Digital Repository Masters Projects Spring 2025 How Simulation Education for Arterial Lines Impacts the Intensive Care Nurses’ Confidence Tina Kaminska Weber State University Follow this and additional works at: https://dc.weber.edu/collection/ATDSON Kaminska, T. 2025. How Simulation Education for Arterial Lines Impacts the Intensive Care Nurses’ Confidence Weber State University Masters Projects. https://dc.weber.edu/collection/ATDSON This Project is brought to you for free and open access by the Weber State University Archives Digital Repository. For more information, please contact scua@weber.edu. WSU REPOSITORY MSN/DNP How Simulation Education for Arterial Lines Impacts the Intensive Care Nurses' Confidence Project Title by Tina Kaminska Student’s Name A project submitted in partial fulfillment of the requirements for the degree of MASTERS OF NURSING Annie Taylor Dee School of Nursing Dumke College of Health Professions WEBER STATE UNIVERSITY April 25, 2025 Ogden, UT Date Tina Kaminska BSN, RN, MSN Student 04/25/2025 Student Name, Credentials (electronic signature) Date Trish Gibbs DNP, RN, CNE 4.26.25 MSN Project Faculty Date (electronic signature) Anne Kendrick, DNP, RN, CNE (electronic signature) DNP, N, CNE MSN Program Director Note: The program director must submit this form and paper. 04/26/2025 Date 1 How Simulation Education for Arterial Lines Impacts the Intensive Care Nurses' Confidence Tina Kaminska, BSN, RN, MSN Student Annie Taylor Dee School of Nursing Weber State University MSN Project 2 Abstract Purposes/Aims: The project aims to evaluate how high-fidelity simulation education impacts intensive care unit nurses’ confidence and skill in managing arterial lines. It seeks to implement HFS education to improve clinical competency and critical thinking. Rationale/Background: Nurses require confidence in their skills to care for complex, highacuity patients. Managing arterial lines requires ICU nurses to have the knowledge and proficiency for accurate diagnostic use. Research suggests that repeated exposure to realistic scenarios increases competency, critical thinking, and confidence. Barriers such as leadership support and organizational culture can hinder participation in continuing education. This project addresses these challenges by fostering a positive learning environment and using HFS scenarios to ensure competency in managing arterial lines. Methods: This project will be implemented in a community hospital ICU using the Iowa Model of Evidence-Based Practice. Data collected from the pre, and post surveys will evaluate selfreported confidence levels, proficiency, knowledge attained and the overall effectiveness of the education simulation. Results: Expected results include increased confidence, critical thinking, clinical decisionmaking, and proficiency. These findings support HFS education as the standard for continuing education. Conclusions: This project demonstrates the importance of HFS education in improving skill competency and confidence among ICU nurses in managing arterial lines. The positive outcomes support expanding HFS education to other skills and acute care areas. Keywords: High Fidelity Simulation, Arterial Lines, Confidence 3 How Simulation Education for Arterial Lines Impacts the Intensive Care Nurses' Confidence One key factor for student nurses to manage clinical situations effectively is to build and strengthen their self-confidence (Guerrero et al., 2022). Moreover, this extends beyond student nurses to encompass newly graduated nurses and seasoned clinicians alike, who must continue to develop and maintain strong self-confidence throughout their practice (Guerrero et al., 2022). According to Guerrero et al. (2022), 'exposure to repetitive high-fidelity simulation (HFS) scenarios has been proven to be an effective teaching strategy to enhance clinical skills.' (p.19). The simulation programs heighten nursing students' abilities and allow them to become more competitive, amplifying their objective analysis skills, proficiency, critical thinking, and self-confidence (Guerrero et al., 2022). Additionally, incorporating various interventions, such as hands-on activities, group learning, online education, and face-to-face lectures, can improve nurses' evidence-based practice knowledge, confidence, attitudes, and skill proficiency (Sapri et al., 2022). Statement of Problem Nurses perceive numerous barriers to continuing education participation (Mlambo et al., 2021). Factors such as organizational culture, manager/leadership support, nursing staff attitude and motivation, and the perceived impact that continuing education in practice were identified as components that impacted the success of continuing education (Mlambo et al., 2021). It is essential to re-engage staff through evidence-based research articles, providing a positive environment that facilitates learning and engaging leadership to provide the encouragement and support nurses need (Mlambo et al., 2021). The lack of evidence-based training standards is 4 another problem. This results in the variability of the nurses' proficiency, which could potentially compromise patient outcomes and the overall quality of care (Canadian et al., 2024). Norris et al. (2019) highlighted the need for targeted educational interventions to boost competence and ensure consistent, high-quality