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Teaching Nursing Students to Stop the Bleed Emergency Preparedness Education for Mass Casualty Events
Teaching and Learning in Nursing 14 (2019) 288–290
Contents lists available at ScienceDirect
Teaching and Learning in Nursing journal homepage: www.jtln.org
Teaching nursing students to Stop the Bleed emergency preparedness education for mass casualty events Valerie Varanelli, MSN, RN, CEN ⁎, Majeda Basilio, MSN, RN, Karen Breda, PhD, MSN, RN College of Education, Nursing and Health Professions, University of Hartford, West Hartford, Connecticut 06117, USA
a r t i c l e
i n f o
Article history: Accepted 6 June 2019 Keywords: Stop the bleed Mass casualty event Emergency preparedness Nursing education
a b s t r a c t There has been a rise in mass casualty events over the past decade. The Stop the Bleed initiative aims to increase survivorship in these events by teaching the basics of bleeding control. This educational intervention was conducted to instruct nursing students on the basics of bleeding control and emergency preparedness. The ultimate result of this project is that 143 future nurses that now have the skills to stop life-threatening bleeding in an emergency situation. © 2019 Organization for Associate Degree Nursing. Published by Elsevier Inc. All rights reserved.
Introduction
Background
A disturbing rise in mass casualty events has taken place over the past decade. Many victims of these disasters turn to the health care system for both acute medical intervention and prolonged support. Nurses are on the frontlines of working with disaster victims and families throughout all stages of recovery. While nurses are expected to perform their duties effectively in a disaster, many of them do not receive appropriate educational preparation to respond to such events. The literature suggests (Boling & Pravikoff, 2017; Shannon, 2015; Pesiridis, Sourtzi, Galanis, & Kalokairinou, 2015; Quail, 2017) that many nursing schools do not have disaster nursing as part of their undergraduate curriculum despite the National League for Nursing Accrediting Commission and the Commission on Collegiate Nursing Education identifying it as an essential component of basic nursing education. Educating nurses for disaster preparedness can easily begin at the prelicensure level during students' undergraduate nursing program. By implementing a curriculum that addresses both disaster preparedness and the nurse's role in disaster response, future nurses will be better prepared for the clinical challenges they will face in disaster situations and in caring for those who have undergone a mass casualty event. The focus of this project was to introduce Stop the Bleed, an important disaster response educational unit, into an associate degree (AD) prelicensure nursing program and to evaluate student responses.
The Stop the Bleed initiative was developed jointly by the Hartford Consensus, Committee on Trauma and the American College of Surgeons with the goal of increasing and improving survivor outcomes in mass casualty or traumatic events. The Stop the Bleed training “teaches current first aid techniques and reinforces bystanders' knowledge to reduce the risk that they'll harm victims or themselves or incur liability when providing first aid” (Thomas, 2017, p. 15). Stop the Bleed, while created for lay persons, is also an ideal program to be used with nursing students as part of the nursing curriculum because it provides a curriculum that can support nurse educators in achieving part of the objective to prepare nursing students in disaster preparation. Stop the Bleed focuses on immediate lifesaving interventions in the presence of uncontrolled bleeding.
⁎ Corresponding author. E-mail address: [email protected]. (V. Varanelli).
Implications for Nursing As seasoned registered nurses certified in Stop the Bleed, we prepared an evidence-based educational unit on the topic for use with prelicensure nursing students in an AD nursing program. Our intervention was based on findings from Strangeland (2010) and others (Pesiridis et al. 2013; Schmidt et al. 2011; Weiner et al. 2005). It was intended to satisfy a small component of the needed disaster preparedness for nurses in AD programs and not intended to address the larger issue of outdated disaster curriculum in nursing education. In response to these gaps in prelicensure nursing education, we presented Stop the Bleed to a class of second year nursing students. Our evidence-based education intervention was intended to provide
https://doi.org/10.1016/j.teln.2019.06.005 1557-3087/© 2019 Organization for Associate Degree Nursing. Published by Elsevier Inc. All rights reserved.
