Managing deteriorating patients: Registered nurses' performance in a simulated setting
- Cooper, Simon J., McConnell-Henry, Tracy, Cant, Robyn, Porter, Joanne, Missen, Karen, Kinsman, Leigh, Endacott, Ruth, Scholes, Julie
- 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.
- 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
- Full Text:
- Reviewed:
- 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.
- Endacott, Ruth, Scholes, Julie, Cooper, Simon J., McConnell-Henry, Tracy, Porter, Joanne, Missen, Karen, Kinsman, Leigh, Champion, Robert
- Authors: Endacott, Ruth , Scholes, Julie , Cooper, Simon J. , McConnell-Henry, Tracy , Porter, Joanne , Missen, Karen , Kinsman, Leigh , Champion, Robert
- Date: 2012
- Type: Text , Journal article
- Relation: International Journal of Nursing Studies Vol. 49, no. 6 (2012), p. 710-717
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- Description: Objectives The study aim was to examine how Registered Nurses identify and respond to deteriorating patients during in-hospital simulation exercises. Design Mixed methods study using simulated actors. Setting A rural hospital in Victoria, Australia. Participants Thirty-four Registered Nurses each completed two simulation exercises. Methods Data were obtained from the following sources: (a) Objective Structured Clinical Examination (OSCE) rating to assess performance of Registered Nurses during two simulation exercises (chest pain and respiratory distress); (b) video footage of the simulation exercises; (c) reflective interview during participants’ review of video footage. Qualitative thematic analysis of video and interview data was undertaken. Results Themes generated from the data were: (1) exhausting autonomous decision-making; (2) misinterpreting the evidence; (3) conditioned response; and (4) missed cues. Assessment steps were more likely to be omitted in the chest pain simulation, for which there was a hospital protocol in place. Conclusions Video review revealed additional insights into nurses’ decision-making that were not evident from OSCE scoring alone. Feedback during video review was a highly valued component of the simulation exercises.
The impact of web-based and face-to-face simulation on patient deterioration and patient safety : Protocol for a multi-site multi-method design
- Cooper, Simon J., Kinsman, Leigh, Chung, Catherine, Cant, Robyn, Boyle, Jayne, Bull, Loretta, Cameron, Amanda, Connell, Cliff, Kim, Jeong-Ah, McInnes, Denise, McKay, Angela, Nankervis, Katrina, Penz, Erika, Rotter, Thomas
- Authors: Cooper, Simon J. , Kinsman, Leigh , Chung, Catherine , Cant, Robyn , Boyle, Jayne , Bull, Loretta , Cameron, Amanda , Connell, Cliff , Kim, Jeong-Ah , McInnes, Denise , McKay, Angela , Nankervis, Katrina , Penz, Erika , Rotter, Thomas
- Date: 2016
- Type: Text , Journal article
- Relation: BMC Health Services Research Vol. 16, no. 1 (2016), p. 1-8
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- Description: Background: There are international concerns in relation to the management of patient deterioration which has led to a body of evidence known as the 'failure to rescue' literature. Nursing staff are known to miss cues of deterioration and often fail to call for assistance. Medical Emergency Teams (Rapid Response Teams) do improve the management of acutely deteriorating patients, but first responders need the requisite skills to impact on patient safety. Methods/design: In this study we aim to address these issues in a mixed methods interventional trial with the objective of measuring and comparing the cost and clinical impact of face-to-face and web-based simulation programs on the management of patient deterioration and related patient outcomes. The education programs, known as 'FIRST2ACT', have been found to have an impact on education and will be tested in four hospitals in the State of Victoria, Australia. Nursing staff will be trained in primary (the first 8 min) responses to emergencies in two medical wards using a face-to-face approach and in two medical wards using a web-based version FIRST2ACTWeb. The impact of these interventions will be determined through quantitative and qualitative approaches, cost analyses and patient notes review (time series analyses) to measure quality of care and patient outcomes. Discussion: In this 18 month study it is hypothesised that both simulation programs will improve the detection and management of deteriorating patients but that the web-based program will have lower total costs. The study will also add to our overall understanding of the utility of simulation approaches in the preparation of nurses working in hospital wards. (ACTRN12616000468426, retrospectively registered 8.4.2016). © 2016 The Author(s).
- Authors: Cooper, Simon J. , Kinsman, Leigh , Chung, Catherine , Cant, Robyn , Boyle, Jayne , Bull, Loretta , Cameron, Amanda , Connell, Cliff , Kim, Jeong-Ah , McInnes, Denise , McKay, Angela , Nankervis, Katrina , Penz, Erika , Rotter, Thomas
- Date: 2016
- Type: Text , Journal article
- Relation: BMC Health Services Research Vol. 16, no. 1 (2016), p. 1-8
- Full Text:
- Reviewed:
- Description: Background: There are international concerns in relation to the management of patient deterioration which has led to a body of evidence known as the 'failure to rescue' literature. Nursing staff are known to miss cues of deterioration and often fail to call for assistance. Medical Emergency Teams (Rapid Response Teams) do improve the management of acutely deteriorating patients, but first responders need the requisite skills to impact on patient safety. Methods/design: In this study we aim to address these issues in a mixed methods interventional trial with the objective of measuring and comparing the cost and clinical impact of face-to-face and web-based simulation programs on the management of patient deterioration and related patient outcomes. The education programs, known as 'FIRST2ACT', have been found to have an impact on education and will be tested in four hospitals in the State of Victoria, Australia. Nursing staff will be trained in primary (the first 8 min) responses to emergencies in two medical wards using a face-to-face approach and in two medical wards using a web-based version FIRST2ACTWeb. The impact of these interventions will be determined through quantitative and qualitative approaches, cost analyses and patient notes review (time series analyses) to measure quality of care and patient outcomes. Discussion: In this 18 month study it is hypothesised that both simulation programs will improve the detection and management of deteriorating patients but that the web-based program will have lower total costs. The study will also add to our overall understanding of the utility of simulation approaches in the preparation of nurses working in hospital wards. (ACTRN12616000468426, retrospectively registered 8.4.2016). © 2016 The Author(s).
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.
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