Patient safety elements taught to preregistration nurses using simulation designs : an integrative review
- Authors: Ryan, Colleen , Kurup, Chanchal , Cant, Robyn , Reid-Searl, Kerry , Johnson, Trish , Barlow, Melanie , Heaton, Leeanne
- Date: 2023
- Type: Text , Journal article , Review
- Relation: Clinical Simulation in Nursing Vol. 84, no. (2023), p.
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- Description: This integrative literature review aimed to examine preregistration nursing simulation-based education aligned to patient safety. Understanding quality standards and simulation best practices used to guide the simulation activities also featured. Eight data bases were searched using a standardized search strategy. A total of 33 studies met the inclusion criteria. Six patient safety standards featured in over 38 simulation scenarios, particularly the management of deteriorating patients. Students’ patient safety knowledge and simulated performances consistently returned significant gains following the interventions. Manikin-based, face to face delivery was the most commonly described simulation modality, followed by virtual simulation and virtual reality programmes. The evidence supports simulation as a beneficial technique for teaching patient safety in nursing education. In future, well planned controlled experimental studies are needed to deliver more evidence. Simulation design best practices aligned to international guidelines could be reported in more depth. © 2023
An update on the most influential nursing simulation studies : a bibliometric analysis
- Authors: Cant, Robyn , Cooper, Simon , Liaw, Sok
- Date: 2022
- Type: Text , Journal article
- Relation: Clinical Simulation in Nursing Vol. 69, no. (2022), p. 7-17
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- Description: Background: Simulation studies in nursing education are increasing, highlighting the need to identify the most cited and influential studies. Method: A bibliometric analysis aimed to describe performance characteristics of the top 40 cited nursing simulation studies within the last three years, mined from the Scopus database. Results: The top 40 studies were published between 2003 and 2017. There was a median study age of 13 years and citations ranged from 674 down to 70. Overall, using 2019 citations as a baseline, extracted articles showed strong citation gains of a median 21% over the last three years. The top cited studies focused on development of simulation-based education and associated learning outcomes. Literature reviews emerged as key information sources, accruing significantly higher citation counts than primary research and descriptive studies. Conclusions: The scholarship of evidenced based simulation is still maturing. Findings from this study enable an understanding of citation outcomes and foci for future impactful research. Additional mapping is required to further understand relationships between the research constituents. © 2022
The impact of emerging simulation-based technologies on the management of deteriorating patients : aiming for a gold standard educational evaluation
- Authors: Cooper, Simon J. , Cant, Robyn , Chung, Catherine , First Act Impact Team
- Date: 2020
- Type: Text , Journal article
- Relation: Clinical Simulation in Nursing Vol. 45, no. (2020), p. 50-59
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- Description: Background: Measuring the impact of patient safety interventions is challenging. This article aims to illustrate a “gold standard” model of program evaluation incorporating examples from two patient deterioration programs. Methods: Australian nurses were trained in primary responses to emergencies in four hospitals using either face-to-face (F2F) or screen-based simulation versions of a simulation program. Evaluation outcomes were measured using Kirkpatrick's evaluation hierarchy covering participant ‘reaction’, ‘learning’, ‘behaviour’ change and ‘results’—based on 1,564 pre–post intervention vital signs chart reviews. Results: Seventy-four nurses participated. Reaction—participant confidence/competence ratings and Learning improved significantly in both modalities (p <.001). Behaviour—oxygen delivery systems were used more appropriately after training in the F2F group (p =.037). Applicable recording of oxygen saturation (SpO2) improved significantly (p ≤.008) in both modalities. Results—at least a two-fold increase in the overall initiation of a clinical review after training, in both modalities (p <.001; effect: d = 0.41 F2F and d = 0.35 screen-based simulation). Conclusions: Kirkpatrick's evaluation model enables a suitable template for gold standard education evaluations. © 2020 International Nursing Association for Clinical Simulation and Learning
- Description: Funding details: State Government of Victoria, 31362
Bibliometric Scan of the 100 Most Cited Nursing Simulation Articles
- Authors: Cant, Robyn , Cooper, Simon J.
