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Changing practice

Human patient simulation can aid staff training in non-invasive ventilation

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Non-invasive ventilation training on wards can be fragmented. A trust developed a training course using simulation of clinical scenarios to improve staff technique

Authors

Sandie McQueen, RGN, is respiratory ward manager; Mike Dickinson, RGN, is human patient simulation training facilitator; Mark Pimblett is hi.tech clinical skills training facilitator; all at Lancashire Teaching Hospitals Foundation Trust

Abstract

McQueen S et al (2010) Human patient simulation can aid staff training in non-invasive ventilation. Nursing Times; 106: 26, early online publication.

Non-invasive ventilation is increasingly used on general wards to manage respiratory disease and staff need training and clinical experience to use this technique effectively. This article describes a training course that used human patient simulation to improve healthcare professionals’ skills and confidence in using and adjusting noninvasive ventilation.

Keywords: Noninvasive ventilation, Human patient simulation, Training, Respiratory care

  • This article has been double-blind peer reviewed

 

While non-invasive ventilation (NIV) is a treatment option for a number of respiratory conditions, in clinical practice, training staff to use this technique can take several months. The national COPD audit highlighted the difficulties of training staff to use this technique (Royal College of Physicians et al, 2008) Problem arise as staff are not always on duty when patients on the ward require NIV and this means that training is fragmented and protracted.

Human patient simulation (HPS), a technique that replicates real clinical situations to develop healthcare professionals’ expertise, can be used to train staff to use NIV. Its popularity has increased in recent years.

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Using HPS

At Lancashire Teaching Hospitals Foundation Trust we developed a one day training course for nursing staff with a special interest in NIV. The course covered various aspects of NIV and for the first time, the use of HPS was integrated into the teaching programme.

The course is held in a room designed to look like a ward side room. A manikin, with voice-overs provided by course trainers, helps to simulate real life clinical situations where NIV is a possible treatment option.

The use of HPS allows participants to examine and respond to a clinical situation, and assemble and apply NIV. They have an opportunity to manage patients in real time, in the safety of a simulated clinical environment. For example, participants have to respond to an initial patient assessment and then react to changing arterial blood gas analysis or patient observations. An example of a case scenario used in the course is outlined in Box 1.

Evaluating the approach

Six members of nursing staff with varying degrees of knowledge and expertise in using NIV and arterial blood gas interpretation were recruited to the first course. Three staff had very limited knowledge of NIV and did not feel confident to initiate or modify treatment plans.

Following the training day, all participants were given the opportunity to start and adjust NIV management on patients in their clinical area. The three staff who had little experience of NIV were able to successfully begin and modify NIV on patients within two weeks of completing the training course.

Conclusion

The training course successfully reduced the time that healthcare professionals needed to become confident and safe to use NIV in their practice. The course has been repeated in the trust and nurses have attended from other organisations

 

Box 1. Example of case scenario used in human patient simulation

Case: COPD type 2 failure.   

Key complaint: acute type 2 respiratory failure.

Case description: 68 year old male lorry driver, with known hypertension, with increasing shortness of breath.

History of presenting condition: two week history of shortness of breath with productive cough (green sputum). Amoxicillin from his GP was ineffective. Reduced exercise tolerance. Orthopnoea (sleeps with four pillows).

Past medical history:

  • Three hospital admissions in the last 18 months for COPD exacerbations;
  • COPD diagnosed 10 years ago;
  • Myocardial infarction in 1999;
  • Intermittent claudication.

Medications:

  • Salbutamol metered dose inhaler (MDI);
  • Tiotropium MDI;
  • Fluticasone propionate MDI.

Social history: lorry driver, smoker (20/day since early 20s), no exercise.

Allergies: pollen.

Key developmental aims:

  • Identify possible COPD diagnosis due to smoking history;
  • Identify type 2 respiratory failure and need for NIV;
  • Initiate NIV with correct mask and settings and respond to arterial blood gas analysis results and changes in clinical condition;
  • Initiate involvement of other multidisciplinary team professionals.
  •  This project won the poster presentation competition at the Association of Respiratory Nurse Specialists conference in 2009.

 

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