Transcript Video Delivery of TTM and the Importance of TrainingMs. Stacey Valin-Voges < Back to Boundaries of Temperature Session 2: The Patient Delivery of TTM and the Importance of Training Presented by Ms. Stacey Valin-Voges So the next speaker is MS Stacey Valor book. She is a senior nurse working in Amsterdam Netherlands and she has just recently completed her master in critical care and probably she's the right person to to fill the gap of implementation. Is she not delivering T. T. M. And the importance of training is the title of my presentation. Can you go to the next? Oh, there we go. And the next it's not working next. Oh, now it's gone way too far. Sorry, everybody there we go. So I'm the mother of two Children. Oh, yay, what happened? Is it still working? Okay. Something happened with my computer. So as the mother of two Children on sunday mornings, I often watch shows with them that I sometimes hope are a little interesting for them that they learned something and the one that I was watching that triggered me that gave me an idea. Yeah, I'm gonna do this for my presentation was a BBC special that was um done by David Attenborough called Breaking boundaries and I thought it went in line with the theme of um breaking or sorry, boundaries of temperature. So he uh well listening to his important message, he so eloquently put about climate change, specifically global warming and how we humans play a role in this. I couldn't help but realize how many of these concepts and those of t t m parallel with each other as applicable as applicable as it is to the earth and the state of our climate. I see its parallels in the complexity of our patients delivered healthcare and abundance of research. We have so many tools and so much knowledge to make a difference for each patient. I see it our responsibility, speaking as a nurse uh to decisively deliver these at the bedside. To quote john rock rocks from the author of the book. The documentary is based on the future is in our hands, there's no time to lose applying T. T. M. As our current best practice by doing this and reevaluating will move from good enough to even better improving future strategies. Global warming versus fever. No matter the scale, every degree matters again. I saw a connection as you know, global warming is the long term heating of the earth's climate system due to human activities which increases heat trapping of greenhouse gas levels in the earth's atmosphere. Every degree matters just as fever in the brain, they both end up wreaking havoc and T T. M. Is our tool to stabilize, minimize or reduce further damage. We have the answer that is more easily applicable and available for every eligible patient than the global changes we collectively would have to make to reduce global warming. How cool is that one can't help but think that if all of those who should be in the know were in the know and aware of T. T. M. As they were of global warming that every patient would have a greater chance of a better quality of life awareness is key next and the last connection that I saw was the holocene versus TTN. The Holocene is a period where the planet's global mean temperature varies between just plus -1 degree. During the entire period. The holocene stable temperature gave us a stable planet. Seasons were predictable. Whether was more predictable, civilization was hereby made possible. Its fundamental effect on earth allowed us to develop and thrive. T. T. M. Targeted temperature management, the maintaining of normal core body temperature, preventing fever. The body's holocene, I thought to myself by applying T. T. M. We lay the groundwork in which patients are given the stability to recover and prevent further brain damage T. T. M. The body's holocene. So the bridge towards the potential of achieving a better quality life for each patient is by delivering quality T. T. M. And how can we deliver quality T. T. M. With this intention. The importance is in the training. So I found it um funny that Dr Abella had spoke about how Covid 19 had a negative impact on how um T. T. M. Was implemented or used on the units. And I do agree with him. However, I do see that there are positive impacts on nursing and how that could potentially have positive impacts in the future while implementing and giving delivering T. T. M. And how can we maintain these challenges. So to quote David Atsenborough again, the COVID-19 pandemic has affected the life of everyone on the planet. Its impact was one that we were well ill equipped to deal with. It overwhelmed health services and brought the global economy to its knees. What was very interesting on the I. C. U. S. Though, Although the angst and the stresses were high. Covid 19 through the eyes of nurses became a challenge, not an obstacle and one that put nurses on the map because it became apparent that too many, that nursing was less of a calling and more of a profession. Despite already being short staffed and overworked, Our leadership qualities were given a podium from which we could demonstrate that our knowledge and expertise were indispensable, showing how productive, efficient and effective a bottom up approach could be the theme from the International nurses day this year was a voice to lead. I think that we made stronger cooperation and collaboration with doctors and health care members and there were just less barriers overall, we showed our resilience and flexibility and awareness of each other's well being and in doing that I think things had to happen fast, protocols needed to be made and put into place so that everyone was working from the same platform. This obviously needed to be done practically and