2003 OPEN FORUM Abstracts
ASSESSMENT OF MECHANICAL VENTILATION KNOWLEDGE
Teresa A. Volsko, BS, RRT, FAARC, Carol Mikanowicz, PhD., RN
Advanced Health Systems, Inc. Hudson, Ohio, Youngstown State University Youngstown, Ohio
Appropriate use of specific modes of mechanical ventilation can reduce mortality, the probability of medical errors and can lower health care costs through the facilitation of appropriate timely discontinuation of ventilatory support. These benefits are dependent upon the knowledge and training that respiratory therapists receive. The purpose of this study was to test respiratory therapists' knowledge of mechanical ventilation through the administration of a written assessment tool. We sought to determine the correlation of assessment tool scores with educational level, experience and employment site. We hypothesized that knowledge assessed through and represented by test scores would have a high correlation with tenure in the field and level of education and a low correlation with employment site.
Methods: A 25-question assessment tool combined case vignettes featuring scenarios with commonly encountered potential indications for mechanical ventilation and questions directed toward the theory and application. All questions were of the multiple-choice variety with four to five single response options. In addition to the test, each participant completed a five-question survey to ascertain clinical experience, education and training, as well as tenure in the field of respiratory care. A total of six organizations (three acute care, two long term care and a university based respiratory therapy technology program) provided a combined sample of 105 respiratory therapists available for participation in this study. Informed consent was obtained prior to participation. The proctored test was anonymous and administered at the participant's place of employment. Data from completed forms (test and questionnaire) were analyzed in SPSS 10.0 for windows (SPSS Inc. Chicago, IL). The main outcome variable was the percentage of correct answers on the test. Statistical significance was established at p < 0.05. Criterion validity was evaluated by testing for an empirical association between test scores and level of education via a one-way analysis of variance (ANOVA). Spearman's rho was used to assess construct validity via the correlation with the test score, employment site and tenure in the field.
RESULTS: A total of 50 of a possible 105 participants (48%) completed the assessment tool and experience survey. Forty-eight of the 50 therapists were trained in a traditional setting (college or university). Participants had varying degrees of longevity tenure ranging from < 1 to 29 years of work experience as a respiratory therapist, mean = 10.84 (SD ± 9.1). The mean test score was 55.1% (range 30 - 76%, SD ± 13.2). We found that while 74% of the therapists participating in the study follow weaning and/or ventilator management protocols, less than 10% (n=5) of the participants had a passing score (>69%).Fourteen therapists (28%) answered less than 50% of the questions correctly. The comparison of assessment test scores varied with the level of formal education completed. Higher test scores were associated with participants achieving advanced formal degrees (p=0.031). There was a statistically significant but weak correlation between longevity tenure in the field and test score (p=0.029, R2 = 0.16). Test scores were not associated with employment site (p=0.309).
Conclusions: Despite training and clinical experience, this group of therapists had deficiencies in knowledge and application of mechanical ventilation, as evidenced by low scores on the assessment test. It is in the recognition of knowledge gaps that a foundation for remedial education can be built. This suggests that the quality of patient care cannot be assumed. More importantly, continued objective-based professional staff development that measures content, educational method and retention rate is critical to guide the teaching of concepts that are associated with lower mortality, improved patient outcomes and reduced health care costs.
Presenter and Correspondent: Teresa A. Volsko, BS, RRT, FAARC Advanced Health Systems, Inc 561 East Hines Hill Road Hudson, Ohio 44236