There were two groups consisting of five participants from each of the hospitals, which will be referred to as group 2H and group 2D. It was decided that both groups should receive the same type of training in this phase of the research study. The rationale for this was there would not be enough time to analyze the data and make any revisions to the instruction between the two groups given that the training sessions took place one day apart. With this phase I included a five-question post survey to glean additional information to drive the research process. Results for group 2H will be presented first then group 2D results will follow. The combined post-survey results follow at the end of this section.
The training for Group 2H, consisting of 5 novice-beginner nurses that met the inclusion criteria, occurred on May 20, 2014. The nurse educators identified these participants and designated a time frame of one hour for the research. The participants were selected from a program referred to as, a nurse residency program. The nurse residency program provides additional support and training for novice nurses throughout their first year of employment. These nurses had completed their orientation and were currently working in their designated areas.
Participants completed their demographic surveys and all five participants had revealed they had received some type of crash-cart training during their initial orientation. They reported that they had been working for at least six months. Two of the five 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”, only one agreed, two responded as undecided, one disagreed and one strongly disagreed in spite of receiving code blue training during their orientation.
All five participants reported they had reviewed the crash cart contents in the workplace since becoming a nurse. At the beginning of the training I asked the nurses three interview
questions. Their responses were recorded, 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?” One nurse stated, “I’m afraid of it all” (Appendix K, line 54). Another stated, “I am afraid of giving the medications” (Appendix K, line 61).
Each of the participants was asked could they describe what the role of a nurse was in a code blue? Some responses follow. “To help the doctor, to do CPR” (Appendix K, line 60), “give the medications” (Appendix K, line 61), “I don’t really know” (Appendix K, line 62). The participants were asked, “Is there one particular part of the crash cart you are more concerned with?” The responses were, “ not knowing what to do”, (Appendix K, line 65) “don’t know where to find items, not recognizing the item” (Appendix K, line 66) and “the medications” (Appendix K, line 67).
After the training the participants completed the CMS survey. An analysis of each subscale and total scores using descriptive statistics for each participant yielded individual and group scores means and standardized deviations for the 34 questions in the CMS. The following results are listed below. Table 8 indicates the group mean and SD for each of the subscales for this group. Each of the individual responses was scored separately and then overall mean and SD for each group score was calculated.
A-the attention scores ranged from 2.87 to 4.5 yielding a group mean score 3.75 (SD 0.73). R-the relevance scores ranged from 3.67 to 4.33 yielding a group mean score 4.09 (0.27). C-the confidence scores ranged from 3.25 to 4.87 yielding a group mean score 4.45 (0.78). S-the satisfaction scores ranged from 3.56 to 4.33 yielding a group mean score 3.8 (0.36). Individual scores were totaled and their total group means was 4.29 (0.49) as seen Table 12. Table 8
Group n A R C S
2H 5 3.75(0.73) 4.09(0.27) 4.45(0.78) 3.8(0.36)
The group was asked for suggestions regarding any of part of the training. One participant stated, “Updated crash cart would be nice.” (Appendix K, line 75). Another participant felt there was not enough time to learn the crash cart. The nurses were asked what part of the training was most useful to them. It was reported that they liked the group size, because the last training they had received did not allow for full participation. One nurse stated, “I liked being able to go into the crash cart and getting the items out. I think the booklet was helpful” (Appendix K, line 69).
I included another post survey 5-point Likert survey that would give me additional information specifically how beneficial the training was. I thought this would save time rather doing an interview with the group. The survey asked participants if the training increased their confidence in identifying and accessing items from the crash, in which two agreed and three strongly agreed. Additionally they were asked if the training process helped with identifying items in the crash. All responses ranged from agreed to strongly agree. All participants believed that learning the crash cart would improve their performance during a code blue (Table 13).
