Hospital nurses often fail to notice clinical signs of deterioration. Introducing an undergraduate course gave students the opportunity to assess acutely ill patients
Billiejoan Rice, MSc, PGDip, BSc (incl RGN), is teaching fellow; Patrick Gallagher, MSc, PGCHET, PGDip, BSc, DipHE, RGN, is teaching fellow; Niall McKenna,PGCHET, BSc, RN, is teaching fellow; Marian Traynor, EdD, MEd, BSc, DASE, RNT, RGN, is senior teaching fellow and assistant director of education; all at School of Nursing and Midwifery, Queen’s University, Belfast; Trevor McNulty, ALS, PLS, ATLS instructor, is senior resuscitation officer, Royal Victoria Hospital, Belfast.
Rice B et al (2010) An immediate life support course improved nursing students’ confidence and knowledge. Nursing Times; 106: 13, early online publication.
Background It is well documented within the literature that hospital staff often fail to appreciate clinical signs of deterioration. This article outlines how the immediate life support course was incorporated into an undergraduate nursing curriculum.
Aim To develop students’ ability to recognise acutely ill patients and determine the relevance of this to clinical practice.
Method The course was delivered to 89 third year nursing students and was run for one full teaching day per week for two weeks. It was evaluated using both quantitative and qualitative measures.
Results and conclusion The course helped students understand what constituted an acutely ill patient and nurses’ role in managing a deteriorating situation. They also reported the experience helped to highlight gaps in their knowledge.
Keywords Immediate life support, Basic life support, Nursing students
- This article has been double-blind peer reviewed
- Nursing students need structured training in immediate life support (ILS) before registration.
- This should be incorporated into the third year of the adult branch programme.
- Nursing students would qualify with an ILS certificate that is valid for 12 months.
Hospital staff often fail to appreciate clinical signs of deterioration, resulting in delayed or inappropriate treatment (Kause et al, 2004; Hillman et al, 2002; Neale, 1998; McQuillan et al, 1998; McGloin et al, 1997; Franklin and Mathew, 1994; Schein et al, 1990). In addition, anxiety and lack of confidence have been highlighted as factors that adversely affect healthcare professionals’ assessment and management of acutely ill patients (Featherstone et al, 2004).
The Nursing and Midwifery Council (2007) stated that students must be fit for practice at the point of registration. It said that nurses should be able to undertake an accurate assessment of patients’ needs and apply knowledge and skills, for example “essential first aid and emergency procedures”, to ensure safe nursing practice.
Yet Nyman and Sihvonen (2000) identified that senior nursing students’ cardiopulmonary resuscitation skills were poor in terms of adequate and prompt assessment of the need for resuscitation.
To address this need, a group of nurse teachers, in partnership with the resuscitation department of a local health trust, explored the potential of introducing the immediate life support (ILS) course into the undergraduate curriculum.
The ILS course is an evidence based course launched by the Resuscitation Council UK in 2002 (RCUK, 2006). It is delivered by advanced life support (ALS) instructors. Students are encouraged to perform skills then critically analyse their practice. The ILS course provides candidates with the knowledge and skills to recognise and treat acutely ill patients before cardiac arrest. It also provides essential knowledge and skills to manage those in cardiac arrest before the resuscitation team arrives (Soar et al, 2003).
Training is undertaken in a simulation practice suite using a medium fidelity simulator, which combines a body manikin with a computer that controls the model’s physiology and the output to monitors showing graphic displays. The observed clinical vital signs and the electrical readings can be controlled and altered in response to interventions and therapies initiated by the users interacting with the manikin.
A medium fidelity simulator responds to instructor intervention via the computer keyboard or a hand held control. They are less resource intensive than high fidelity simulators and used widely in skills and simulation centres (Ker and Bradley, 2007).
The ILS course aims to standardise existing local resuscitation skills courses and provide the first responder with the core skills to initiate early basic life support (BLS) and rapid defibrillation.
As a result, candidates would have the skills necessary to manage a cardiac arrest scenario before expert help arrives (Hulme et al, 2003). It is acknowledged that the first responder is most likely to be a nurse and this pivotal role may apply equally to nursing students (Soar et al, 2003; Coady, 1999).
