Patient experiences during the planned perioperative care pathway: An integrative review

AIMS

This integrative review aimed to synthesize evidence about the patients' experiences during the planned perioperative care pathway.

DESIGN

Integrative review.

DATA SOURCES

Cumulative Index to Nursing and Allied Health Literature (CINAHL), Medline Ovid, Scopus, and American Psychological Association (APA) PsychINFO. Original, peer-reviewed studies published in English between 2012 and 2023 exploring patient experiences during the planned perioperative care pathway were reviewed.

METHODS

This review was guided by the Whittemore and Knafl method and followed PRISMA guidelines to search the literature. Twenty-two articles were selected for the final study.

RESULTS

Three themes emerged: Sharing of information is empowering; interpersonal relationships are valued by patients, and hospital systems and care co-ordination influence the patient experience.

CONCLUSIONS

The quality and consistency of the information patients receive can both support and undermine patient confidence in health professionals. The quality of relationships that participants experience and effective communication with health professionals can support or compromise the quality of the patients' perioperative experience. The nature of the hospital systems and care co-ordination in hospital has implications for the quality of recovery from surgery.

IMPACT

This review evaluates whether national and international health services and organizations, adhering to the WHO guidelines, have developed and implemented intentionally focused perioperative care with the aims to achieving effective and sustainable surgical outcomes through increased patient satisfaction.

NO PATIENT OR PUBLIC CONTRIBUTION

This article is an integrative review and does not include patient or public contribution.

Falls risk perception measures in hospital: a COSMIN systematic review

Falls prevention in hospital continues to be a research priority because of the poor health outcomes and financial burdens that can arise. Recently updated World Guidelines for Falls Prevention and Management strongly recommend evaluating patients' concerns about falling as part of a multifactorial assessment. The aim of this systematic review was to evaluate the quality of falls risk perception measures for adults in a hospital setting. This review was conducted using the Consensus-based Standards for the selection of health Measurement Instruments guidelines and provides a comprehensive summary of these instruments, including psychometric properties, feasibility and clinical recommendations for their use. The review followed a prospectively registered protocol, in which a total of ten databases were searched between the years 2002 and 2022. Studies were included if the instruments measured falls risk perception and/or other psychological falls constructs, if they were conducted in a hospital setting and if the target population contained hospital inpatients. A total of 18 studies met the inclusion criteria, encompassing 20 falls risk perception measures. These falls risk perception instruments were grouped into five falls-related constructs: Balance Confidence, Falls Efficacy/Concern, Fear of Falling, Self-Awareness and Behaviour/Intention. Two of the patient reported outcome measures (PROMs) received Class A recommendations (Falls Risk Perception Questionnaire and the Spinal Cord Injury-Falls Concern Scale); however, this rating is only applicable for the populations/context described in the studies. Thirteen PROMs received Class B recommendations, solidifying the need for further validation studies of these PROMs.

Perceptions of being a registered nurse (PRN): development and validation of a survey tool

BACKGROUND

Nursing students enter nursing programs with idealistic perceptions of what it is to be a nurse. Upon graduation, many find these perceptions mismatched with the actual nurse's role. This can lead to discontentment in their chosen career. These issues highlight the importance of nursing students developing an understanding of the nurse's role during their undergraduate nursing education. One way to accomplish this is to assess perceptions and address them accordingly during the nursing program. Survey tools assessing perceptions of nursing exist but lack contemporary and multicultural foci.

AIM

To develop a feasible, valid, and reliable survey tool to identify nursing students' perceptions of being a nurse.

DESIGN/METHODS

In Phase 1, a literature review and Nominal Group Technique meetings were used to generate primary survey items. Phase 2 included a pre-pilot and online pilot testing of the Perceptions of being a Registered Nurse (PRN) survey tool with 797 nursing students across all year levels at three Australian Universities.

RESULTS

The 34-item PRN survey tool uses a five-point Likert scale to measure nursing students' perceptions of nursing, including factors influencing a nurse's well-being, attributes and qualities of nurses, the role of the nurse, and nursing professionalism. The Item-Content validity index was high (> 0.78), and the inter-item correlation validity was identified by Pearson's product-moment coefficient of r = .712. Internal reliability was confirmed with a Cronbach's alpha = 0.83. Based upon the participation completion rate, the survey tool was deemed applicable and feasible. The majority of respondents believed that nurses have altruistic attributes; however, perceptions of nursing varied significantly when rating factors influencing the physical, emotional, and social well-being of a nurse. In later stages of training, respondents were more likely to agree that nursing is physically and emotionally demanding and that nurses experience social isolation due to shift work, finding it difficult to achieve a work-life balance.

