Sue & Bill Gross School of Nursing

Purpose / Aims

The purpose of the DNP quality improvement (QI) project is to evaluate and increase the confidence of intensive care unit (ICU) nurses in managing the Impella, a percutaneous mechanical circulatory support (PMCS) device used in patients with cardiogenic shock (CS). The project aims to improve nursing confidence levels by ≥ 10%, increase device knowledge scores by ≥ 30%, and narrow confidence intervals by ≥ 30 % across two hospital ICUs.

Rationale / Background

Despite the increasing involvement of technology in medical practice, the incidence of cardiogenic shock is increasing, yet the in-hospital survivability of patients remains low (Lang et al., 2020). The in-hospital mortality rates of cardiogenic shock (CS) range from 30-60%, with out-of-hospital mortality as high as 50% within 30 days after discharge. A national study conducted between 2007 and 2017 revealed the survival rate was only about 40% from approximately 400,000 patients treated for cardiogenic shock (Lang et al., 2020). Cardiogenic shock affects nearly 40,000 to 50,000 individuals in the United States annually, and the incidence of cardiogenic shock has increased over the last fifteen years (Osman et al., 2021). There are many treatment options for CS, but the main focus for the project will be the Impella, as current evidence shows higher efficacy and survival rates for CS treatment compared to other PMCS devices.

Brief Description of Undertaking / Best Practice (Approach, Methods, Measurement)

The project uses a pre–post QI design. ICU nurses from two hospitals complete a baseline survey to assess demographics, Impella knowledge, confidence, and educational needs. An educational tool is then delivered over two weeks, followed by a post-intervention survey one month later. Quantitative measures include pre- and post-comparisons of confidence levels and correct knowledge responses. Qualitative feedback from nurses will provide insight into the perceived usefulness and inform educational adjustments. Improvement will be assessed through Welch’s independent samples t-test and thematic analysis of narrative responses.

Assessment/ Outcomes

Following implementation of the educational intervention and nurse-driven resource tool, improvements were observed in both nursing confidence and knowledge related to Impella device management. Overall confidence increased from 52% pre-intervention to 81% post-intervention, with the proportion of nurses reporting no confidence decreasing from 21.8% to 0% and those reporting high confidence increasing from 22.7% to 44%. Mean knowledge scores improved from 4.43 to 5.53 out of 7, reflecting a 15-percentage-point increase in Impella knowledge scores. These findings indicate that the intervention was associated with enhanced nurse confidence and improved understanding of Impella device management in the ICU setting.

Conclusion

Implementation of a structured educational intervention combined with a nurse-driven resource tool was associated with improved nursing confidence and knowledge in Impella device management. These findings highlight the importance of standardized training resources and clinical education to support competency in high-acuity settings. Implications include the need for sustainable competency evaluation strategies, integration of standardized protocols, and ongoing quality improvement initiatives. Future research is recommended to evaluate long-term outcomes and the impact of standardized Impella management on patient care.