Innovation and Research
Doctor of Nursing Practice (DNP)
Dr. Sharon Stanke uses simulation to better prepare novice nurses to handle crises in open–heart patients
A practicing nurse for 30 years, alumna Dr. Sharon Stanke ('11) says "bringing a higher standard of expertise to the bedside" was her motivation in pursuing Chatham's Doctor of Nursing Practice degree. With 28 years of her career dedicated to providing care in the intensive care unit, Sharon's evidence–based practice change capstone project was aimed at better preparing novice nurses (less than 1 year of critical care experience) to care for acutely critically ill patients. Her project had such incredible results that it even caught the eye of the U.S. undersecretary for health.
"Our traditional education left the novice nurse unprepared, was my belief," says Sharon, who is a critical care educator at the Minneapolis Veteran's Affairs Health Care System and an adjunct faculty member in the Bachelor of Science in Nursing program at Globe University/Minnesota School of Business.
With a focus on improving the management of hemodynamics (blood flow) and pharmacology, Sharon wanted to increase the stability of open–heart patients under the care of novice nurses. She found that under the care of an experienced nurse, the patient was unstable 30 percent of the time, compared to being unstable 52 percent of the time under the care of a novice nurse. "My goal was to get the novice nurse to improve 50 percent, or to have the patient instability at 40 percent of the time," she says.
There is a fine art to achieving effective simulation learning, Sharon explains. The learners must be put into an uncomfortable zone that requires them to stretch–yet they should be kept out of a zone that makes them feel like failures.
"Simulation is becoming the education trend," says Sharon. "I think it's going to end up being the gold standard of education." Sharon also raises the issue of ethics in simulation. She notes that it is ethically wiser to practice errors on a simulated patient, rather than a real one.
Sharon designed four scenarios that provided novice nurses with the opportunity to integrate and use theory taught in the traditional orientation plan. The first scenario was designed to simply familiarize participants with the simulation environment, presenting novice nurses with a standardized cardiac arrest or code scenario. The second scenario helps participants learn how changing the patient's medication dosage affects vital signs. The third scenario requires participants to wean the stable post–operative open–heart patient off all pharmacology agents. And the final scenario presents the participant with a complicated open–heart patient, requiring aggressive changes to the pharmacology medicines and vital signs to try to save the patient. A team–centered debriefing followed the simulation.
Following the simulation, open–heart surgical patient outcomes demonstrated a 172 percent improvement in hemodynamic stability while under the care of novice nurses, compared to the baseline numbers. Post–simulation, patient hemodynamic instability was measured at 16 percent of the time, down from 52 percent, while on vasoactive medication, which affects blood pressure and heart rate. These results were so positive that word quickly spread throughout in the nursing community–and one trail of e–mails eventually made its way to Washington, D.C., where the undersecretary for health took notice–and even requested that Sharon give a presentation on her evidence–based practice change project.
Going forward, Sharon will be designing simulations to train nurses on a national level in order to have standardization in its implementation.
"If we invest in good quality education, we will obtain good patient outcomes," says Sharon. "The tradition of on–the–job training gives us average patient outcomes."
Sharon's evidence–based practice change project is just one example of how Chatham University students can work to improve patient care far and wide throughout the course of the DNP program. For more profiles of Chatham DNP graduates making their mark on the nursing world, visit http://www.chatham.edu/academics/colleges/ccps/dnp/alum.cfm.
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