CONCLUSIONS

The PRN survey tool was found to be valid, reliable, and feasible. Future use and outcomes from PRN assessments may lead to changes to nursing curricula that enhance nursing students' perceptions of nursing.

An exploration into early childhood physical literacy programs: A systematic literature review

This review explored the impact of physical literacy programs designed to engage two- to five-year-old preschool children. The Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) was used. Six EBSCO host databases were searched for the period 2011 to April 2021 using the search terms “physical literacy,” “early childhood,” and “impact.” Articles were excluded if physical literacy was not the focal intervention. The final data set consisted of seven-peer reviewed articles meeting the eligibility criteria and quality assessment for this review. Three themes were created using Braun and Clark’s (2006) approach to thematic analysis: Holistic benefits of physical literacy, Barriers to physical literacy and Education begins at home. Early childhood physical literacy programs provide holistic benefits for children; however, further research is needed in an Australian context. Families and community members working in the early childhood sector could benefit from further education and training to improve physical literacy awareness.

Exploring Hospital Inpatients' Awareness of Their Falls Risk: A Qualitative Exploratory Study

Patient falls in hospital may lead to physical, psychological, social and financial impacts. Understanding patients' perceptions of their fall risk will help to direct fall prevention strategies and understand patient behaviours. The aim of this study was to explore the perceptions and experiences that influence a patient's understanding of their fall risk in regional Australian hospitals. Semi-structured, individual interviews were conducted in wards across three Australian hospitals. Participants were aged 40 years and over, able to communicate in English and were mobile prior to hospital admission. Participants were excluded from the study if they returned a Standardised Mini-Mental State Examination (SMMSE) score of less than 18 when assessed by the researcher. A total of 18 participants with an average age of 69.8 years (SD ± 12.7, range 41 to 84 years) from three regional Victorian hospitals were interviewed for this study. Data were analysed using a reflexive thematic analysis identifying three major themes; (1) Environment (extrinsic) (2) Individual (intrinsic), and (3) Outcomes, as well as eight minor themes. Participants recognised the hazardous nature of a hospital and their personal responsibilities in staying safe. Falls education needs to be consistently delivered, with the focus on empowering the patient to help them adjust to changes in their clinical condition, whether temporary or permanent.

Evaluating the effects of a Therapeutic Day Rehabilitation program and inclusion of gardening in an Australian Rural Community Health Service

Therapeutic day rehabilitation (TDR) is a non-residential intensive structured program designed for individuals recovering from substance misuse. A weekly afternoon of therapeutic gardening was a new incentive initiated in a TDR program at one Australian community health service, designed to give participants the opportunity to spend time outdoors connecting with nature and each other. The aim of this study was to explore perceptions of participants enrolled in this program by employing a convergent parallel mixed-method design using qualitative individual, semi-structured interviews (n = 14) and longitudinal quantitative quality of life (QOL) data at three different intervals (n = 17). The analysis of the quantitative data showed that there was a statistically significant increase in the participants' QOL scores in three of four domains (physical health, psychological, social relationships) when comparing baseline and post completion of the TDR. These observed changes were maintained at the 4-week follow up. The key findings from the semi-structured interviews include positive effects for participants on social connectivity, structure and achievement, understanding of recovery and relaxation from contact with nature. This study shows that a combination of TDR and therapeutic gardening can improve participants' physical health, psychological health and social relationships.

Evaluation of an assessment model to reduce waitlist times for occupational therapy in a rural community health setting

OBJECTIVE

Community occupational therapy services have seen an increase in demand over the last three years, resulting in longer waitlist times for service provision, particularly in rural areas where it is difficult to recruit experienced occupational therapists. Utilising a demand management model, the Basic Assessment Model Pre-Screening Tool was developed by a team of Occupational Therapists and allied health assistants to decrease client waitlist times at one rural community health service.

DESIGN

An evaluation of the implementation of an assessment model with comparison of quantitative data pre and post intervention.