V. Varanelli et al. / Teaching and Learning in Nursing 14 (2019) 288–290
emergency preparedness education and hands-on skills specifically on massive bleeding control during an emergency or a disaster. Planning and Curriculum Implementation We identified a local community college as an ideal site for the Stop the Bleed intervention and gained permission from the AD nursing program director to implement the evidence-based education intervention using the Stop the Bleed curriculum with the school's senior-level prelicensure nursing students. The nursing director supported the program and allowed the intervention to be implemented with the students as part of their classroom nursing course and skills laboratory. We collaborated with the program director and nursing faculty and decided that the course would be taught in two parts. Part 1 involved a 30-minute classroom lecture about the principles of bleeding control and the origins of the Stop the Bleed initiative. Part 2 occurred on the same day and involved a 30-minute handson skills session in the nursing laboratory. In the skills laboratory, we instructed students on tourniquet application and traumatic wound packing. We used skill trainers to simulate wound packing, and all students practiced skills with instructor oversight. Students of the school were required to participate in the class as part of their mandatory preclinical skills day. Students ranged in ages from 18 to over 50 years and were all in their second year of a 2-year AD nursing program. The students participating in this intervention had previously completed two semesters of clinical rotations. We designed an evaluation to measure student learning about the basics of bleeding control. Evaluation questions were developed from the Stop the Bleed curriculum. Students were surveyed prior to the start of the classroom lecture. At the conclusion of the skills laboratory, students were asked to repeat the survey as a posttest.
289
mannequins, students practiced scenarios using common clothing such as a t-shirt, scarf, and belt and using a stick or pen as technique to tighten the tourniquet. Students also practiced using common clothing on hand as a source to pack wounds when compression bandages or blood-clotting gauze was inaccessible. The overwhelming consensus of the group was that the knowledge and skills gained from the lecture and the hands-on practical in laboratory would help them intervene in life-threatening emergencies. Relevance to Faculty and Lessons Learned The outcomes of this project provide valuable information on nursing students' interest and engagement level when addressing the topic of responding to life-threatening emergencies. In the literature review, the need for emergency preparedness training in nursing curriculum with prelicensure students is vital and should be improved. Nursing students who participated in this intervention reported greater understanding, increased confidence, and willingness to respond and to intervene if faced with a life-threatening situation. This project shed light on the fact that there is an apparent gap in education on this topic for nursing faculty and students. With continuous rise in mass casualty events in the United States, going forward this intervention can be utilized as a model in nursing curriculum to address the benefits of providing basic lifesaving education for faculty and future nurses. This course offers a unique opportunity for AD faculty to prepare students for changes in the health care environment in real time. The Stop the Bleed program allows AD programs to prepare their students with a nationally recognized certification.
Student Responses
Conclusions
The evidence-based educational intervention was specifically designed to measure and compare comprehension and skills gained from implementation of the intervention. The entire class (143) participated in the project. A pretest and posttest survey was used to compare student knowledge before and after the implementation. Overall student scores achieved an increase of 13% from 86.8% to 99.8%. After completing both the didactic and the hands-on demonstration portion, nearly every student (98.6%) correctly identified two major types of bleeding, compared with 86.8% pre-intervention. All of the students participating in the four phases of the intervention correctly answered questions that assessed their knowledge in basic skills during a mass casualty or a life-threatening emergency. Questions specific to injury mechanisms that result in serious bleeding were asked. Students were able to identify and differentiate between work-related injuries, home-related injuries, mass shootings, and motor vehicle crashes. Safety was emphasized by the instructors in both the didactic and hands-on portion of the intervention. Students successfully demonstrated understanding of scene safety and the significance of staying alert during a massive bleeding emergency or a massive casualty situation. During the practical laboratory session, students were presented with different scenarios and challenges that can arise during a lifethreatening situation that were designed to encourage critical thinking skills and problem solving. Students practiced applying tourniquets on themselves and each other. Students also correctly demonstrated applying gauze and properly applied direct pressure to areas that contraindicate tourniquet use such as wounds to the neck, chest, abdomen, and groin. The group was given scenarios that challenged them to use improvised tourniquets when there is not a scientifically designed tourniquet on hand. Using medical
This evidence-based educational intervention demonstrated the need for improved disaster preparedness curriculum in prelicensure nursing programs. More robust and updated content can easily be implemented in other AD nursing programs. Students who participated in this project were enthusiastic and excited to learn about the Stop the Bleed initiative, believing it was valuable to both their nursing practice and non-nursing skills. Programs similar to this one can be conducted at a diverse set of locations. Prior to implementation of the Stop the Bleed curriculum, the participating students did not possess basic lifesaving skills needed in a life-threatening emergency that involves massive bleeding. The Stop the Bleed skills taught in this educational intervention are as critical as Basic Life Support for cardiac arrests or respiratory failure, which is a mandatory universal course in many prelicensure nursing programs. The ultimate result of this project is that 143 future nurses in the community now have the skills to stop life-threatening bleeding in an emergency situation. The overwhelming positive response, energy, and engagement of this single group of nursing students for both the topic and style of education (didactic and hands-on) is a winning intervention to foster maximum outcomes with other groups of nursing faculty and students. References Boling, B., & Pravikoff, D. (2017). Disaster preparedness training for healthcare personnel. CINAHL Nursing Guide.. Pesiridis, T., Kalokairinou, A., & Sourtzi, P. (2013). Nursing student's perceptions of disaster nursing: Implications for curricula development. Nursing Care & Research, 35, 63–74. Pesiridis, T., Sourtzi, P., Galanis, P., & Kalokairinou, A. (2015). Development, implementation and evaluation of a disaster training programme for nurses: A switching replications randomized controlled trial. Nursing Education in Practice, 15, 63–67.