care. Nurses are often in rapidly changing clinical situations and environments that require them to deliver complex patient care. Without adequate knowledge and training to meet the demands of high-acuity patients, they may lack the confidence needed to provide safe and effective care. It is essential for nurses to continuously update their knowledge through clinical education to maintain proficiency (Wray, 2021). Significance of the Project This project is significant in its focus on enhancing self-confidence and clinical competency among critical care nurses. Guerrero et al. (2022) emphasized that repeated exposure to simulation programs significantly boosts nursing students' abilities, critical thinking, and selfconfidence. This is crucial as self-confidence directly impacts nurses' ability to manage clinical situations effectively, leading to better patient care and outcomes (Stewart, 2021). This project also addresses the barriers nurses face in continuing education. Organizational factors such as culture, leadership support, and staff motivation were identified as significant barriers by Mlambo et al. (2021). By creating a positive learning environment and engaging leadership, the project aims to overcome these barriers to facilitate continuous professional development and improve nursing practice and self-confidence. Hands-on activities, group learning, and online education will be incorporated into this project, as each component can significantly improve nurses' knowledge, confidence, and skills in evidence-based practice (Sapri et al., 2022). These learning methods align with the broader goal of evidence-based standardized nursing practices improving clinical patient outcomes. 5 Simulation-based learning has significantly improved self-effectiveness among nursing students and practicing nurses (Tully, 2024). By engaging in realistic clinical scenarios, nurses can improve their decision-making and critical thinking skills, which allows for competent practice in an environment that will enable nurses to refine their skills and eliminate risk or harm to the patient (Tully, 2024). After the simulation and a 30-minute demonstration on how to properly insert an arterial line, 80 percent of the participants who had never set up or inserted an arterial line were able to do so successfully, demonstrating the effectiveness of the simulation (Walsh et al., 2019). Review of Literature This literature review aims to explore current evidence regarding nurse confidence when caring for the acute patient. For ICU nurses caring for patients with arterial lines, how does continuing education with the use of simulators, as compared to not continuing education, affect ICU nurses' confidence in the skills that are required to perform when they are caring for higher acuity patients? Framework For this study, the Iowa Model will be the framework for implementing the project. The Iowa model is an evidence-based practice model that supports the change process and promotes consistent and reliable evidence-based care (Duff et al., 2020). The Iowa model has also demonstrated efficacy in aiding the translation of research findings into practice to improve patient outcomes (Brown, 2014). The steps that create the Iowa model are identifying a trigger/opportunity, stating the purpose, forming a team, appraising the relevant research, designing a pilot, practicing the pilot 6 on a small scale, integrating and sustaining the practice change, and disseminating the results (Brown, 2014). By guiding pilot change in practice, the Iowa Model will directly apply to the implementation of this project. This change will be integrated through a team's collaborative efforts, including an educational member, CNO, unit manager, and nurse leadership. The Iowa Model of Evidence-Based Practice will facilitate the implementation of this project by providing a structured approach with clear steps, ensuring that changes are systematically integrated. Engaging key stakeholders such as an educational member, CNO, unit manager, and nurse leadership promotes collaborative efforts, enhancing the project's success. Through evidence-based practices, pilot testing, and continuous evaluation, the model ensures sustainable improvements and effective resource management. Strengths and Limitations Nurses in the ICU who care for patients with arterial lines have the depth and ability to perform precise hemodynamic monitoring and obtain diagnostic samples, which are vital when caring for critically ill patients. However, limitations include potential adverse events, infections, and inaccurate blood pressure measurements because of the gap between practice and literature and the lack of tools that do not appropriately stabilize the wrist joint (Duff et al., 2020). The Iowa Model addresses these limitations by identifying gaps and incorporating research to bridge them, ensuring safer and more accurate patient care. Simulators significantly boost ICU nurses' confidence in their continuing education skills by providing a safe environment for nurses to practice and learn from mistakes without the risk of harm (Guerrero et al., 2022). This approach improves patient safety, and nurses report 7 increased self-efficacy (Guerrero et al., 2022). This information aligns with the Iowa Model's emphasis on continuous education and evidence-based