SETTING

Rural Community Health Service in Victoria, Australia PARTICIPANTS: 456 clients that were registered as community-based clients requiring occupational therapy services.

MAIN OUTCOME MEASURE

Following the implementation of the newly developed Basic Assessment Model the number of occupational therapy assessments increased and there was a decrease in the median wait time that clients were on the waitlist in comparison to pre implementation.

RESULTS

There was a statistically significant decrease (p<0.001) in the median number of days spent on the waitlist for the post intervention group (80 days) compared to the pre intervention group (105 days).

CONCLUSION

The results of this study suggest that waiting lists for community occupational therapy services can be reduced by implementing this basic assessment model ultimately improving the health outcomes of clients.

Reflections on an international nursing placement experience in Nepal: A thematic analysis

BACKGROUND

Increasing patient diversity, as a result of growing global interaction, has necessitated that nursing academics better prepare nursing students to provide culturally appropriate and respectful care to their patients, particularly in culturally diverse countries such as Australia. One approach to improve cultural awareness of nursing students is a cultural immersion placement, and this paper describes such an experience which has been embraced by undergraduate participants. Purpose of this paper was to describe experiences, cultural awareness and challenges encountered by final year undergraduate nursing students undertaking a 22-day cultural immersion placement in Nepal. The researchers accompanied one group of students per year on this trip, which was repeated for three consecutive years. Describing and reflecting on the lived experience of nursing students engaged in this cultural immersion placement has helped to discern how this experience affects the cultural awareness of undergraduate nursing students and helps to decrease the challenges for similar placements in the future.

DESIGN AND METHODS

To gain insight into the way this initiative impacted on the development of the participant's cultural competence, a qualitative descriptive design was chosen. Semi-structured interviews were carried out over three consecutive years with final year undergraduate nursing students upon their return from Nepal over three consecutive years. Data analysis followed standard suggestions for a systematic, unbiased approach to dealing with the condensed text, and was analysed using thematic analysis.

RESULTS

The findings suggested that this experience, albeit of limited duration, provided a significant contribution to students' understanding of cross-cultural awareness in the context of providing health care.

CONCLUSIONS

There was a strong implication from the outcomes that this cultural immersion placement should be permanently integrated into the undergraduate nursing course. There was, however, indication that there is room for added reflection and advantages to be made from the experience.

Beyond simulation - Extracurricular volunteering in nursing education: A focus group

BACKGROUND

A reduction in clinical placement hours has seen alternative teaching methods being explored in nursing education in Australia. The use of simulated patients in academic laboratories is highly utilised, however, may still be limiting learning opportunities.

OBJECTIVE

The objective of this research was to describe the learning experiences of nursing students who participated in supervised extracurricular, volunteering opportunities during their nursing studies.

DESIGN

A descriptive qualitative design was used to discover and understand learning experiences of a volunteering encounter, described from the nursing student perspective.

SETTING

The Pit Stop men's health check program is a collaboration of local health organisations, volunteering their time to provide free health checks at a farming Field Day event in regional Victoria, Australia.

PARTICIPANTS

Twelve second year undergraduate nursing students volunteered at the 2019 Pit Stop event, over a four day period and outside their normal study requirements. Seven volunteers then participated in post event research, sharing experiences and providing feedback.

METHODS

One semi-structured focus group interview was conducted at University campus, using reflective and open ended questioning. Interviews were audio recorded and transcribed. Thematic analysis identified common themes.

RESULTS

Students unanimously recommended the real life learning experiences and reported an increased confidence and competence in basic communication and clinical skills, not always provided in the simulated environment of the academic laboratory. Their motivation to attend was driven by wanting more real life contact with patients, having time to practice skills and experience diversity within their practice. Students also recommended future volunteering ideas that would potentially provide additional learning opportunities.

CONCLUSIONS

Experiential learning such as simulation is highly valued in current nursing education, however, students still crave the real life learning experiences from working with human patients. With limited clinical exposure currently offered to students within nursing education programs, additional opportunities such as supervised volunteering may be worth considering when preparing confident and competent nurse graduates.

The impact of intellectual disability nurse specialists in the United Kingdom and Eire Ireland: An integrative review

AIM

To identify and evaluate the impact of Intellectual Disability Nurse Specialists person-centred care for people with intellectual disability.

