Developing a Standardized Learning Curve
Condition: Registered Nurses; Nursing Personnel; Motor Skills
Study type: Interventional

Summary: 
      The nurses were learned the theoretical and practical skills previously during their
      studentship period. The procedures will be the first time the nurses wanted to perform in
      ICU. All clinical situations including patient, procedure, and shift will be similar for
      nurses. The end point will be reaching to the 95 score of learning curve. The reason for
      selection less than 5 percent variation was the flattening of learning curve (the plateau
      section).
    

Detailed description: 
      All new registered nurses in intensive care unit (ICU) from 1 April 2016 until next 24 months
      from 10 mixed beds ICUs will be selected through convenience sampling and according to
      fulfilling the inclusion criteria.

      For data collection, a specific checklist as many as selected techniques according to the
      three panel of expert sessions was validated. The members of expert panel were three
      intensivists, five anesthesiologists, three pulmonologists, five internists, one
      nephrologist, one cardiologist, and ten highly experienced ICU nurses. Firstly, extensive
      review of the literature based on the latest documents and articles for techniques was done.
      The Kendal agreement coefficient between the panel of expert members for selecting the
      primary materials to constitute the checklist was 0.976 (P Value <0.0001). According to the
      extensive review of the literature, a primary checklist as many as selected techniques was
      generated. The primary checklist as many as selected techniques generated in the first expert
      panel session. After the 90 minutes discussion about the primary checklist as many as
      selected techniques, the primary consensus was achieved. The primary checklist as many as
      selected techniques sent to the expert members for purifying, improving and editing. The
      results of the second 120 minutes distance session were analyzed meticulously by principle
      investigator and two independent researchers (K=0.943 with P Value <0.0001). Based on the
      results of the second session, the third version of the checklists as many as selected
      techniques was prepared. According to the 120 minutes final session, the checklists as many
      as selected techniques for clinical survey was prepared. The checklists had different domains
      according to the selected techniques. The scoring of each checklist's questions was based on
      the 3 status. Ability to perform alone (2 score), ability to perform with helping (1 score)
      and inability to perform (0 score). Each question had specific importance coefficient among 1
      to 5. The philosophy of the different coefficients for the questions in the domains was
      related to the importance degree of question. Thus, besides the domain scores, each domain
      had specific importance coefficient. The total score of the checklist comes from multiplying
      the question score to question importance coefficient with percent. Then, the highest score
      of the checklist was 100 percent and the lowest score was 0 percent. The nurses received full
      classical education according to the final three-step checklist components by a full ICU
      trainer in five 120 minutes sessions as theoretically. The trainer did not inform from the
      research questions and study. During the three validation sessions, content validity ration
      (CVR) with 28 panelists were 0.59 and content validity index (CVI) 0.95. Reliability of the
      checklist was determined based on the inter-rate reliability with Kappa agreement test among
      principle investigator and intensivists (r= 0.94), anesthesiologists (r= 0.92),
      pulmonologists (r= 0.90), internists (r= 0.93), nephrologist (r= 0.97), cardiologist (r=
      0.95), and three of the nurses (r= 0.91, 90, and 92), separately. Reliability of the
      checklist was determined based on the intera-rate reliability with Kappa agreement test by
      principle investigator (r= 0.96), intensivists (r= 0.91), anesthesiologists (r= 0.92),
      pulmonologists (r= 0.94), internists (r= 0.92), nephrologist (r= 0.93), cardiologist (r=
      0.90), and three of the nurses (r= 0.90, 93, and 94), separately. For decreasing the
      researcher effect on the nurses, the results of two primary weeks will not be considered.
      Following each nurse will be continued until achieving the flattening of the learning curve.
    

Intervention name(s): Doing Different ICU techniques and skills
Intervention type(s): Procedure
Intervention model: Single Group Assignment
Masking: None (Open Label)
Primary purpose: Basic Science
Keywords: standardized learning curve; Nurse; intensive care unit; Mastery; Training; Developing; Skills