Authors (including presenting author) :
TSANG WL(1), LIM JJM(1), NG WF(1), LAU SY(1), WONG KY(1)
Affiliation :
(1)Department of Surgery, United Christian Hospital
Introduction :
Leveraging six years of experience, traditional CPR drills were revamped into high-fidelity simulations (HFS) to enhance nurse readiness in averting tracheotomy complications.
Objectives :
To develop a comprehensive tracheostomy-crisis simulation program for nurses, aligning with evidence-based practices, educational standards, and simulation principles.
Methodology :
The framework includes six phases aligned with INACSL Healthcare Simulation Standards of Best Practice.
In the initial phase, training gaps were identified through clinical observations and semi-structured interviews. The conceptual framework evolved by merging elements from NLN/Jeffries Simulation Theory and author's previous studies in 2018 and 2023.
The second phase focused on developing simulation-based education (SBE). SMART objectives were set to demonstrate knowledge, skills, and attitudes in managing tracheostomy emergencies. Nurse simulationists and a head-neck surgeon collaborated on scenario design and safety protocols under The Basic Assumption from the US Centre for Medical Simulation to ensure participant well-beings and learning outcomes. With support from various hospital teams, high-fidelity models were created.
During the third phase, a pilot implementation on December 27, 2023 demonstrated substantial knowledge and skill enhancements among participants, establishing a foundation for further iterations.
The fourth phase integrated lectures with flipped classrooms to provide solid theoretical foundations for future trainings. Participants reviewed corporate and departmental guidelines online before clinical applications. Collaborating with head-neck surgeons, local and overseas nurse clinicians and speech therapists, a curriculum of five lectures was developed.
The fifth phase involved a quantitative quasi-experimental quality improvement project that assessed the impact of an HFS workshop on healthcare professionals (n=33), launched on November 22, 2024. Knowledge and confidence in managing tracheostomy emergencies of participants were evaluated using C-Scale under the permission from overseas nursing scholar Professor Susan E. Grundy.
In the sixth phase, evaluations following The Kirkpatrick Model was conducted, focusing on participants' reactions, learning, behavior changes, and organizational impacts.
Result & Outcome :
A Wilcoxon Signed-Rank test revealed a significant difference between the pre- and post-training C-scale assessments (z=-4.555, p< .001). The median post-HFS C-scale was 18/25, compared to 11/25 pre-HFS. Similarly, a significant difference was found in knowledge assessments (z=-4.649, p< .001), with a median increase from 4/14 pre-HFS to 8/14 post-HFS. Evaluated through The Kirkpatrick Model, qualitative feedback indicated behavior changes, including enhanced safety practices. This HFS-approach leads to cost savings, enhanced patient outcomes, and scalable programs, promoting continuous healthcare enhancement and organizational sustainability.
