Development and evaluation of a simulation-based early-mobility curriculum for paediatric intensive care nurses
Corresponding Author
Jessica M. LaRosa
Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
Correspondence
Jessica M. LaRosa, Charlotte Bloomberg Children's Center, 1800 Orleans Street, Suite 6368, Baltimore, MD 21287, USA.
Email: [email protected]
Search for more papers by this authorHallie Lenker
Department of Physical Medicine & Rehabilitation, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
Search for more papers by this authorRazvan Azamfirei
Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
“George Emil Palade” University of Medicine, Pharmacy, Science, and Technology, Targu Mures, Romania
Search for more papers by this authorStephanie Morgenstern
Department of Pediatric Nursing, Charlotte R. Bloomberg Children's Center, Johns Hopkins Hospital, Baltimore, Maryland, USA
Search for more papers by this authorKrista Hajnik
Charlotte R. Bloomberg Children's Center, Johns Hopkins Hospital, Baltimore, Maryland, USA
Search for more papers by this authorColleen Mennie
Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
Search for more papers by this authorBeth Wieczorek
Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
Search for more papers by this authorKristen M. Brown
School of Nursing, Johns Hopkins University, Baltimore, Maryland, USA
Search for more papers by this authorNicole Shilkofski
Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
Search for more papers by this authorSapna R. Kudchadkar
Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
Department of Physical Medicine & Rehabilitation, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
Search for more papers by this authorCorresponding Author
Jessica M. LaRosa
Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
Correspondence
Jessica M. LaRosa, Charlotte Bloomberg Children's Center, 1800 Orleans Street, Suite 6368, Baltimore, MD 21287, USA.
Email: [email protected]
Search for more papers by this authorHallie Lenker
Department of Physical Medicine & Rehabilitation, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
Search for more papers by this authorRazvan Azamfirei
Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
“George Emil Palade” University of Medicine, Pharmacy, Science, and Technology, Targu Mures, Romania
Search for more papers by this authorStephanie Morgenstern
Department of Pediatric Nursing, Charlotte R. Bloomberg Children's Center, Johns Hopkins Hospital, Baltimore, Maryland, USA
Search for more papers by this authorKrista Hajnik
Charlotte R. Bloomberg Children's Center, Johns Hopkins Hospital, Baltimore, Maryland, USA
Search for more papers by this authorColleen Mennie
Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
Search for more papers by this authorBeth Wieczorek
Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
Search for more papers by this authorKristen M. Brown
School of Nursing, Johns Hopkins University, Baltimore, Maryland, USA
Search for more papers by this authorNicole Shilkofski
Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
Search for more papers by this authorSapna R. Kudchadkar
Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
Department of Physical Medicine & Rehabilitation, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
Search for more papers by this authorAbstract
Background
Early mobility is one strategy to reduce the harm from immobility that children experience in the paediatric intensive care unit (PICU). Early-mobility programmes rely on nurses, who currently perceive insufficient training as a barrier to mobilizing critically ill children. Nurses have identified simulation as a strategy to improve implementation of early-mobility protocols.
Aim
To use adult learning theory to develop an early-mobility simulation curriculum for nurses and to evaluate if the curriculum improves nursing self-efficacy, knowledge and skills in mobilizing critically ill children.
Study Design
Using a curriculum development framework, an interprofessional team created a simulation curriculum. The educational strategies included group simulations, debriefing sessions and didactic sessions. The curriculum evaluation was conducted as quality improvement initiative using a pre-post quasi-experimental design to evaluate nurses' mobility self-efficacy, knowledge and clinical skills.
Results
Eleven PICU nurses participated in the simulation-based early mobility curriculum. Before participation in the curriculum, 73% of nurses felt fairly confident and no nurses felt confident mobilizing a PICU patient. After participation, 100% of nurses felt at least fairly confident mobilizing a PICU patient (p = .031). Knowledge scores improved from a median of 14 (IQR, 12–16) questions correct to 17 (IQR, 16–18) questions correct (p = .001). Nurses completed more required clinical tasks during the Observed Structured Clinical Examination, with improvement from a median of 15 items correct (IQR, 14–16) to 19 items correct (IQR, 15–20; p = .0037).
Conclusions
Developing a simulation-based early-mobility curriculum for PICU nurses is feasible. Nurses who completed the curriculum had improved self-efficacy, knowledge and clinical skills in mobilizing critically ill children.
Relevance to Clinical Practice
The findings of this study demonstrate that simulation is a potentially useful educational tool to teach nurses to safely and effectively mobilize critically ill children. The strategy should be evaluated further to determine if it impacts physical rehabilitation at the bedside.
