Evaluating a critical care internship program

The authors describe the evaluation of their Critical Care Internship Program. The program was evaluated by job knowledge and clinical performance of graduate nurses compared to nurses with past critical care or medical-surgical experience.     

Implementing a critical care course for ward nurses

This article describes the setting up and evaluation of a course for ward-based nurses, which is designed to improve their skills in caring for highly dependent patients. The authors suggest such courses can increase nurses' confidence and competence and, as well as enhancing care, can improve communication with senior staff about issues of concern.     

Outcomes-based education in a critical care nursing course

Educational institutions are being asked to develop more meaningful ways to measure student learning. The critical care nursing faculty at this baccalaureate institution have delineated a process of outcomes-based education that they use as evidence of successful learning in their course. The faculty regard this as an ongoing project in which this evidence can only lead to continuing improvement.     

Evaluating evidence-based practice within critical care

Background and Aims: Between 2002‐2005 the Trust undertook an action research project to evaluate a corporate practice development strategy. During this period clinicians became practitioner‐researchers utilising a variety of methods to evaluate the influence of practice development. One aspect of this focused upon evaluation of evidence based guidelines. This article concentrates upon this process and the learning from this within critical care. Method: Within critical care it was recognised that the standard of guidelines and protocols varied in terms of the amount of evidence used to underpin decision making. A group was set up to evaluate and appraise these using a structured format such as the Appraisal of Guidelines for Research and Evaluation (AGREE) Instrument. Findings: The initial evaluation (cycle 1) highlighted learning associated with the process of using the instrument within critical care, as well as where the quality of the guidelines could be improved. The second cycle of evaluation demonstrated that implementation of the action plans as a consequence of cycle 1 resulted in an improvement in the quality of the guidelines. It also resulted in streamlining the process of undertaking guideline appraisal across a Trust. Discussion and Conclusions: Action resulting from analysis of the findings of cycle 1 led to a cultural change in which the structure of a tool such as the AGREE instrument could be beneficial in the development of future guidelines. This has been sustained both within critical care and Trust wide with various initiatives such as the establishment of critical care multidisciplinary guideline development groups and a Trust wide electronic library management system.     

Evidence-based education and the evaluation of a critical care course

A critical care nursing course was designed to enhance knowledge attainment for RNs new to critical care, and to prepare seasoned critical care nurses for specialty certification. The convenience sample of nurses (N = 57) was either enrolled in the 16-session course (n = 27) or assigned to a control group (n = 30). A repeated measures design allowed data collection at three time points: precourse, course completion, and 6 months after course completion. Mean scores on the Basic Knowledge Assessment Tool were significantly higher for course participants at the time of course completion, and scores continued to remain high 6 months later, demonstrating important retention of critical care knowledge.     

Evaluating the critical care family satisfaction survey for chronic critical illness

Recognition of the family as a component of patient-centered critical care has shifted our attention to the assessment of family satisfaction in the intensive care unit (ICU). To date, there are no established measures of satisfaction with ICU care for family members of the chronically critically ill (CCI). This study evaluated psychometric properties of the Critical Care Family Satisfaction Survey (CCFSS) in 326 family members of the CCI using exploratory and confirmatory factor analysis (CFA). From the exploratory factor analysis, two unique structural models emerged, each with alpha coefficients of .72 to .91 and discriminant validity among factors (r < .70). The CFA confirmed the best-fitting structural model was a 14-item, three-factor solution (χ(2) = 354, df = 148, p < .001, Tucker Lewis Index = .88, Comparative Fit Index = .90, root mean square error of approximation = .06). Thus, the modified 14-item version of the CCFSS is reliable and valid in family members of CCI patients.     

Steering a course towards advanced nurse practitioner: a critical care perspective

Aim: This article is a report of a study of the experiences of expert critical care nurses in their transition to the role of advanced nurse practitioner within an intensive care unit (ICU) setting. Background: The advanced nurse practitioner role was developed to support the ICU team and to undertake many of the roles traditionally associated with junior medical staff in this specialized area. The impetus for this study therefore was generated from the need to explore the role development experiences of trainee advanced nurse practitioners to inform future developments and practice. Methods: This study used grounded theory methodology to conduct and analyse data from 25 participants. The data were collected between March 2010 and August 2010, using interview format. Data collection and analysis was conducted simultaneously using methods associated with grounded theory, theoretical sampling and the constant comparative method. Results: ‘Staying the course to advanced nursing practice’ emerged as the core category, with four related major categories and substantive codes. In conjunction, the substantive theory explaining the essential processes involved comprised of three inextricably linked processes: situational, development and conceptual meaning. The developed conceptual model captures the unique experiences of expert critical care nurses during their transition to confident and competent advanced nurse practitioners. Conclusion: This study provides an account of the role transition from expert critical care nurse to advanced nurse practitioner, specifically the synthesis of expert nursing practice with traditional medical values. The conceptual model has the potential to be utilized as a framework for others embarking upon similar projects, informing advanced nurse practitioner roles within and out with critical care settings.     

