Measuring the safety climate in an Australian emergency department
- Authors: Connell, Clifford , Cooper, Simon J. , Endacott, Ruth
- Date: 2021
- Type: Text , Journal article
- Relation: International Emergency Nursing Vol. 58, no. (2021), p.
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- Description: Background: There are numerous intricate human, system and cultural factors that can impact upon the safe and effective implementation of patient safety systems (e.g. rapid response systems). Safety climate is one of these factors and is a measure of frontline healthcare workers’ shared perceptions, behaviours, beliefs and attitudes towards the organisation's culture of safety. Safety climate scores are also associated with the frequency of errors and adverse events in the healthcare setting. However, there is little evidence regarding the relationships between attitudes to patient safety and staff characteristics such as emergency care expertise and experience. The aims of this study were to measure perceptions of the safety climate in an Australian metropolitan Emergency Department and examine relationships between safety climate perceptions and staff characteristics. Methods: The Victorian Managed Insurance Authority Safety Climate Survey was administered to all doctors (n = 44) and nurses (n = 119) at an Australian emergency department. Results: Completed surveys were received from 127 (78%) respondents, 25 (52%) doctors and 100 (84%) nurses. Reliability analysis showed very good internal consistency of all 43-items of the survey (α = 0.94). With the exception of stress recognition, nurses rated the organisation's commitment to patient safety higher than doctors in all remaining attitudinal domains (p < 0.05). Both groups acknowledge that fatigue, increased workload and stress recognition negatively impacts upon patient safety. There was a significant trend for declining safety climate ratings related to participants’ clinical competence level and experience across all domains except stress recognition (p < 0.05). Conclusions: The Safety Climate Survey appears to be a reliable measure of patient safety climate for use in Emergency Departments. Emergency doctors and nurses did not perceive there to be a strong organisational commitment to patient safety in an Australian Emergency Department. Emergency Departments can provide a safer environment through genuine commitment to safety culture improvement which capitalises on the insights, intrinsic strengths and behaviours characteristic of the ED team's expertise and experience. This kind of commitment can positively influence the effectiveness of actions taken to minimise risk to patient safety and improve ED staff job satisfaction and effectiveness. © 2021 Elsevier Ltd
Practice priorities for acute care nursing : a Delphi study
- Authors: Connell, Clifford , Plummer, Virginia , Crawford, Kimberley , Endacott, Ruth , Foley, Pieternella , Griffiths, Debra , Innes, Kelli , Schwerdtle, Patricia , Walker, Lorraine , Morphet, Julia
- Date: 2020
- Type: Text , Journal article
- Relation: Journal of Clinical Nursing Vol. 29, no. 13-14 (2020), p. 2615-2625
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- Description: Aims and objectives: To describe the risk and frequency of challenges in acute care nursing, and the practice priorities in Australian hospital wards based upon expert consensus. Background: Health care is facing increasing demands that are negatively impacting upon the safety and quality of nursing care. Design: Delphi Method. Method: A three-round electronic Delphi method was used to collect and synthesise expert consensus opinion of 30 participants in Rounds One and Two of the survey, and 12 participants in Round Three. The study was carried out from July to December 2016. This study complied with the STROBE checklist. Results: High patient acuity or complexity, as well as inadequate bed space on wards, are “very high” risks that occur “often” and “very often,” respectively. The pressure to admit patients, delayed medical review and patient boarding are all “high” risks that occur “often.” Though only occurring “sometimes,” inadequate numbers and skill mix of staff, suboptimal communication and early or inappropriate discharge all pose a “very high” risk to patient care. Conclusion: The key practice priorities for nurse managers should include the design, implementation and evaluation of sustainable system-wide frameworks, processes and models of care that address patient boarding, communication and discharge processes, job satisfaction, staffing numbers and expertise. Relevance to clinical practice: This study provides a description of the challenges that face acute care nursing in the provision of safe and high-quality care. © 2020 John Wiley & Sons Ltd
Trade agreements and the risks for the nursing workforce, nursing practice and public health : A scoping review
- Authors: Kidgell, Dianna , Hills, Danny , Griffiths, Debra , Endacott, Ruth
- Date: 2020
- Type: Text , Journal article , Review
- Relation: International Journal of Nursing Studies Vol. 109, no. (2020), p. 1-10