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V. Varanelli et al. / Teaching and Learning in Nursing 14 (2019) 288–290
Quail, M.T. (2017). What's the Stop the Bleed campaign?. Nursing, 47(12), p. 15–16. DOI:10:1097/01 Schmidt, C. K., Davis, J. M., Sanders, J. L., Chapman, L. A., Cisco, M. C., & Hady, A. R. (2011). Exploring nursing students' level of preparedness for disaster response. Nursing Education Perspectives, 32(6), 380–383. Shannon, C. C. (2015). Using a simulated mass casualty incident to teach response readiness: A case study. Journal of Nursing Education, 54(4), 215–219.
Strangeland, P. A. (2010). Disaster nursing: A retrospective review. Critical Care Nursing Clinics of North America, 22, 421–436. https://doi.org/10.1016/j.ccell. 2010.09.003. Thomas, M. (2017). What's the stop the bleed campaign? Nursing, 47(12), 15–16. Weiner, E., Irwin, M., Trangenstein, P., & Gordon, J. (2005). Emergency preparedness curriculum in nursing schools in the United States. Nursing Education Perspectives, 26(6), 334–339.
Contents lists available at ScienceDirect
Teaching and Learning in Nursing journal homepage: www.jtln.org
Teaching nursing students to Stop the Bleed emergency preparedness education for mass casualty events Valerie Varanelli, MSN, RN, CEN ⁎, Majeda Basilio, MSN, RN, Karen Breda, PhD, MSN, RN College of Education, Nursing and Health Professions, University of Hartford, West Hartford, Connecticut 06117, USA
a r t i c l e
i n f o
Article history: Accepted 6 June 2019 Keywords: Stop the bleed Mass casualty event Emergency preparedness Nursing education
a b s t r a c t There has been a rise in mass casualty events over the past decade. The Stop the Bleed initiative aims to increase survivorship in these events by teaching the basics of bleeding control. This educational intervention was conducted to instruct nursing students on the basics of bleeding control and emergency preparedness. The ultimate result of this project is that 143 future nurses that now have the skills to stop life-threatening bleeding in an emergency situation. © 2019 Organization for Associate Degree Nursing. Published by Elsevier Inc. All rights reserved.
Introduction
Background
A disturbing rise in mass casualty events has taken place over the past decade. Many victims of these disasters turn to the health care system for both acute medical intervention and prolonged support. Nurses are on the frontlines of working with disaster victims and families throughout all stages of recovery. While nurses are expected to perform their duties effectively in a disaster, many of them do not receive appropriate educational preparation to respond to such events. The literature suggests (Boling & Pravikoff, 2017; Shannon, 2015; Pesiridis, Sourtzi, Galanis, & Kalokairinou, 2015; Quail, 2017) that many nursing schools do not have disaster nursing as part of their undergraduate curriculum despite the National League for Nursing Accrediting Commission and the Commission on Collegiate Nursing Education identifying it as an essential component of basic nursing education. Educating nurses for disaster preparedness can easily begin at the prelicensure level during students' undergraduate nursing program. By implementing a curriculum that addresses both disaster preparedness and the nurse's role in disaster response, future nurses will be better prepared for the clinical challenges they will face in disaster situations and in caring for those who have undergone a mass casualty event. The focus of this project was to introduce Stop the Bleed, an important disaster response educational unit, into an associate degree (AD) prelicensure nursing program and to evaluate student responses.
