Abstract TP312: Simulation Based Education for Neurology Nurses to Improve In-hospital Stroke Emergency Performance

Introduction: An in-hospital stroke emergency demands timely decision making and prioritization of tasks by the stroke team nurse. Simulation-based medical education (SBME) focuses on obtaining clinical skills in psychomotor, cognitive and affective domains and is superior to the traditional style of education with improved outcomes of knowledge, skills and behaviors and demonstrable effects for patient-related outcomes. A stroke simulation study at our center showed significant improvements in the cognitive and affective domain of new residents and this next phase aims at incorporating members of the multidisciplinary stroke team. Hypothesis: SBME improves stroke emergency performance, particularly for inexperienced stroke team members. Methods: Eight neuro ICU nurses participated in a high fidelity patient simulation of an in-hospital ischemic stroke eligible for IV tPA. The nurse independently managed every nursing task including a focused patient assessment, verifying and evaluating vitals and treating appropriately, expediting labs, managing common obstacles and coordinating care with the stroke team. Nurses completed an affective survey, pre- and post-test cognitive assessment and debriefing with feedback. An evaluator completed a real-time checklist of pre-defined tasks and the subject participated in a review of their performance with the stroke team. Results: Subjects showed a 19.4% improvement in the cognitive assessment post-simulation (p=0.02). The affective survey showed nurses were confident in their ability to perform the NIHSS. While there was no significant change in the affective domain post simulation due to the subject groups being too small for statistical comparison, recognition of normal parameters (labs and vitals) for treatment of stroke showed an improvement of 6.25%. Conclusion: SBME can facilitate the acquisition of technical skills and non-technical skills such as team work, communication, decision-making and cognizance of personal limitations. This pilot demonstrated that nurses can benefit in the cognitive domain through simulation and feedback indicated that a stroke simulation with increased interaction among stroke team members, with defined roles would add to the fidelity of the simulation.