Assessing Outcome Measurements and Impact of Simulation in Neurocritical Care Training: A Systematic Review.

ABSTRACT: AIM: The use of simulation training in neurocritical care is increasing. Yet, the pooled impact on patient and trainee outcomes remains unclear. This systematic review aims to determine the outcome measurements used after simulation training in neurocritical care and to synthesize the current evidence about the impact of simulation training on these outcomes. METHODS: A 3-step search was conducted in CINAHL, Cochrane, MEDLINE, PsychINFO, and Scopus. The inclusion criteria were composed of studies exploring simulation training in neurocritical care, published in English between 2000 and 2023. Two reviewers independently conducted screening, critical appraisal, and data extraction, using standardized Joanna Briggs Institute tools. Meta-analysis was precluded because of clinical, methodological, and statistical heterogeneity. RESULTS: Nine relevant studies were found: 1 quality improvement project and 8 quasi-experimental studies. The overall quality of the relevant studies was moderate to high (61.1%-77.8%). Three types of outcome measurements for simulation in neurocritical care were identified: knowledge and clinical performance; confidence and comfort; and teamwork, communication, and leadership skills. Simulation training was associated with a significant improvement in knowledge and clinical performance, and confidence and comfort, but not in communication and leadership skills. CONCLUSION: Significant improvement in trainees' outcomes was observed. The current literature includes significant heterogeneity in the methods of evaluating simulation outcomes, although no patient outcomes were observed. Investigating the effect of simulation in neurocritical care training on patient outcomes in future studies is warranted.

Continuous Lactate Measurement Devices and Implications for Critical Care: A Literature Review.

The aim of this article is to review the literature on lactate measurements in critical care and the current devices used to measure noninvasively and invasively. Lactate measurements are currently being used as a way to measure the severity of sepsis. Intravascular and subcutaneous devices are some of the ways that these measurements can be continuously gathered as well as point-of-care blood tests. New devices that are being currently used with athletes can measure lactate noninvasively. As the advance of technology continues to move at a fast speed, an evaluation of literature is needed to assess the continued support of lactate and the ability to move to noninvasive devices in critical care. A literature search was conducted in February 2020, using PubMed, CINAHL, MEDLINE, and Cochrane databases. There remains support for the use of lactate and continuous lactate monitoring; however, currently, noninvasive devices are not available for the critical care environment. There are invasive techniques that are being used to measure lactate continuously in critical care and are beneficial for the cardiac surgery population. The review of the literature on continuous lactate measurements produced evidence that supports prediction of morbidity and mortality. There are no current noninvasive lactate measurement devices that can be used in critical care, but they are being currently used in the athletic community. Invasive continuous lactate measurement devices are currently being used and beneficial.

Patient Deterioration in the Adult Progressive Care Unit: A Scoping Review.

BACKGROUND: The American Heart Association set a goal in 2010 to double the percentage of hospitalized adult patients who survive cardiac arrest by 2020. Because of acuity and interventions, progressive care patients are a population of interest to address this goal. The state of the literature involving patient deterioration, which can lead to cardiac arrest, in the progressive care setting has yet to be explored. OBJECTIVE: A scoping review was done to investigate the literature involving patient deterioration in adult progressive care units in order to map knowledge, identify themes, and discover areas for research potential. METHODS: The scoping review began with an extensive literature search and a multistep review. The characteristics of the final group of studies were charted and grouped according to common themes. RESULTS: There were 13 studies in the final group. All studies were conducted in the United States and most by interprofessional teams. Three themes were evident in the review, training methods, surveillance, and monitoring systems. DISCUSSION: Patient deterioration in the progressive care unit may benefit from team-based training methods involving checklists or protocols. Nurses can use surveillance, including physical assessment and technology, to recognize early warning signs. Lastly, the use of systems that identify patterns in vital signs can be useful to reduce patient harm. Further research in this area care is warranted and could potentially improve patient outcomes and nursing practice.

Innovative solutions: using case studies to generate increased nurse's clinical decision-making ability in critical care.

Learning to care for critically ill patients requires a high level of critical thinking, clinical decision-making ability, and a substantial knowledge base. At this nursing school, an elective Critical Care Nursing course for last-semester seniors was designed to include active learning strategies, focusing on the use of case studies to facilitate learning. Results indicate significantly improved final examination scores for those involved with the case-study pedagogy. In addition, students identified enhanced communication skills. Two complex cases are presented for others to use with their educational programs.

A unique collaborative nursing evidence-based practice initiative using the Iowa model: a clinical nurse specialist, a health science librarian, and a staff nurse's success story.

PURPOSE/OBJECTIVES: The purpose of this article was to share how the collaboration of a clinical nurse specialist (CNS), a health science librarian, and a staff nurse can heighten staff nurses' awareness of the evidence-based practice (EBP) process. BACKGROUND/RATIONALE: The staff nurse is expected to incorporate EBP into daily patient care. This expectation is fueled by the guidelines established by professional, accrediting, and regulatory bodies. Barriers to incorporating EBP into practice have been well documented in the literature. DESCRIPTION OF THE PROJECT/INNOVATION: A CNS, a health science librarian, and a staff nurse collaborated to develop an EBP educational program for staff nurses. The staff nurse provides the real-time practice issues, the CNS gives extensive knowledge of translating research into practice, and the health science librarian is an expert at retrieving the information from the literature. INTERPRETATION/CONCLUSION: The resulting collaboration at this academic medical center has increased staff nurse exposure to and knowledge about EBP principles and techniques. The collaborative relationship among the CNS, health science librarian, and staff nurse effectively addresses a variety of barriers to EBP. IMPLICATIONS: This successful collaborative approach can be utilized by other medical centers seeking to educate staff nurses about the EBP process.