Heiser Rosenberg Carol E, Terhaar Mary F, Ascenzi Judith A, Walbert Anna, Kokoszka K Michelle, Perretta Julianne S, Miller Marlene R
Jt Comm J Qual Patient Saf. 2017 May;43(5):251-258. doi: 10.1016/j.jcjq.2017.02.007. Epub 2017 Mar 28.
Ambulatory central-line infections in children with cancer are life-threatening. Infections are two to three times more frequent in outpatients than inpatients, for whom evidence-based bundles have decreased morbidity. Most cancer care now takes place at home, where parents perform many of the same tasks as nurses. However, parents often feel stressed and unprepared. To address this, high-fidelity simulation, which has been effective for teaching novice nurses, was evaluated for parent central-line education.
In a feasibility study using a pretest/posttest design, after completion of usual central-line education, parents participated in a high-fidelity simulation practice session. Parents were assessed in three domains: (1) knowledge of infection prevention; (2) psychomotor skill competence; and (3) ability to recognize health care provider nonadherence to best practices. Parents also completed a 5-point Likert simulation experience survey.
A convenience sample of 17 parents participated between December 2015 and March 2016. Knowledge median scores increased from pre- to posttest from 10 to 15 of 16 points possible (p ≤ 0.001; Wilcoxon signed rank test). Median skills scores increased from pre- to posttest from 8 to 12 points of 12 possible (p ≤ 0.001). Following simulation, median recognition scores increased from 3 to 6 with 6 points possible (p ≤ 0.001). For the parent experience survey, 100% of participants strongly agreed or agreed that simulation was meaningful for learning central-line care.
As an adjunct to usual care central-line education, translation of high-fidelity simulation to parent education is a novel approach that shows promise for improving central-line care at home in children with cancer.
癌症患儿的门诊中心静脉导管感染会危及生命。门诊患者的感染发生率是住院患者的两到三倍，而基于循证的综合措施已降低了住院患者的发病率。目前，大多数癌症护理在家中进行，家长承担着许多与护士相同的工作。然而，家长常常感到压力大且毫无准备。为解决这一问题，我们对高仿真模拟教学法进行了评估，该方法在新手护士教学中已被证明有效，此次用于家长中心静脉导管护理教育。
在一项采用前测/后测设计的可行性研究中，家长在完成常规中心静脉导管护理教育后，参加一次高仿真模拟实践课程。对家长在三个方面进行评估：（1）感染预防知识；（2）操作技能水平；（3）识别医护人员未遵循最佳实践的能力。家长还完成了一份5级李克特模拟体验调查问卷。
2015年12月至2016年3月期间，17名家长组成的便利样本参与了研究。知识测试的中位数得分从前测的10分（满分16分）提高到后测的15分（p≤0.001；Wilcoxon符号秩检验）。技能测试的中位数得分从前测的8分（满分12分）提高到后测的12分（p≤0.001）。模拟教学后，识别能力测试的中位数得分从3分（满分6分）提高到6分（p≤0.001）。在家长体验调查问卷中，100%的参与者强烈同意或同意模拟教学对学习中心静脉导管护理有意义。
作为常规中心静脉导管护理教育的辅助手段，将高仿真模拟教学法应用于家长教育是一种新方法，有望改善癌症患儿在家中的中心静脉导管护理。