- Date: 2019
- Type: Text , Journal article
- Relation: Clinical Simulation in Nursing Vol. 36, no. (2019), p. 1-7
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- Description: Background: Bibliometrics involves statistical analyses of publication data, particularly citation analysis, to determine popularity/impact of articles and authors. Methods: Citation analysis was conducted on the "top 100'' cited nursing simulation articles in the Scopus database in April 2019. Results: The median number of article citations was 84 (mean = 100.4; range, 53-557). Citations were steadily accumulated after publication; the majority between year four and year seven. Two-thirds of the articles were led by authors from the United States. Conclusions: This report on bibliometric mapping helps to graphically illustrate the evolution of simulation articles in the field of nursing.
Exploring the extent to which simulation-based education addresses contemporary patient safety priorities : a scoping review
- Authors: Seaton, Philippa , Levett-Jones, Tracy , Cant, Robyn , Cooper, Simon , Kelly, Michelle , McKenna, Lisa , Ng, Linda , Bogossian, Fiona
- Date: 2019
- Type: Text , Journal article , Review
- Relation: Collegian Vol. 26, no. 1 (2019), p. 194-203
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- Description: Background: There is unprecedented increase in use of simulation-based education in healthcare settings. The key driver is improving quality and safety in healthcare. To date, there is limited understanding of the degree to which this goal has been achieved. Aim: This scoping review aimed to explore the extent to which simulation-based education in healthcare has addressed and impacted contemporary patient safety priorities. Methods: Systematic searches of literature (2007–2016) were based on each of 10 patient safety priorities articulated in Australia's National Safety and Quality Health Service Standards and New Zealand's Health, Quality and Safety Indicators and markers. Included primary studies evaluated transferability to practice and/or behavioural change and improved patient outcomes, based on Kirkpatrick's training evaluation model Level 3 and Level 4. Findings: Fifteen papers met inclusion criteria. Studies aligned with four of ten National Safety and Quality Health Service Standards: (3). Preventing and controlling healthcare associated infections; (4). Medication safety; (6). Clinical handover; (9). Recognising and responding to clinical deterioration. The studies were indicative of potential for simulation-based education to have a significant impact on patient safety. Discussion: Studies that qualify as translational science, demonstrating changes in clinician behaviours and improved patient outcomes, are emerging. Little evidence from Australian and New Zealand contexts suggests that outcomes of simulation-based education in this region are not commensurate with the significant government investments. Conclusion: Translational studies, despite being difficult to design and conduct, should form part of a thematic, sustained and cumulative program of simulation-based research to identify translational science. © 2018 Australian College of Nursing Ltd
What's in a name? Clarifying the nomenclature of virtual simulation
- Authors: Cant, Robyn , Cooper, Simon J. , Sussex, Roland , Bogossian, Fiona
- Date: 2019
- Type: Text , Journal article
- Relation: Clinical Simulation in Nursing Vol. 27, no. (2019), p. 26-30
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- Description: Clinical simulation is an essential component of health professional education. Digital technologies can provide students with near-reality, interactive virtual simulation learning experiences on static and mobile appliances. Clarification is needed, however, regarding the various types of virtual simulation and the different program components. We drew on published literature to define virtual simulation modalities and to offer definitive terminology to clarify the nomenclature and composition of virtual simulation. Reporting should include description of ‘Fidelity’ ‘Immersion’ and ‘Patient’ to add clarity and utility to research in the field.