DESIGN

An Integrative review of the literature was performed between January 2007-December 2017.

METHODS

Searching the PubMed Library of Medicine, Cumulative Index of Nursing and Allied Health Literature (CINAHL), Medline Ovid, PsychINFO, Health Source: Nursing/Academic edition. A total of eight articles were selected for the final study example, including four mixed methods studies and four qualitative studies.

RESULTS

Three Intellectual Disability Nurse Specialist models were evaluated, and three main themes emerged: person-centred care, organizational and practice development.

CONCLUSION

The Intellectual Disability Nurse Specialist expert knowledge and skills contribute to the development of effective systems and processes. The results highlighted the complex nature of the Intellectual Disability Nurse Specialist role and the importance of ongoing development, promotion and evaluation and their contribution to care in the healthcare setting.

The Association between Health Literacy and Self-Rated Health Amongst Australian University Students

Health literacy is the capacity to understand, access, and effectively utilize health information and healthcare to make informed health decisions. This cross-sectional study uses the multi-dimensional Health Literacy Questionnaire (HLQ) to investigate associations between demographic characteristics, self-rated health and health literacy among students (n = 932) in two Australian universities. We used Pearson's chi-square to determine differences in self-rated health between demographic groups, Cohen's defect Sizeto measure differences in HLQ scale scores between demographic groups, and logistic regression to determine associations between HLQ scores and self-rated health. A clear association was found between self-rated health and health literacy: as health literacy increased, so did self-rated health. Findings also demonstrate lower health literacy for culturally and linguistically diverse students, and those studying Arts compared to Health degrees. Lower self-rated health was correlated with HLQ scales including being less active in managing one's own health, having less social support for one's health, possessing insufficient health information and lower confidence in navigating the healthcare system. This study provides a comprehensive picture of potentially vulnerable students and identifies strategies for supporting their health endeavors while studying at university.

A review of Code Blue activations in a single Regional Australian Healthcare Service: A retrospective descriptive study of RISKMAN data

BACKGROUND

In the case of life-threatening conditions such as respiratory or cardiac arrest, or the clinical deterioration of the patient, a Code Blue activation may be instigated. A Code Blue activation involves a team of advanced trained clinicians attending the emergency needs of the patient.

AIMS AND OBJECTIVES

The aim of the study was to explore the number of cases of Code Blue activations, looking at the timing, clinical ward, diagnosis and activation criteria while noting cases where escalation from a Medical Emergency Team (MET) call occurs in one Regional Healthcare Service in Victoria, Australia, over a six-year period.

METHODS

A quantitative retrospective descriptive study of Code Blue emergencies over a six-year period from June 2010 to June 2016 was conducted. Data collected from the RISKMAN program operating at a single site was imported into SPSS (V 22) for descriptive statistical analysis. A STROBE EQUATOR checklist was used for this study (see File S1).

FINDINGS

The majority of Code Blue activations were male (59%, n = 127) and aged between 70 and 89 years of age (43%, n = 93). A Code Blue activation was more likely to occur at 08:00 hr, 14:00 hr or 22:00 hr, corresponding to the nurses' change in shift, with the majority of Code Blues (27.8%, n = 60) occurring in the emergency department. Cardiac arrest was the main activation criterion with 54.6% (n = 118) cases followed by respiratory arrest (14%, n = 32). Interestingly, 20% (n = 45) of the Code Blue activations were upgraded from a Medical Emergency Team (MET) call.

CONCLUSION

This project has produced several interesting findings surrounding Code Blue activations at one regional healthcare service which are not present in existing literature and is worthwhile for further investigation.

RELEVANCE TO CLINICAL PRACTICE

Understanding Code Blue activation criteria, common timings (month, time of day) and patient demographics ensures clinicians can remain vigilant in watching for the signs of patient deterioration and improve staff preparedness Code Blue events.

Physical deterioration in an acute mental health unit: A quantitative retrospective analysis of medical emergencies

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.

Qualified nurses' perceptions of nursing graduates' abilities vary according to specific demographic and clinical characteristics. A descriptive quantitative study

BACKGROUND

Evidence from the literature and anecdotally from clinical settings suggests that newly graduated nurses are not fully prepared to be independent practitioners in healthcare settings.

