Backgroud and Purpose: A well-established best practice in providing safe, high quality care for patients with stroke is screening swallowing prior to oral intake. Effective implementation strategies are needed to support evidence based swallowing screening. The use of simulation is now being widely used to train healthcare professionals in evidence based practices. The purpose of this project was to assess the feasibility of simulation training modules (STMs) to support delivery of evidence based swallowing screening with frontline emergency department (ED) nurses.
Methods: A train-the-trainer approach was used with (n=8) nurse champions who received didactic instruction and training with video clips and medical mannequins programmed to simulate auditory elements of stroke swallowing screening. After demonstration of mastery, each nurse champion then trained their peers using the same format. Feasibility for implementation of the STMs was evaluated through process mapping. Acquisition of skills was evaluated with a competency checklist and medical mannequins simulated with various stroke patient profiles. Knowledge was assessed using a pre/posttest.
Results: A portable simulation lab was set up in the ED and nurse champions trained 100% of nursing staff over a two-month period. A total of 16 simulation sessions were needed to train all nursing staff (N=42). Didactic and video clip review was completed in 45-minute group sessions followed by 30-minute simulation practice sessions. Competency and knowledge was assessed 2-weeks after completing STMs. Competency checkoff sessions were completed in approximately 15-minutes. There was a significant increase in nurses’ knowledge and skills from baseline to posttest.
Conclusions: It is feasible to implement STMs with frontline ED nurses. The STMs were beneficial for training and acquisition of skills in a controlled environment with a variety of patient examples. Repeated practice is critical to develop the auditory perceptual skills necessary for swallowing screening interpretation. STMs can be used in the ED for nurses to independently practice and improve swallowing screening skills.