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Int J Nurs Stud. 2012 Jun;49(6):710-7. doi: 10.1016/j.ijnurstu.2011.11.018. Epub 2011 Dec 22.

Identifying patient deterioration: using simulation and reflective interviewing to examine decision making skills in a rural hospital.

Author information

  • 1Faculty of Health, Drake Circus, Plymouth PL4 8AA, UK. ruth.endacott@plymouth.ac.uk

Abstract

OBJECTIVES:

The study aim was to examine how Registered Nurses identify and respond to deteriorating patients during in-hospital simulation exercises.

DESIGN:

Mixed methods study using simulated actors.

SETTING:

A rural hospital in Victoria, Australia.

PARTICIPANTS:

Thirty-four Registered Nurses each completed two simulation exercises.

METHODS:

Data were obtained from the following sources: (a) Objective Structured Clinical Examination (OSCE) rating to assess performance of Registered Nurses during two simulation exercises (chest pain and respiratory distress); (b) video footage of the simulation exercises; (c) reflective interview during participants' review of video footage. Qualitative thematic analysis of video and interview data was undertaken.

RESULTS:

Themes generated from the data were: (1) exhausting autonomous decision-making; (2) misinterpreting the evidence; (3) conditioned response; and (4) missed cues. Assessment steps were more likely to be omitted in the chest pain simulation, for which there was a hospital protocol in place.

CONCLUSIONS:

Video review revealed additional insights into nurses' decision-making that were not evident from OSCE scoring alone. Feedback during video review was a highly valued component of the simulation exercises.

Copyright © 2011 Elsevier Ltd. All rights reserved.

PMID:
22197052
[PubMed - indexed for MEDLINE]
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