In this phase there were 4 participants referred to as group 1D. The initial training lasted approximately 11/2 hours in the third week of April 2014. These participants were identified as being novice-beginner nurses. I asked the nurses three interview questions at the beginning of the training. Their responses were recorded, and then later transcribed and coded. The first question posed to the participants was, “What is your biggest fear or concern in participating in a code blue?” The participants voiced their concerns as follows: fear of not knowing what to do, fear of patient dying, fear of looking stupid, and not knowing where things are in the cart.
Each of the participants was asked if they could describe what the role of a nurse was in a code blue? The participants could not fully articulate or describe the role of the nurse in a code blue. One participant stated, “I have no idea” (Appendix K, line 13). Another stated, “to help the doctor” (Appendix K, line 14). The participants were asked, “Is there one particular part of the crash cart you are more concerned with?” The responses were, not knowing what was in it, not knowing how to use the equipment, and not knowing the process of a code blue (Appendix K). “I don’t know what the medications are used for and how to give them” (Appendix K, line 19). “I have never seen the insides of the crash cart” (Appendix K, line 20).
Three of the four nurses reported having participated in a code blue in the past however when responding to the statement, I am confident in participating in a code blue in which 50% (2) responded by disagreeing and 50% (2) responded by strongly disagreeing. Three of the participants had not reviewed the crash cart contents since becoming a nurse or even in nursing school. One respondent had reviewed the crash cart contents one time in the workplace since becoming a nurse.
After the training the participants were asked to complete the CIS survey questions. The response scale for the CIS survey ranges from 1 (not true) to 5 (very true) for each item. An analysis of the subscales (ARCS) and the total scores using descriptive statistics for each
participant yielded individual and group scores means and standardized deviations for the 34 questions survey. The following results are in Table 6 and show the group mean and SD for each of the subscales ARCS for group 1D. Each of the individual responses for group 1D was scored separately and then an overall mean and SD for each group score was calculated.
A-the attention scores ranged from 2.5 to 4 yielding a group mean score 3.7 (0.79). R-the relevance scores ranged from 3.33 to 4.33 yielding a group mean score 3.97 (0.45). C-the confidence scores ranged from 2.25 to 4 yielding a group mean score 3.43 (0.86). S-the satisfaction scores ranged from 2.11 to 4.33 yielding a group mean score 3.5 (0.89). Individual scores were totaled and their total group mean was 3.85 (0.63) as shown in Table12. Table 6
CIS RESULTS ARCS subscales for group 1D
Group n A R C S
1D 4 3.7(0.79) 3.97(0.43) 3.43(0.86) 3.5 (0.89)
Upon examining group 1D data, it was very clear that the instruction had failed to capture learner attention, especially with the participant 1d, whose score was 2.5 in the attention subscale (Table 7). I analyzed all the responses in the CIS, specifically focusing on the subscale attention scores, to see why the instruction had failed this participant. Question 1, in the CIS survey asked, “The instructor knows how to make us feel enthusiastic about the subject matter of this training”, the respondent selected not true. In question 4, which had reverse scoring (see Table 2) asked, “This class has very little in it that captured my attention” the respondent selected, very true. Question 10, “The instructor creates suspense building up to a point” the same participant responded not true. The last question in this subscale was question 29, “My curiosity was often
stimulated by the questions asked or the problems presented during this class” the response was not true, revealing that this participant did not feel engaged and was not satisfied with the overall training.
Table 7
Id INDIVIDUAL RESULTS
Participant A R C S
1d 2.5 3.33 2.25 2.11
Note. Individual results for all subscales for participant 1d from group 1D
Participants were then interviewed as a group for ten minutes after the training. They were asked, “Tell me what was the most useful part of the training today?” One participant stated, “I was bored” (Appendix K, line 26), and another stated, “Being able to look inside the cart and kind of knowing what you need for this and how to piece and put those things together” (Appendix K, line 30). Others stated, “I liked the hands on focus, how to piece and put together things” (Appendix K, line 32) and, “I did like that we eventually did hands on, but I would like to have more time to practice” (Appendix K, line 33). This was something the participants stated several times.
Participants were asked, “What suggestions do you have for improving this instruction?” One of the respondents stated, “I would like it if we could review the medications more” (Appendix K, line 23). Others stated, “We need more time to review the cart” (Appendix K, line 25) and, “I would like to go into the crash cart by myself or as a group to find the things in the crash cart” (Appendix K, line 34). Participants collectively expressed it would be helpful to have the training later during the orientation.
This information was entered into a word processing program identifying individuals by letter and coding their responses. I consolidated all the information into common themes such as time, practice, fears and suggestions. With this information I was able to use their feedback to make further revisions to the instruction. Through my reflections and observations I documented things that I felt hindered or enhanced the training.
I ran out of time and felt rushed to cover all the material. I observed some of the participants with arms folded as I pulled out the items from the crash cart. Some looked bewildered when I was demonstrating how to flush medication through an intravenous line. I later realized that these novice nurses did not have the knowledge to connect this information to the crash cart. They lacked knowledge in the drug drawer with the emergency drugs because of their inexperience.
After an in-depth analysis of the data collected and paying attention to what the participants had stated, I met with the design team to make the necessary changes for the next group of participants. I tried to address the individual areas in the ARCS subscale where the scores showed a deficiency. Keller suggests factors in the environment can be made to overcome boredom such as changes in the pace and approach while eye contact can establish and maintain and attention (Keller, 2010).
I removed the additional mockup supplemental material that was used in this group. I changed some of the strategies to get the participants more engaged. I decided to add a 5-point Likert scale post survey at the end of the training and limited the interview questions to only a couple at the beginning and a couple at the end of the training.