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Nurse Training with Simulation: An Innovative Approach to Teach Complex Microsurgery Patient Care
Mitchell D. Flurry, MD, John Potochny, MD, Kurtis Moyer, MD, Sebastian Brooke, MD, Brett Micholetti, MD.
Penn State Hershey, Hershey, PA, USA.

BACKGROUND:
Hospitals where microsurgery is performed face challenges teaching staff nurses the spectrum of care for these infrequently encountered, complex patients. Currently, no standard exists to train microsurgery nurses. Learning often happens by direct patient encounters and on-the-job-training. Outcomes, therefore, may be affected by poor hand-offs between inexperienced personnel. Simulation training is an accepted part of education in healthcare today, however in this field it has not been incorporated into nursing education. Reported benefits of simulation training include: practicing common or uncommon tasks in a safe environment, standardized scenarios, and learning with the opportunity for immediate feedback. Our objective is to design a simulation course for nurses focusing on the procedures, communication, and interactions necessary for successful microsurgery.
METHODS:
Quality care reviews at our institution revealing post-operative morbidity provoked an interest in identifying possible areas of improvement. Survey responses of nurses suggested that care of microsurgery patients would improve if nurses better understood the entire spectrum of these patients’ treatment. This includes flap selection, post-operative management, the view through the microscope from a surgeon perspective, as well as basic nursing care. This formed the foundation to develop an accredited nursing course addressing the basic knowledge, tools, and skills necessary to care for microsurgery patients throughout their hospital stay. The course was constructed around both lectures pertaining to evidence-based microsurgery, monitoring techniques, and pharmacology as well as simulated OR, SICU, PACU, Trauma Bay, and Floor scenarios. Familiarity with equipment, situational awareness and communication skills was emphasized. Evaluation of participants began with a pre-course exam to test their existing knowledge. Upon completion of the four-hour simulation course participants took a final evaluation and were then asked to rate the course, the instructors and their satisfaction. Long-term knowledge retention was assessed by a six-month follow up questionnaire.
RESULTS:
Fourteen nurses participated in the initial course. Average test scores of basic microsurgery knowledge was 72% pre-course and 92% post-course. Educational value, ability to recognize and apply what was learned, effectiveness of lectures and simulation, and overall course quality was rated very high or high by 86% of respondents; 0% respondents rated it as low or very low. Six-month follow up test score average was 88% with a 43% response rate.
CONCLUSIONS:
Learning to care for complex microsurgery patients should not be left to chance on-the-job-training experiences or nurse hand-offs in the middle of the night. Simulation can provide effective clinical training in a safe, controlled environment without possibility of direct patient harm. Our results show that simulation is highly rated by nurses and effective with a 20% improvement in basic microsurgery knowledge. Additionally, six-month follow up survey of course participants shows long-term knowledge retention. Simulated patient care training should be considered to augment the clinical experience in hospitals with low microsurgery patient volumes.


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