Description:
Nursing students are required to develop clinical knowledge, skills and attitudes for professional practice. However, objectivity and parity of students' clinical assessments has been questioned. In the last decade, more objective techniques have been developed, with increased use of Objective Structured Clinical Examinations. We reviewed objective clinical assessment measures used in preregistration nursing courses to determine utilization and the validity and reliability of assessment techniques. A systematic search was made of quantitative research publications between 2000 and May 2011, identifying 16 studies that were subsequently reviewed. The validity and reliability of studies varied, with six studies judged as high quality, using various methodologies. This paper describes methods of instrument development and reports on their application in preregistration nursing programs.
Description:
Nursing management of physical deterioration of patients within acute mental health settings is observed, recorded, and actively managed with the use of standardized Adult Deterioration Detection System (ADDS) charts. Patient deterioration may require the urgent assistance of a hospital rapid response or Medical Emergency Team. A five-and-a-half-year (2011–2016) audit of hospital-wide Medical Emergency Team attendances was conducted in an acute mental health unit of a single large 250 bed regional hospital in Victoria, Australia. Data were extracted from the hospitals’ quality and patient safety program, RISKMan, and entered into a statistical data program for analysis. A total of 140 patient records were analysed, and the ‘Worried’ category (34%, n = 47) was the principle reason for a Medical Emergency Team call in a mental health ward, followed by hypotension (23%, n = 31) and a low Glasgow Coma Score (16%, n = 22). Upon further investigation of the ‘Worried’ category, the most common conditions recorded were an altered conscious state (22%, n = 9), low oxygen saturation (20%, n = 8), or chest pain (17%, n = 7). Activation of Medical Emergency Team calls predominantly occurred in the daylight morning hours (6am–12md). When data were compared to the general hospital patients, the context of the physiological deterioration of the mental health patients was strikingly similar. Further research is recommended to ascertain the extent and frequency with which staff working in mental health units are performing vital signs monitoring as an essential component of detection of early signs of physiological deterioration.
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.
Description:
Simulation-based education has become a ubiquitous teaching approach in nursing. However, ensuring the quality of simulation research is critical. We reviewed the methodological quality of 26 quantitative studies published in Clinical Simulation in Nursing, 2017. The Medical Education Research Study Quality Instrument and Simulation Research Evaluation Rubric showed that nearly all studies were of moderate to high quality (rated ≥50%). Correlation coefficients showed that interrater agreement was high overall (≥0.94). In conclusion, this was a valid approach for examining simulation study quality. Although most included studies were of high quality, some elements of study reporting can be improved upon.
Description:
Simulation-based education has become a ubiquitous teaching approach in nursing. However, ensuring the quality of simulation research is critical. We reviewed the methodological quality of 26 quantitative studies published in Clinical Simulation in Nursing, 2017. The Medical Education Research Study Quality Instrument and Simulation Research Evaluation Rubric showed that nearly all studies were of moderate to high quality (rated ≥50%). Correlation coefficients showed that interrater agreement was high overall (≥0.94). In conclusion, this was a valid approach for examining simulation study quality. Although most included studies were of high quality, some elements of study reporting can be improved upon.
Description:
Introduction: Emergency nurses are at risk of compassion fatigue. Compassion fatigue caused by exposure to suffering may compromise the individual's personal wellbeing and reduce work efficiency. Methods: A quantitative cross-sectional survey with open responses was conducted using the Professional Quality of Life: Compassion Satisfaction and Compassion Fatigue (ProQOL) scale and open-ended questions. Responses from a convenience sample of 86 nurses from two hospital emergency departments in Victoria, Australia, were analysed. Results: The median score for Compassion Satisfaction was 78% with all nurses reporting average to high scores. Most had average levels of Compassion Fatigue: Burnout median score was 53% and Secondary Traumatic Stress median score 49%. No statistically significant correlation was found between scales nor with influencing demographic characteristics. A qualification in emergency nursing was predictive of Compassion Satisfaction. Six descriptive job-associated factors contributed to nurses' stress: human resources, the organisation, job-specific components, patient mix and professional and personal components. Conclusion/s: Average to high levels of Compassion Satisfaction and low to average levels of Compassion Fatigue were found in emergency nurses. Issues contributing to stress were work and role related. An understanding of these stressors may help nurses and nurse managers to ameliorate emergency nurses' levels of stress and help limit staff burnout.
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.
Description:
Aim To develop a valid, reliable and feasible teamwork assessment measure for emergency resuscitation team performance. Background Generic and profession specific team performance assessment measures are available (e.g. anaesthetics) but there are no specific measures for the assessment of emergency resuscitation team performance. Methods (1) An extensive review of the literature for teamwork instruments, and (2) development of a draft instrument with an expert clinical team. (3) Review by an international team of seven independent experts for face and content validity. (4) Instrument testing on 56 video-recorded hospital and simulated resuscitation events for construct, consistency, concurrent validity and reliability and (5) a final set of ratings for feasibility on fifteen simulated ‘real time’ events. Results Following expert review, selected items were found to have a high total content validity index of 0.96. A single ‘teamwork’ construct was identified with an internal consistency of 0.89. Correlation between the total item score and global rating (rho 0.95; p < 0.01) indicated concurrent validity. Inter-rater (k 0.55) and retest reliability (k 0.53) were ‘fair’, with positive feasibility ratings following ‘real time’ testing. The final 12 item (11 specific and 1 global rating) are rated using a five-point scale and cover three categories leadership, teamwork and task management. Conclusion In this primary study TEAM was found to be a valid and reliable instrument and should be a useful addition to clinicians’ tool set for the measurement of teamwork during medical emergencies. Further evaluation of the instrument is warranted to fully determine its psychometric properties.
Description:
This paper focuses on changes in the educational preparation of undergraduate nurses in line with contemporary primary and preventative healthcare models. We evaluated a new Australian nursing and community care degree programme using focus groups with 38 students in their first years of study, and quantitative performance data (regarding entry, performance and course attrition). Four main themes were identified related to students’ course experience: ‘I think community health should be an elective’; ‘Focus on relevance to practice’; ‘Teaching by non-nursing academics’ and ‘Access to support during transition to university.’ Overall pass rates were 94% (first year) and 97% (second year) with a low 11% attrition rate. We conclude that based on prior experiences and stereotypical views, students may be ambivalent about the inclusion of primary and preventative care models which nevertheless are essential to enhance practice and to prepare the future nursing workforce
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.
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.