The educational impact of web-based and face-to-face patient deterioration simulation programs : An interventional trial
- Authors: Chung, Catherine , Cooper, Simon J. , Cant, Robyn , Connell, Cliff , McKay, Angela , Kinsman, Leigh , Gazula, Swapnali , Boyle, Jayne , Cameron, Amanda , Cash, Penelope , Evans, Lisa , Kim, Jeong-Ah , Masud, Rana , McInnes, Denise , Norman, Lisa , Penz, Erika , Rotter, Thomas , Tanti, Erin , Breakspear, Tom
- Date: 2018
- Type: Text , Journal article
- Relation: Nurse Education Today Vol. 64, no. (2018), p. 93-98
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- Description: Background: There are international concerns relating to the management of patient deterioration. The “failure to rescue” literature identifies that nursing staff miss cues of deterioration and often fail to call for assistance. Simulation-based educational approaches may improve nurses’ recognition and management of patient deterioration. Objectives: To investigate the educational impact of the First2Act web-based (WB) and face-to-face (F2F) simulation programs. Design & Setting: A mixed methods interventional cohort trial with nursing staff from four Australian hospitals. Participants: Nursing staff working in four public and private hospital medical wards in the State of Victoria. Methods: In 2016, ward nursing staff (n = 74) from a public and private hospital completed three F2F laboratory-based team simulations with a patient actor in teams of three. 56 nursing staff from another public and private hospital individually completed a three-scenario WB simulation program (First2ActWeb) [A 91% participation rate]. Validated tools were used to measure knowledge (multi-choice questionnaire), competence (check-list of actions) and confidence (self-rated) before and after the intervention. Results: Both WB and F2F participants’ knowledge, competence and confidence increased significantly after training (p ≤0.001). Skill performance for the WB group increased significantly from 61% to 74% (p ≤ 0.05) and correlated significantly with post-test knowledge (p = 0.014). No change was seen in the F2F groups’ performance scores. Course evaluations were positive with median ratings of 4/5 (WB) and 5/5 (F2F). The F2F program received significantly more positive evaluations than the WB program (p < 0.05), particularly with regard to quality of feedback. Conclusion: WB and F2F simulation are effective education strategies with both programs demonstrating positive learning outcomes. WB programs increase ease of access to training whilst F2F enable the development of tactile hands on skills and teamwork. A combined blended learning education strategy is recommended to enhance competence and patient safety. © 2018 Elsevier Ltd
The value of simulation-based learning in pre-licensure nurse education : A state-of-the-art review and meta-analysis
- Authors: Cant, Robyn , Cooper, Simon J.
- Date: 2017
- Type: Text , Journal article , Review
- Relation: Nurse Education in Practice Vol. 27, no. (2017), p. 45-62
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- Description: Simulation modalities are numerous in nursing education, with a need to reveal their range and impact. We reviewed current evidence for effectiveness of medium to high fidelity simulation as an education mode in pre-licensure/pre-registration nurse education. A state-of-the-art review and meta-analyses was conducted based on a systematic search of publications in English between 2010 and 2015. Of 72 included studies, 43 were quantitative primary studies (mainly quasi-experimental designs), 13 were qualitative studies and 16 were reviews of literature. Forty of 43 primary studies reported benefits to student learning, and student satisfaction was high. Simulation programs provided multi-modal ways of learning. A meta-analysis (8 studies, n = 652 participants) identified that simulation programs significantly improved clinical knowledge from baseline. The weighted mean increase was 5.0 points (CI: 3.25–6.82) on a knowledge measure. Other objectively rated measures (eg, trained observers with checklists) were few. Reported subjective measures such as confidence and satisfaction when used alone have a strong potential for results bias. Studies presented valid empirical evidence, but larger studies are required. Simulation programs in pre-licensure nursing curricula demonstrate innovation and excellence. The programs should be shared across the discipline to facilitate development of multimodal learning for both pre-licensure and postgraduate nurses.
- Description: Simulation modalities are numerous in nursing education, with a need to reveal their range and impact. We reviewed current evidence for effectiveness of medium to high fidelity simulation as an education mode in pre-licensure/pre-registration nurse education. A state-of-the-art review and meta-analyses was conducted based on a systematic search of publications in English between 2010 and 2015. Of 72 included studies, 43 were quantitative primary studies (mainly quasi-experimental designs), 13 were qualitative studies and 16 were reviews of literature. Forty of 43 primary studies reported benefits to student learning, and student satisfaction was high. Simulation programs provided multi-modal ways of learning. A meta-analysis (8 studies, n = 652 participants) identified that simulation programs significantly improved clinical knowledge from baseline. The weighted mean increase was 5.0 points (CI: 3.25–6.82) on a knowledge measure. Other objectively rated measures (eg, trained observers with checklists) were few. Reported subjective measures such as confidence and satisfaction when used alone have a strong potential for results bias. Studies presented valid empirical evidence, but larger studies are required. Simulation programs in pre-licensure nursing curricula demonstrate innovation and excellence. The programs should be shared across the discipline to facilitate development of multimodal learning for both pre-licensure and postgraduate nurses. © 2017 Elsevier Ltd
Simulation in the Internet age: The place of Web-based simulation in nursing education. An integrative review
- Authors: Cant, Robyn , Cooper, Simon J.