safely. Less time was spent on gaining opinions about what everyone thought about the protocol and there was more time spent about evaluating whether it was what was implemented actually worked and it would be so cool if we could do that with certain things within T T. M. As well. What is quality T. T. M. And how can we deliver it? So last year I also used a very similar slide just for everybody who would like to know yet again um T. T. M. For out of hospital cardiac arrest patients and neurologically injured patients. As stated by dr martin. It's controlled automated and with precision on the I. C. U. And Professor Fabio to cone has stated that it's no delay in initiation site of measurement is important. Rapid time to target temperature. A temperature feedback is important. An adequate method of delivery length of cooling, slow rewarming shivering control and as T. T. M. Two has um illustrated yet again avoiding fever. I think it's also of course very important to keep in mind that questioning these protocols and guidelines and tailoring T. T. M. For each patient is very important. Training and development and practice. So research has shown us that effective training of individuals and teams leads to improved performance, reduction of errors, saved lives and enhanced safety. The science behind training and development is complex implementation of T. T. M. Training is no different because it involves gaining knowledge of disease processes, how they're treated in theory and in practice which which devices are used to manage temperature and other important compounding factors, factors such as how to treat shivering. Um not to mention tips and tricks from expertise um from nurses and T T. M. To help with troubleshooting on the work floor. I think it's important to train in layers on an ICU. There are often enthusiasts, expert nurses, novice nurses and students training a group of nurses as super users can help motivate other nurses on the work floor to ensure protocol adherence ultimately improving care and possible patient outcome. So where can training improve T. T. M. On the I. C. U. Uh My thesis that I completed um almost a year and a half ago now was two parts. The 1st 50% was my research and the 2nd 50% was an implementation project. So the title of my um actual research project was maintenance of target temperature and protocol adherence during targeted temperature management. A retrospective cohort study to gain a product, a broader perspective of target temperature maintenance and protocol adherence. I completed a baseline assessment that was conducted over the course of a year. My study was called the T. T. M. Pump study, purposeful upgrading of TTN management practices together temperature manners matters because I couldn't do it alone. In my study, I included 74 patients, 48 of which were out of hospital cardiac arrest patients and 26 patients who had severe brain injury. My primary objective was to investigative patients maintained target temperature during the maintenance phase of target temperature management. The results were in line with most other research to date, there was definite room for improvement but interestingly when reflected on, based on the temperature the T. T. M. Two protocol, they were actually quite acceptable. My secondary endpoints were to investigate protocol adherence related to the process of T. T. M. Delivery. The results of the secondary endpoints I found more interesting. For example, patient temperature at which the cooling device was initiated, how frequently patients were actively warmed and how long neurologically patients who met protocol criteria to be cooled had a temperature above 38 degrees before T. T. M. Was initiated. Overall Protocol adherence was low which could indicate gaps in nursing knowledge, acknowledging these gaps in nursing knowledge and identifying the barriers the experience were key and further being able to address these issues the importance of training and closing the gap. In order to improve T. Tm management practices. I needed to identify which factors nurses experience as barriers to practice. After conducting interviews and combining these results with the results from my study, I was able to create an implementation diagnosis, the herringbone model highlights the main determinants and issues pointing out to the problem. Most of the points revolve around knowledge experience the lack of education, communication and knowledge between doctors and other departments and issues with devices being faulty or unavailable. Giving T. T. M a holistic reboot on the unit by reaching out to the whole team with educational training, um hands on device simulations, case discussions and increasing the number of super users was in my eyes away to provide a good foundation from which we could improve our care to illustrate just how complex training can be. From a nursing perspective. I've chosen the following model, empowering education, A new model for in service training of nervous staff, nursing staff. I find it effective because it's not a top down model, it gets all levels involved, Not only our nurses expected to complete self directed learning here, there are practical hands on learning aspects as well as opportunities for them to help design and implement facets of the training. Management can also take part in helping to accommodate and facilitate opportunities in coordination with nurses involved Woven in the theory is this model of this model are the six principles of Angry Doggie from Malcolm Knowles, the art and science of learning and training. So the six points that he covers are adults need to know why they need to learn something. Adults