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Final-year nursing studentsí ability to assess, detect and act on clinical cues of deterioration in a simulated environment


Endacott, R and Scholes, J and Buykx, P and Cooper, S and Kinsman, L and McConnell-Henry, T, Final-year nursing students' ability to assess, detect and act on clinical cues of deterioration in a simulated environment, Journal of Advanced Nursing, 66, (12) pp. 2722-2731. ISSN 0309-2402 (2010) [Refereed Article]

Copyright Statement

Copyright 2010 The Authors

DOI: doi:10.1111/j.1365-2648.2010.05417.x


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 1∆5 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 studentsí 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.

Item Details

Item Type:Refereed Article
Keywords:clinical judgement, deterioration, nurse education, nursing students, patient safety, simulation
Research Division:Health Sciences
Research Group:Health services and systems
Research Field:Health and community services
Objective Division:Health
Objective Group:Provision of health and support services
Objective Field:Nursing
UTAS Author:Kinsman, L (Professor Leigh Kinsman)
ID Code:97760
Year Published:2010
Web of Science® Times Cited:48
Deposited By:Health Sciences B
Deposited On:2015-01-13
Last Modified:2015-04-13

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