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- Description: Background: Trade agreements in the 21st century have evolved to include provisions that affect domestic public policy and public health in signatory countries. There are growing calls for health professionals and public health advocates to pursue an active advisory role in trade negotiations in order to anticipate and prevent negative outcomes for health services and public health. Aim: This scoping review explored current literature to identify existing knowledge of the implications of trade agreements for the nursing workforce, nursing practice and public health using as an example the 2018 'Comprehensive and Progressive Agreement for Trans-Pacific Partnership'. Design: Scoping review Data sources: Emerald Insight, Informit, Ovid MEDLINE, PubMed, ProQuest, Scopus, and a number of specialist Economics, International Trade and Business, and International Relations databases. Grey literature included national and international policy documents. Review method: Literature was selected according to extraction field criteria, supplemented by hand searching of relevant grey literature and snowballing references from the selected literature reference lists. Analysis was undertaken to identify key themes emerging from the literature. Review results: Six key themes relevant to nursing workforce, nursing practice or public health were 1. Lack of consultation with public health and health professionals in trade negotiations; 2. Implications of strengthened intellectual property provisions for equitable access to medicines (including biologics) and medical devices; 3. Threats to government capacity to regulate domestic policy for public health and health services through 'Investor State Dispute Settlement' provisions 4. Threats to government capacity to regulate domestic policy for public health and health services through 'Regulatory Coherence' 5. Potential limited benefits to communities and increased health inequities 6. Potential implications of increased temporary migration. Gaps were identified in the literature for implications for nursing practice and the nursing workforce from regulatory and labour provisions of trade agreements. Conclusions: The analysis of the literature reviewed is of international importance for the nursing workforce, nursing practice and public health. Policymakers must anticipate and respond to how the inclusion of labour or regulatory provisions in trade agreements will affect nursing practice and the nursing workforce, and how this may subsequently impact on the health of communities globally. (C) 2020 Elsevier Ltd. All rights reserved.
What factors influence midwives to provide obstetric high dependency care on the delivery suite or request care be escalated away from the obstetric unit? Findings of a focus group study
- Authors: James, Alison , Cooper, Simon J. , Stenhouse, Elizabeth , Endacott, Ruth
- Date: 2019
- Type: Text , Journal article
- Relation: Bmc Pregnancy and Childbirth Vol. 19, no. 1 (2019), p. 1-15
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- Description: Background In the United Kingdom, midwives will engage in discussions with the multidisciplinary team as to whether they can provide Obstetric High Dependency Care (OHDC) on the Delivery Suite or whether a woman's care should be escalated to the critical care team. This study aimed to explore the question: What factors influence midwives to provide OHDC or request care be escalated away from the obstetric unit in hospitals remote from tertiary referral centres? Methods Focus groups were undertaken with midwives (n = 34) across three obstetric units in England, with annual birth rates ranging from 1500 to 5000 per annum, in District General Hospitals. Three scenarios in the form of video vignettes of handover were used as triggers for the focus groups. Scenario 1; severe pre-eclampsia, physiologically unstable 2; major postpartum haemorrhage requiring invasive monitoring 3; recent admission of woman with chest pain receiving facial oxygen and requiring continuous electrocardiogram (ECG) monitoring. Two focus groups were conducted in each of the obstetric units with experienced midwives. Data were analysed using a qualitative framework approach. Results Factors influencing midwives' care escalation decisions included the care environment, a woman's diagnosis and fetal or neonatal factors. The overall plan of care including the need for ECG and invasive monitoring were also influential factors. Midwives in the smallest obstetric unit did not have access to the facilities for OHDC provision. Midwives in the larger obstetric units provided OHDC but identified varying degrees of skill and sometimes used 'workarounds' to facilitate care provision. Midwifery staffing levels, skill mix and workload were also influential. Some differences of opinion were evident between midwives working in the same obstetric units as to whether OHDC could be provided and the support they would enlist to help them provide it. Reliance on clinical guidelines appeared variable. Conclusions Findings indicate that there may be inequitable OHDC provision at a local level. Organisationally robust systems are required to promote safe, equitable OHDC care including skills development for midwives and precise escalation guidelines to minimise workarounds. Training for midwives must include strategies that prevent skills fade.