need to build on their experience. Adults need to feel responsible for their learning, they need to be ready to learn if training solves an immediate problem and adults want to learn, sorry adults want their training to be problem focused and they learn best when motivation comes intrinsically as adults, we need to know why we need to learn something, What's in it for me, when we understand what's in it. For me, were much more likely to sit up and pay attention. A practical example, seeing and hearing about positive results. I see you follow up clinics according to research could lead to better health outcomes for ICU survivors and provide useful feedback for nurses. Hearing about success stories will empower nurses and help to motivate us when delivering T. T. M. Just as the next speaker will probably also help us. The second is experience gaining knowledge. Being capable and competent. Nursing competency includes a variety of components such as knowledge, skills, attitudes, thinking ability and values. Therefore nursing competency training should incorporate various educational programs. T. T. M. Nursing practice is situation dependent and clinical judgment training through reflection is important for improving nursing competency, bedside teaching and the use of specific patient cases to allow for discussion are really helpful qualification in terms of being certified to deliver T. T. M. And its devices is also necessary and varies based on institutional and country based guidelines and third self concept having autonomy and control. And I relate that on online training nurses value their autonomy and investing in ways to retain. This is valued convenience and flexibility. Were highly rated among the most important advantages of online learning using online training to increase the scope of knowledge and retraining a skill set specifically about T. T. M. Will help nurses to study at their own pace and at times that are convenient to them enabling nurses to relate this knowledge to current patient populations and increasing the understanding of how best programs to how best to program devices, a synergistic effect will occur. So nurses will become empowered, regaining autonomy and in turn patients will receive better care readiness and that in motivation and immediate problem solving and that as evidence based research So adults adults learn best when the training can help them solve an immediate problem in real life. I think it's wrong to assume that nurses are only pragmatic by nature and that we always simply want is the basic information to perform a given task. Although this may be true in times of crisis COVID-19 being a very recent worldwide example of that or to simplify processes in order to reduce workload at the end of the day. The collective voice and opinion I hear from my colleagues is we want to understand why discussing the evidence is important. We do what we do, knowing what kind of benefit it's going to potentially have for our patients. So each individual nurse wants to do it even better. Nurses having adequate knowledge to have an educated discussion at the bedside might just give nurses the edge. They need to give patients a better chance of having a better quality of life when time constraints and other workload pressures are present. We sometimes fall into the good enough and every nurse wants to fulfill their work as professionally as possible by following protocol or more so being able to tailor our care to each patient's specific needs, problem, orientation, knowledge, skills and abilities. Um so we're problem solvers, nurses are much more likely to learn when they feel the training can help them. Right now, bedside teaching again is the perfect opportunity to solve problems, explain protocols and how devices work best at the bedside. The presence of super users or champions will help to motivate nurses by quickly solving problems at the bedside and reinforcing skills learned during previous training sessions. Research even states that in the absence of these champions, exchange of knowledge through inter professional collaboration can act as a barrier to protocol, adherence and lastly intrinsic motivation, internal motivators, they create a better self concept and more opportunities for professional growth experience. Experience. Experience, nurses at the bedside manage the care of patients receiving T. T. M. Therapy have an enormous opportunity. T. Tm is complex and understanding how to fine tune the multiple therapies within it aimed at reducing temperature variability and preventing fever ultimately will improve neurological outcome. That's what we hope all the time and the patient's chance of survival. What can encourage nurses to be more invested in carrying out T. T. M. As stipulated in institutions protocols, since we know the first few hours matter the most. And if we only strictly manage temperature for the 1st 24 hours then we have to make those count, intrinsic motivation may be the most important of the six principles each principal building on the next in this model to achieve intrinsic motivation, we need to gain experience and I've got this attitude. So my take home message is T. T. M. Is the body's holocene temperature stability And prevention of fever. Let's take advantage of the positive effects that COVID-19 has had on nursing leadership and the current available opportunities for training and the importance of training itself. Being able to deliver quality. T T. M. Is so important and empowering nurses and giving them the opportunity to do that is even more important. Let's aim at improving the quality of our patient lives. Thank you for your time. Created by
