Abstract
Recent research confirms that the performance of novice nurses is generally poor due to limited experience. This makes them lack confidence in cases of emergency. It is clear from the research that the best way of improving the performance of these novice nurses is subjecting them to practical processes of offering emergency care, such as cardiopulmonary resuscitation to patients who are in critical condition. Given the fact that they cannot experiment with patients, the best way of gaining this experience is by using human factor engineering mannequin simulation. It offers these novice nurses an environment that would allow them to practice what they would do in a real emergency case but using a mannequin.
Problem
The role of nurses in the current American society is rapidly changing due to various changes taking place in this field. Days, when nurses were mere assistants of doctors who waited to be given instructions on what to do, are long gone. Currently, nurses have clearly defined roles that they are expected to perform within the hospital setting. Anderson (2005) says that nurses are currently expected to take offer emergency care for patients who need emergency medical attention before a doctor is called upon to offer specialized medical care. This means that nurses should be able to respond to cases, which need cardiopulmonary resuscitation as a way of increasing the survival chances of their patients. However, recent research has proven that most of the healthcare institutions in this country have nurses who are unable to offer emergency care for patients because they lack the skill and experience to do this. According to Benner (2001), it is unfortunate that a large number of nurses in the United States are still not able to respond to cases of resuscitation when faced with such scenarios. The scholar observes that there are rising cases of neurologic mortality and morbidity, which are directly related to the inability of nurses to respond to such cases appropriately. There has been a concern that most nurses do not have the necessary skills to offer emergency medical care for the patients, which is always considered a way of improving the medical condition before doctors arrive. According to Wilson (2012), novice nurses have limited knowledge and experience to provide cardiopulmonary resuscitation. This makes them unable to handle cardiac arrest cases. This means that they are unprepared for such cases and are very anxious when forced to handle such cases. Scholars report that some nurses have worsened patients’ conditions because they are unsure of the right method to follow when handling some of the resuscitation procedures.
According to Baker (2005), there is a clear sign that pediatric care providers lack enough knowledge that can help save patients’ lives during cases of emergency. This is a very dangerous scenario because, in the current nursing profession, nurses are not mere assistants in healthcare faculties, but are considered part of the medics. They are professionals who are expected to be in a position to save lives during emergencies when the need arises. Friedman and Quinn (2008) say that something must be done to change the current state of affairs if these nurses are to achieve their rightful status in this field. According to them, the solution lies with human factor engineering mannequin simulation. This technology will offer novice nurses the opportunity to gain the experience needed in this field. They will be learn how they can respond to cases of emergency in an effective manner. This integrated literature review focuses on how Human Factor Engineering Mannequin Simulation can be used to improve the performance of novice nurses.
Significance of the research
According to Thoureen (2013), nurses need more technology-oriented training in order to offer quality services that meet the expected standards. The research by this scholar recommends that ways should be found to ensure nurses are more equipped when dealing with cardiopulmonary resuscitation among other cases of emergencies as and when they arrive within the medical institutions. The research by Crowther (2003) identifies a need for more training among nurses, especially on the use of technology. This research is, therefore, very significant in offering a solution on how this training can take place using modern human factor engineering. According to Baker (2005), human factor engineering simulation has been identified as the most appropriate way of enhancing the skills and experience of the nurses, which allows them to be more prepared to face such medical needs. Riley (2008) says that human factor engineering has brought up the use of mannequins in medical training and is considered a practical way of making nurses understand what they should do in cases of emergencies. This research focuses on the utilization of the concept of human factor engineering by incorporating simulation training to improve the novice nurses’ performance, response time, and patient outcome when initiating a mock code.
