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Undergraduate nursing students' performance in recognising and responding to sudden patient deterioration in high psychological fidelity simulated environments: an Australian multi-centre study

Citation

Bogossian, F and Cooper, S and Cant, R and Beauchamp, A and Porter, J and Kain, V and Bucknall, T and Phillips, NM and The FIRST2ACT™ Research Team, Undergraduate nursing students' performance in recognising and responding to sudden patient deterioration in high psychological fidelity simulated environments: an Australian multi-centre study, Nurse Education Today, 34, (5) pp. 691-696. ISSN 0260-6917 (2014) [Refereed Article]

Copyright Statement

Copyright 2013 Elsevier Ltd.

DOI: doi:10.1016/j.nedt.2013.09.015

Abstract

BACKGROUND: Early recognition and situation awareness of sudden patient deterioration, a timely appropriate clinical response, and teamwork are critical to patient outcomes. High fidelity simulated environments provide the opportunity for undergraduate nursing students to develop and refine recognition and response skills.

OBJECTIVES: This paper reports the quantitative findings of the first phase of a larger program of ongoing research: Feedback Incorporating Review and Simulation Techniques to Act on Clinical Trends (FIRST2ACTTM). It specifically aims to identify the characteristics that may predict primary outcome measures of clinical performance, teamwork and situation awareness in the management of deteriorating patients.

DESIGN: Mixed-method multi-centre study.

SETTING: High fidelity simulated acute clinical environment in three Australian universities.

PARTICIPANTS: A convenience sample of 97 final year nursing students enrolled in an undergraduate Bachelor of Nursing or combined Bachelor of Nursing degree were included in the study.

METHOD: In groups of three, participants proceeded through three phases: (i) pre-briefing and completion of a multi-choice question test, (ii) three video-recorded simulated clinical scenarios where actors substituted real patients with deteriorating conditions, and (iii) post-scenario debriefing. Clinical performance, teamwork and situation awareness were evaluated, using a validated standard checklist (OSCE), Team Emergency Assessment Measure (TEAM) score sheet and Situation Awareness Global Assessment Technique (SAGAT). A Modified Angoff technique was used to establish cut points for clinical performance.

RESULTS: Student teams engaged in 97 simulation experiences across the three scenarios and achieved a level of clinical performance consistent with the experts' identified pass level point in only 9 (1%) of the simulation experiences. Knowledge was significantly associated with overall teamwork (p=.034), overall situation awareness (p=.05) and clinical performance in two of the three scenarios (p=.032 cardiac and p=.006 shock). Situation awareness scores of scenario team leaders were low overall, with an average total score of 41%.

CONCLUSIONS: Final year undergraduate nursing students may have difficulty recognising and responding appropriately to patient deterioration. Improving pre-requisite knowledge, rehearsal of first response and team management strategies need to be a key component of undergraduate nursing students' education and ought to specifically address clinical performance, teamwork and situation awareness.

Item Details

Item Type:Refereed Article
Keywords:education, nursing, patient deterioration, simulation, clinical performance, clinical decision making, situation awareness, team work
Research Division:Medical and Health Sciences
Research Group:Public Health and Health Services
Research Field:Public Health and Health Services not elsewhere classified
Objective Division:Health
Objective Group:Health and Support Services
Objective Field:Nursing
Author:Cant, R (Dr Robyn Cant)
ID Code:97793
Year Published:2014
Web of Science® Times Cited:28
Deposited By:Health Sciences B
Deposited On:2015-01-13
Last Modified:2015-08-04
Downloads:0

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