Achieving collaborative workplace learning in a university critical care course.

The purpose of this paper is to describe the development, implementation and evaluation of a new critical care curriculum based on the tenets of collaborative workplace learning. It also examines lecturers' and clinical educators' issues, and explores students' evaluations of the old curriculum compared with those of the new curriculum. Three data collection methods were used for this study. Comprehensive notes were maintained of the meetings conducted with lecturers, clinical educators and representative students during the development and implementation of the course. Three focus group interviews were conducted with students before the introduction of the new curriculum and three focus group interviews were conducted during first semester following implementation of the new curriculum. Quality-of-teaching surveys were also completed by two groups of critical care course students: one group before and one group following the introduction of the new curriculum. Major findings in this study included: developing a sense of ownership of the curriculum for clinical educators, clinical educators' difficulties with addressing their responsibilities, amalgamating theoretical learning with clinical practice, and tackling students' workload. This paper demonstrates the value of using the collaborative workplace learning approach in strategically addressing the challenges of developing and conducting a university critical care course.     

A course in critical care for ward staff

A government review has acknowledged that many critically ill patients are being cared for on acute wards. A lack of resources and intensive care beds, combined with low staffing levels, have led to increased demands being placed on wards that are already struggling to care for critically ill patients. Research shows that ward nurses are well placed to identify early indications of complications and initiate appropriate interventions, and that poor outcomes and some deaths are potentially avoidable. This article describes how one trust developed an in-house education programme to support nurses caring for acutely and critically ill patients on the wards.     

Use of human patient simulation in an undergraduate critical care course

Human patient simulation provides students with experiences and skills they might not otherwise encounter in a clinical rotation. It also offers an experience during which the time is suspended, thus affording students time to think critically, make decisions, and act, as opposed to the fast-paced hospital environment where students may have neither a clear picture of the situation nor adequate time to act. This article presents the design of a simulation center within a school of nursing along with several areas of considerations for successful implementation of the laboratory. A simulation scenario focusing on the acute coronary syndrome used during a final semester critical care nursing course is described and student evaluation of the experience analyzed. The evaluation includes student assessment of the simulation process for the development of necessary patient care skills and the ability to test decision-making and critical thinking skills. The experience with the initial integration of simulation into the nursing curriculum is discussed, inclusive of opportunities for improvement.     

A blueprint for developing an undergraduate critical care nursing course.

The purpose of this article is to provide a blueprint for nursing programs to create or modify baccalaureate critical care courses. The benefits of providing a critical care course include offering students an in-depth experience in a specialty area, reinforcing previously learned medical-surgical content, and improving students' critical thinking skills. In addition, hospitals are given the opportunity to interact with students while also recruiting them into a high-demand area.     

Development and testing of a Hyperlearning Model for design of an online critical care course

Many U.S. colleges and universities are discovering innovative and exciting ways of using information technology to promote the process of teaching and learning and to extend education to new populations of students. Nurse educators in academia and service settings are developing interactive e-learning programs or courses to meet this need, and to either enhance practice concepts and basic skills or orient new associates to the clinical organization. In continuing education programs, students need flexibility and convenience to concurrently meet their personal and academic goals, and consumer demand for online instruction is increasing. The challenge is to prepare a comprehensive, high-quality, cost-effective e-learning course to meet educational standards and competencies. To meet this challenge, an instructional design model, the Hyperlearning Model, was developed based on Chickering and Gamson's principles of best practices in undergraduate education, to guide the development of an online course for basic critical care content. In this article, I describe the creation and testing of an instructional design model for developing content in this online course.     

Introducing student nurses to critical care: shadow a critical care nurse

The lack of student experience in critical care makes it difficult for graduate nurses to anticipate what expectations and demands might confront them in intensive care. Consequently, some new graduates discounted critical care as an opportunity available to them. Our institution believed that critical care had special qualities and if those qualities could be demonstrated to nurses, recruitment would improve. An unexpected benefit from the program was the positive staff nurse response to showcasing their skills and expertise. The success of the program was evidenced by the student evaluations and the hiring of students. To date, seven nursing students out of 20 who attended the program have been hired by the hospital. The long-term impact of the program on retention and recruitment is difficult to predict. The department will track these students, as they do all new hires; however, the initial success warranted continuation of the program. Student response to the program has resulted in plans to expand the "shadow a nurse" concept housewide to showcase the nursing specialities such as rehabilitation, maternal/child health, oncology, orthopedics, chemical dependency, and critical care. Current planning involves designing a program aimed toward high school students, with the goal of encouraging young people to consider nursing as a career.