Implementing a pediatric MV educational program improved theoretical knowledge and practical skills in both nurses and physicians, and increased compliance with treatment goals in two pediatric intensive care units.
We report significant post-intervention improvements in theoretical knowledge and practical skill performance among both professional groups. However, staff had already performed strongly during baseline evaluation (Fig. 2). Nurses scored lower on the TT compared to physicians. In contrast, nurses performed better than physicians in the PST and ventilator setup. We expected this result due to the local task assignments. The implementation significantly improved physicians’ practical skills and significantly reduced the time that physicians and nurses needed to set up a ventilator. The staff of both professions with limited experience (0–5 years) scored lower in the TT than more experienced staff (> 5 years). Inexperience was not a relevant factor in PST performance (Fig. 3), indicating that nurses, in particular, acquire theoretical knowledge with increasing professional experience. The notable drop-out rates within our study, particularly evident in the TT group (nurses: 26%, physicians: 10%) and even more prominently in the PST group (nurses: 47%, physicians: 24%), can be attributed to a combination of factors. These factors encompass staff turnover, the intricate nature of the testing environment which took place during regular working hours, and the anxiety-inducing testing scenario that deterred certain participants from undergoing the test a second time.
Supplementary Figure 3 illustrates the correlation between staff experience and performance in theory and practical skill tests. Surprisingly, we observed that practical skill test performance improvement was largely independent of staff experience (mean improvement: 22%). However, for the theory test, there was an interesting trend: inexperienced and highly experienced staff showed significant improvements, while moderately experienced staff demonstrated improvements in individual topics but no significant overall increase in performance. In the theory test, Intrapulmonary shunts, Ventilator-associated pneumonia, and High-frequency oscillatory ventilation were identified as particularly challenging topics for the participants. On the other hand, the practical skills test revealed that both nurses and physicians faced difficulties with alarm management, display settings, inspiratory time selection, and making ventilation adjustments for compliance changes.
These results suggest that training initiatives should cater to both inexperienced staff and highly experienced individuals. In our setting, physicians scored lower than nurses in practical skills, indicating a potential lack of exposure to practical aspects, possibly influenced by task distribution within our clinic. Tailored training to address specific knowledge gaps would be highly beneficial.
We used an educational film (www.uke.de/picu-nicu) available to the team as a self-learning offering which was well adopted (Fig. 1) and proved to be a resource-effective and efficient measure for standardized and contemporary training [24]. We tested the theoretical knowledge of the participants but moreover their practical skills in using the equipment and their abilities to respond to clinical challenges using OSCE. Although OSCE can only partially reflect clinical reality [14, 18, 21], in our study setting, OSCE was well suited to test the psychomotor skills of the participants.
Our aim was to establish a standardized and inclusive educational approach that would enhance the understanding and awareness of the tasks and challenges faced by both professional groups. This objective aligns with the fundamental principles of effective interprofessional education, as outlined by van Diggele [17]. By promoting interprofessional education, we sought to diminish hierarchical barriers and empower nursing professionals to actively engage and contribute their expertise, ultimately enhancing patient safety. The notable increase in self-confidence observed among the participants of our study suggests that both professions have gained a heightened level of proficiency in the field of mechanical ventilation in children (Supplementary Fig. 2). When designing our educational program, we carefully considered the guiding principles put forth by van Diggele et al., which delineate key considerations for planning and implementing interprofessional facilitation in both classroom and clinical settings [17].
With patient safety, the high staff turn-over [25], and the high proportion of inexperienced staff in intensive care units in mind, a practical, consistent, and resource-effective education is of great importance in health care [19, 20].
This initiative defined numerous aspects regarding ventilator setup, the visible display of all relevant parameters, and specifications for alarm limits and patient monitoring during MV. Compliance with these treatment goals was only accessible through random checks of patients and respirators. The mean compliance to treatment goals rose rapidly by about 7% after the intervention, well above the aim of 90%, and remained at this high level (Fig. 4). This effect was also significant after correcting for multiple checks in some patients calculating a mixed-effects model (sTable 1). Incorrect respirator setup, settings, and missing alarm limits occurred significantly less frequently after the intervention, reflecting higher team compliance with treatment goals. To our knowledge, this study is the first to report improvements in the team’s theoretical knowledge, practical skills, and immediate improvements in compliance with MV treatment goals in actual pediatric patients after an educational intervention.
Future studies should investigate whether improved team knowledge and optimized ventilator settings result in better patient outcomes and enhanced patient safety for ventilated children. This may require validating the instruments used in this study and establishing a collaborative multi-center, regional, or national training program in partnership with professional organizations.
Limitations
We conducted the study at only one institution. Our approach involved a comprehensive bundle of measures, making it challenging to isolate the specific impact of each component retrospectively. The distribution of roles in the setup of ventilators and their adjustment may vary locally, and additional specialized professionals may be involved in respiratory management, thus restricting the generalizability of the results. In addition, pediatric ventilator management is a complex skill, and neither international recommendations nor universal agreements exist among experts regarding MV goals for children. We, therefore, defined local treatment goals and MV settings and adapted the educational program to local requirements. Although we did not determine the difficulty level of the two TTs and PSTs, the cross-over testing study design, coupled with randomized assignment and per-participant analysis, minimized the potential impact of any variations, thus providing a robust evaluation of the intervention’s effectiveness. Participants performed similarly in the two TTs and PSTs before the intervention, that a similar level of difficulty of the tests can be assumed. Blinding of the TT and PST assessors and random checks were impossible because of the study design. Knowing that they participated in the initiative, the treating team may have changed their behavior (Hawthorne effect).