Open Research
DATA AVAILABILITY STATEMENT
The data that support the findings of this study are available from the corresponding author upon reasonable request.
REFERENCES
- 1Ong C, Lee JH, Leow MKS, Puthucheary ZA. Functional outcomes and physical impairments in pediatric critical care survivors: a scoping review. Pediatr Crit Care Med. 2016; 17(5): e247-e259. doi:10.1097/PCC.0000000000000706
- 2Knoester H, Bronner MB, Bos AP. Surviving pediatric intensive care: physical outcome after 3 months. Intensive Care Med. 2008; 34(6): 1076-1082. doi:10.1007/s00134-008-1061-4
- 3Choong K, Fraser D, Al-Harbi S, et al. Functional recovery in critically ill children, the “WeeCover” multicenter study. Pediatr Crit Care Med. 2018; 19(2): 145-154. doi:10.1097/PCC.0000000000001421
- 4Pollack MM, Holubkov R, Funai T, et al. Pediatric intensive care outcomes: development of new morbidities during pediatric critical care. Pediatr Crit Care Med. 2014; 15(9): 821-827. doi:10.1097/PCC.0000000000000250
- 5Pinto NP, Rhinesmith EW, Kim TY, Ladner PH, Pollack MM. Long-term function after pediatric critical illness: results from the survivor outcomes study. Pediatr Crit Care Med. 2017; 18(3): e122-e130. doi:10.1097/PCC.0000000000001070
- 6Wieczorek B, Burke C, Al-Harbi A, Kudchadkar SR. Early mobilization in the pediatric intensive care unit: a systematic review. J Pediatr Intensive Care. 2015; 4(4): 212-217. doi:10.1055/s-0035-1563386
10.1055/s-0035-1563386 Google Scholar
- 7Choong K, Zorko DJ, Awojoodu R, et al. Prevalence of acute rehabilitation for kids in the PICU: a Canadian multicenter point prevalence study. Pediatr Crit Care Med. 2021; 2: 181-193. doi:10.1097/PCC.0000000000002601
10.1097/PCC.0000000000002601 Google Scholar
- 8Ista E, Scholefield BR, Manning JC, et al. Mobilization practices in critically ill children: a European point prevalence study (EU PARK-PICU). Crit Care. 2020; 24(1): 368. doi:10.1186/s13054-020-02988-2
- 9Kudchadkar SR, Nelliot A, Awojoodu R, et al. Physical rehabilitation in critically ill children: a multicenter point prevalence study in the United States. Crit Care Med. 2020; 48(5): 634-644. doi:10.1097/CCM.0000000000004291
- 10Choong K, Awladthani S, Khawaji A, et al. Early exercise in critically ill youth and children, a preliminary evaluation: the wEECYCLE pilot trial. Pediatr Crit Care Med. 2017; 18(11): e546-e554. doi:10.1097/PCC.0000000000001329
- 11Cuello-Garcia CA, Mai SHC, Simpson R, Al-Harbi S, Choong K. Early mobilization in critically ill children: a systematic review. J Pediatr. 2018; 203: 25-33.e6. doi:10.1016/j.jpeds.2018.07.037
- 12Needham DM, Korupolu R, Zanni JM, et al. Early physical medicine and rehabilitation for patients with acute respiratory failure: a quality improvement project. Arch Phys Med Rehabil. 2010; 91(4): 536-542. doi:10.1016/j.apmr.2010.01.002
- 13Burtin C, Clerckx B, Robbeets C, et al. Early exercise in critically ill patients enhances short-term functional recovery. Crit Care Med. 2009; 37(9): 7-2505. doi:10.1097/CCM.0b013e3181a38937
- 14Schweickert WD, Pohlman MC, Pohlman AS, et al. Early physical and occupational therapy in mechanically ventilated, critically ill patients: a randomised controlled trial. Lancet. 2009; 373(9678): 1847-1882. doi:10.1016/S0140-6736(09)60658-9
- 15Tipping CJ, Harrold M, Holland A, Romero L, Nisbet T, Hodgson CL. The effects of active mobilisation and rehabilitation in ICU on mortality and function: a systematic review. Intensive Care Med. 2017; 43(2): 171-183. doi:10.1007/s00134-016-4612-0
- 16Wieczorek B, Ascenzi J, Kim Y, et al. PICU up!: impact of a quality improvement intervention to promote early mobilization in critically ill children. Pediatr Crit Care Med. 2016; 17(12): e559-e566. doi:10.1097/PCC.0000000000000983