AIMS AND OBJECTIVES

The aim of this study was to explore perceptions of qualified nurses in relation to the practice readiness of newly registered nursing graduates and determine whether these views differ according to specific demographic characteristics, clinical settings, and geographical locations.

DESIGN

A descriptive quantitative design was used.

METHODS

An online survey tool was used to assess how qualified nurses (n=201) in Victoria, Australia, rated newly graduated nurses' abilities on 51 individual clinical skills/competencies in eight key skill areas. A composite score was calculated for each skill area and a comparative analysis was undertaken on the various cohorts of participants according to their demographic and clinical characteristics using one-way ANOVA and post hoc tests.

RESULTS

Newly graduated nurses were found to be lacking competence in two key skill areas and were rated as performing adequately in the remaining six skill areas assessed. Significant differences (p≤0.05) in performance were found according to the age of the nurse, number of years registered, the educational setting in which they undertook their nurse education, their role, and the clinical area in which they worked. There were no significant differences according to whether the nurse worked in the private or public healthcare sector. Few differences were found between nurses working in a metropolitan vs. regional/rural healthcare setting.

CONCLUSION

This is the first study to quantify the scale of this problem. Our findings serve as a reference for both nurse education providers and healthcare settings in better preparing nursing graduates to be competent, safe practitioners in all clinical areas.

Registered nurses' perceptions of new nursing graduates' clinical competence: A systematic integrative review

Over the past decade, many questions have been raised about graduates' clinical competence and fitness for practice upon completion of their undergraduate education. Despite the significance of this issue, the perspectives of registered nurses have rarely been examined. This systematic review explores the perceptions of experienced registered nurses regarding the clinical competence of new nursing graduates. Original research studies published between 2004-2014 were identified using electronic databases, reference lists, and by searching "grey literature." Papers were critically reviewed and relevant data extracted and synthesized using an approach based on Preferred Reporting Items for Systematic Reviews and Meta-Analysis. From 153 studies initially identified, 15 original research papers were included. Four main research themes were identified: clinical/technical skills, critical thinking, interaction/communication, and overall readiness for practice. Areas of concern in relation to the clinical competence of new nursing graduates specifically related to two themes: critical thinking and clinical/technical skills. Further research is required on strategies identified within the literature with the ultimate aim of ensuring new nursing graduates are safe and competent practitioners.

Babies and machines that go 'beep': first-year nursing students' preferred areas of future practice

Students of nursing enter their programmes of study with preconceived ideas of what a career in their chosen profession will entail. The literature suggests that images from the media and past experiences contribute to these perceptions. Although it is positive images of the profession that will usually attract an individual to a career in nursing, often more negative perceptions will direct students away from potentially rewarding areas of specialization. This paper describes career projections of nursing students enrolled in the first year of four preservice nursing programmes at the rural campus of one Australian university. Part of a larger study, the data reported here indicate that most respondents intend to practice in the areas of midwifery, paediatrics and emergency nursing. Oncology, community nursing, aged care and mental health nursing all ranked poorly across three rounds of surveys. These findings have implications for practicing nurses and nurse educators who seek to dispel inaccurate images of these important specializations.

Situation awareness in undergraduate nursing students managing simulated patient deterioration

BACKGROUND

Nursing work often occurs in complex and potentially hazardous settings. Awareness of patient and practice environments is an imperative for nurses in practice.

OBJECTIVES

To explore nursing students' situation awareness while engaging in simulated patient deterioration scenarios.

DESIGN

The educational process of FIRST(2)ACT was the model for the nurse intervention. Situation awareness was measured quantitatively using the Situation Awareness Global Assessment tool. Four domains were measured: physiological perception (patient parameters), global perception (surroundings), comprehension (interpretation of information), and projection (forecasting outcomes).

SETTINGS

Clinical laboratories at each of three participating universities.

PARTICIPANTS

Ninety-seven nursing students from three Australian universities.

METHODS

Between March and July 2012, students participated in three video-recorded simulation events, in which a trained actor played patient roles and groups of three students worked as teams. To measure situation awareness, following the simulation each team leader was taken to a separate room and asked to report on a question set regarding the patient's vital signs, bedside setting and medical diagnosis.

