Neuro Boot Camp: An Innovative Academic-Practice Partnership Provides
Specialty Training for Neurocritical Care Advanced Practice Providers
By Molly McNett, PhD, RN, CNRN
The field of neurocritical care is rapidly
evolving. With higher acuity among critically
ill neurologically impaired patients and
advances in complex neuromonitoring,
research findings support improved outcomes
when patients are cared for by dedicated
neurocritical care teams.1 As a result, there
is demand for highly skilled health care
providers practicing in a collaborative
environment. Advanced practice providers
(APPs), including advanced practice registered nurses (APRNs)
and physician assistants (PAs), are a key component to delivery
of cost-effective, quality neurocritical care.2-4 Numerous
opportunities for APPs in neurocritical care exist, with
most teams reliant on APP integration to provide 24-hour
management for critically ill patients.
Despite the growing job market for neurocritical care APPs, there
is little formalized training. Lack of training may contribute to
unfilled positions and high turnover rates within teams. One
academic-practice partnership aims to address this need for
training with an intensive, two-day training program for APPs
interested or new to the field of neurocritical care. Academicpractice
partnerships are advocated as an important mechanism to
strengthen practice, lead change and advance health.4
Neurocritical Care Boot Camp (“Neuro Boot Camp”) is jointly
offered by The MetroHealth System and the Frances Payne Bolton
(FPB) School of Nursing at Case Western Reserve University in
Cleveland, Ohio. The program was designed by Molly McNett,
PhD, RN, CNRN, Director of Nursing Research at MetroHealth,
and Chris Winkelman, PhD, ACNP, FAANP, FCCM, associate
professor at FPB. These two Neuro Boot Camp organizers bring
unique perspectives to program design and development based
on their experiences working with experts in neurocritical care
and educating APPs interested in this highly specialized field.
Pooling resources from two major institutions in the Cleveland
area created an innovative program promoting skills acquisition,
collaborative communication and evidence-based care.
Day one of Neuro Boot Camp is comprised of lectures followed
by case-based scenarios. Regional experts in neuropharmacology,
neuroradiology, best-practice guidelines, and stroke care
delivery provide both in-depth content and opportunities
for collaborative decision making. Participants work in small
groups in an interactive classroom on Case Western Reserve
University campus, using oversized touch screens to review
images including radiographs, magnetic resonance images (MRIs),
and computerized tomography (CT) scans and related records.
Participants work in teams, with imbedded experts at each station,
to hone diagnostic reasoning and determine management options.
Day two takes place at The Center for Simulation at MetroHealth
and includes application of content presented day one.
Participants rotate through performance-based stations that
include simulated patient scenarios, use of partial task trainers and
ultrasound exercises using a standardized live patient. In addition,
human cadavers are utilized for placement of external ventricular
drains (EVD), intracranial pressure (ICP) monitoring devices and
endotracheal intubation.
The simulation scenario stations use high-fidelity mannequins
controlled remotely by simulation staff in a room separated by a
two-way mirror. Staff record participant’s actions for review and
debriefing. These scenarios aid participants in transitioning to a
role where they are the team leader and making decisions to guide
treatment. Each scenario incorporates interactions with other
members of the health care team and patient family members to
strengthen communication skills while directing care in a high
acuity environment.
Stations with partial task trainers
include one-on-one instruction
with expert clinicians for centralline
insertion, arterial-line
placement and suturing. The
ultrasound station includes
content on various techniques
for volume assessment and line
placement; the live, simulated
patient can provide feedback
on sensations related to probe
placement during practice. At the
cadaver station,
participants
practice invasive
skills under the
direction of course
neurosurgeon
faculty for EVD/
ICP placement
to increase their
confidence and
skill level in a
safe learning
environment.
Seasoned APPs
assist with
intubation
practice, as well as
improving mastery
of laryngoscope
and videographic
intubation devices.
The initial
cohort for the
program included
participants from
several states,
counties and cities
across the region.
Evaluative data indicate all were extremely satisfied with the
learning opportunities, faculty and content. Many participants
expressed interest in returning for more advanced techniques and
topics in the next planned programs. Neuro Boot Camp will be
offered again in May, 2018. More information can be found at
https://nursing.case.edu/neuro-boot-camp.
References
1. McNett MM, Horowitz DA, Participants in the International
Multidisciplinary Consensus Conference on Multimodality
Monitoring. International multidisciplinary consensus conference
on multimodality monitoring: ICU processes of care.
Neurocrit Care. 2014 Dec;21 Suppl 2:S215-28.
2. Caserta FM, Depew M, Moran J. Acute care nurse
practitioners: the role in neuroscience critical care. J Neurol Sci
2007; 261:167-171.
3. Yeager S. The neuroscience acute care nurse practitioner: role
development, implementation, and improvement. Crit Care
Nurs Clin North Am 2009; 21:561-593.
4. Yeager S, Shaw KD, Casavant J, et al. An acute care nurse
practitioner model of care for neurosurgical patients. Crit Care
Nurse 2006; 26:57-64.
5. Everett LQ, Bowers B, Beal JA, et al. Academic-practice
partnerships fuel future success. J Nurs Adm 2012; 42:554-556.
Photography by Roger Mastroianni, courtesy of Case Western
Reserve University.
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