- 17Hanna ES, Zhao S, Shannon CN, Betters KA. Changes in provider perceptions regarding early mobility in the PICU. Pediatr Crit Care Med. 2020; 21(1): e30-e38. doi:10.1097/PCC.0000000000002177
- 18Choong K, Foster G, Fraser DD, et al. Acute rehabilitation practices in critically ill children: a multicenter study. Pediatr Crit Care Med. 2014; 15(6): e270-e279. doi:10.1097/PCC.0000000000000160
- 19LaRosa JM, Nelliot A, Zaidi M, Vaidya D, Awojoodu R, Kudchadkar SR. Mobilization safety of critically ill children. Pediatrics. 2022; 149(4):e2021053432. doi:10.1542/peds.2021-053432
- 20Joyce CL, Taipe C, Sobin B, et al. Provider beliefs regarding early mobilization in the pediatric intensive care unit. J Pediatr Nurs Nurs Care Child Fam. 2018; 38: 15-19. doi:10.1016/j.pedn.2017.10.003
- 21Hunter OO, George EL, Ren D, Morgan D, Rosenzweig M, Klinefelter TP. Overcoming nursing barriers to intensive care unit early mobilisation: a quality improvement project. Intensive Crit Care Nurs. 2017; 40: 44-50. doi:10.1016/j.iccn.2016.10.005
- 22Curtis L, Irwin J. Ambulation of patients who are mechanically ventilated: nurses' views. Nurs Manag (Harrow). 2017; 24(4): 34-39. doi:10.7748/nm.2017.e1599
- 23Kim C, Kim S, Yang J, Choi M. Nurses' perceived barriers and educational needs for early mobilisation of critical ill patients. Aust Crit Care. 2019; 32(6): 451-457. doi:10.1016/j.aucc.2018.11.065
- 24Patel RV, Redivo J, Nelliot A, et al. Early mobilization in a PICU: a qualitative sustainability analysis of PICU up! Pediatr Crit Care Med. 2021; 22(4): e233-e242. doi:10.1097/PCC.0000000000002619
- 25Wayne DB, Butter J, Siddall VJ, et al. Simulation-based training of internal medicine residents in advanced cardiac life support protocols: a randomized trial. Teach Learn Med. 2005; 17(3): 202-208. doi:10.1207/s15328015tlm1703_3
- 26Wayne DB, Butter J, Siddall VJ, et al. Mastery learning of advanced cardiac life support skills by internal medicine residents using simulation technology and deliberate practice. J Gen Intern Med. 2006; 21(3): 251-256. doi:10.1111/j.1525-1497.2006.00341.x
- 27Oermann MH, Kardong-Edgren S, Odom-Maryon T, et al. Deliberate practice of motor skills in nursing education: CPR as exemplar. Nurs Educ Perspect Natl Leag Nurs. 2011; 32(5): 311-315. doi:10.5480/1536-5026-32.5.311
- 28Sawyer T, Sierocka-Castaneda A, Chan D, Berg B, Lustik M, Thompson M. Deliberate practice using simulation improves neonatal resuscitation performance. Simul Healthc. 2011; 6(6): 327-336. doi:10.1097/SIH.0b013e31822b1307
- 29Steinemann S, Berg B, Skinner A, et al. In situ, multidisciplinary, simulation-based teamwork training improves early trauma care. J Surg Educ. 2011; 68(6): 472-477. doi:10.1016/j.jsurg.2011.05.009
- 30Draycott TJ, Crofts JF, Ash JP, et al. Improving neonatal outcome through practical shoulder dystocia training. Obstet Gynecol. 2008; 112(1): 14-20. doi:10.1097/AOG.0b013e31817bbc61
- 31Phipps MG, Lindquist DG, McConaughey E, O'Brien JA, Raker CA, Paglia MJ. Outcomes from a labor and delivery team training program with simulation component. Am J Obstet Gynecol. 2012; 206(1): 3-9. doi:10.1016/j.ajog.2011.06.046
- 32Barsuk JH, Cohen ER, Feinglass J, McGaghie WC, Wayne DB. Use of simulation-based education to reduce catheter-related bloodstream infections. Arch Intern Med. 2009; 169(15): 1420-1423. doi:10.1001/archinternmed.2009.215
- 33Ohtake PJ, Lazarus M, Schillo R, Rosen M. Simulation experience enhances physical therapist student confidence in managing a patient in the critical care environment. Phys Ther. 2013; 93(2): 216-228. doi:10.2522/ptj.20110463
- 34Shoemaker MJ, Riemersma L, Perkins R. Use of high fidelity human simulation to teach physical therapist decision-making skills for the intensive care setting. Cardiopulm Phys Ther J. 2009; 20(1): 13-18. doi:10.1097/01823246-200920010-00003
