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.
Best practice in clinical simulation education − are we there yet? A cross-sectional survey of simulation in Australian and New Zealand pre-registration nursing education
- Authors: Bogossian, Fiona , Cooper, Simon J. , Kelly, Michelle , Levett-Jones, Tracy , McKenna, Lisa , Slark, Julia , Seaton, Philippa
- Date: 2018
- Type: Text , Journal article
- Relation: Collegian Vol. 25, no. 3 (2018), p. 327-334
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- Description: Background: Simulation is potentially a means of increasing clinical education capacity. Significant investments have been made in simulation but the extent to which this has improved uptake, quality and diversity of simulation use is unclear. Aim: To describe the current use of simulation in tertiary nursing education programs leading to nurse registration Australia and New Zealand, and determine whether investments in simulation have improved uptake, quality and diversity of simulation experiences. Methods: A cross sectional electronic survey distributed to lead nursing academics in programs leading to nurse registration in Australia and New Zealand. Findings: 51.6% of institutions responded and reported wide variation in allocation of program hours to clinical and simulation learning. Simulation was embedded in curricula and positively valued as an adjunct or substitute for clinical placement. While simulation environments were adequate, staff time, training and resource development were barriers to increasing the quality, amount and range of simulation experiences. Quality assurance and robust evaluation were weak. Discussion: Simulation program hours are inconsistently reported and underutilized in terms of potential contribution to clinical learning. Benefits of capital investment in simulation physical resources have been realised, but barriers persist for increasing high quality simulation in nursing programs. Conclusion: Transitioning components of clinical education from the clinical to tertiary sectors has resource implications. Establishment of sustainable, high quality simulation experiences requires staff training, shared resources, best practice and robust evaluation of simulation experiences in nursing curricula. © 2017 Australian College of Nursing Ltd
An analysis of nursing students’ decision-making in teams during simulations of acute patient deterioration
- 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
Leadership and teamwork in medical emergencies: Performance of nursing students and registered nurses in simulated patient scenarios
- Authors: Endacott, Ruth , Bogossian, Fiona , Cooper, Simon J. , Forbes, Helen , Kain, Victoria , Young, Susan , Porter, Joanne , First2Act Team
- Date: 2015
- Type: Text , Journal article
- Relation: Journal of Clinical Nursing Vol. 24, no. 1-2 (2015), p. 90-100
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- Description: Aims and objectivesTo examine nursing students' and registered nurses' teamwork skills whilst managing simulated deteriorating patients.Background Studies continue to show the lack of timely recognition of patient deterioration. Management of deteriorating patients can be influenced by education and experience.DesignMixed methods study conducted in two universities and a rural hospital in Victoria, and one university in Queensland, Australia.Methods Three simulation scenarios (chest pain, hypovolaemic shock and respiratory distress) were completed in teams of three by 97 nursing students and 44 registered nurses, equating to a total of 32 student and 15 registered nurse teams. Data were obtained from (1) Objective Structured Clinical Examination rating to assess performance; (2) Team Emergency Assessment Measure scores to assess teamwork; (3) simulation video footage; (4) reflective interview during participants' review of video footage. Qualitative thematic analysis of video and interview data was undertaken.ResultsObjective structured clinical examination performance was similar across registered nurses and students (mean 54% and 49%); however, Team Emergency Assessment Measure scores differed significantly between the two groups (57% vs 38%, t = 6·841, p < 0·01). In both groups, there was a correlation between technical (Objective Structured Clinical Examination) and nontechnical (Team Emergency Assessment Measure) scores for the respiratory distress scenario (student teams: r = 0·530, p = 0·004, registered nurse teams r = 0·903, p < 0·01) and hypovolaemia scenario (student teams: r = 0·534, p = 0·02, registered nurse teams: r = 0·535, p = 0·049). Themes generated from the analysis of the combined quantitative and qualitative data were as follows: (1) leadership and followership behaviours; (2) help-seeking behaviours; (3) reliance on previous experience; (4) fixation on a single detail; and (5) team support.Conclusions There is scope to improve leadership, team work and task management skills for registered nurses and nursing students. Simulation appears to be beneficial in enabling less experienced staff to assess their teamwork skills.Relevance to clinical practiceThere is a need to encourage less experienced staff to become leaders and for all staff to develop improved teamwork skills for medical emergencies.
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.
The perspectives of Australian midwifery academics on barriers and enablers for simulation in midwifery education in Australia: a focus group study
- Authors: Fox-Young, Stephanie , Brady, Susannah , Brealy, W , Cooper, Simon J. , McKenna, Lisa , Hall, Helen , Bogossian, Fiona
- Date: 2012
- Type: Text , Journal article
- Relation: Midwifery Vol. 28, no. 4 (2012), p. 435-441
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- Description: Objective: To describe Australian midwifery academics' perceptions of the current barriers and enablers for simulation in midwifery education in Australia and the potential and resources required for simulation to be increased. Design: A series of 11 focus groups/interviews were held in all states and territories of Australia with 46 participating academics nominated by their heads of discipline from universities across the country. Findings: Three themes were identified relating to barriers to the extension of the use of simulated learning environments (SLEs) ('there are things that you can't simulate'; 'not having the appropriate resources'; and professional accreditation requirements) and three themes were identified to facilitate SLE use ('for the bits that you're not likely to see very often in clinical'; ['for students] to figure something out before [they] get to go out there and do it on the real person'; and good resources and support). Key conclusion: Although barriers exist to the adoption and spread of simulated learning in midwifery, there is a long history of simulation and a great willingness to enhance its use among midwifery academics in Australia. Implications for practice: While some aspects of midwifery practice may be impossible to simulate, more collaboration and sharing in the development and use of simulation scenarios, equipment, space and other physical and personnel resources would make the uptake of simulation in midwifery education more widespread. Students would therefore be exposed to the best available preparation for clinical practice contributing to the safety and quality of midwifery care.
Is simulation a substitute for real life clinical experiences in Midwifery? A qualitative examination of the perceptions of educational leaders
- Authors: McKenna, Lisa , Bogossian, Fiona , Hall, Helen , Bady, S , Fox-Young, Stephanie , Cooper, Simon J.
- Date: 2011
- Type: Text , Journal article
- Relation: Nurse Education Today Vol. 31, no. 7 (2011), p. 682-686
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- Description: This paper describes the perceptions of midwifery educational leaders concerning the potential for simulation to provide a realistic experience in midwifery education. A qualitative design was employed using focus groups which were audio-taped and transcribed verbatim. Data were analysed using thematic analysis. Eleven focus groups were conducted with 46 key midwifery academics across Australia. Three main themes emerged relating to realism and simulation in midwifery practice: 'we already use a lot of simulation', 'level of realism of manikins', and 'some things cannot be simulated'. Simulation is currently widely used in midwifery education, but this is limited due to realism of available models and equipment. Despite this, within a woman-centred, holistic approach to care there are many aspects of midwifery practice that cannot be easily simulated. There is a need for research and development of realistic simulation approaches to support the enhanced use of simulation. Furthermore, strategies for developing approaches that reflect midwifery care provision need to be developed.