- Date: 2014
- Type: Text , Journal article
- Relation: Nurse Education Today Vol. 34, no. 12 (2014), p. 1435-1442
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- Description: Objective The objective of this article was to review the literature on utilisation and place of Web-based simulation within nursing education. Web-based simulation combines electronic multimedia options with a central video or virtual world to produce interactive learning activities mediated by the learner. Design An integrative review. Data sources A search was conducted of healthcare databases between 2000 and 2014 and of Internet sources for hosted simulation programs in nursing. Eighteen primary programs were identified for inclusion. Review methods A strategy for integrative review was adopted in which studies were identified, filtered, classified, analysed and compared. Results and discussion Of 18 programs, two game-based programs were identified which represented a ‘virtual world’ in which students could simultaneously or individually immerse themselves in a character role-play. However, most programs (n = 10) taught an aspect of procedural patient care using multimedia (e.g. video, audio, graphics, quiz, text, memo). Time-limited sequences, feedback and reflective activities were often incorporated. Other studies (n = 8) taught interpersonal communication skills or technical skills for equipment use. Descriptive study outcomes indicated ease of program use, strong satisfaction with learning and appreciation of program accessibility. Additionally, four studies reported significant improvements in knowledge post-intervention. Conclusion Web-based simulation is highly acceptable to students and appears to provide learning benefits that align with other simulation approaches and it augments face-to-face teaching. Web-based simulation is likely to have a major place in nursing curricula in the next decade, yet further research is necessary to objectively evaluate learner outcomes and to justify its use.
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
- 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.
Managing patient deterioration: A protocol for enhancing student nurses' competence through web-based simulation and feedback techniques
- 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 simulation experiences: impact on teaching and learning
- Authors: Buykx, Penny , Cooper, Simon J. , Kinsman, Leigh , Scholes, Julie , McConnell-Henry, Tracy , Cant, Robyn
- Date: 2012
- Type: Text , Journal article
- Relation: Collegian: Journal of the Royal College of Nursing Australia Vol. 19, no. 3 (2012), p. 125-129
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- Description: Early recognition and management of patient deterioration are essential nursing skills, and can be improved through education and experience. However, both nursing students and registered nurses may have few opportunities to develop and maintain the emergency management skills necessary to ensure patient safety. Using both theory and empirical evidence, we have developed a simulation-based educational model, ‘FIRST2ACT’ (Feedback Incorporating Review and Simulation Techniques to Act on Clinical Trends), to provide nurses with a high-fidelity learning experience. The model has been tested in three different settings: it is highly acceptable to learners, adaptable to different training needs, and shows promise in improving actual clinical performance.
Simulation based learning in midwifery education: a systematic review
- Authors: Cooper, Simon J. , Cant, Robyn , Porter, Joanne , Bogossian, Fiona , McKenna, Lisa , Brady, Susannah , Fox-Young, Stephanie
- Date: 2012
- Type: Text , Journal article
- Relation: Women and Birth Vol. 25, no. 2 (2012), p. 64-78
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- Description: Abstract Aim To critically examine the evidence for simulation based learning in midwifery education. Background Simulated Learning Programs (SLPs) using low to high fidelity techniques are common in obstetric professionals’ education and focus on the development of team work, labour and obstetric emergencies. Review methods A systematic review incorporating critical appraisal approaches, setting clear objectives and a defined search and analysis strategy. Evidence from obstetrics, neonatology, technical and non-technical skills (teamwork) was included where it informed the development of midwifery curricula. Studies in English from 2000 to 2010 were included searching CINAHL Plus, OVID Medline, Cochrane, SCOPUS and ProQuest and Google Scholar. Results Twenty-four papers were identified that met the inclusion criteria. All were quantitative reports; outcomes and levels of evidence varied with two notable papers indicating that simulation had an impact on clinical practice. Benefits of SLP over didactic formats were apparent, as were the development of non-technical skills confidence and competence. The study outcomes were limited by the range of evidence and context of the reports which focussed on obstetric emergency training using a number of simulation techniques. Conclusion There is evidence that simulated learning of midwifery skills is beneficial. Simulation learning has an educational and clinical impact and advantages over didactic approaches. Where clinical practice is infrequent i.e. obstetric emergencies, simulation is an essential component of curricula. Simulation enhances practice and therefore may reduce the time taken to achieve competence; however there is no evidence from the literature that simulation should replace clinical practice.
