performance would convince the observer that I’m competent.

149 2.7 1.1 3.3 1.0 < .001

4. . I feel that I perform the task without hesitation.

149 2.7 1.1 3.3 1.0 < .001

5. I feel sure of myself as I perform the task.

149 2.7 1.1 3.3 1.0 < .001

6. I feel satisfied with my performance. 149 2.7 1.2 3.3 1.1 < .001

Group differences based on years of experience for pre simulation items. (Total Number of Subjects = 153)

< 3 Years of experience (N = 74, 48%)

3+ Years (N = 79, 52%)

Item (Pre-

simulation)

Mean SD Median Mean SD Median *P Value ( Mann Whitney U Test)

1. VAS 2.2 0.9 2 3.2 1.1 3 <0.001

2. Correct 2.2 0.9 2 3.1 1.1 3 <0.001

3. No Hesitation

2.2 0.9 2 3.2 1.1 3 <0.001

4. Observe 2.3 1.0 2 3.1 1.1 3 <0.001

5. Sure 2.2 0.9 2 3.2 1.1 3.5 <0.001

6. Satisfied 2.1 0.9 2 3.2 1.2 3 <0.001

Group differences based on ACLS certification for pre-simulation items. (Total Number of Subjects = 153)

No ACLS(N = 105, 69%) ACLS (N = 48, 31%)

Item (Pre-

simulation)

Mean SD Median Mean SD Median *P Value ( Mann Whitney U Test)

1. VAS 2.3 0.9 2 3.5 1.1 3 <0.001

2. Correct 2.5 1.0 2 3.2 1.1 3 <0.001

3. No Hesitation

2.5 1.0 2 3.4 1.1 3 <0.001

4. Observe 2.5 1.0 2 3.2 1.1 3 <0.001

5. Sure 2.5 1.0 2 3.3 1.1 3.5 <0.001

6. Satisfied 2.4 1.1 2 3.3 1.2 3 <0.001

Group differences based on Previous Mock Code experience for pre-simulation items. (Total Number of Subjects = 153)

No Mock Code (N = 40, 26%)

Previous Mock Code (N = 113, 74%)

Item (Pre-

simulation)

Mean SD Median Mean SD Median *P Value ( Mann Whitney U Test)

1. VAS 2.3 1.1 2 2.8 1.1 30.022

2. Correct 2.4 1.1 2 2.8 1.0 30.041

3. No Hesitation

2.4 1.1 2 2.9 1.1 3 0.042

4. Observe 2.4 1.2 2 2.9 1.1 30.014

5. Sure 2.4 1.2 2 2.9 1.1 30.023

6. Satisfied 2.4 1.3 2 2.8 1.1 3 0.065

Comparison between Critical Care and other units in terms of pre-simulation items. (Total Number of Subjects = 153)

Other (N = 126, 82%) Critical Care (N = 27,

18%)

Item

(Pre-test) Mean SD Median Mean SD Median *P Value

( Mann Whitney U Test)

1. VAS 2.5 1.0 2 3.4 1.3 4 0.002

2. Correct 2.5 1.0 2 3.4 1.1 4 <0.001

3. No Hesitation

2.6 1.1 2 3.5 1.2 4 <0.001

4. Observe 2.6 1.0 2 3.3 1.2 4 0.003

5. Sure 2.6 1.1 2 3.4 1.2 4 <0.001

6. Satisfied 2.6 1.1 2 3.3 1.3 4 0.002

Influences on Confidence

• BLS– No statistically significant difference between the groups

(BLS<6 months, BLS:7-18 months, BLS>18 months) in terms of any of the pre-simulation items (p>0.05)

• ACLS– Statistically significant differences (p<0.001) on all pre-

simulation measures• Previous Mock Code Experience

– significant differences (p<0.05) on most measures• Nursing Unit

– Statistically significant differences (p<0.001) on all pre-simulation measures

• Years of Nursing– Statistically significant differences (p<0.001) on all pre-

simulation measures

Limitations/ Barriers

• Convenient sample– Limited to Magnet designated, teaching

hospital– Only new nurses to facility and rehires > 2

years away from hospital• Response bias• Attrition of longitudinal data

Feedback

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Confidence defined in Novations.com Retrieved September 20, 2007 from http://www.novations.com/services/efficacy/articles/what-is-confidence,39.html

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