(7) Web-Based Simulations to Improve Core Competencies of Cardiac Nurse Practitioners Caring for Patients with Left Ventricular Assist Devices: A Quality Improvement Project

Abstract: Background
An increased prevalence of patients with left ventricular assist devices (LVADs) and related complications require cardiac nurse practitioners (NPs) to be knowledgeable and confident to safely care for this population. Knowledge and practice gaps exist for cardiac NPs in managing hospitalized LVAD patients at the institution where this quality improvement (QI) project was implemented, highlighting the importance of methods to achieve provider LVAD.

Methods
A QI design was implemented with 11 cardiac NPs in an inpatient tertiary care setting. Descriptive statistics were collected for demographic data. Ten identical pre-test and post-test questions assessed LVAD complication recognition. Occupational Self-Efficacy- Short Version was measured pre-module and post-module. Participants completed the adapted Simulation Effectiveness Tool - Modified following simulations. Three Plan-Do-Study-Act cycles were performed.

Results:
Knowledge question mean scores significantly improved from pre LVAD module (M = 63.6) to post LVAD module (M =72.7) completion (p = .005) with a trivial effect (Cohen’s d = .094). All participants agreed (strongly or somewhat) to all statements in the SET-M subscales including prebriefing learning, confidence, and debriefing. Significant improvement was seen in OSS-SV pre LVAD module (M = 3.95) to post LVAD module (M =4.50) completion (p = .016) with a medium to large effect (Cohen’s d = .730).

Conclusions/implications
This QI project using web-based simulations improved decision making, knowledge, confidence, and core competencies for cardiac NPs caring for LVAD patients, supporting future use of web-based simulations for improving cardiac NP core competencies in caring for LVAD patients.