Clinical educationThe first 3 minutes: Optimising a short realistic paediatric team resuscitation training session
Introduction
Society expects health care professionals to be competent in paediatric resuscitation. However, the low incidence of paediatric cardiac arrest makes skill maintenance through clinical practice alone almost impossible. Only 1.06/1000 children admitted to hospital are reported to experience a cardiac arrest (Tibballs and Kinney, 2006). Of these, less than one in five will occur on a ward (Nadkarni et al., 2006, Tibballs and Kinney, 2006). Many hospitals have highly skilled Medical Emergency Teams (MET) who respond to patient deterioration and cardiac arrest. Even at a tertiary hospital with a dedicated MET team, it may take up to three minutes for the MET team to arrive. Until then, ward teams remain responsible for the provision of initial resuscitation. Without targeted training, doctors and nurses who are expected to provide initial critical resuscitation may not receive adequate opportunities to attain and maintain competence.
The Australian Resuscitation Council (ARC) first introduced Advanced Paediatric Resuscitation guidelines in 1995 (Australian Resuscitation Council, n. d.), aimed at the promotion of simplicity and uniformity in resuscitation techniques and terminology (Australian Resuscitation Council, 2013). However, guideline knowledge and skill competence does not guarantee translation into effective practice. Recommendations from the 2015 International Consensus on Cardiopulmonary and Emergency Cardiovascular Care Science included improving education, as well as individual and team performance through team training (Bhanji et al., 2015). A growing body of evidence demonstrates the positive effects of simulation-based resuscitation training on technical skills as well as team skills (Ackermann, 2009, Allan et al., 2010, Brennan et al., 2013, Hill et al., 2010, Kane et al., 2011, Mesmer, 2008, Niles et al., 2009, Plant et al., 2011, Sawyer et al., 2013, von Arx and Pretzlaff, 2010, Wayne et al., 2008). Much of this work has been undertaken with critical care staff. Little evidence exists regarding resuscitation training needs of interprofessional teams across non-critical care areas.
Inconsistency was identified when considering training opportunities for doctors and nurses at a large metropolitan tertiary paediatric hospital. Nurses undertook an annual Basic Life Support (BLS) knowledge and practical skill assessment; however, these occurred as solo assessments, away from the clinical area in an artificial environment. In contrast, doctors working outside critical care areas received little or no training. Additionally, there was no routine interprofessional resuscitation team training or opportunities to practice team roles and responsibilities in real time. In order to address this training gap, in 2013 an innovative, short simulation based, interprofessional team resuscitation training session was developed. The training session covered an ARC guideline review, identification of predicted responder roles, and incorporated two, three minute simulations which were each followed by short debriefs. In order to determine the effectiveness of the training we conducted an in-depth evaluation.
Section snippets
Design
The study applied the principles of action research, which can be described as planning, acting, observing and analysing, developing an understanding of the situation and improving practice through a spiral of informing and learning (Grundy and Kemmis, 1981). Rigour in action research is established through following the four stages of planning, acting, observing and reflecting, and in this study, was established through implementation of two key phases, which included these four stages.
Findings
The demographic data describing participants is outlined in Table 1.
Findings indicated that those classified as ‘experts’ were more comfortable with knowledge, skills and preparedness to perform CPR in a team than ‘non-experts’. ‘Non-experts’ larger standard deviation scores also indicated greater variability between responders, as seen in Table 2.
The process of data analysis led to emergent themes and sub-themes relating to how the training session addressed teamwork and learning. These themes
Discussion
A key benefit of utilising simulation training methods is anchoring learning to emotion through the creation of realism. Participants in our simulation-based team resuscitation training session valued the realism of this training. The extent to which simulation mimics reality is also described as simulation fidelity, and refers to technical or physical mannequin capabilities, as well as environmental and psychological reality (Beaubien and Baker, 2004). Although many simulation studies utilise
Conclusion
In summary, the revised simulation-based interprofessional team training session now complements current nursing and medical resuscitation training opportunities in our hospital. Importantly, it provides opportunities for interprofessional teams to practice this high risk, infrequent event in their clinical environment. It lays the foundation for future work investigating whether the principles of team training session could be applied to other high risk, time critical events, such as
Conflict of interest statement
Authors of the manuscript titled ‘The first 3 minutes: Optimising a short realistic paediatric team resuscitation training session’, Joanne McKittrick, Sally Lima, Sharon Kinney and Meredith Allen have no affiliations with or involvement in any organisation or entity with any financial interest, or non-financial interest in the subject matter or materials discussed in this manuscript.
Acknowledgements
Mitchell Finlayson, technological support.
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