Tara Mahramus

Clinical nurse specialist assessment of nurses' knowledge of heart failure.

Purpose/Objective: Patients’ self-management of heart failure (HF) is associated with improved adherence and reduced readmissions. Nurses’ knowledge about self-management of HF may influence their ability to adequately perform discharge education. Inadequate nurse knowledge may lead to insufficient patient education, and insufficient education may decrease patients’ ability to perform self-management. Prior to developing interventions to improve patient education, clinical nurse specialists should assess nurses’ knowledge of HF. The purpose of this study was to determine nurses’ knowledge of HF self-management principles. Design: This was a prospective, exploratory, and descriptive online test. Settings: There were 3 patient care settings: tertiary care teaching hospital, community hospital, and home healthcare division. Sample: The sample was composed of 90 registered nurses who worked directly with patients with HF. Methods: Nurses completed an online test of knowledge using the Nurses’ Knowledge of Heart Failure Education Principles instrument. Findings: Registered nurses (n = 90) completed the knowledge test instrument; their average score was 71% (SD, 10.8%) (range, 20%–90%). The percentage of correct items on each subscale ranged from 63.9% (SD, 30.0) for medications to 83.3% (SD, 25.0) for exercise. Only 8.9% of respondents achieved a passing score of greater than 85%, and a passing score was not associated with any demographic characteristics. Conclusions: Overall, nursing knowledge of HF self-management principles was low. Scores from our nurses were similar to those found in other studies. Implications: There is a need to develop interventions to improve nursing knowledge of HF self-management principles. Clinical nurse specialists can be instrumental in developing knowledge interventions for nurses.

Two Hours of Teamwork Training Improves Teamwork in Simulated Cardiopulmonary Arrest Events.

Purpose/Aim: Teamwork during cardiopulmonary arrest events is important for resuscitation. Teamwork improvement programs are usually lengthy. This study assessed the effectiveness of a 2-hour teamwork training program. Design: A prospective, pretest/posttest, quasi-experimental design assessed the teamwork training program targeted to resident physicians, nurses, and respiratory therapists. Methods: Participants took part in a simulated cardiac arrest. After the simulation, participants and trained observers assessed perceptions of teamwork using the Team Emergency Assessment Measure (TEAM) tool (ratings of 0 [low] to 4 [high]). A debriefing and 45 minutes of teamwork education followed. Participants then took part in a second simulated cardiac arrest scenario. Afterward, participants and observers assessed teamwork. Results: Seventy-three team members participated—resident physicians (25%), registered nurses (32%), and respiratory therapists (41%). The physicians had significantly less experience on code teams (P < .001). Baseline teamwork scores were 2.57 to 2.72. Participants’ mean (SD) scores on the TEAM tool for the first and second simulations were 3.2 (0.5) and 3.7 (0.4), respectively (P < .001). Observers’ mean (SD) TEAM scores for the first and second simulations were 3.0 (0.5) and 3.7 (0.3), respectively (P < .001). Program evaluations by participants were positive. Conclusions: A 2-hour simulation-based teamwork educational intervention resulted in improved perceptions of teamwork behaviors. Participants reported interactions with other disciplines, teamwork behavior education, and debriefing sessions were beneficial for enhancing the program.

Perceptions of teamwork among code team members.

Background: Cardiopulmonary arrest (CPA) teams, known as code teams, provide coordinated and evidenced-based interventions by various disciplines during a CPA. Teamwork behaviors are essential during CPA resuscitation and may have an impact on patient outcomes. Objectives: The purpose of this study was to explore the perceptions of teamwork during CPA events among code team members and to determine if differences in perception existed between disciplines within the code team. Methods: A prospective, descriptive, comparative design using the Code Teamwork Perception Tool online survey was used to assess the perception of teamwork during CPA events by medical residents, critical care nurses, and respiratory therapists. Results: Sixty-six code team members completed the Code Teamwork Perception Tool. Mean teamwork scores were 2.63 on a 5-point scale (0–4). No significant differences were found in mean scores among disciplines. Significant differences among scores were found on 7 items related to code leadership, roles and responsibilities between disciplines, and in those who had participated on a code team for less than 2 years and certified in Advanced Cardiac Life Support for less than 4 years. Conclusions: Teamwork perception among members of the code team was average. Teamwork training for resuscitation with all disciplines on the code team may promote more effective teamwork during actual CPA events. Clinical nurse specialists can aid in resuscitation efforts by actively participating on committees, identifying opportunities for improvement, being content experts, leading the development of team training programs, and conducting research in areas lacking evidence.