This research has been developed with the knowledge that nurses need to be more equipped to make them more knowledgeable and confident when handling various medical emergencies in healthcare institutions. The research done by Levine (2013) has recommended the use of human factor engineering mannequin simulation as a way of making this training a success and this research seeks to bring out how this can be made a reality. Dickson (2007) says, “Using mock code simulation to improve responder performance during the first five minutes of a patient emergency is necessary to make nurses more equipped when handling emergencies.” This research will help nurses to identify declining status of the patient, which requires urgent intervention. This will make a big difference in the field of nursing. It will help improve the efficiency of these nurses. The purpose of this research is to elaborate on the importance of using human factor engineering mannequin simulation to improve the performance of novice nurses.
Methodology
Research design
Every research project employs a specific research design in order to achieve the expected result based on the available instruments (Fleischman & Barondess, 2004). It is important to state clearly the appropriate method to be used in this project not only to authenticate the validity of this research, but also to make it clear to those who may be interested in following the same method in their future studies. In order to bring focus to the appropriate method for this research, it is important to understand what the research seeks to achieve. According to Dickson (2007), it is important for the nurses to be able to perform necessary interventions based on patient’s assessment. Above all, these health practitioners should be able to offer these services in a timely manner in order to be able to make a difference in patient’s life. To achieve the desired results, the researcher will use secondary sources of data from books, internet, peer-reviewed journals, and some websites.
In this research, the data came from online peer reviewed evidence based journals on this topic. The journals included subjects of nursing, nurse leadership, nursing education, human factor engineering, simulation in health care, staff development, and the website of American Heart Association. The researcher will also conduct research at the United States Department of Veterans Health Administration’s intranet in order to gather sufficient information on human factor engineering mannequin simulation. The researcher will also make a communication with the clinical advisor on the integrative literature review. The communication will be made through face to face, via emails, and by phone calls. The researcher will conduct an integrative literature review of literatures published from 2002 to 2013 that describes experimental investigations of incorporating human factors engineering and high fidelity simulation for the purpose of developing a position on the issue of using this technology. The researcher will also use the American Heart Association guidelines for cardiopulmonary resuscitation education of emergency cardiovascular care. The searches will include PubMed, Medline, the Cumulative Index to Nursing and Allied Health Literature (CINAHL), United States Department of Veterans Health Administration intranet using the terms “human factor engineering concept”, “human factor in nursing”, “human factor in education,” “acquisition of learning,” “high fidelity simulation,” “CPR simulation,” “nursing simulation,” “code blue simulation,” “multidisciplinary team simulation, simulation in healthcare”. The researcher plans to extract information regarding study design, sample, outcomes, analysis, methods, findings, and limitations from the articles that meet criteria for the level of evidence in this integrative literature review. PICO: Does incorporating the concept of human factor engineering with high fidelity simulation improve the response time, performance, and collaborative efforts in novice and non-acute nurses during a cardiopulmonary resuscitation event?
Setting
The focus of this research is to determine the importance of using human factor engineering mannequin simulation to improve the performance of novice nurses through an integrated literature review. It is always important to define the setting of the research in order to allow those using the material to know the degree of its authenticity. According to Crowther (2003), when defining a setting of such a research, it is always important to define whether it is based on primary research or secondary data analysis. As was stated in the abstract, this is an integrated literature review, which means that the research data will be collected from peer-reviewed journals, books, and other online sources talking about this topic. According to Levine (2013), when conducting a secondary research, a lot of care should be taken to ensure that, secondary data that is used meets the requirements for the research. In this research, the integrated literature review was conducted via web. The researcher used a number of online libraries that had the recommended literatures that could meet the expectations of this research.
Ducharme (2005) say that it is also important to define the scenarios for such experiments. This is because when the scenario of the experiment is different from the concept under investigation, then it is not possible to assume that the resultant data will be able to satisfy the needs of the experiment (Carlson, Riegel, & Moser, 2001). In this research, the researcher was keen to identify scholarly articles that had focused on the use of human factor engineering mannequin simulation to improve the performance of novice nurses. The selected journals also had outcomes of their research clearly stated.
