Identifying patient deterioration: using simulation and reflective interviewing to examine decision making skills in a rural hospital
- 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.
Managing women with acute physiological deterioration: student midwives performance in a simulated setting
- Authors: Cooper, Simon J. , Bulle, Bree , Biro, Mary Anne , Jones, Janet , Miles, Maureen , Gilmour, Carole , Buykx, Penny , Boland, Rosemarie , Kinsman, Leigh , Scholes, Julie , Endacott, Ruth
- Date: 2012
- Type: Text , Journal article
- Relation: Women and Birth Vol. 25, no. 3 (2012), p. e27-e36
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- Description: Abstract Objective Midwives’ ability to manage maternal deterioration and ‘failure to rescue’ are of concern with questions over knowledge, clinical skills and the implications for maternal morbidity and, mortality rates. In a simulated setting our objective was to assess student midwives’ ability to assess, and manage maternal deterioration using measures of knowledge, situation awareness and skill, performance. Methods An exploratory quantitative analysis of student performance based upon performance, ratings derived from knowledge tests and observational ratings. During 2010 thirty-five student, midwives attended a simulation laboratory completing a knowledge questionnaire and two video, recorded simulated scenarios. Patient actresses wearing a ‘birthing suit’ simulated deteriorating, women with post-partum and ante-partum haemorrhage (PPH and APH). Situation awareness was, measured at the end of each scenario. Applicable descriptive and inferential statistical tests were, applied to the data. Findings The mean total knowledge score was 75% (range 46–91%) with low skill performance, means for both scenarios 54% (range 39–70%). There was no difference in performance between the scenarios, however performance of key observations decreased as the women deteriorated; with significant reductions in key vital signs such as blood pressure and blood loss measurements. Situation, awareness scores were also low (54%) with awareness decreasing significantly (t(32) = 2.247, p = 0.032), in the second and more difficult APH scenario. Conclusion Whilst knowledge levels were generally good, skills were generally poor and decreased as the women deteriorated. Such failures to apply knowledge in emergency stressful situations may be resolved by repetitive high stakes and high fidelity simulation.
Patient deterioration education: Evaluation of face-to-face simulation and e-simulation approaches
- 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.