Enhancing Nursing Skills to Care for Patients with Chronic Obstructive Pulmonary Disease

Abstract

Best practices in the care of patients experiencing a deteriorating condition include identifying changes in patient condition and initiating prompt and effective interventions. Nurses frequently fail to recognize deteriorating conditions and serious exacerbation of symptoms and thus are limited in providing appropriate supportive care to patients with COPD. Innovative strategies, such as the implementation of clinical simulations, are reported to be effective in reinforcing essential clinical decision-making skills to assist nurses in developing the knowledge and skills to better recognize and intervene in the care of deteriorating conditions in patients with COPD. The purpose of this Doctor of Nursing Practice quality improvement project was to develop, implement and evaluate the use of two simulation experiences to assist registered nurses to recognize and intervene in deteriorating conditions in chronically ill adult patients with COPD. Simulation scenarios included the patient with exacerbation of COPD and the patient with a spontaneous pneumothorax as a result of COPD complications. A convenience sample of seven licensed registered nurses from diverse clinical backgrounds participating in a nursing orientation program at an urban, general adult medicine and surgical hospital in Baltimore, Maryland engaged in the project. The NLN/ Jeffries Simulation Theory and the INASCL Standards of Best Practices in Simulation provided the framework for the project. Utilizing the three phases of the simulation experience, the seven registered nurses were immersed in the two simulated clinical situations. Baseline knowledge of the care of the patient with COPD and spontaneous pneumothorax was assessed by administering a 10 item, paper-pencil pre-test aligned to the simulation objectives. The simulation experiences were evaluated using the Creighton Competency Evaluation Instrument (C-CEI) and a 10 item posttest. The clinical nurse educator and the DNP project director used the C-CEI tool to separately evaluate participant performance in each simulation experience. The project director with clinical nurse educator validation, set the competency score for the C-CEI at 75%. The scores on the C-CEI were collected as an aggregate of the nurses delivering care to the simulated patient. All groups of nurses scored above 75%. A T-test (n=7, p =.000) for dependent groups was used to evaluate whether students’ performance on the COPD and pneumothorax pre-test improved on the post-test. There was a statistically significant increase in the COPD and pneumothorax mean scores from the pre-test to the post-test. The completed DNP project supports the use of clinical simulation to train and remediate practicing nurses. The participating nurses were able to immerse themselves in a realistic clinical situation and care for the simulated patients in a safe environment as though the patients were real. The participating nurses could identify significant changes in patient condition and were competent in intervening and caring for the deteriorating conditions of a COPD patient. Evidence from this DNP quality improvement project supports the need for continued clinical work and program evaluation on the development, and implementation of hospital based clinical simulation programs for nurses.