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Managing deteriorating patients: rural registered nurses’ performance in a simulated setting. The FIRST2ACT Patient Dete

Managing deteriorating patients: rural registered nurses’ performance in a simulated setting. The FIRST2ACT Patient Deterioration Program. A/Professor Dr Simon Cooper – Director of Research. School of Nursing and Midwifery, Monash University, Victoria, Australia

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Managing deteriorating patients: rural registered nurses’ performance in a simulated setting. The FIRST2ACT Patient Dete

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  1. Managing deteriorating patients: rural registered nurses’ performance in a simulated setting.The FIRST2ACT Patient Deterioration Program • A/Professor Dr Simon Cooper – Director of Research. School of Nursing and Midwifery, Monash University, Victoria, Australia And McConnel-Henry T. Cant R. Porter J. Kinsman L. Endacott R. Scholes J.

  2. Managing deteriorating patients Background • Patient deterioration • High acuity – general wards • ‘Failure to rescue’ – Suboptimal care (SOCCER) • Medical Emergency Teams • De-skilling • Situation awareness • cockpit crews • perception, understanding, projection • Simulation • Safe repetition of skills • Matching reality • Scarcity of student placements

  3. Study series • A systematic review of simulation in nursing – Cant & Cooper 2010 • Nursing students’ knowledge, skill, and situation awareness. Cooper et al 2010 – NBV funded • Management of deteriorating women – Cooper et al – current. Equity Trustees: Walter Cottman Fund • Management of deterioration in rural hospitals. Cooper et al – current. Gippsland – Monash University Grant • Simulation in midwifery – a national review – Bogossian et al – current. Health Workforce Australia • Team management of deterioration in rural hospitals. Cooper et al – Contract research funding • Current: Development of on line/DVD patient deterioration simulated learning program. ALTC

  4. Managing deteriorating patients Study 4: Management of deterioration in a rural hospital setting Aim • To assess registered nurses’ ability to manage patient deterioration using measures of: • Knowledge • Situation awareness • Skill performance. • Pre-post intervention notes review to assess the impact of the intervention (FIRST2ACT)

  5. Previous simulated settings

  6. Current simulated setting

  7. Managing deteriorating patients Instruments

  8. Managing deteriorating patients • Participants: registered nurses from a rural hospital ward (n=41) • 35 were recruited (1.5 hour session) • Instruments and intervention • Validated MCQ focussing on ‘ABCs’

  9. Managing deteriorating patients Instruments: 2. Two videoed simulations (for each participant) • AMI – high information low uncertainty (easiest) • COPD – low information – high uncertainty (hardest) • Both patients deteriorated significantly at the 4 minute mark and ran for 8 minutes

  10. Managing deteriorating patients Instruments 3. Situation awareness (17 questions at end of scenario using SAGAT) • Global e.g. is suction available? • Physiological e.g. what is the heart rate? • Comprehension e.g. what do you think is wrong? • Projection e.g. what do you think may happen to the heart rate? 4. Video review ‘photo elicitation’ (to elicit decision points and strategies) 5. Performance feedback • Evaluation • And to assess the impact of the training intervention - time series analysis –examining vital signs documentation, and frequency and oxygen delivery . Notes review included 258 before 242 after intervention.

  11. Managing deteriorating patients Results

  12. Managing deteriorating patients Results • MCQ: The average total score was 67% (range 27 – 91%) • Skill performance:an average score of 50% (range 26-74%). • However skill performance decreased significantly between the first and second halves of each scenario (p=0.003) despite the obvious cues in the later stage of each scenario.

  13. Results • Situation awareness scores also averaged 50% with poor perception of the situation especially recall of vital signs Overall • A wide range of performance in line with previous study of student nurses (however knowledge scores were significantly lower than students p=0.006)

  14. Results • Notes review (time series analysis). Post intervention significant improvements in • appropriate frequency of observations (p=0.025) • administration of oxygen (p=0.05) • and charting of pain scores (p=0.001)

  15. Managing deteriorating patients Summary • Application of knowledge was an issue • Performance decreased as patients deteriorated (including fewer vital sign measurements) • Situation awareness was generally low • However the training FIRST2ACT did have a significant impact on performance

  16. FIRST2ACT (Feedback Incorporating Review and Simulation Techniques to Act on Clinical Trends) 1. Developing core knowledge - classroom based learning 2. Assessment: stimulus for learning- Knowledge test 5. Performance Feedback Debriefing 4. Reflective Review Photo elicitation 3. Simulation High fidelity kinesthetic skills development

  17. Summary • Application of knowledge issues: • Failures to practice in realistic settings (clinical skills teaching) • Workplace culture – ‘we don’t do it like that here’ • Performance decrement when anxious • Skill decline issues • Repetitive high fidelity and high stakes simulation, including teaching of inductive and comparative clinical reasoning, (chunking/trends) are essential • The FIRST2ACT program does have an impact on practice.

  18. ANY QUESTIONS • Cooper S. Cant R. Porter J. Bogossian F. McKenna L. Brady S. Fox-Young S. Simulated based learning in midwifery education: a systematic review. Women and Birth. In Press • Buykx, P., Kinsman, L., Cooper, T., McConnell-Henry, T., Cant, R., Endacott, R. & Scholes, J. FIRST2ACT: Educating nurses to identify patient deterioration - a theory-based model for best practice simulation education. Nurse Education Today. In Press • McKenna, Cooper et al. Is simulation a substitute for real life clinical experience in midwifery? A qualitative examination of the perceptions of educational leaders. Nurse Education Today. In Press • Bogossian F, Cooper S et al. Simulation based learning in Australian midwifery curricula: Results of a national electronic survey. Women and Birth. In Press • Cooper S. Buykx P. McConnell-Henry T. Kinsman L. McDermott S. (2011) Simulation: can it eliminate failure to rescue Nursing Times. 107; 3; Jan 25-31. • Endacott R. Cooper S. Scholes J. Kinsman L. McConnell-Henry T. (2010) When do patient signs become cues? Detecting clinical cues of deterioration in a simulated environment. Journal of Advanced Nursing.66(12), 2722–2731 • Cant R. & Cooper S. (2010) Simulation-based learning in nurse education: systematic review. Journal of Advanced Nursing. 66, 1, 3-15. • Cooper S. Kinsman L. Buykx P. McConnell-Henry T. Endacott R. Scholes J. (2010) Managing the Deteriorating Patient in a Simulated Environment: Nursing Students’ Knowledge, Skill, And Situation Awareness. Journal of Clinical Nursing. Vol 19, Issue 15, 2309-2318

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