Academic journal article Nursing Education Perspectives

Multi-Center Development and Testing of a Simulation-Based Cardiovascular Assessment Curriculum for Advanced Practice Nurses

Academic journal article Nursing Education Perspectives

Multi-Center Development and Testing of a Simulation-Based Cardiovascular Assessment Curriculum for Advanced Practice Nurses

Article excerpt


Abstract Cardiovascular assessment skills are deficient among advanced practice nursing students, and effective instructional methods to improve assessment skills are needed. The purpose of this study was to develop, implement, and evaluate outcomes of a cardiovascular assessment curriculum for advanced practice nurses at four institutions. Each institution used a one-group pre-to-post-intervention design. Educational interventions included faculty-led, simulation-based case presentations using the Harvey® cardiopulmonary patient simulator (CPS), and independent learning sessions using the CPS and a multimedia, computer-based CD-ROM program. Outcome measures included a 31-item cognitive written exam, a 13-item skills checklist used in each of a three-station objective structured clinical exam, learner self-efficacy and satisfaction survey, instructor satisfaction and self-efficacy survey, and a participant logbook to record practice time using the self-learning materials. Thirty-six students who received the simulation-based training showed statistically significant pre-to-post-test improvement in cognitive knowledge and cardiovascular assessment skills.

Key Words Cardiopulmonary Patient Simulator - Deliberative Practice - Harvey - Simulation-Based Curriculum

THE EVER-CHANGING LANDSCAPE OF HEALTH CARE HAS AF FECTED THE TRAINING OF HEALTH CART PROFESSIONALS. Decreased access to patients, restrictions on student interventions, and economic constraints have driven educators to find novel and improved ways to train their students. Even without changes in the clinical environment, numerous studies have revealed that acquisition of clinical skills by experience alone is inadequate to obtain mastery (Barrett et al., 2006; Issenberg & McGaghie, 2002; Wayne, Barsuk, O'Leary, Fudala, & McGaghie, 2008).

In situations where mastery seems to have occurred by successful completion of a course, such as advanced cardiac life support, and the passing of clinical and didactic examinations, retention becomes a problem (Wayne et al., 2005). Inadequacies in clinical education result in knowledge and skills that are never fully developed or are lost over time, translating into errors during the delivery of patient care. Deliberate practice and the mastery learning model have shown promising results with regard to mastering and retaining knowledge and performance of clinical skills (Wayne et al., 2008).

Background Cardiovascular assessment skills, including auscultation, are deficient among advanced practice nursing (APN) students and providers, and effective instructional methods to improve cardiovascular assessment skills are needed (Mangione & Nieman, 1997). Prior studies have shown that clinical experience often does not lead to improvement in skills. Mangione and Nieman found that medical students identified only 20 percent of 12 cardiac events correctly, with the rate for internal medicine residents 19 percent. A study by Vukanovic-Criley et al. (2006) found no improvement in auscultation skills after the third year of medical school among medical students, residents, and faculty, although cardiology fellows demonstrated superior skills.

Results from studies by Issenberg & McGaghie (2002) and Wayne et al. (2008) have shown that simulation technology and deliberate, repetitive practice resulted in a large and significant improvement in the recognition of simulated heart sounds and recordings of actual human heart sounds. Issenberg and McGaghie found that practice with simulated heart sounds significantly improved performance compared to the usual clinical experience.

Deliberate practice is an evidence-based teaching method grounded in information processing and behavioral theories of skill acquisition and maintenance (Ericsson, 2004, 2006; Ericsson & Charness, 1994; Ericsson, Krampe, & Tesch-Römer, 1993). The goal in a simulation learning context is constant skill, knowledge, or professional improvement, not just maintenance of the status quo. …

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