The Stop the Bleed initiative was developed jointly by the Hartford Consensus, Committee on Trauma and the American College of Surgeons with the goal of increasing and improving survivor outcomes in mass casualty or traumatic events. The Stop the Bleed training “teaches current first aid techniques and reinforces bystanders' knowledge to reduce the risk that they'll harm victims or themselves or incur liability when providing first aid” (Thomas, 2017, p. 15). Stop the Bleed, while created for lay persons, is also an ideal program to be used with nursing students as part of the nursing curriculum because it provides a curriculum that can support nurse educators in achieving part of the objective to prepare nursing students in disaster preparation. Stop the Bleed focuses on immediate lifesaving interventions in the presence of uncontrolled bleeding.
⁎ Corresponding author. E-mail address: [email protected]. (V. Varanelli).
Implications for Nursing As seasoned registered nurses certified in Stop the Bleed, we prepared an evidence-based educational unit on the topic for use with prelicensure nursing students in an AD nursing program. Our intervention was based on findings from Strangeland (2010) and others (Pesiridis et al. 2013; Schmidt et al. 2011; Weiner et al. 2005). It was intended to satisfy a small component of the needed disaster preparedness for nurses in AD programs and not intended to address the larger issue of outdated disaster curriculum in nursing education. In response to these gaps in prelicensure nursing education, we presented Stop the Bleed to a class of second year nursing students. Our evidence-based education intervention was intended to provide
https://doi.org/10.1016/j.teln.2019.06.005 1557-3087/© 2019 Organization for Associate Degree Nursing. Published by Elsevier Inc. All rights reserved.
V. Varanelli et al. / Teaching and Learning in Nursing 14 (2019) 288–290
emergency preparedness education and hands-on skills specifically on massive bleeding control during an emergency or a disaster. Planning and Curriculum Implementation We identified a local community college as an ideal site for the Stop the Bleed intervention and gained permission from the AD nursing program director to implement the evidence-based education intervention using the Stop the Bleed curriculum with the school's senior-level prelicensure nursing students. The nursing director supported the program and allowed the intervention to be implemented with the students as part of their classroom nursing course and skills laboratory. We collaborated with the program director and nursing faculty and decided that the course would be taught in two parts. Part 1 involved a 30-minute classroom lecture about the principles of bleeding control and the origins of the Stop the Bleed initiative. Part 2 occurred on the same day and involved a 30-minute handson skills session in the nursing laboratory. In the skills laboratory, we instructed students on tourniquet application and traumatic wound packing. We used skill trainers to simulate wound packing, and all students practiced skills with instructor oversight. Students of the school were required to participate in the class as part of their mandatory preclinical skills day. Students ranged in ages from 18 to over 50 years and were all in their second year of a 2-year AD nursing program. The students participating in this intervention had previously completed two semesters of clinical rotations. We designed an evaluation to measure student learning about the basics of bleeding control. Evaluation questions were developed from the Stop the Bleed curriculum. Students were surveyed prior to the start of the classroom lecture. At the conclusion of the skills laboratory, students were asked to repeat the survey as a posttest.
289
mannequins, students practiced scenarios using common clothing such as a t-shirt, scarf, and belt and using a stick or pen as technique to tighten the tourniquet. Students also practiced using common clothing on hand as a source to pack wounds when compression bandages or blood-clotting gauze was inaccessible. The overwhelming consensus of the group was that the knowledge and skills gained from the lecture and the hands-on practical in laboratory would help them intervene in life-threatening emergencies. Relevance to Faculty and Lessons Learned The outcomes of this project provide valuable information on nursing students' interest and engagement level when addressing the topic of responding to life-threatening emergencies. In the literature review, the need for emergency preparedness training in nursing curriculum with prelicensure students is vital and should be improved. Nursing students who participated in this intervention reported greater understanding, increased confidence, and willingness to respond and to intervene if faced with a life-threatening situation. This project shed light on the fact that there is an apparent gap in education on this topic for nursing faculty and students. With continuous rise in mass casualty events in the United States, going forward this intervention can be utilized as a model in nursing curriculum to address the benefits of providing basic lifesaving education for faculty and future nurses. This course offers a unique opportunity for AD faculty to prepare students for changes in the health care environment in real time. The Stop the Bleed program allows AD programs to prepare their students with a nationally recognized certification.