practice. Analysis of Literature The common theme of enhancing nursing skills through continuing education and simulation is evident across these studies. HFS, e-learning, continuing professional development, and targeted educational interventions are crucial in improving nurses' competence, confidence, and critical thinking skills (Alharbi et al., 2024). These educational strategies are essential for preparing nurses to meet the demands of modern healthcare and provide high-quality patient care. Walter and Terry (2020) produced five studies that concluded that many factors influence nurse engagement in continuing education but that through professional development, they can provide quality care and develop more extensive skills. Search Strategies To conduct a literature search, ScienceDirect, PubMed Central, Ovid, and Weber State University's Stewart Library's OneSearch were utilized. To ensure the information is current, this literature review included articles published within the last five years, 2019-2024. Keywords included in the search were self-confidence staff nursing, arterial lines, competence, simulation, evidence-based practice, intensive care learning, clinical simulation, lifelong learning, professional development, and critical thinking skills. Synthesis of Literature The reviewed literature shows how valuable HFS is in nursing and the importance of continuing education. Research suggests that HFS significantly impacts critical thinking and boosts confidence among nursing students and staff nurses. Three themes were identified in the 8 literature: 1) High-fidelity simulation enhances confidence and skill. 2) Continuing professional development is necessary, and 3) Continual education predicts positive patient outcomes. High-Fidelity Simulation Enhances Confidence and Skill High-fidelity simulation has significantly enhanced nursing students' and staff nurses' critical thinking, skills, and confidence (Guerrero et al., 2022). Guerrero et al. (2022) conducted a quasi-experimental study with a sample size of 120 participants. This included both staff nurses and nursing students. The study found that high-fidelity simulation experiences improved critical thinking skills, satisfaction, and self-confidence, with statistically significant differences between pre-and post-test scores (p < 0.0001). The realistic scenarios provided through simulations allow participants to develop skill competencies and boost their confidence in the acute setting. Sapri et al. (2022) conducted a systematic review and a meta-analysis, which included ten studies and 2,712 participating nurses. Data suggested that educational interventions, including high-fidelity simulation, effectively improve evidence-based practice, attitudes, confidence, skills, and knowledge among nurses. Additionally, Johnson and Lee (2023) conducted pre and post-test assessments with a statistically significant p-value of <0.001. The study showed that nurse knowledge, selfconfidence, and appropriate nursing interventions were markedly increased. These findings emphasize the importance of high-fidelity simulation in fostering critical thinking, skills, and confidence in nursing practice. Continuing Professional Development Is a Necessity Continuing professional development is essential for nurses to maintain high standards of care when adapting to the ever-changing healthcare world. Smith and Brown (2022) 9 demonstrated the importance of continual professional development using the teaching back method, which is considered a form of continuing education for nurses, to improve nurses' ability to educate patients successfully. Surveys identified a significant increase in nurses' confidence levels post-intervention, highlighting the positive impact of ongoing professional development within nursing practice (Smith & Brown, 2022). A meta-synthesis review of 25 qualitative studies revealed that nurses' perception of continual professional development was fundamental to professionalism and lifelong learning (Mlambo et al., 2021). Five themes were identified in the study, including the importance of the culture and the environment to facilitate continual professional development and the impact on practice and the standard of care for the patients (Stewart, 2021). The study also explored the learning experiences of new nurses in intensive care units through an exploratory qualitative case study involving six new ICU nurses and six senior ICU nurses. The challenges that are faced by new nurses within the ICU and the importance of supportive relationships to help them learn and adapt were also identified. Both studies highlight the critical role of continual professional development in enhancing nurses' skills, knowledge, and overall professional development, leading to improved patient outcomes (Stewart, 2021). Continual Education Predicts Positive Patient Outcomes Continual education is a key predictor of positive patient outcomes (Norris et al., 2019). A pilot study at a rural community hospital was conducted, where they provided patient deterioration simulation education to new graduate nurses. This study used newly graduated nurses and administered pre- and post-intervention assessments to examine how self-confidence and competence were affected (Norris et al., 2019). The results indicated that self-confidence was