Document Type

Final Project

Graduation Date

Spring 5-5-2022

Degree Name

Doctor of Nursing Practice

First Advisor

Diane Brage Hudson




The purpose of this pilot feasibility study was to assess if a simulation-based mastery learning (SBML) intervention on central venous catheter (CVC) dressing changes by staff nurses at Nemaha County Hospital could further develop staff nurses’ central line care skills by increasing their knowledge of a central line dressing change, improving their comfort level and learning self-efficacy with central line care, determining if there is a relationship between knowledge, learning self-efficacy and comfort in the clinical area, and assessing nurses’ satisfaction on the SBML intervention. The clinical research questions being explored are, “Will nurses in a Nebraska critical access hospital in Auburn, Nebraska who engage in a SBML intervention on central venous access dressing changes and cares develop their skills and increase their knowledge, comfort level, and learning self-efficacy with such cares after the intervention? Will they increase their satisfaction and positive attitude learning via the SBML format?


A SBML workshop for central line dressing changes was implemented at Nemaha County Hospital’s yearly skills fair. The proposed study design was a pretest-posttest, educational pilot intervention. The staff nurses used live SBML to demonstrate a CVC dressing change for internal jugular venous catheters. A 19-point checklist devised from the Center for Disease Control and the hospital’s policy was used to evaluate their performance. Participants completed a knowledge assessment, comfortability rating assessment, and self-efficacy assessment pre and post intervention. An assessment of satisfaction and attitude was completed at the end of the intervention. Demographic data was collected for descriptive purposes. The theoretical framework used in the study included the behavioral learning theory as it focuses on behavior change and improvement, with behavior change being indicative of knowledge, learning, and competence acquisition. Learning in simulated social environments contributes strongly to learner knowledge, behavior change, competence, and personal development.


A sample size of 11 registered nurses (RN) and 3 licensed practical nurses (LPN) participated. There was a significant positive Pearson correlation between change in comfort and change in self-efficacy pre and post intervention. There was a significant difference on change in comfort between day and night shift with night shift having a larger increase in comfort compared to the day shift nurses. Skill development was measured once immediately post demonstration. It was found that there were no significant differences on the outcome measures between LPNs and RNs.


Clinical staff at critical access hospitals may have little opportunity to experience seldom performed nursing tasks. Overall, the comfortability and self-efficacy for central line dressing changes improved after the SBML intervention. Participants reported a positive attitude towards utilizing SBML during education of central line dressing changes. The disadvantage of this study was the small sample size and the lack of opportunity to redemonstrate the skills assessment. Ideally, a larger sample size with more clinical staff or staff from multiple hospitals could offer more insight into the benefits of utilizing SBML for training skills.