Barsuk Jeffrey H, Cohen Elaine R, Mikolajczak Anessa, Seburn Stephanie, Slade Maureen, Wayne Diane B
Author Affiliations: Associate Professor of Medicine and Director of Simulation and Patient Safety (Dr Barsuk), Research Associate (Ms Cohen), and Vice Dean of Education and Dr John Sherman Appleman Professor of Medicine (Dr Wayne), Department of Medical Education, Northwestern University Feinberg School of Medicine; and Infection Preventionist (Ms Mikolajczak), Nurse Education Consultant (Ms Seburn), and Vice President of Operations and Associate Chief Nurse Executive (Ms Slade), Department of Nursing, Northwestern Memorial Hospital, Chicago, Illinois.
J Nurs Adm. 2015 Oct;45(10):511-7. doi: 10.1097/NNA.0000000000000243.
This study evaluated the impact of a simulation-based mastery learning (SBML) curriculum on central line maintenance and care among a group of ICU nurses.
The intervention included 5 tasks: (a) medication administration, (b) injection cap (needleless connector) changes, (c) tubing changes, (d) blood drawing, and (e) dressing changes. All participants underwent a pretest, engaged in deliberate practice with directed feedback, and completed a posttest. We compared pretest and posttest scores and assessed correlations between demographics, self-confidence, and pretest performance.
The number of nurses passing each task at pretest varied from 24 of 49 (49%) for dressing changes to 44 of 49 (90%) for tubing changes. At pretest, scores ranged from a median of 0.0% to 73.1%. At posttest, all scores rose to a median of 100.0%. Total years in nursing and ICU nursing had significant, negative correlations with medication administration pretest performance (r = -0.42, P = .003; r = -0.42, P = .003, respectively).
ICU nurses displayed large variability in their ability to perform central line maintenance tasks. After SBML, there was significant improvement, and all nurses reached a predetermined level of competency.
本研究评估了基于模拟的掌握学习（SBML）课程对一组重症监护病房（ICU）护士中心静脉导管维护与护理的影响。
干预包括5项任务：（a）给药，（b）更换注射帽（无针连接器），（c）更换管路，（d）采血，以及（e）更换敷料。所有参与者都进行了预测试，在有针对性的反馈下进行刻意练习，并完成了后测试。我们比较了预测试和后测试的分数，并评估了人口统计学、自信心和预测试表现之间的相关性。
预测试时通过每项任务的护士人数从更换敷料的49人中的24人（49%）到更换管路的49人中的44人（90%）不等。预测试时，分数范围从中位数0.0%到73.1%。后测试时，所有分数均升至中位数100.0%。护理总年限和ICU护理年限与给药预测试表现呈显著负相关（分别为r = -0.42，P = .003；r = -0.42，P = .003）。
ICU护士在执行中心静脉导管维护任务的能力上表现出很大差异。经过SBML后，有显著改善，所有护士都达到了预定的能力水平。