This study aimed to explore the potential of introducing the ILS course into an undergraduate curriculum and to determine whether it assists students in their preparation for clinical practice.
The ILS course was delivered over one full teaching day per week, over two weeks. It consisted of an eclectic mix of lectures, practical skills stations, and simulated cardiac arrest scenario teaching (CAS Teach).
Content was based on the established European Resuscitation Council guidelines for adult basic life support (Soar et al, 2003).
The lectures examined the recognition of sick patients and prevention of cardiac arrest using the advanced life support (ALS) algorithm. The practical stations covered the assessment of critically ill patients, airway management and safe defibrillation (RCUK, 2006). The course included a process of continuous assessment which enabled the instructor to identify candidates who may require extra tuition (Soar et al, 2003).
Third year nursing students, who had completed a range of placements and were embarking on further hospital based placements as senior students, were invited to participate in the study (n=156) - 89 volunteered. This meant that students completed the course during the penultimate placement of their training.
Data collection and analysis
The course was evaluated using both quantitative and qualitative measures to determine students’ perceptions of and attitudes to:
- Clinical skills development;
- Relevance of the ILS course to their practice.
Participants completed a 17 item questionnaire using Likert scales and open ended sections for comment. Personal data was not included, which ensured anonymity. Questionnaires were analysed descriptively using SPSS version 15.0. Open ended responses from the questionnaire data were analysed by content and thematic analyses.
The study was conducted under the necessary ethical procedures and the head of school gave approval.
A total of 89 nursing students completed the ILS course and 87 questionnaires were submitted for analysis. From the sample surveyed, 85% (n=74) of respondents were undertaking the degree in adult nursing pathway, with the remainder following the diploma pathway. Some 68% (n=59) of participants had had a recent (within one year) placement in coronary care, intensive care or accident and emergency unit.
Findings showed that a total of 95% (n=83) agreed or strongly agreed that the ILS course was an essential component of the undergraduate nursing sciences programme (Fig 1). Nearly all (97%, n=84) students supported this, disagreeing or strongly disagreeing that the ILS would have no advantage in their nursing career.
Some qualitative feedback, confirming students’ positive response, indicated that the course was beneficial in providing essential skills:
“Excellent course… great experience and skills gained” (respondent 9).
On the subject of the course’s perceived contribution, 97% (n=84) said that it would have a benefit on clinical practice (Fig 2), while 84% (n=73) felt the ILS course would mean they were less anxious when providing care in cardiac arrest situations.
While the majority of students found the course beneficial, feedback also identified the intensity of the course as a source of stress, with its length and other academic commitments as contributing factors:
“… intensive for one day…” (respondent 54);
“Perhaps too much to learn in one day…” (respondent 30).
Fig 3 shows the number who felt that the ILS course should be a requirement of an undergraduate nursing sciences programme, while Fig 4 shows those who felt it should be delivered in an interprofessional context.
The findings show that feedback on the ILS course was overwhelmingly positive. It is clear that nursing students recognise that this course should be an essential component of the undergraduate nursing sciences programme.
Comments such as those below demonstrate the importance that students placed on the course:
“This course should be on the curriculum of every nursing course” (respondent 25);
“It is vital, especially in preparation for practice and management placements” (respondent 78).
The ILS course is ideal in providing students with the opportunity to recognise and systematically assess sick patients and take action to prevent cardiac arrests. It also provides them with a clearer understanding of their role if a cardiac arrest occurs and helps increase their knowledge and skills.
Students said the course “is vital for nurses” and it improved their confidence in “dealing with sick patients and cardiac arrests”. These comments demonstrate that they perceived their confidence had greatly improved. It helped them understand the nature of acute illness and nurses’ role in managing a deteriorating situation. Students also reported that the experience helped to highlight gaps in their knowledge.
The ILS course provides students with the necessary skills to assess and manage deteriorating patients. Ideally, it should
be incorporated into the third year of the
adult branch programme. This would ensure that students acquire skills in acute care. They would also be awarded an ILS certificate that is valid for 12 months on graduation.
A longitudinal study to evaluate the value of the ILS course in assessing and managing critically ill patients is being undertaken with this sample group and the results will be reported.
- The original paper (Rice et al, 2009) was published in Nursing in Critical Care and is available at tinyurl.com/article-wiley
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