Group 2D consisted of 5 novice nurses that were currently in their orientation. This group met the criteria of novice-beginner nurse and participated in the study on May 21, 2014. This group received 11/2 hours of training. Results from the demographic survey revealed that all the nurses in this group reported they had never participated in a code blue, nor had they ever reviewed the crash cart contents with anyone since becoming a RN. All five nurses reported the last time they reviewed the crash cart contents was in nursing school. When asked how many
times they have participated in a code blue, they all responded to zero times. Participants were asked to select a response to the statement, “I am confident in participating in a code blue”, where 90% (4) disagreed, and 10% (1) strongly disagreed with the statement.
The feedback and results I received from the previous group of nurses prompted me to make some changes in my training to engage this group of nurses. I decided to get the participants more actively involved by having them pull the items from the cart instead of me. I could see that the participants really liked pulling the items from the cart (Appendix H). I had the participants from hospital D remove the items from the drawers, name each item and state its use. Each participant took turns until the drawer was emptied.
An analysis of each subscale and total scores using descriptive statistics for each participant yielded individual and group scores, means, and standardized deviations for 34 questions in the CMS. The results are listed below. Table 9 indicates the group mean and SD for each of the subscales in this group. Each of the individual responses was scored separately and then overall mean and SD for each group score was calculated.
A-the attention scores ranged from 4.38 to 4.75 yielding a group mean score 4.47 (0.16). R-the relevance scores ranged from 4.22 to 4.44 yielding a group mean score 4.33 (0.08). C-the confidence scores ranged from 4.5 to 5 yielding a group mean score 4.72 (0.12). S-the satisfaction scores ranged from 4 to 4.44 yielding a group mean score 4.2 (0.20). Individual scores were totaled and a total group means was 4.71 (0.06) as shown Table 12.
Table 9
Group n A R C S
2D 5 4.47(0.16) 4.33(0.08) 4.72(0.12) 4.2(0.20)
The group was asked if there were any suggestions to any of part of the training they had received. One participant stated, “I like the training” (Appendix K, line 76). Another participant felt there was not enough time to learn the crash cart. The nurses were asked what part of the training was most useful to them. One nurse stated, “going into the crash cart” (Appendix K, line 72).
It was decided with this iteration, that all ten participants would be given a five-question post survey Likert scale 1(strongly agree) to 5 (strongly disagree) to glean additional information on the training. When the participants were asked did the training increase their confidence in identifying items in the crash cart, 100% (10) strongly agreed. They were asked did they feel prepared to participate in a code blue as the result of the training, 60% (6) agreed to strongly agree and 40% (4) were neutral. When asked did the training process help in identifying the items in the crash cart, 80% (8) strongly agreed and 20% (2) agreeing. The last statement asked, learning the crash cart contents will improve their performance in a code blue with 70% (7) strongly agreeing and 20% (3) agreed see Table 13.
I compared scores between both group 2D and 2H and then those scores with group 1D in this phase (see Table 10). Both group 2D and 2H scores had increased from group 1D results in all of the subscales (see Table 11). Table 10 compares both groups subscale results in which 2H scores were lower than their counter part 2D. The attention and the confidence scores were lower with group 2H, which I attribute to the outdated crash cart and the one-hour time constraint. This appears to have had an impact on the instruction and outcomes of the training.
The attention subscale contained questions that asked if the instructor did anything to create suspense or anything unusual in the training (Appendix F). For these questions participants in 2H scored lower. The subscale score for satisfaction was also slightly lower with group 2H than in 2D. The group 2H scored lower when asked did they get recognition or feedback from the instructor and did they feel pleased with the instructor’s appraisal of them. This data analysis was shared with the design team and further changes to the design were made. Table 10
CIS results group 2H and 2D
Subscales 2H 2D
A 3.75 (0.73) 4.47 (0.16)
R 4.09 (0.27) 4.43 (0.08)
C 4.45 (0.18) 4.72 (0.12)
S 3.8 (0.36) 4.20 (0.20)