Intervention
In every research, there may bring a need for intervention in order to ensure that the much-needed results are obtained (Oermann, 2005). In this research, it was important to ensure that the literatures used were peer-reviewed and are current. This research was not based on a primary research and therefore, the researcher was not able to conduct an independent empirical research. It was purely based on the reports of other scholars who conducted empirical research in this field. It is important to ensure that the validity of this research is not compromised. To ensure that varying thoughts of various literatures used in this research are harmonized, the researcher was keen on selecting literatures that had received the highest positive reviews. The researcher also incorporated a high number of peer-reviewed articles as a way of comparing different views and taking a position based on the views confirmed through empirical research.
Conceptual foundation
According to Artinian (2002), it is important to develop a conceptual model whose primary objective will be to convey fundamental principles and functionality of a given system it represents. In this case, the researcher developed a model that would help understand the way this research will be conducted to achieve the expected success. The figure below illustrates the model used in this experiment.
The research will begin by understanding the main objectives of the research. The researcher will first internalize what this research entails. The next step would be to develop research question based on the research objectives. The researcher would be seeking answers to the research questions set at this stage (Fiscella & Williams, 2004). The next stage would involve selecting the appropriate secondary sources of data that would be used in this research. At this stage, the researcher will identify books, journals, and other online data sources talking about this topic. These sources must answer the questions set at the previous stage. The researcher will then move to the next stage of confirming the appropriateness of the sources identified. This would involve determining their authenticity and relevance to the topic. Of interest at this stage would be to determine if the selected sources have validly responded to the questions developed by the researcher.
Data collection
The model above describes data collection process. In this research, the focus is on how novice nurses performance can be improved using human factor engineering mannequin simulation. The researcher will concentrate on literatures, which were published between 2002 to 2013 about human factor engineering and fidelity simulation. This research will also make use of the guidelines of American Heart Association for cardiovascular resuscitation education of emergency cardiovascular care. This will help the researcher compare the findings of other researchers on this topic with the set principles and determine if they are in adherence with the set guidelines. The searchers that will be conducted in this research will include PubMed, the Cumulative Index to Nursing and Allied Health Literature (CINAHL), Medline, and the United States Department of Veterans Health Administration. The procedure below describes how the researcher seeks to find the relevant data from these sources in the internet.
Procedures
According to Chin (2007), procedure should be clearly defined because this is a scientific research and needs to be repeated in a real case scenario in future. This scholar says that it is important to hold random medical-surgical in situ mock code twice a month (Weinger, 2011). In this study, the researcher used PubMed, Medline, United States Department of Veterans Health Administration and Cumulative Index to Nursing and Allied Health Literature websites to obtain the needed information. Some of the key terms used in this search were ‘high fidelity simulation’, ‘code blue simulation’, ‘nursing simulation’, ‘CRP simulation’, ‘human factor’, and ‘simulation in healthcare’. The researcher-extracted information on the study design used in these journals, the samples they used, their research outcome, method of analysis used findings, and possible limitations.
Data Analysis
According to Chin (2007), it is important to determine the appropriate data analysis technique that suits the project in order to obtain the desired result. In this research, the researcher used integrated literature review to obtain the needed data. This data was analyzed by determining the purpose of the literatures available, the participants that were involved in the research, the intervention used in that research and its findings. These journals were also analyzed to determine their relevance to a scholarly project. The researcher decided to use integrated literature review because of the limited time available (Oermann, 2005). The results obtained from these literatures will form the basis of the findings of this research.
Limitations
As Anderson (2005) observes, every research will have its limitations based on a number of factors. Limitations for this integrative literature review include the minimum amount of published research on human factor engineering in nursing and human factor engineering as it pertains to utilizing high-fidelity simulation scenarios to educate and train nurses for cardiorespiratory resuscitation. Other limitations of this revealed that the majority of the literature review conducted studies with short time spans between identifying the study groups, implementing the training and assessment and outcome of the training.