Student Responses
Conclusions
The evidence-based educational intervention was specifically designed to measure and compare comprehension and skills gained from implementation of the intervention. The entire class (143) participated in the project. A pretest and posttest survey was used to compare student knowledge before and after the implementation. Overall student scores achieved an increase of 13% from 86.8% to 99.8%. After completing both the didactic and the hands-on demonstration portion, nearly every student (98.6%) correctly identified two major types of bleeding, compared with 86.8% pre-intervention. All of the students participating in the four phases of the intervention correctly answered questions that assessed their knowledge in basic skills during a mass casualty or a life-threatening emergency. Questions specific to injury mechanisms that result in serious bleeding were asked. Students were able to identify and differentiate between work-related injuries, home-related injuries, mass shootings, and motor vehicle crashes. Safety was emphasized by the instructors in both the didactic and hands-on portion of the intervention. Students successfully demonstrated understanding of scene safety and the significance of staying alert during a massive bleeding emergency or a massive casualty situation. During the practical laboratory session, students were presented with different scenarios and challenges that can arise during a lifethreatening situation that were designed to encourage critical thinking skills and problem solving. Students practiced applying tourniquets on themselves and each other. Students also correctly demonstrated applying gauze and properly applied direct pressure to areas that contraindicate tourniquet use such as wounds to the neck, chest, abdomen, and groin. The group was given scenarios that challenged them to use improvised tourniquets when there is not a scientifically designed tourniquet on hand. Using medical
This evidence-based educational intervention demonstrated the need for improved disaster preparedness curriculum in prelicensure nursing programs. More robust and updated content can easily be implemented in other AD nursing programs. Students who participated in this project were enthusiastic and excited to learn about the Stop the Bleed initiative, believing it was valuable to both their nursing practice and non-nursing skills. Programs similar to this one can be conducted at a diverse set of locations. Prior to implementation of the Stop the Bleed curriculum, the participating students did not possess basic lifesaving skills needed in a life-threatening emergency that involves massive bleeding. The Stop the Bleed skills taught in this educational intervention are as critical as Basic Life Support for cardiac arrests or respiratory failure, which is a mandatory universal course in many prelicensure nursing programs. The ultimate result of this project is that 143 future nurses in the community now have the skills to stop life-threatening bleeding in an emergency situation. The overwhelming positive response, energy, and engagement of this single group of nursing students for both the topic and style of education (didactic and hands-on) is a winning intervention to foster maximum outcomes with other groups of nursing faculty and students. References Boling, B., & Pravikoff, D. (2017). Disaster preparedness training for healthcare personnel. CINAHL Nursing Guide.. Pesiridis, T., Kalokairinou, A., & Sourtzi, P. (2013). Nursing student's perceptions of disaster nursing: Implications for curricula development. Nursing Care & Research, 35, 63–74. Pesiridis, T., Sourtzi, P., Galanis, P., & Kalokairinou, A. (2015). Development, implementation and evaluation of a disaster training programme for nurses: A switching replications randomized controlled trial. Nursing Education in Practice, 15, 63–67.
290
V. Varanelli et al. / Teaching and Learning in Nursing 14 (2019) 288–290
Quail, M.T. (2017). What's the Stop the Bleed campaign?. Nursing, 47(12), p. 15–16. DOI:10:1097/01 Schmidt, C. K., Davis, J. M., Sanders, J. L., Chapman, L. A., Cisco, M. C., & Hady, A. R. (2011). Exploring nursing students' level of preparedness for disaster response. Nursing Education Perspectives, 32(6), 380–383. Shannon, C. C. (2015). Using a simulated mass casualty incident to teach response readiness: A case study. Journal of Nursing Education, 54(4), 215–219.
Strangeland, P. A. (2010). Disaster nursing: A retrospective review. Critical Care Nursing Clinics of North America, 22, 421–436. https://doi.org/10.1016/j.ccell. 2010.09.003. Thomas, M. (2017). What's the stop the bleed campaign? Nursing, 47(12), 15–16. Weiner, E., Irwin, M., Trangenstein, P., & Gordon, J. (2005). Emergency preparedness curriculum in nursing schools in the United States. Nursing Education Perspectives, 26(6), 334–339.