Novice nurses knowledge and skill performance in high crisis situations during the COVID-19 pandemic

ABSTRACT

Background: The Covid-19 pandemic caused over 38,900 deaths in the state of Ohio with a cumulative hospitalization (March 2020-July 2022) of approximately 119,500. The pandemic propelled novice nurses to quickly demonstrate knowledge and skills of high crisis patient care, such as Advance Life Support (ALS) events. This forced organizations to rapidly deploy educational interventions to support the novice nurse's delivery of high-quality emergent patient care delivery. The literature supports simulation to improve the novice nurses' self-confidence yet, the literature remains unclear regarding how simulation enhances knowledge and skill performance, especially during a pandemic. Methods: Using an experimental randomized controlled, longitudinal, pre-test, post-test design, this study examined the effects of adding an on-line Advance Life Support (ALS) patient scenario module to the current ALS program when exploring participant training experience, knowledge, and skill of the required ALS concepts (initiating cardiopulmonary resuscitation, ECG rhythm recognition, pharmacology, and team communication) during high crisis patient care situations. A convenience sample (N=27) of novice nurses who are employed at a Mid-Western health system were randomly assigned to control and intervention groups. Both groups completed a demographic questionnaire followed by participation in a video-taped, ALS high fidelity simulation and debrief for evaluation of baseline knowledge and skill performance at baseline and at three months. Between the simulations (1 month) the intervention group received the same written clinical update as the control group, plus an independent on-line patient scenario of ALS concepts. Qualitative descriptors of the novice nurse's experience of participating in high crisis simulations were explored. Results: Nine participants completed this study. Quantitative descriptive statistics for trends noted, at baseline, both the control and intervention groups scored low (Control 25% n=4;Intervention 67% n=5) for the skills of "Initiating high quality CPR).". Post intervention, the control group missed CPR resuming in less than 10 seconds after defibrillating at 150-200 joules. When assessing the participants practice areas the control group had 3 of the 4 participants in the ICU and 1 in the Progressive Care units. This missed skill item could be contributed to the oversaturation of codes, coupled with the mental exhaustion form the pandemic, could lead to missed care even during practiced repetitive skills. Quantitative data trends for knowledge and skill coupled with the participant attrition rate of 67% (n=18) led to the exploration of the experience of novice nurses participating in ALS cardiac arrest training during a pandemic. Three qualitative descriptors emerged by examining the transcripts from the simulation debriefs for all simulations team collaboration, mental distress, and increased confidence to incorporate new skills. Conclusions: On-line independent patient scenarios provided reinforcement of ALS knowledge and skill concepts. Critical knowledge and skill team communication principles may not be reinforced when providing patient care. Simulation debriefs allow the novice nurses to apply fundamental concepts in a safe learning environment. Novice nurses need scaffolding of knowledge to grow and maintain their knowledge, skill, and confidence. Future education experiences should be designed to allow for frequent dosing of simulations with structured debriefs. (PsycInfo Database Record (c) 2023 APA, all rights reserved)