RESULTS AND CONCLUSIONS

Overall, situation awareness was low (41%). Of the four domains, physiological perceptions scored the lowest (26%) and projection the highest (59%). Final year nursing students may not have well developed situation awareness skills, especially when dealing with these types of scenarios. Education providers need to consider ways to assist students to fully develop this attribute. Findings suggest that this is an aspect of undergraduate nursing education that requires significant consideration by curriculum developers.

Preparation for high-acuity clinical placement: confidence levels of final-year nursing students

AIM

To measure final-year nursing students' preparation for high-acuity placement with emphasis on clinical skill performance confidence.

BACKGROUND

Self-confidence has been reported as being a key component for effective clinical performance, and confident students are more likely to be more effective nurses. Clinical skill performance is reported to be the most influential source of self-confidence. Student preparation and skill acquisition are therefore important aspects in ensuring students have successful clinical placements, especially in areas of high acuity. Curriculum development should aim to assist students with their theoretical and clinical preparedness for the clinical environment.

METHOD

A modified pretest/posttest survey design was used to measure the confidence of third-year undergraduate nursing students (n = 318) for placement into a high-acuity clinical setting. The survey comprised four questions related to clinical placement and prospect of participating in a cardiac arrest scenario, and confidence rating levels of skills related to practice in a high-acuity setting. Content and face validity were established by an expert panel (α = 0.90) and reliability was established by the pilot study in 2009. Comparisons were made between confidence levels at the beginning and end of semester.

RESULTS

Student confidence to perform individual clinical skills increased over the semester; however their feelings of preparedness for high-acuity clinical placement decreased over the same time period. Reported confidence levels improved with further exposure to clinical placement.

CONCLUSION

There may be many external factors that influence students' perceptions of confidence and preparedness for practice. Further research is recommended to identify causes of poor self-confidence in final-year nursing students.

Expanding the clinical placement capacity of rural hospitals in Australia: displacing Peta to place Paul?

In order to identify opportunities to build capacity for clinical placements, we mapped and described the organisation of student placements at three hospitals, each with multiple education providers, in rural Victoria, Australia. Using a cross-sectional, mixed method design, data were collected by survey, interviews and discussion with student placement coordinators representing 16 clinical health disciplines. Teaching and supporting students was regarded as an important part of the service each hospital provided and a useful staff recruitment strategy. There were peaks and troughs in student load over the year, though this was less marked for medicine and dentistry than for nursing and allied health disciplines. Whilst placements were managed largely on a discipline basis, each hospital had taken steps to communicate information about student placements across disciplines and to identify opportunities for interprofessional education (IPE). Placement capacity could be increased by sharing placement data within hospitals, smoothing the utilisation patterns across the year, capitalising on opportunities for IPE when there is concurrent placement of students from different disciplines, and through better employment of underutilised clinical areas.

Managing patient deterioration: assessing teamwork and individual performance

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.

Managing deteriorating patients: registered nurses' performance in a simulated setting

AIM

To examine, in a simulated environment, rural nurses' ability to assess and manage patient deterioration using measures of knowledge, situation awareness and skill performance.

BACKGROUND

Nurses' ability to manage deterioration and 'failure to rescue' are of significant concern with questions over knowledge and clinical skills. Simulated emergencies may help to identify and develop core skills.

METHODS

An exploratory quantitative performance review. Thirty five nurses from a single ward completed a knowledge questionnaire and two video recorded simulated scenarios in a rural hospital setting. Patient actors simulated deteriorating patients with an Acute Myocardial Infarction (AMI) and Chronic Obstructive Pulmonary Disease (COPD) as the primary diagnosis. How aware individuals were of the situation (levels of situation awareness) were measured at the end of each scenario.

RESULTS

KNOWLEDGE OF DETERIORATION MANAGEMENT VARIED CONSIDERABLY (RANGE: 27%-91%) with a mean score of 67%. Average situation awareness scores and skill scores across the two scenarios (AMI and COPD) were low (50%) with many important observations and actions missed. Participants did identify that 'patients' were deteriorating but as each patient deteriorated staff performance declined with a reduction in all observational records and actions. In many cases, performance decrements appeared to be related to high anxiety levels. Participants tended to focus on single signs and symptoms and failed to use a systematic approach to patient assessment.

CONCLUSION

Knowledge and skills were generally low in this rural hospital sample with notable performance decrements as patients acutely declined. Educational models that incorporate high fidelity simulation and feedback techniques are likely to have a significant positive impact on performance.