improved with a large effect size and a value of 0.48 (Norris et al., 2019). This data shows 10 that simulation education can improve new nurses' confidence and competence in managing patient deterioration, ultimately leading to better patient outcomes (Norris et al., 2019). Similarly, Rouleau et al. (2017) studied how e-learning in a continuing education context in nursing care impacts patient outcomes. This systematic review included qualitative, quantitative, and mixed studies and aimed to develop an understanding of how e-learning impacts nursing practice. This study again showed a positive influence on nursing practice, knowledge, and skill development. Wray (2021) stated that 'continuing professional development (CPD) enables nurses to continually update and renew their knowledge and skills, enhance evidence-based practice and ultimately ensure that they can meet patient needs and service delivery in a constantly changing practice environment.' Support for evidence-based practice in the form of education in conjunction with leadership has been shown to be one of the most effective ways to promote positive patient outcomes (Duff et al., 2020). Al-Omary et al., (2024) stated that there are many challenges throughout the process of continuing professional development but note that the reported positive impacts of CPD are numerous. Summary of Literature Review Findings and Application to the Project The common theme of these studies showed the critical role of continuing education and simulation in enhancing nursing skills (Guerrero et al., 2022; Norris et al., 2019; Mlambo et al., 2021; Rouleau et al., 2017). E-learning, high-fidelity simulation, and professional development can significantly increase nurses' confidence, competence, and critical thinking ability. Guerrero et al. (2022) and Sapri et al. (2022) found that simulation is a prerequisite to improved nurses' confidence, competence, and critical thinking abilities. Additionally, Smith and Brown (2022) 11 and Mlambo et al. (2021) highlighted the importance of professional development. Further, a nurse's continual education is a vital predictor of positive patient outcomes (Norris et al., 2019). This information will be valuable in advocating for continuing education programs that utilize simulation with a structured format. Being able to demonstrate that these methods have a direct impact on nurse performance, as well as patient care, contributes to the integration of simulation and professional development as a standard of practice in the nursing profession. Implementing these strategies will ensure that nurses are appropriately prepared to care for highacuity patients with confidence and competence, leading to improved patient outcomes and a higher level of care. Project Plan and Implementation The effectiveness of simulation education in enhancing the confidence of intensive care nurses, particularly in managing arterial lines, is an important area of education. As confidence is a crucial factor for nurses to handle clinical situations accurately, it is essential to promote and continuously develop this trait in student nurses and newly graduated and experienced clinicians (Guerrero et al., 2022). HFS has been identified as an effective teaching strategy to strengthen clinical skills and boost confidence among nursing professionals. Examining these factors aims to provide insights into enhancing clinical education and ultimately improving outcomes. Plan and Implementation Process This initiative will ensure staff can access education when relieved from patient care duties (Walter and Terry, 2021). They will be provided with clear learning outcomes, goals, and simulation equipment. The program will be in a community hospital, including a 3-bed Intensive Care Unit (ICU). 12 The first step in initiating the project will be to form a team composed of hospital educators, clinical nurses, unit directors, simulation experts, respiratory therapists, and CNO. A needs assessment will be conducted to understand the current level of confidence and proficiency of the ICU nurses so that the gaps can be identified for training purposes. Once approval is obtained from the CNO, the simulation scenario and learning workshop will be created with the help of the hospital educator. Next, organizing and scheduling the learning workshops will be facilitated by the hospital educator with the assistance of the ICU clinical coordinator. The workshops will include clear objectives for each evidence-based learning activity, ensuring measurable outcomes align with hospital protocols. The data from the pre-assessment given to the ICU nurses will be compiled to ensure that the training aligns with the assessment findings and addresses gaps in nursing knowledge. Staff training for the HFS will begin in July 2025 and will be offered in three sessions to accommodate the various schedules and ensure maximum participation. During each session, comprehensive training on arterial line management using HFS scenarios will be conducted. The nurse will be able to learn and practice hands-on in a safe and controlled environment to promote confidence in these skills (Guerrero et al., 2022). After these three sessions, the participants will have the opportunity to reflect on their learning experience through a post-intervention evaluation survey. Qualitative and quantitative data will be collected regarding the nurses' confidence level, proficiency, understanding of the skills, and satisfaction with the education provided. This information will then be compiled to assess the impact of education on the skills reviewed and the nurse's confidence in managing arterial lines. 