Exploring novice RN's perception of ACLS simulation : recognition and prevention of failure to rescue
Authors:   , Niemeyer Maryann 
Published: December 2023

The purpose of this study was to determine whether simulation in healthcare improves novice RNs' perceived self-efficacy for recognizing and responding to changes in patient's condition. Having 6-24 months' nursing experience, novice RNs have characteristically little practical RN experience. Medical errors, harm resulting from the delivery of care, constitute the third leading cause of death in the U.S. with 50 [percent]-60 [percent] of medical errors deemed preventable. One common preventable medical error is known as failure to rescue (FTR), characterized as delays in responding to changes in the patient's condition. Failure to rescue events frequently occur in the presence of a novice registered nurse (novice RN). Many hospitalized patients who experienced an adverse change in condition exhibited abnormal changes in symptoms and vital signs 8-24 hours prior to the event. To mitigate FTR occurrences, novice RNs need training to safely expedite and intensify their experience with adverse changes in patient's condition. With this in mind, the first chapter of this dissertation discusses the background and significance of patient instability and failure to rescue, the demand for nurses, novice RNs, and simulation. In addition, the conceptual framework provides a foundation for exploring novice RN's perceptions of clinical behavior towards responding to changes in patient condition through the use of ACLS simulation. Lastly, the purpose of this study, aims and research questions are noted. Chapter 2 is a systematic literature review of qualitative, quantitative, and mixed methods research completed to explore effective continuing education strategies that target novice RNs' professional development, enhance clinical confidence, and focus on patient safety (Niemeyer, 2018). This report identifies simulation in healthcare, an interactive technique replacing real experiences with guided experiences, delivered excellent results with helping novice RNs gain skills and knowledge enhancing their clinical practice. Simulation was also shown to improve self-efficacy in pretest-posttest studies. The systematic review informed the design of the purpose, aims, and questions for this study. The dissertation proposal presented in Chapter 3 details the purpose of the study: to explore how ACLS simulation influences a novice RN's perceived ability to recognize and respond to changes in the patient's condition that if otherwise left untreated, would result in a failure to rescue. It is a mixed methods study that includes 16 novice RN participants who completed the General Self-Efficacy (GSE) survey before and within 3 months after ACLS simulation. Twelve of those participants completed individual interviews with within 3 months after the ACLS simulation. Chapter 4 is a manuscript which includes the results from the Specific Aims and Research Questions. The study design is a mixed methods approach aimed at deriving quantitative as well as qualitative findings for preventing failure to rescue events. Sixteen novice RN completed a GSE survey before receiving ACLS simulation training and again within 2-3 months after the training was completed. Results of the GSE test-retest ([alpha][greater than] .05, t = 3.229, p = .006), were statistically significant. Participants were found to have gained an average of 3.5 points on their GSE scores. Twelve of the 16 nurses participated in individual interviews within 3 months of training completion. Three thematic patterns were found: 1. Recognizing Limited Capacity, 2. Identifying and Managing Change, and 3. Reliance on Supportive Connections. Overall, findings indicate that novice RNs demonstrate an increase in their perceived self-efficacy from ACLS simulation learning strategies. This chapter will be submitted for publication. Chapter 5 contains a discussion of the findings found in the qualitative and quantitative strands of the study. The significance of the work and the strengths and limitations of the study are examined. Finally, recommendations for future research endeavors are addressed.