PICU Nurse Practitioner Memorial Sloan Kettering Cancer Center New York, NY
Introduction: A compassionate extubation simulation training experience was implemented within the Pediatric Intensive Care Unit (PICU) at an academic medical center in New York City. At this center, compassionate extubations are infrequently performed and prior to implementation of this project, there were no formal training opportunities related to this procedure or a pediatric specific roadmap to guide efforts. Given the infrequency, significant variation in approach to compassionate extubations, and limited training provided to clinical staff on the intervention, these events often cause unease amongst staff. This project served to answer the question: For healthcare providers in the PICU, does participation in one compassionate extubation simulation training with a roadmap as a resource improve confidence with performing this procedure?
Methods: The Knowledge-to-Action Framework conceptual model was used for a structured approach to translate evidence-based knowledge into practice. The NLN Jeffries Simulation Theory guided the simulation design, identifying seven key components to consider when developing simulations. A one group pretest-posttest design project was implemented in the PICU using The Confidence Scale (C-Scale) to evaluate registered nurse and advanced practice provider confidence with performing a compassionate extubation before and after the simulation. The simulation experience focused on both conversational skills surrounding the event and the technical skills required to successfully carry out the procedure.
Results: The sample was described using descriptive statistical analysis and the Wilcoxon signed-rank test was used to evaluate for differences between first and second observations. A Wilcoxon signed-rank test determined that the compassionate extubation simulation elicited a statistically significant median increase in C-Scale scores after participation in the simulation (median = 20) compared to C-Scale scores prior (median = 12), W = 45, p = 0.007.
Conclusions: This compassionate extubation simulation program improved healthcare provider confidence with performing the procedure in the PICU. The simulation experience is now being offered outside of the PICU within the institution and the experience has been extended to a neighboring institution as well.