13 Interdisciplinary Team The team will include the ICU nurses, clinical nurse educators, hospitalists, support staff such as respiratory therapists, clinical coordinators, the chief nursing officer, and the unit director. ICU Nurses. ICU nurses will be able to bring their experiences and knowledge to identify the challenging areas associated with providing arterial line care and participating in continuing education (Wray, 2021). Clinical Educator. The clinical nurse educator will be able to help develop and implement simulation education and ensure that it aligns with the hospital policies and EBP. The clinical educator will also serve as the bridge from the community hospital to the larger division. Chief Nursing Officer. The CNO will provide insight into the policies and procedures set in place. The CNO will use leadership to help cultivate a positive learning environment in the organization and set expectations for unit directors. Unit Director. The unit director will have valuable information regarding staffing ratios, policies and procedures for caring for arterial lines, and department feedback. The unit director will augment the Chief Nursing Officer’s role in helping to facilitate a positive learning environment among staff. Hospitalist. Collaboration and teamwork with the hospitalists will provide a clear understanding of what is expected with arterial lines, treatment orders, and management of the nursing staff. Support Staff. Support staff such as respiratory therapists and clinical coordinators will be able to bring insight from their expertise and offer support to critical care nurses in managing arterial lines and improving patient outcomes. 14 Description and Development of Project Deliverables An Arterial line quick guide (see Appendix A) was created for easy reference. This will be a valuable resource that will help ICU nurses with their proficiency and confidence while managing arterial lines. This deliverable will provide the ICU nurse with general information and quickly guide the ICU nurse in how to care for and troubleshoot common issues they might encounter. An educational PowerPoint presentation (See Appendix B) will provide essential information to the nurses regarding the management of arterial lines. The information is organized in a clear and structured manner that will be easily accessible to ICU nurses. The arterial line safety checklist (see Appendix C) is essential to assess the nurses' proficiency in HFS education. This checklist will help identify the gaps in education, reinforce best practice, and improve the nurse's confidence in their skills (van der Steen et al., 2023). This checklist will also promote improved patient outcomes by ensuring the patient receives quality care. A pre-assessment survey (see Appendix D) and a post-assessment survey (see Appendix E) are included. The pre-assessment survey will identify current confidence and skill level while working with arterial lines as well as information knowledge. The post-assessment survey will evaluate the effectiveness of the learning scenario. An individualized evaluation tool (see Appendix F) will provide each participant with personalized feedback which will ‘foster a supportive learning environment’ (Tian et al., 2025). Timeline The proposal for this project will be presented to the CNO, the administrative team, ICU director, and hospitalists. The proposal highlights the need for increased education to increase 15 proficiency and confidence among ICU nurses when managing arterial lines. Once approval is granted, a team that includes the hospital educator, ICU nurse leadership, hospitalists, support staff such as respiratory therapy leaders, and clinical coordinators who actively engage with the ICU, CNO, and the ICU director will be established. March through April, the team and project goals will be formulated. Current nurses' confidence levels and competency will be identified through a pre-assessment survey and education created to address those gaps. From May through June, the training workshop and handouts will be created. Based on current evidence-based practice guidelines, information will focus on managing arterial lines through HFS. July the training sessions will begin. Three different sessions will be offered throughout the month to accommodate the various schedules of the ICU nurses. At the end of August, the post-surveys and assessments of the participants will be collected and formulated into data. That data will be compiled into a report to show the effectiveness of the education as well as the confidence level of the nurses. Finally, in September 2025, evaluation data will be disseminated to stakeholders, including the CNO, with a formal proposal to add the simulation activity as required hospital competency education for nurses caring for arterial lines. Project Evaluation There will be an internal review of the information obtained from the pre and postassessments by the nurse leader. This summative evaluation data will then be provided to the