List of Titles

A trial of e-simulation of sudden patient deterioration (FIRST2ACT WEB

- Bogossian, Fiona, Cooper, Simon J., Cant, Robyn, Porter, Joanne, Forbes, Helen, McKenna, Lisa, Kinsman, Leigh, Endacott, Ruth, Devries, Brett, Philips, Nicole, Bucknall, Tracey, Young, Susan, Kain, Victoria

Authors: Bogossian, Fiona , Cooper, Simon J. , Cant, Robyn , Porter, Joanne , Forbes, Helen , McKenna, Lisa , Kinsman, Leigh , Endacott, Ruth , Devries, Brett , Philips, Nicole , Bucknall, Tracey , Young, Susan , Kain, Victoria
Date: 2015
Type: Text , Journal article
Relation: Nurse Education Today Vol. 35, no. 10 (2015), p. e36-e42
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Description: Background: High-fidelity simulation pedagogy is of increasing importance in health professional education; however, face-to-face simulation programs are resource intensive and impractical to implement across large numbers of students. Objectives: To investigate undergraduate nursing students' theoretical and applied learning in response to the e-simulation program-FIRST2ACT WEBTM, and explore predictors of virtual clinical performance. Design and setting: Multi-center trial of FIRST2ACT WEBTM accessible to students in five Australian universities and colleges, across 8 campuses. Participants: A population of 489 final-year nursing students in programs of study leading to license to practice. Methods: Participants proceeded through three phases: (i) pre-simulation-briefing and assessment of clinical knowledge and experience; (ii) e-simulation-three interactive e-simulation clinical scenarios which included video recordings of patients with deteriorating conditions, interactive clinical tasks, pop up responses to tasks, and timed performance; and (iii) post-simulation feedback and evaluation.Descriptive statistics were followed by bivariate analysis to detect any associations, which were further tested using standard regression analysis. Results: Of 409 students who commenced the program (83% response rate), 367 undergraduate nursing students completed the web-based program in its entirety, yielding a completion rate of 89.7%; 38.1% of students achieved passing clinical performance across three scenarios, and the proportion achieving passing clinical knowledge increased from 78.15% pre-simulation to 91.6% post-simulation.Knowledge was the main independent predictor of clinical performance in responding to a virtual deteriorating patient R2=0.090, F(7, 352)=4.962, p<0.001. Discussion: The use of web-based technology allows simulation activities to be accessible to a large number of participants and completion rates indicate that 'Net Generation' nursing students were highly engaged with this mode of learning. Conclusion: The web-based e-simulation program FIRST2ACTTM effectively enhanced knowledge, virtual clinical performance, and self-assessed knowledge, skills, confidence, and competence in final-year nursing students. © 2015 Elsevier Ltd.

An analysis of nursing students’ decision-making in teams during simulations of acute patient deterioration

- Bucknall, Tracey, Forbes, Helen, Phillips, Nicole, Hewitt, Nicky, Cooper, Simon J., Bogossian, Fiona, FIRST2ACT Investigators

Authors: Bucknall, Tracey , Forbes, Helen , Phillips, Nicole , Hewitt, Nicky , Cooper, Simon J. , Bogossian, Fiona , FIRST2ACT Investigators
Date: 2016
Type: Text , Journal article
Relation: Journal of Advanced Nursing Vol. 72, no. 10 (2016), p. 2482-2494
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Description: Aim: The aim of this study was to examine the decision-making of nursing students during team based simulations on patient deterioration to determine the sources of information, the types of decisions made and the influences underpinning their decisions. Background: Missed, misinterpreted or mismanaged physiological signs of deterioration in hospitalized patients lead to costly serious adverse events. Not surprisingly, an increased focus on clinical education and graduate nurse work readiness has resulted. Design: A descriptive exploratory design. Methods: Clinical simulation laboratories in three Australian universities were used to run team based simulations with a patient actor. A convenience sample of 97 final-year nursing students completed simulations, with three students forming a team. Four teams from each university were randomly selected for detailed analysis. Cued recall during video review of team based simulation exercises to elicit descriptions of individual and team based decision-making and reflections on performance were audio-recorded post simulation (2012) and transcribed. Results: Students recalled 11 types of decisions, including: information seeking; patient assessment; diagnostic; intervention/treatment; evaluation; escalation; prediction; planning; collaboration; communication and reflective. Patient distress, uncertainty and a lack of knowledge were frequently recalled influences on decisions. Conclusions: Incomplete information, premature diagnosis and a failure to consider alternatives when caring for patients is likely to lead to poor quality decisions. All health professionals have a responsibility in recognizing and responding to clinical deterioration within their scope of practice. A typology of nursing students’ decision-making in teams, in this context, highlights the importance of individual knowledge, leadership and communication. © 2016 John Wiley & Sons Ltd

Doing the right thing at the right time: Assessing responses to patient deterioration in electronic simulation scenarios using course-of-action analysis.

