Assuring the effectiveness of nursing technical training: the experience of a 75-bed critical care unit

Purpose

To evaluate contributions of a workshop training program in assuring and improving nursing technical procedure performance.

Description

Currently, there are three most critical issues concerning the performance of nursing technical procedures: the high number of procedures; the short time available to train the staff on the job; and the difficulty of measuring the effectiveness of the training program. We observed and received some complaints from patients' families that some special procedures were not performed in a uniform way. One of these was continuous ambulatory peritoneal dialysis (CAPD).

Quality indicators were elected for peritoneal dialysis. The initial analysis showed that the worst results were related to the incidence of peritonitis or peritoneal dialysis technique-related infection. In the period from October to December 1998, there were three episodes of infection in 68 patient-days (one peritonitis to each 1.3 patient-month). A workshop training program was developed to improve the nursing performance in CAPD procedure. Next, we applied a PDCA deming cycle (January 1999): `plan', evaluation of the technique used and also the training program development; `do', training of the nursing staff; `check', re-evaluation of the technique and new analysis of infection incidence; and `act', retraining (if necessary) and continuous nurse education.

Evaluation

Fifty-six nurses (100%) were trained. When we evaluated the understanding of the technique, twenty-five of them (44%) were not fully compliant with the standard technique and had to be retrained. Afterward a new evaluation revealed that all of them were then compliant (Fisher's exact test, P < 0.001). During January to June 1999, we observed no new cases of peritonitis in 94 patient-days (incidence-density analysis, P = 0.07).

Outcomes

This preventive approach allows a practical and systematic feedback from the professional involved, a uniform procedure performance, a customized retraining, and detection of technical faults before the real performance with patients.