A trial of e-simulation of sudden patient deterioration (FIRST2ACT WEB
- 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.
Designing a medical records review tool: An instructional guide
- Authors: McConnell-Henry, Tracy , Cooper, Simon J. , Endacott, Ruth , Porter, Joanne , Missen, Karen , Sparkes, Louise
- Date: 2015
- Type: Text , Journal article
- Relation: Contemporary Nurse Vol. 50, no. 1 (2015), p. 72-79
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- Description: Background: Medical Records Reviews (MRR) are commonly used in research and quality activities in health care, however, there is a paucity of literature offering a step by step guide to devising a reliable, user-friendly tool. Aim: This instructional paper focuses on the stages used to design and implement successful MRR using examples from two reviews in Australian rural hospitals investigating the responses of Registered Nurses to patient deterioration, and guided by time series principals. Methods: The MRR were conducted in two rural hospitals in conjunction with a simulation learning intervention where nurses rehearsed clinical management of a deteriorating patient. A six-step template is presented to guide practitioners on how to design and use a MRR tool. Conclusion: When well-planned and appropriately used, MRR provides an excellent means for examining patient outcomes in addition to safety and quality of care.
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.
Managing patient deterioration: assessing teamwork and individual performance
- Authors: Cooper, Simon J. , Cant, Robyn , Porter, Joanne , Missen, Karen , Sparkes, Louise , McConnell-Henry, Tracy , Endacott, Ruth
- Date: 2013
- Type: Text , Journal article
- Relation: Emergency Medicine Journal Vol. 30, no. 5 (2013), p.
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- Description: Objective To assess the ability of rural Australian nurse teams to manage deteriorating patients. Methods This quasi-experimental design used pre- and post-intervention assessments and observation to evaluate nurses' simulated clinical performance. Registered nurses (n=44) from two hospital wards completed a formative knowledge assessment and three team-based video recorded scenarios (Objective Structured Clinical Examinations (OSCE)). Trained patient actors simulated deteriorating patients. Skill performance and situation awareness were measured and team performance was rated using the Team Emergency Assessment Measure. Results Knowledge in relation to patient deterioration management varied (mean 63%, range 27–100%) with a median score of 64%. Younger nurses with a greater number of working hours scored the highest (p=0.001). OSCE performance was generally low with a mean performance of 54%, but performance was maintained despite the increasing complexity of the scenarios. Situation awareness was generally low (median 50%, mean 47%, range 17–83%, SD 14.03) with significantly higher levels in younger participants (r=−0.346, p=0.021). Teamwork ratings averaged 57% with significant associations between the subscales (Leadership, Teamwork and Task Management) (p<0.006), the global rating scale (p<0.001) and two of the OSCE measures (p<0.049). Feedback from participants following the programme indicated significant improvements in knowledge, confidence and competence (p<0.001). Conclusion Despite a satisfactory knowledge base, the application of knowledge was low with notable performance deficits in these demanding and stressful situations. The identification and management of patient deterioration needs to be taught in professional development programmes incorporating high fidelity simulation techniques. The Team Emergency assessment tool proved to be a valid measure of team performance in patient deterioration scenarios.
