Flurry Mitchell, Brooke Sebastian, Micholetti Brett, Natoli Noel, Moyer Kurtis, Mnich Stephanie, Potochny John
Division of Plastic Surgery, The Pennsylvania State University, Penn State Milton S. Hershey Medical Center, Hershey, PA 17033-0850, USA.
Ann Plast Surg. 2012 Oct;69(4):459-61. doi: 10.1097/SAP.0b013e31824b3db4.
Simulation has become an integral part of education at all levels within the medical field. The ability to allow personnel to practice and learn in a safe and controlled environment makes it a valuable tool for initial training and continued competence verification. An area of specific interest to the reconstructive microsurgeon is assurance that the nursing staff has adequate training and experience to provide optimum care for microsurgery patients. Plastic surgeons in institutions where few microsurgeries are performed face challenges teaching nurses how to care for these complex patients. Because no standard exists to educate microsurgery nurses, learning often happens by chance on-the-job encounters. Outcomes, therefore, may be affected by poor handoffs between inexperienced personnel. Our objective is to create a course that augments such random clinical experience and teaches the knowledge and skills necessary for successful microsurgery through simulated patient scenarios. Quality care reviews at our institution served as the foundation to develop an accredited nursing course providing clinical training for the care of microsurgery patients. The course combined lectures on microsurgery, pharmacology, and flap monitoring as well as simulated operating room, surgical intensive care unit, postanesthesia care unit, Trauma Bay, and Floor scenarios. Evaluation of participants included precourse examination, postcourse examination, and a 6-month follow-up. Average test scores were 72% precourse and 92% postcourse. Educational value, effectiveness of lectures and simulation, and overall course quality was rated very high or high by 86% of respondents; 0% respondents rated it as low. Six-month follow-up test score average was 88%. Learning to care for microsurgery patients should not be left to chance patient encounters on the job. Simulation provides a safe, reproducible, and controlled clinical experience. Our results show that simulation is a highly rated and effective way to teach nurses microsurgery patient care. Simulated patient care training should be considered to augment the clinical experience in hospitals where microsurgery is performed.
模拟已成为医学领域各级教育中不可或缺的一部分。它能让人员在安全可控的环境中进行实践和学习，这使其成为初始培训和持续能力验证的宝贵工具。重建显微外科医生特别感兴趣的一个领域是确保护理人员具备足够的培训和经验，以便为显微外科手术患者提供最佳护理。在很少进行显微外科手术的机构中，整形外科医生在教导护士如何护理这些复杂患者时面临挑战。由于不存在教育显微外科护士的标准，学习往往是在工作中偶然遇到时发生的。因此，结果可能会受到经验不足人员之间交接不善的影响。我们的目标是创建一门课程，增强这种随机的临床经验，并通过模拟患者场景教授成功进行显微外科手术所需的知识和技能。我们机构的质量护理审查作为基础，开发了一门经认可的护理课程，为显微外科手术患者的护理提供临床培训。该课程结合了显微外科、药理学和皮瓣监测的讲座，以及模拟手术室、外科重症监护病房、麻醉后护理病房、创伤室和病房场景。对参与者的评估包括课前考试、课后考试和为期6个月的随访。平均测试成绩课前为72%，课后为92%。86%的受访者将教育价值、讲座和模拟的有效性以及整体课程质量评为非常高或高；0%的受访者将其评为低。6个月随访测试成绩平均为88%。学习护理显微外科手术患者不应依赖于工作中偶然遇到的患者。模拟提供了一种安全、可重复和可控的临床经验。我们的结果表明，模拟是一种评价很高且有效的方法，可教导护士护理显微外科手术患者。对于进行显微外科手术的医院，应考虑采用模拟患者护理培训来增强临床经验。