- Cooper, Simon J., Cant, Robyn, Bogossian, Fiona, Bucknall, Tracey, Hopmans, Ruben

Authors: Cooper, Simon J. , Cant, Robyn , Bogossian, Fiona , Bucknall, Tracey , Hopmans, Ruben
Date: 2015
Type: Text , Journal article
Relation: CIN: Computers, Informatics, Nursing Vol. 33, no. 5 (2015), p. 199-207
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Description: International studies indicate that the recognition and management of deteriorating patients in hospitals are poor and that patient assessment is often inadequate. Face-to-face simulation programs have been shown to have an impact on educational and clinical outcomes; however, little is known about performance in contemporary healthcare e-simulation approaches. Using data from an open-access Web-based patient deterioration program (FIRSTACTWeb), the performance of 367 Australian nursing students in identification of treatment priorities and clinical actions was analyzed using a military model of Course of Action Simulation Analysis. Participants' performance in the whole program demonstrated a significant improvement in knowledge and skills (P ≤ .001) with high levels of participant satisfaction. Course of Action Simulation Analysis modeling identified three key participant groupings within which only 18% took the "best course of action" (the right actions and timing), with most (70%) completing the right actions but in the wrong order. The remaining 12% produced incomplete assessments and actions in an incorrect sequence. Contemporary approaches such as e-simulation do enhance educational outcomes. Measurement of performance when combined with Course of Action Simulation Analysis becomes a useful tool in the description of outcomes, an understanding of decision making, and the prediction of future events.

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Managing patient deterioration: A protocol for enhancing student nurses' competence through web-based simulation and feedback techniques

- Cooper, Simon J., Beauchamp, Alison, Bogossian, Fiona, Bucknall, Tracey, Cant, Robyn, Devries, Brett, Endacott, Ruth, Forbes, Helen, Hill, Robyn, Kinsman, Leigh, Kain, Victoria, McKenna, Lisa, Porter, Joanne, Phillips, Nicole, Young, Susan

Authors: Cooper, Simon J. , Beauchamp, Alison , Bogossian, Fiona , Bucknall, Tracey , Cant, Robyn , Devries, Brett , Endacott, Ruth , Forbes, Helen , Hill, Robyn , Kinsman, Leigh , Kain, Victoria , McKenna, Lisa , Porter, Joanne , Phillips, Nicole , Young, Susan
Date: 2012
Type: Text , Journal article
Relation: BMC Nursing Vol. 11, no. 18 (2012), p.1-7
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Description: Aims To describe a funded proposal for the development of an on-line evidence based educational program for the management of deteriorating patients. Background There are international concerns regarding the management of deteriorating patients with issues around the ‘failure to rescue’. The primary response to these issues has been the development of medical emergency teams with little focus on the education of primary first responders. Design/Methods A mixed methods triangulated convergent design. In this four phase proposal we plan to 1. examine nursing student team ability to manage deteriorating patients and based upon these findings 2. develop web based educational material, including interactive scenarios. This educational material will be tested and refined in the third Phase 3, prior to evaluation and dissemination in the final phase. Conclusion This project aims to enhance knowledge development for the management of deteriorating patients through rigorous assessment of team performance and to produce a contemporary evidence-based online training program.

Patient deterioration education: Evaluation of face-to-face simulation and e-simulation approaches

- Cooper, Simon J., Cant, Robyn, Bogossian, Fiona, Kinsman, Leigh, Bucknall, Tracey

Authors: Cooper, Simon J. , Cant, Robyn , Bogossian, Fiona , Kinsman, Leigh , Bucknall, Tracey
Date: 2015
Type: Text , Journal article
Relation: Clinical Simulation in Nursing Vol. 11, no. 2 (2015), p. 97-105
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Description: Background Simulation-based education is one strategy that may be used to teach nursing students to recognize and manage patient deterioration. Method Final-year preregistration nursing students (n = 97) completed three face-to-face laboratory-based team simulations with a simulated patient (actor) and 330 students individually completed a three-scenario Web-based simulation program: FIRST2ACTWeb™. Results Both groups achieved moderate performance scores (means: face to face, 49%; e-simulation, 69%). Course evaluations were positive, skill gain showing a greater effect size in the face-to-face program than for e-simulation, and higher satisfaction and more positive appraisal. Conclusion Face-to-face simulation and e-simulation are effective educational strategies with e-simulation offering greater feasibility. Either strategy is likely to add value to the learning experience.

Profiling nurse practitioner practice patterns at a major urban acute health service

- Lowe, Grainne, Jennings, Natasha, Tregaskis, Peter, Kenneally, Anne, Bucknall, Tracey