The FIRST2ACT simulation program improves nursing practice in a rural Australian hospital
- Authors: Kinsman, Leigh , Buykx, Penny , Cant, Robyn , Champion, Robert , Cooper, Simon J. , Endacott, Ruth , McConnell-Henry, Tracy , Missen, Karen , Porter, Joanne , Scholes, Julie
- Date: 2012
- Type: Text , Journal article
- Relation: Australian Journal of Rural Health Vol. 20, no. 5 (2012), p. 270-274
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- Description: Objective: To measure the impact of the Feedback Incorporating Review and Simulation Techniques to Act on Clinical Trends (FIRST2ACT) simulation program on nursing observations and practice relevant to patient deterioration in a rural Australian hospital. Design: Interrupted time series analysis. Setting: A rural Australian hospital. Participants: All registered nurses (Division 1) employed on an acute medical/surgical ward. Intervention: The FIRST2ACT simulation program. Outcome measures: Appropriate frequency of a range of observations and administration of oxygen therapy. Results: Thirty-four nurses participated (83% of eligible nurses) in the FIRST2ACT program, and 258 records were audited before the program and 242 records after. There were statistically significant reductions in less than satisfactory frequency of observations (P = 0.009) and pain score charting (P = 0.003). There was no measurable improvement in the administration of oxygen therapy (P = 0.143), while the incidence of inappropriate nursing practice for other measures both before and after the intervention was too low to warrant analysis. Conclusion: FIRST2ACT was associated with measurable improvements in nursing practice.
FIRST2ACT: Educating nurses to identify patient deterioration - a theory-based model for best practice simulation education
- Authors: Buykx, Penny , Kinsman, Leigh , Cooper, Simon J. , McConnell-Henry, Tracy , Cant, Robyn , Endacott, Ruth
- Date: 2011
- Type: Text , Journal article
- Relation: Nurse Education Today Vol. 31, no. 7 (2011), p. 687-693
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- Description: Delayed assessment and mismanagement of patient deterioration is a substantial problem for which educational preparation can have an impact. This paper describes the development of the FIRST2ACT simulation model based on well-established theory and contemporary empirical evidence. The model combines evidence-based elements of assessment, simulation, self-review and expert feedback, and has been tested in undergraduate nurses, student midwives and post-registration nurses. Participant evaluations indicated a high degree of satisfaction and substantial self-rated increases in knowledge, confidence and competence. This evidence-based model should be considered for both undergraduate and post-registration education programs.
Managing deteriorating patients: Registered nurses' performance in a simulated setting
- Authors: Cooper, Simon J. , McConnell-Henry, Tracy , Cant, Robyn , Porter, Joanne , Missen, Karen , Kinsman, Leigh , Endacott, Ruth , Scholes, Julie
- Date: 2011
- Type: Text , Journal article
- Relation: The Open Nursing Journal Vol. 5, no. (2011), p. 120-126
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- Description: Aim: To examine, in a simulated environment, rural nurses’ ability to assess and manage patient deterioration using measures of knowledge, situation awareness and skill performance. Background: Nurses’ ability to manage deterioration and ‘failure to rescue’ are of significant concern with questions over knowledge and clinical skills. Simulated emergencies may help to identify and develop core skills. Methods: An exploratory quantitative performance review. Thirty five nurses from a single ward completed a knowledge questionnaire and two video recorded simulated scenarios in a rural hospital setting. Patient actors simulated deteriorating patients with an Acute Myocardial Infarction (AMI) and Chronic Obstructive Pulmonary Disease (COPD) as the primary diagnosis. How aware individuals were of the situation (levels of situation awareness) were measured at the end of each scenario. Results: Knowledge of deterioration management varied considerably (range: 27%-91%) with a mean score of 67%. Average situation awareness scores and skill scores across the two scenarios (AMI and COPD) were low (50%) with many important observations and actions missed. Participants did identify that ‘patients’ were deteriorating but as each patient deteriorated staff performance declined with a reduction in all observational records and actions. In many cases, performance decrements appeared to be related to high anxiety levels. Participants tended to focus on single signs and symptoms and failed to use a systematic approach to patient assessment. Conclusion: Knowledge and skills were generally low in this rural hospital sample with notable performance decrements as patients acutely declined. Educational models that incorporate high fidelity simulation and feedback techniques are likely to have a significant positive impact on performance.