Clinical decision-making: midwifery students' recognition of, and response to, postpartum haemorrhage in the simulation environment
- Authors: Scholes, Julie , Endacott, Ruth , Biro, Mary Anne , Bulle, Bree , Cooper, Simon J. , Miles, Maureen , Gilmour, Carole , Buykx, Penny , Kinsman, Leigh , Boland, Rosemarie , Jones, Janet , Zaidi, Fawzia
- Date: 2012
- Type: Text , Journal article
- Relation: BMC Pregnancy and Childbirth Vol. 12, no. 19 (2012), p. 1-12
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- Description: Background This paper reports the findings of a study of how midwifery students responded to a simulated post partum haemorrhage (PPH). Internationally, 25% of maternal deaths are attributed to severe haemorrhage. Although this figure is far higher in developing countries, the risk to maternal wellbeing and child health problem means that all midwives need to remain vigilant and respond appropriately to early signs of maternal deterioration. Methods Simulation using a patient actress enabled the research team to investigate the way in which 35 midwifery students made decisions in a dynamic high fidelity PPH scenario. The actress wore a birthing suit that simulated blood loss and a flaccid uterus on palpation. The scenario provided low levels of uncertainty and high levels of relevant information. The student's response to the scenario was videoed. Immediately after, they were invited to review the video, reflect on their performance and give a commentary as to what affected their decisions. The data were analysed using Dimensional Analysis. Results The students' clinical management of the situation varied considerably. Students struggled to prioritise their actions where more than one response was required to a clinical cue and did not necessarily use mnemonics as heuristic devices to guide their actions. Driven by a response to single cues they also showed a reluctance to formulate a diagnosis based on inductive and deductive reasoning cycles. This meant they did not necessarily introduce new hypothetical ideas against which they might refute or confirm a diagnosis and thereby eliminate fixation error. Conclusions The students response demonstrated that a number of clinical skills require updating on a regular basis including: fundal massage technique, the use of emergency standing order drugs, communication and delegation of tasks to others in an emergency and working independently until help arrives. Heuristic devices helped the students to evaluate their interventions to illuminate what else could be done whilst they awaited the emergency team. They did not necessarily serve to prompt the students' or help them plan care prospectively. The limitations of the study are critically explored along with the pedagogic implications for initial training and continuing professional development.
Emergency training boosts confidence
- Authors: Buykx, Penny , Missen, Karen , Cooper, Simon J. , Porter, Joanne , McConnell-Henry, Tracy , Cant, Robyn , Kinsman, Leigh , Endacott, Ruth , Scholes, Julie
- Date: 2012
- Type: Text , Journal article
- Relation: Australian Nursing Journal Vol. 19, no. 7 (2012), p. 43
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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.
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.
Final -year nursing student's ability to assess, detect and act on clinical cues of deterioration in a simulated environment
- Authors: Endacott, Ruth , Cooper, Simon J. , Scholes, Julie , Kinsman, Leigh , McConnell-Henry, Tracy
- Date: 2010
- Type: Text , Journal article
- Relation: Journal of Advanced Nursing Vol. 66, no. 12 (2010), p. 2722-2731
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- Description: Aim. This is a report of a study investigating processes used by final-year nursing students to recognize and act on clinical cues of deterioration in a simulated environment. Background. Initial decisions about patients who are deteriorating in medical and surgical wards are often made by newly qualified nurses and doctors, increasing the risk of clinical error. There has been an emphasis on the use of teams in simulation; however, signs of deterioration are missed by individual clinicians. Methods. During July 2008, final-year undergraduate nursing students in Australia attended a simulation laboratory for 1Æ5 hours and completed a knowledge questionnaire and two (mannequin-based) scenarios simulating deteriorating patients with hypovolaemic and septic shock. Scenarios were video-recorded and reflective interviews conducted. Additionally, scenarios were stopped around the midpoint to ascertain students’ level of Situation Awareness. Results. Fifty-one students participated in the study, providing a total of 102 videoed scenarios and 51 interviews. Thematic analysis of video data and reflective interviews identified considerable differences in processes used by students to identify cues. Four aspects of cue recognition were evident: initial response, differential recognition of cues, accumulation of signs and diversionary activity. Conclusion. Nursing skills training should emphasize the importance of trends in identifying and acting on deterioration and the need for systematic assessment in stressful situations. Nursing curricula should focus on enhancing the ability to piece information together, including linking pathophysiology with patient assessment, and identify trends, rather than seeing observations as parallel to each other.
