Jarding Laura, Hogden Laurie A, Messier Stephen E, Kozmenko Valeriy, Simanton Edward, Bjornson Kerri, Ortman Brockmueller Charisse
Boekelheide NICU, Sanford Children's Hospital, Sioux Falls, South Dakota (Mss Jarding, Bjornson, and Ortman Brockmueller and Drs Hogden and Messier); Division of Neonatology and Department of Pediatrics (Drs Messier and Hogden), and Department of Internal Medicine (Dr Kozmenko), University of South Dakota-Sanford School of Medicine, Vermillion, South Dakota; Parry Center for Clinical Skills and Simulation, Sioux Falls, South Dakota (Dr Kozmenko); and University of Nevada Las Vegas School of Medicine, Las Vegas, Nevada (Dr Simanton).
Adv Neonatal Care. 2018 Oct;18(5):386-392. doi: 10.1097/ANC.0000000000000520.
Neonatal nurse practitioner (NNP) procedural competence is essential. Procedural simulation provides opportunity to practice high-risk, low-frequency procedures and helps improve skill retention. A formal procedural simulation experience was created in an attempt to provide sufficient experience for NNPs. While preparing for the simulation experience, the group recognized the lack of validated competency metrics for most neonatal intensive care unit (NICU) procedures.
The purpose of this study was to create and validate procedural checklists measuring competence of NNPs participating in simulated performance of 9 high-risk NICU procedures.
IRB approval was obtained and NNPs agreed to data collection. A self and peer assessment tool was developed and distributed to NNPs, nurses, and neonatologists to gather a baseline perception of procedural competency. Procedural checklists were then developed to measure/assess individual skills against a standard. Benchmark videos were created to demonstrate the standard approach to procedural performance. Each procedural skill performed by the NNP participant was scored by 3 individual evaluators: once in real time and twice by video recording analysis.
FINDINGS/RESULTS: A Cronbach α was used to measure the reliability and validity of the procedural checklists. Comparison was made between live grading and video-based grading scores using analysis of variance. Difference between grading modalities was less than 3% and nonsignificant for 8 of 9 procedures. No significant difference was found between individual graders for any of the skills being evaluated and suggested high interrater reliability of the checklists.
Objective, standardized procedural checklists are valid tools to evaluate NNP procedural skills in simulation. Procedural simulation experiences help strengthen skills, improve performance, and possibly improve patient outcomes.
新生儿执业护士（NNP）的操作能力至关重要。操作模拟为练习高风险、低频率的操作提供了机会，并有助于提高技能保留率。为了给NNP提供足够的经验，创建了一个正式的操作模拟体验。在为模拟体验做准备时，该团队认识到大多数新生儿重症监护病房（NICU）操作缺乏经过验证的能力指标。
本研究的目的是创建并验证用于衡量参与9项高风险NICU操作模拟表现的NNP能力的操作检查表。
获得了机构审查委员会（IRB）的批准，NNP同意进行数据收集。开发了一种自我和同行评估工具，并分发给NNP、护士和新生儿科医生，以收集对操作能力的基线认知。然后制定操作检查表，以根据标准衡量/评估个人技能。创建了基准视频来展示操作执行的标准方法。NNP参与者执行的每项操作技能由3名独立评估人员评分：一次实时评分，两次通过视频记录分析评分。
使用克朗巴哈α系数来衡量操作检查表的信度和效度。使用方差分析对现场评分和基于视频的评分进行比较。对于9项操作中的8项，评分方式之间的差异小于3%且无统计学意义。在评估的任何技能方面，独立评分者之间均未发现显著差异，这表明检查表具有较高的评分者间信度。
客观、标准化的操作检查表是评估模拟中NNP操作技能的有效工具。操作模拟体验有助于强化技能、提高表现，并可能改善患者结局。