Authors: Lowe, Grainne , Jennings, Natasha , Tregaskis, Peter , Kenneally, Anne , Bucknall, Tracey
Date: 2018
Type: Text , Journal article
Relation: Collegian Vol. 25, no. 3 (2018), p. 277-283
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Description: Background: Research detailing the practice patterns and services provided by nurse practitioners within a large health care facility is currently lacking in the literature. This study fills a gap in the literature by reporting on the practices of nurse practitioners in a variety of clinical specialty areas within the one health care setting. Aim: To identify the practices of nurse practitioners in different contexts across one health service. BackgroundAn expanding cohort of nurse practitioners within an Australian health service increasingly delivers services to more complex patients. Understanding this phenomenon assists future workforce planning. Methods: An exploratory survey of nurse practitioner practice patterns in a metropolitan health service was conducted. Nurse practitioners electronically entered data from patient encounters for two weeks. Descriptive analysis of the quantitative data was conducted. Results: Nine nurse practitioner specialties were identified and 341 encounters were analysed. All specialty groups included counselling and education in patient management. The use of nurse practitioner extensions to practice was dependent on the specialty area including prescribing medicines. Conclusions: Nurse practitioner scope of practice differs across specialties and is determined by patient cohorts and associated diagnoses. The results highlighted the diversity and depth of services provided by nurse practitioners. Understanding the scope of practice assist with future nurse practitioner role development andimplementation. © 2017 Australian College of Nursing Ltd

Situation awareness in undergraduate nursing students managing simulated patient deterioration

- McKenna, Lisa, Missen, Karen, Cooper, Simon J., Bogossian, Fiona, Bucknall, Tracey, Cant, Robyn

Authors: McKenna, Lisa , Missen, Karen , Cooper, Simon J. , Bogossian, Fiona , Bucknall, Tracey , Cant, Robyn
Date: 2014
Type: Text , Journal article
Relation: Nurse Education Today Vol. 34, no. 6 (June 2014), p. e27-e31
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Description: Background: Nursing work often occurs in complex and potentially hazardous settings. Awareness of patient and practice environments is an imperative for nurses in practice. Objectives: To explore nursing students' situation awareness while engaging in simulated patient deterioration scenarios. Design: The educational process of FIRST2ACT was the model for the nurse intervention. Situation awareness was measured quantitatively using the Situation Awareness Global Assessment tool. Four domains were measured: physiological perception (patient parameters), global perception (surroundings), comprehension (interpretation of information), and projection (forecasting outcomes). Settings: Clinical laboratories at each of three participating universities. Participants: Ninety-seven nursing students from three Australian universities. Methods: Between March and July 2012, students participated in three video-recorded simulation events, in which a trained actor played patient roles and groups of three students worked as teams. To measure situation awareness, following the simulation each team leader was taken to a separate room and asked to report on a question set regarding the patient's vital signs, bedside setting and medical diagnosis. Results and Conclusions: Overall, situation awareness was low (41%). Of the four domains, physiological perceptions scored the lowest (26%) and projection the highest (59%).Final year nursing students may not have well developed situation awareness skills, especially when dealing with these types of scenarios. Education providers need to consider ways to assist students to fully develop this attribute. Findings suggest that this is an aspect of undergraduate nursing education that requires significant consideration by curriculum developers.

Undergraduate nursing students' peformance in recognising and responding to sudden patient deterioration in high psychological fidelity simulated environments: Quantitative results from an Australian multi-centre study

- Bogossian, Fiona, Cooper, Simon J., Cant, Robyn, Beauchamp, Alison, Porter, Joanne, Kain, Victoria, Bucknall, Tracey, Phillips, Nicole

Authors: Bogossian, Fiona , Cooper, Simon J. , Cant, Robyn , Beauchamp, Alison , Porter, Joanne , Kain, Victoria , Bucknall, Tracey , Phillips, Nicole
Date: 2014
Type: Text , Journal article
Relation: Nurse Education Today Vol. 34, no. 5 (2014), p. 691-696
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Description: Objectives This paper reports the quantitative findings of the first phase of a larger program of ongoing research: Feedback Incorporating Review and Simulation Techniques to Act on Clinical Trends (FIRST2ACTTM). It specifically aims to identify the characteristics that may predict primary outcome measures of clinical performance, teamwork and situation awareness in the management of deteriorating patients. Design Mixed-method multi-centre study. Setting High fidelity simulated acute clinical environment in three Australian universities. Participants A convenience sample of 97 final year nursing students enrolled in an undergraduate Bachelor of Nursing or combined Bachelor of Nursing degree were included in the study. Method In groups of three, participants proceeded through three phases: (i) pre-briefing and completion of a multi-choice question test, (ii) three video-recorded simulated clinical scenarios where actors substituted real patients with deteriorating conditions, and (iii) post-scenario debriefing. Clinical performance, teamwork and situation awareness were evaluated, using a validated standard checklist (OSCE), Team Emergency Assessment Measure (TEAM) score sheet and Situation Awareness Global Assessment Technique (SAGAT). A Modified Angoff technique was used to establish cut points for clinical performance. Results Student teams engaged in 97 simulation experiences across the three scenarios and achieved a level of clinical performance consistent with the experts' identified pass level point in only 9 (1%) of the simulation experiences. Knowledge was significantly associated with overall teamwork (p = .034), overall situation awareness (p = .05) and clinical performance in two of the three scenarios (p = .032 cardiac and p = .006 shock). Situation awareness scores of scenario team leaders were low overall, with an average total score of 41%. Conclusions Final year undergraduate nursing students may have difficulty recognising and responding appropriately to patient deterioration. Improving pre-requisite knowledge, rehearsal of first response and team management strategies need to be a key component of undergraduate nursing students' education and ought to specifically address clinical performance, teamwork and situation awareness.

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