Mixed methods research: a design for emergency care research?
- Authors: Cooper, Simon J. , Porter, Joanne , Endacott, Ruth
- Date: 2010
- Type: Text , Journal article
- Relation: Emergency Medicine Journal Vol. 28, no. (2010), p. 682-685
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- Description: This paper follows previous publications on generic qualitative approaches, qualitative designs and action research in emergency care by this group of authors. Contemporary views on mixed methods approaches are considered, with a particular focus on the design choice and the amalgamation of qualitative and quantitative data emphasising the timing of data collection for each approach, their relative ‘weight’ and how they will be mixed. Mixed methods studies in emergency care are reviewed before the variety of methodological approaches and best practice considerations are presented. The use of mixed methods in clinical studies is increasing, aiming to answer questions such as ‘how many’ and ‘why’ in the same study, and as such are an important and useful approach to many key questions in emergency care.
Managing the deteriorating patient in a simulated environment: Nursing students' knowledge , skill, and situation awareness
- Authors: Cooper, Simon J. , Kinsman, Leigh , Buykx, Penny , McConnell-Henry, Tracy , Endacott, Ruth , Scholes, Julie
- Date: 2009
- Type: Text , Journal article
- Relation: Journal of Clinical Nursing Vol. 19, no. 15 (2009), p. 2309-2318
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- Description: Abstract AIM: To examine, in a simulated environment, the ability of final-year nursing students to assess, identify and respond to patients either deteriorating or at risk of deterioration. BACKGROUND: The early identification and management of patient deterioration has a major impact on patient outcomes. 'Failure to rescue' is of international concern, with significant concerns over nurses' ability to detect deterioration, the reasons for which are unknown. DESIGN: Mixed methods incorporating quantitative measures of performance (knowledge, skill and situation awareness) and, to be reported at a later date, a qualitative reflective review of decision processes. METHODS: Fifty-one final-year, final-semester student nurses attended a simulation laboratory. Students completed a knowledge questionnaire and two video-recorded simulated scenarios (mannequin based) to assess skill performance. The scenarios simulated deteriorating patients with hypovolaemic and septic shock. Situation awareness was measured by randomly stopping each scenario and asking a series of questions relating to the situation. RESULTS: The mean knowledge score was 74% (range 46-100%) and the mean skill performance score across both scenarios was 60% (range 30-78%). Skill performance improved significantly (p < 0.01) by the second scenario. However, skill performance declined significantly in both scenarios as the patient's condition deteriorated (hypovolaemia scenario: p = 0.012, septic scenario: p = 0.000). The mean situation awareness score across both scenarios was 59% (range 38-82%). Participants tended to identify physiological indicators of deterioration (77%) but had low comprehension scores (44%). CONCLUSION: Knowledge scores suggest, on average, a satisfactory academic preparation, but this study identified significant deficits in students' ability to manage patient deterioration. RELEVANCE TO CLINICAL PRACTICE: This study suggests that student nurses, at the point of qualification, may be inadequately prepared to identify and manage deteriorating patients in the clinical setting.
Qualitative Research: Specific designs for qualitative research in emergency care?
- Authors: Cooper, Simon J. , Chapman, Ysanne , Endacott, Ruth
- Date: 2009
- Type: Text , Journal article
- Relation: Emergency Medicine Journal Vol. 26, no. (2009), p. 773-776
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- Description: This article follows our description of generic qualitative approaches, focusing on the specific designs of ethnography, grounded theory and phenomenology. Distinguishing features are described, including methodological approaches and methods for enhancing rigour. The use of these designs in emergency care is unusual but informative, and important work has been produced. Whether used in a pure or applied manner, it is likely that such approaches will add to our understanding of the emergency world.