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Managing the deteriorating patient in a simulated environment: nursing students' knowledge, skill and situation awareness


Cooper, S and Kinsman, L and Buykx, P and McConnell-Henry, T and Endacott, R and Scholes, J, Managing the deteriorating patient in a simulated environment: nursing students' knowledge, skill and situation awareness, Journal of Clinical Nursing, 19, (15-16) pp. 2309-2318. ISSN 0962-1067 (2010) [Refereed Article]

Copyright Statement

Copyright 2010 Blackwell Publishing Ltd

DOI: doi:10.1111/j.1365-2702.2009.03164.x


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.

Item Details

Item Type:Refereed Article
Keywords:decision-making; education; patient deterioration; simulation; situation awareness
Research Division:Health Sciences
Research Group:Health services and systems
Research Field:Health services and systems not elsewhere classified
Objective Division:Health
Objective Group:Provision of health and support services
Objective Field:Nursing
UTAS Author:Kinsman, L (Professor Leigh Kinsman)
ID Code:97779
Year Published:2010
Web of Science® Times Cited:111
Deposited By:Health Sciences B
Deposited On:2015-01-13
Last Modified:2015-04-13

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