- 35Thomas EM, Rybski MF, Apke TL, Kegelmeyer DA, Kloos AD. An acute interprofessional simulation experience for occupational and physical therapy students: key findings from a survey study. J Interprof Care. 2017; 31(3): 317-324. doi:10.1080/13561820.2017.1280006
- 36Silberman NJ, Panzarella KJ, Melzer BA. Using human simulation to prepare physical therapy students for acute care clinical practice. J Allied Health. 2013; 42(1): 25-32. doi:10.2307/48721796
- 37Wyatt S, Meacci K, Arnold M. Integrating safe patient handling and early mobility: combining quality initiatives. J Nurs Care Qual. 2020; 35(2): 130-134. doi:10.1097/NCQ.0000000000000425
- 38Hendricks-Munoz KD, Mayers RM. A neonatal nurse training program in kangaroo mother care (KMC) decreases barriers to KMC utilization in the NICU. Am J Perinatol. 2014; 31(11): 987-992. doi:10.1055/s-0034-1371359
- 39Gupta N, Sones A, Powell M, et al. Quality improvement methodology to optimize safe early mobility in a pediatric intensive care unit. Pediatr Qual Saf. 2020; 6(1):e369. doi:10.1097/pq9.0000000000000369
- 40Thomas PA, Kern DE, Hughes MT, Chen BY. Curriculum Development for Medical Education: A Six-Step Approach. 3rd ed. Johns Hopkins University Press; 2015.
- 41Kennedy E, Murphy GT, Misener RM, Alder R. Development and psychometric assessment of the nursing competence self-efficacy scale. J Nurs Educ. 2015; 54(10): 550-558. doi:10.3928/01484834-20150916-02
- 42Krippendorff K. Content Analysis: an Introduction to its Methodology. 4th ed. SAGE Publication Inc.; 2018. doi:10.4135/9781071878781
10.4135/9781071878781 Google Scholar
- 43Choi W, Dyens O, Chan T, et al. Engagement and learning in simulation: recommendations of the Simnovate engaged learning domain group. BMJ Simul Technol Enhanc Learn. 2017; 3(suppl 1): S23-S32. doi:10.1136/bmjstel-2016-000177
- 44Leigh GT. High-fidelity patient simulation and nursing students' self-efficacy: a review of the literature. Int J Nurs Educ Scholarsh. 2008; 5(1): 1-17. doi:10.2202/1548-923X.1613
10.2202/1548?923X.1613 Google Scholar
- 45Franklin AE, Lee CS. Effectiveness of simulation for improvement in self-efficacy among novice nurses: a meta-analysis. J Nurs Educ. 2014; 53(11): 607-614. doi:10.3928/01484834-20141023-03
- 46Bandura A. Self-Efficacy: the Exercise of Control. Worth Publishers; 1997.
- 47Hermes C, Nydahl P, Blobner M, et al. Assessment of mobilization capacity in 10 different ICU scenarios by different professions. PLoS One. 2020; 15(10):e0239853. doi:10.1371/journal.pone.0239853
- 48Burgener AM. Enhancing communication to improve patient safety and to increase patient satisfaction. Health Care Manag. 2017; 36(3): 238-243. doi:10.1097/HCM.0000000000000165
10.1097/HCM.0000000000000165 Google Scholar
- 49Brown KM, Mudd SS, Perretta JS, Dodson A, Hunt EA, McMillan KN. Rapid cycle deliberate practice to facilitate “nano” in situ simulation: an interprofessional approach to just-in-time training. Crit Care Nurse. 2021; 41(1): e1-e8. doi:10.4037/ccn2021552
- 50Dadiz R, Riccio J, Brown K, Emrich P, Robin B, Bender J. Qualitative analysis of latent safety threats uncovered by in situ simulation-based operations testing before moving into a single-family-room neonatal intensive care unit. J Perinatol. 2020; 40(suppl 1): 29-35. doi:10.1038/s41372-020-0749-3
- 51Shilkofski N, Hunt EA. Identification of barriers to pediatric Care in Limited-Resource Settings: a simulation study. Pediatrics. 2015; 136(6): e1569-e1575. doi:10.1542/peds.2015-2677
- 52Yang CP, Hunt EA, Shilkofski N, Dudas R, Egbuta C, Schwartz JM. Can telemedicine improve adherence to resuscitation guidelines for critically ill children at community hospitals? A randomized controlled trial using high-Fidelity simulation. Pediatr Emerg Care. 2017; 33(7): 474-479. doi:10.1097/PEC.0000000000000653
