Methods Used to Assess Critical Care Nurses’ Ability to Detect the Deteriorating Patient and the Perceived Effectiveness of Those Methods A dissertation submitted to the Graduate School of the University of Cincinnati in partial fulfillment of the requirements for the degree of Doctor of Philosophy in Nursing Research Within the College of Nursing Submitted by Julia K Eberwine PhD, RN, CCRN-K, PCCN-CMC April 29, 2016 University of Phoenix Master of Science in Nursing, March 2002 Miami University Bachelor of Science in Nursing, May 1987 Associate Degree in Nursing, May 1983 Committee Chair Elaine T. Miller PhD, RN, CRRN, FAAN, FAHA 1 2 Abstract Problem: Detection of critically-ill patient deterioration is an essential nursing skill that impacts healthcare costs and the mortality and morbidity of 128 deaths out of every 1,000 patients nationally. The ability to effectively assess skills in critical care nurses is often given to the critical care educator who has not been provided standardized tools that can accurately measure competence. Purpose: The primary purpose of this descriptive correlational study was to identify the criteria and measurement methods critical care nurse educators use to assess nurses' ability to detect the early signs of patient deterioration and describe the perceived effectiveness of the measurement methods used. The secondary purpose was to explore the association of critical care nurse educators' characteristics, hospital characteristics, and geographic regions with the type of methods and perceived effectiveness in the evaluation. Design: The critical care nurse educator population was accessed through the American Association of Critical Care Nurses (AACN). An invitation with a Survey Monkey link was provided in AACN’s weekly eNewsletter for persons to access and participate for a total of 4 weeks. Results: The study received a total of 245 responses from the Survey Monkey. However, only 72 responses were considered valid based upon the criteria of answering all questions related to the key measurements of interest (specifically in Q’s 23-25). The reasons for this are unknown, but the survey did allow participants to skip questions. Sixty eight percent of participants showed education level at Masters prepared and above, higher than national level of 12% in similar studies. Both Classroom Education and Direct Observation were considered most frequently used methods among nursing educators. Most (72%) of the nursing educator also 3 considered the Direct Observation as the most effective method in education, higher than the second most effective method (28%) in Simulation (Live). Perceived effectiveness of all methods was examined found not affected by demographics, education and years of experience of nursing educators. Perceived effectiveness of most of the methods were also find not associated to nursing units, except that the perceived effectiveness of simulation methods were positively associated to the number of criteria used to detect deteriorating patients. Conclusions: The lack of responses did not allow attaining rich data from all survey questions; but the 72 responses on the critical questions provided information that future research can be built upon. While the education for the educators is Masters prepared and above, it may not be appropriate to compare as national studies are looking at all nurses. Despite the popularity of simulation as an effective teaching method, direct observation remains a favored method and viewed as the most effective method. Simulation is also the method least used by the participants. There is literature supporting the use of simulation and how it facilitates learning; however these educators are not using it. This lack of use will be explored in future research designed to support the critical care educator in their role of assessment of nurses’ practice. 4 5 6 Acknowledgements I would like to thank the following people: My Dissertation Committee Elaine T. Miller PhD, RN, CRRN, FAAN, FAHA Dissertation Chair Kimberly Johnson PhD, RN, CEN Jun Ying, PhD My Family, in particular my father C. Donald Eberwine and my mother Marcella Eberwine and the University of Cincinnati, College of Nursing for the support through this journey 7 8 Table of Contents Chapter 1 – Introduction………………………………...…………………………………… 11 Chapter 2 – A Review of the Literature……………………………………………………… 19 Chapter 3 – Proposed Study …………………………………….………………….….......... 43 Article 1 - A Review of the Literature on Methods to Assess Critical Care Nurses’ Competency Evaluating Deteriorating Patients …..……………………………...57 Article 2 - Methods Used to Assess Critical Care Nurses’ Ability to Detect the Deteriorating Patient and the Perceived Effectiveness of Those Methods ..……………………87 Article 3 - Translating Methods to Assess Critical Care Nurse Performance into Practice Using the Stevens Star Model of Knowledge Transformation ..………………..107 List of Tables Article 1 – Figure 1 – Search of the Literature……………………………………………… 77 Article 1 – Figure 2 – Additional Search of the Literature ………………………………… 79 Article 1 – Table 1 – Whittemore and Knafl’s Framework Stages ……………………….. 81 Article 1 – Table 2 – Article Analysis Using Whittmore and Knafl ……………………… 83 Article 1 – Table 3 – Comparison of Score Components ……………...…………………… 85 Article 2 – Table 1 – Summary of Demographics of Critical Care Nurse Educators ……101 Article 2 – Table 2 – summary of Nursing Characteristics ………………………………. 102 Article 2 – Table 3 – Summary of Characteristics of Nursing Unit ……………………….103 Article 2 – Table 4 – Perceived Effectiveness of Methods vs. Number of Criteria Used to Detect a Deteriorating Patient …………………………………………………..104 Article 2 – Table 5 – Responses to Critical Questions …………………………………….. 105 Article 3 – Diagram 1 – Stevens Star Model of Knowledge Transformation ………….. 117 9