Results
According to Aghababian (2002), a research will always be considered successful when it is able to meet the purpose for which it was intended to. In the data that was obtained, it came out clearly that novice nurses could improve their performance if they used human factor engineering mannequin simulation. Most of these literatures were in agreement that the best way of improving performance of the novice nurses is by exposing them to a practical session of offering emergency service. This is further discussed below.
Discussion
In the research done by Anderson (2005), the participants were in five groups of four nurses. Each group was taken through emergency response process that needed provision of cardiopulmonary resuscitation. Each group would undergo the same process four times, and in each scenario, their performance were measured in terms of their knowledge on what they are expected to do, the level of experienced they exhibited when undertaking the process, and the confidence they had in each of the four times they carried out the experiment.
In each case, their performance would be entered into a table, with these three factors measured on a scale of one to five (where one meant limited in the quality analyzed and five meant excellence in the quality). Each group had its own table with four columns for the first to the fourth experiment.
According to a similar research by Anderson (2005), all the four groups in this experiment showed a similar pattern, though to varying degrees. Based on the experiment obtained, the first experiment for all the four groups demonstrated that the nurses were naïve when called upon to respond to the cases presented. Each member of the group was reluctant to take the first step even after it was explained that it should be teamwork. When the nurses started working on this experiment, each member seemed to be lost on what should be done, and their effort not to destroy the instrument used in the experiment surpassed their effort to save the virtual patient. However, this changed with subsequent experiments in each group.
According to Oermann (2005) who conducted a similar research, the more these nurses are subjected to this experiment the more they gained knowledge, experience, and confidence in what they were doing. The fourth experiment demonstrated that upon undertaking the same procedure severally, these nurses became more knowledgeable and confident of what they were doing. They became aware of what was expected of them during such cases of emergency and showed more willingness to undertake such procedures in future. This confirmed that human factor engineering mannequin simulation could help improve the performance of novice nurses. The findings of this scholar is supported by McQuillan (2009) who says that the more these nurses are allowed to participate in a practical situation of responding to emergency, the more they gain experience and the more they become efficient. This argument is also supported by the research done by Fleischman and Barondess (2004) that had a similar outcome. This means that using human factor engineering mannequin simulation is best way of improving the performance of novice nurses.
Implications
According to Hodges (2009), a research can only be considered as being resourceful if its implications can help transform society in a positive way. This research confirmed that human factor engineering mannequin simulation is important in improving the performance of nurses. This research confirms that nurses are always willing to learn how to respond to various cases of emergency that would help save lives before a medical doctor can be called upon. The experiment shows that the best way of making these novice nurses is more knowledgeable and confident in this field is to subject them to a practical scenario of handling a similar situation. However, it is not possible to use a human being as an object of experiment. This is not acceptable by law, and very unethical based on the code of conduct for this profession (Fleischman & Barondess, 2004). This means that this process must be conducted using objects that resemble human beings. This is what human engineering mannequin simulation factor offers. This research therefore, strongly recommends the use of human factor engineering mannequin simulation in improving the knowledge and confidence of novice nurses. This will help in improving their performance.
Summary
Technology has transformed the medical sector positively. However, there has been a limited focus on using this technology to improve the performance of novice nurses. Recent researchers have stated that most of the nurses in this country have limited knowledge on how to respond to various cases of emergencies such as provision of cardiopulmonary resuscitation. This limited skill has made them anxious whenever they have to attend to such cases, a fact that has worsened their performance. However, the invention of human factor engineering mannequin simulation has come as a solution to this problem. This research has demonstrated that most of the novice nurses are unable to attend to these emergency cases because they lack experience. This makes them lack confidence in responding to such emergencies, making their performance even worse. However, there the only way of making these novice nurses more experienced and confident in responding to these cases is by allowing them to engage in practical sessions of offering these emergency services. Because they may not use patients to practice, human factor engineering mannequin simulation comes in as the solution to this.
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