hospital staff and CNO. The data will highlight the project's impact on nurse confidence levels and self-reported proficiency in caring for arterial lines. A detailed report will be given to 16 relevant stakeholders and those serving the hospital administrative team. The feedback received from the assessments will be used for future educational material to refine future training. Formative evaluation of this education will involve a pre-assessment survey to assess current levels of confidence levels as well as proficiency levels in arterial line management. Formative verbal feedback will also be obtained from nursing staff during the training sessions. The summative evaluation will look at the overall effectiveness of the training program using qualitative feedback, data analysis, and feedback from key stakeholders. Ethical Considerations Obtaining informed consent from nursing staff is essential to ensure participants understand the intended objectives, method, and potential benefit of increased confidence and proficiency. As simulation scenarios will be used, it will be important to protect patient privacy and de-identify any information that may be used to help simulate realistic scenarios. This will maintain the Health Information Portability and Accountability Act (HIPAA) while using patient information in training scenarios. All hands-on training will be done in a controlled and simulated environment. The hospital educator will supervise the training. Ethically, it will be important to ensure that as staff participate in the training, everyone is treated equally and that the process is transparent. This process will provide all participants with equal opportunities by providing equal access to resources, feedback, and open communication. Resources will be obtained, aligning with the cost analysis to ensure that it upholds ethical standards and is most beneficial to the hospital, staff, and the patients cared for. Discussion 17 Repetitive exposure to HFS scenarios has been shown to be an effective teaching and learning strategy to improve clinical skills and competency (Guerrero et al., 2022). Nurses will become more proficient in the skills they are learning, exhibit critical thinking, and increase their confidence (Guerrero et al., 2022). Nurses perceive many barriers to participating in continuing education, including barriers from the organizational culture, leadership, and staff attitudes (Mlambo et al., 2021). However, research has shown that when there is a lack of EBP training, the standard of care patients receive is quite variable, nurses are not as proficient, and patients experience compromised outcomes (Canadian et al., 2024). It is essential for nurses to stay proficient in their skills, and this is done through continuing education. The purpose of this project is to promote proficiency in caring for arterial lines, as well as improve self-confidence among ICU nurses through implementing HFS scenarios. Evidence-based Solutions for Dissemination Hattie & Timperely (2007) found that feedback tailored to the individual enhances learning and confidence. Each participant will receive a personalized report that provides constructive feedback (Appendix G). There will also be a post-learning debriefing session for those who participated. This will enhance the participants’ learning experience and help them learn from the collective experience of the other participants (Bentley, 2021). The nurse leader will share the results of the study through a poster presentation. This presentation will be given to Weber State University clinicians, educators as well as peers. Significance to Advanced Nursing Practice 18 This project addresses the need for core competency for advanced practice among nurses. This includes the ability to manage complex and critical clinical situations with confidence and proficiency. With HFS scenarios and other continuing educational activities, the project is intended to improve clinical skills, promote proficiency in caring for arterial lines, and boost self-confidence among ICU nurses (Mlambo et al., 2021). Barriers that nurses face in receiving continuing education will be addressed to ensure that they receive support from their department leadership and are provided with a safe learning environment (Walter and Terry, 2021). The EBP training will target an identified gap in training associated with arterial line competency and management. Additionally, this project supports continuing education in developing advanced nursing practice and provides high-quality, patientcentered care. Implications The most significant limitation of this project will be the use of HFS. This form of education can be very cost-intensive and resource-intensive (Hippe et al., 2020). The technology and cost may limit this project. Resources will be provided by what the hospital education department has available. While there are two functional HFS rooms where the technology can be provided, the equipment and personnel to run the technology may also be limited. There will also be variability in how the HFS scenarios are implemented. Implementation will depend on staff participation, attitude, and support provided by leadership and the resources that will be available. These variables can affect the effectiveness of the HFS scenarios (Wyatt, 2023). All ICU nurses