Impact of structured simulation-based and on-job training program on nurses’ competency in pediatric peripheral intravenous cannulation: Children’s hospital experience

Abstract

Background: Peripheral intravenous cannulation (PIVC) is a frequent invasive, painful procedure in children. Nursing education and competency are of great importance to decrease complications. Objectives: to evaluate the impact of structured simulation-based PIVC training and on-job assessment program on nurses’ knowledge, attitudes, and performance. Design: Settings/participants: A prospective, structured, competency improvement training, assessment, feed back, and reassessment conducted on 150 pediatric nurses. They provided nursing care for in-patients at the newly open Children’s hospital, Ain Shams University. Methods: PIVC insertion skills and care knowledge, structured simulation-based mannequin training arm veni puncture model and on-job assessment were conducted. In the preparatory phase, 15 nurses were interviewed to develop the assessment tools. Knowledge and attitudes were assessed quantitatively using a validated self- administered questionnaire. Structured simulation-based training, and on-job skill assessment were performed using validated observer checklist. Assessment performed at enrollment (baseline), immediate post training, and reassessment 2-months after the training, using same tools. Results: Knowledge, performance, and attitudes were significantly improved for the 150 trained nurses. There was improvement in immediate post training assessment than the reassessment after 2-months, compared to baseline for total knowledge score; peripheral cannula insertion score; hand washing before aseptic procedure; skin antisepsis at puncture site; no puncture site palpation after disinfection; apply sterile dressing to puncture site, p = 0.00, respectively. There was improvement in the reassessment after 2-months than post training assessment, compared to baseline for the total attitude score, p = 0.02; peripheral cannula care, p = 0.00; aseptic technique, p = 0.00; wearing protective gloves, p = 0.01; total practice score, p = 0.00. Years of experience, last 6-months training course, practice level, educational level, age, and attitude influence overall performance. Conclusions: Structured simulation-based training and on-job skill assessment are effective for improvement of PIVC insertion and care. Continuous education, feedback, assessment/reassessment, and monitoring should be recommended to retain the gained improvement in attitudes, knowledge, and skills. Changing workplace structure and improve work environment should be studied as factors that might affect learning.