"Use of Non-Technical Skills Training & Video Simulation to Improve Knowledge Among Nurse Anesthesia Trainees"

3 Introduction.5 Literature Review.8 Methods.21 Results.27 Discussion.30 Appendix A: Recruitment Email.38 Appendix B: Information Sheet.39 Appendix C: Demographic Information Questionnaire.41 Appendix D: Pre-Test Non-Technical Skills Knowledge Assessment Tool.42 Appendix E: Post-Test Non-Technical Skills Knowledge Assessment Tool.46 Appendix F: Answer Key.50 Appendix G: Non-Technical Skills Instructional Video Script.51 Table 1 Demographics of Study Participants.60 Table 2 KR-20 of Knowledge Assessment Tool.61 Table 3 Wilcoxon Signed Rank Test.62 Table 4 (a, b, c) Descriptive Data of Posttest Scores.63 Table 5 and 6Paired Sample Statistics.65 Figure 1. Bar Graphs Representing the KAT Mean Scores at Pre and Post-Instructional Video.67 Appendix H: Evidence Based Table on Non-Technical Skills and Video Simulation.68 References.76 NON-­‐TECHNICAL SKILLS VIDEO SIMULATION 3 Abstract Background: The transition from didactic component to clinical practice is challenging for nurse anesthesia trainees. When faced with an airway crisis, successful management involvesBackground: The transition from didactic component to clinical practice is challenging for nurse anesthesia trainees. When faced with an airway crisis, successful management involves non-technical skills, which include recognition, decision-making, and prioritization. Limited data is available on the efficacy of instructional video on enhancing non-technical skills during airway crisis management among nurse anesthesia trainees. Purpose: The purpose of this study was to examine the efficacy of instructional video simulation on enhancing the nurse anesthesia trainee’s knowledge of recognition, decisionmaking, and prioritization during bronchospasm and laryngospasm airway crises. Methods: A quasi-experimental pre-test and post-test design was used to investigate the effect of an instructional video simulating the proper non-technical skills of recognition, decision-making, and prioritization. Results: A convenience sample of 27 second and third year nurse anesthesia trainees were recruited. A Wilcoxon Signed Ranks Test demonstrated that the median post-test scores were statistically higher that the median pre-test scores between pre and post-instructional video [Z= 4.473; p=0.000 (2-tailed)] with adequate pre and post-test Kuder-Richardson-20 (KR-20) scores (0.533, 0.686). Specifically, post-test median prioritization scores for bronchospasm and laryngospasm were statistically higher than median pre-test scores [t=-5.366; p=0.000 (2-tailed)]; [t=-8.588; p=0.000 (2-tailed)]. Conclusion: The findings demonstrate the effectiveness of instructional video simulation on non-technical skills, specifically prioritization, during airway crises such as bronchospasm and laryngospasm for nurse anesthesia trainees. According to the results, utilizing a pre-test/post-test NON-­‐TECHNICAL SKILLS VIDEO SIMULATION 4 design and instructional video simulation improved non-technical skills knowledge among nurse anesthesia trainees. Keywords: non-technical skills, recognition, decision-making, prioritization, airway crisis, bronchospasm, laryngospasm, nurse anesthesia trainees NON-­‐TECHNICAL SKILLS VIDEO SIMULATION 5 Introduction Background and Significance Medical errors are defined as errors or mistakes committed by health professionals, which result in harm to the patient (National Center for Biotechnology Information, U.S. National Library of Medicine, 2017). Medical errors are distinct from malpractice, which arise from gross negligence, reprehensible ignorance, or criminal intent. Anesthesia occurs in a high stakes environment within the healthcare industry where human factors account for 80% of accidents across the board in high-risk organizations (Wunder, 2016). Non-technical skills have been linked to preventable medical errors. Strategies to prevent medical errors cannot solely focus on the development of clinical knowledge, but must also address non-technical skills (Gordon et al., 2016). Non-technical skills include task management, team working, situation awareness, and decision-making (Fletcher, McGeorge, Flin, Glavin, & Maran, 2002; Hoff; Jameson, Hannan, & Flink, 2004; Runciman et al., 2008). Non-technical skills are not traditionally taught in the didactic portion of anesthesia curriculum despite strong evidential support that they are important factors for maintaining and improving patient safety (Gordon, Darbyshire, & Baker, 2012). Nurse anesthesia trainees have minimal clinical experience to develop non-technical skills prior to the transitions from didactic classroom style education to clinical residency (Lee et