will need to be provided with the opportunity to receive this education in a manner that promotes a safe learning environment. This will fall under the limitations of this 19 project as the unit is often understaffed. Limited staff and staff buy-in regarding the importance of the project may be a weakness and impact on the overall effectiveness of the project (Walter, 2021). This project has the potential to promote critical thinking skills and improve competency and self-confidence. Through HFS education, the ICU nurses will be better prepared to function within their role. This factor is a major strength of this project. The HFS scenarios will also be developed from current research, ensuring that the education the nurses receive is up to date, resulting in better and safer patient outcomes. Nurses will also be able to learn, practice, and demonstrate skills in a safe and controlled learning environment, which is also a major strength of the project. Recommendations To help ICU nurses feel more confident in the management of arterial lines and provide them with the necessary skills to maintain arterial lines, it is important to use HFS training (Tully, 2024). HFS education will fill the gaps in knowledge and provide nurses with the needed education and skills to manage arterial lines. Studies show that HFS education will improve patient care outcomes and reduce complications when managing arterial lines (Elhabashy et al., 2024). Feedback received from key stakeholders on this project has been very positive and supportive. CNO, ICU leadership and ancillary staff, have expressed their support for this project and the benefits that have been proposed. Conclusions In conclusion, when there is a lack of standardized training, it places patients at risk, adverse reactions increase, and preventable errors are made (Elhabashy et al., 2024). Research 20 shows that HFS consistently improves patient outcomes, improves self-confidence and increases competency (Guerrero et al. (2022) and Sapri et al. (2022)). 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Int J Nurs Health Care Res 6: 1456. https://doi.org/10.29011/2688-9501.101456 25 Appendix A 26 Appendix B PowerPoint for Employee Engagement PPTDeliverableKaminska.pptx 27 Appendix C Arterial Line Skill Checklist Category Skill Insertion and placement • Demonstrates understanding of arterial sites. • Demonstration of Modified Allen’s Test • Demonstrates understanding of sterile adherence • Demonstrates ability to interpret arterial pressure waveforms and identify abnormalities • Demonstrates ability to zero that transducer • Performs appropriate inspection of arterial line for air bubbles, kinds and connections • Correctly identify waveforms • Correctly identify alternate insertion sites if the primary site has failed • Verifies line patency • Appropriately monitors for limb ischemia • Demonstrates understanding of patient education of arterial lines • Demonstrates appropriate patient positioning with an arterial line • Adheres to strict sterile techniques • Ensures equipment is functioning properly and regular maintenance is up to date • Verifies correct patient/procedure • Demonstrates proper disposal of sharps Monitoring Troubleshooting Patient Care Safety Evaluation 1= No Experience 2 = Needs Assistance 3 = Competent 28 Appendix D 29 Appendix E Pre-Assessment Using a scale of 1 to 3 (1= Not Confident and 3= Confident) rate your confidence in: 1. Ability to perform routine care for an arterial line. ___ 2. Identifying the complications that are associated with arterial lines. ___ 3. How to troubleshoot for common issues with arterial lines. ___ Choose one of the following that rates your experience level of managing arterial lines: • • • • Beginner: I have limited experience/no experience with managing arterial lines. Intermediate: I have some experience, and I can perform basic care with supervision. Advanced: I am proficient and able to manage arterial lines independently. Expert: I am highly skilled and can educate others on arterial line management. Answer the following multiple-choice questions 1. Select ALL that apply to common complications of arterial lines? A. Infection B. Pneumothorax C. Hematoma D. Thrombosis 2. When troubleshooting an arterial line that has a dampened waveform, what should the FIRST step be: A. Flush the line B. Do nothing, this is a normal finding C. Check the height of the transducer D. Replace the catheter. 30 Appendix F Post Assessment Using a scale of 1 to 3 (1= Not confident and 3= Confident), rate your confidence in: 1. Ability to perform routine care for an arterial line ___ 2. Identifying the complications that are associated with arterial lines ___ 3. How to troubleshoot for common issues with arterial lines ___ Did the HFS scenario and material meet your learning needs? Please choose one: 1. 2. 3. 4. Yes, completely Partially Neutral No, my learning needs were not met Please answer the following questions: 1. Identify one learning item from the HFS scenario that you can apply to practice? 2. After this training, do you feel more confident in managing arterial lines? Why or why not? 3. What information would you like additional education/practice on? 31 Appendix G Evaluation Template Strengths Observed Areas for improvement Application of knowledge Skill level assessment Closing Remarks