Development and evaluation of a simulation-based early-mobility curriculum for paediatric intensive care nurses

Background: Early mobility is one strategy to reduce the harm from immobility that children experience in the paediatric intensive care unit (PICU). Early-mobility programmes rely on nurses, who currently perceive insufficient training as a barrier to mobilizing critically ill children. Nurses have identified simulation as a strategy to improve implementation of early-mobility protocols.

Aim: To use adult learning theory to develop an early-mobility simulation curriculum for nurses and to evaluate if the curriculum improves nursing self-efficacy, knowledge and skills in mobilizing critically ill children.

Study design: Using a curriculum development framework, an interprofessional team created a simulation curriculum. The educational strategies included group simulations, debriefing sessions and didactic sessions. The curriculum evaluation was conducted as quality improvement initiative using a pre-post quasi-experimental design to evaluate nurses' mobility self-efficacy, knowledge and clinical skills.

Results: Eleven PICU nurses participated in the simulation-based early mobility curriculum. Before participation in the curriculum, 73% of nurses felt fairly confident and no nurses felt confident mobilizing a PICU patient. After participation, 100% of nurses felt at least fairly confident mobilizing a PICU patient (p = .031). Knowledge scores improved from a median of 14 (IQR, 12-16) questions correct to 17 (IQR, 16-18) questions correct (p = .001). Nurses completed more required clinical tasks during the Observed Structured Clinical Examination, with improvement from a median of 15 items correct (IQR, 14-16) to 19 items correct (IQR, 15-20; p = .0037).

Conclusions: Developing a simulation-based early-mobility curriculum for PICU nurses is feasible. Nurses who completed the curriculum had improved self-efficacy, knowledge and clinical skills in mobilizing critically ill children.

Relevance to clinical practice: The findings of this study demonstrate that simulation is a potentially useful educational tool to teach nurses to safely and effectively mobilize critically ill children. The strategy should be evaluated further to determine if it impacts physical rehabilitation at the bedside.