Preparing for RN Practice: The Impact of a Deteriorating Patient Simulation on Senior Students' Clinical Skill Capabilities and Responses

Wednesday, 1 August 2012: 8:30 AM

Michelle A. Kelly, RN, BSc, MN1
Jan Forber, RN, BHS, MCLS1
Lisa Conlon, RN, BHS, MCN1
Helen Stasa, BA (Phil), BA (Psy)1
Michael A. Roche, RN, PhD, MHSc, BHSc, DipAppSc, CertMHN2
(1)Faculty of Nursing, Midwifery and Health, University of Technology, Sydney (UTS), Sydney, Australia
(2)Faculty of Nursing Midwifery and Health, University of Technology, Sydney (UTS), Sydney, Australia

Learning Objective 1: The learner will be able to understand the contribution of rehearsing deteriorating patient simulation scenarios to subsequent clinical performance and patient outcomes.

Learning Objective 2: The learner will be able to determine opportunities for similar learning experiences in their curricula, courses or clinical practice settings.

Purpose: Opportunities for undergraduate students to observe or care of a deteriorating patient cannot be guaranteed during clinical experiences. Tailored simulations enable deliberate rehearsal of such situations and provide opportunity to reiterate recommended practices based on patient safety research (Australian Commission on Safety and Quality in Health Care 2011; Gantt & Webb-Corbett 2010). The study aim was to evaluate the contribution of a deteriorating patient simulation to senior nursing students’ clinical skill capabilities and responses.

 Methods: Final year nursing students engaged in a team-based simulation encounter. A pre-post design using a locally developed and piloted survey was adopted. Sixty two students completed the surveys rating their perceived performance on 10 clinical variables including patient assessment, communication, technical ability, team interactions and seeking help.

Results: Overall, self-rated ability across all variables demonstrated significant improvement post simulation: total mean scores, from a possible range of 10 – 40, (pre and post respectively) were 23.8 (SD 3.77) and 27.4 (SD 4.14) (p<0.01). Specific variables which showed significant differences post simulation (range of 1-4) were: assessing and recognising a deteriorating patient (2.42 Vs 2.67, p<0.01); approaching a medical officer for help (2.62 Vs 2.78, p=0.021); and approaching external services e.g. a medical emergency team for help (2.35 Vs 2.73, p<0.01).

Conclusion: The simulation encounter significantly improved self-rated ability across several domains. Most improvement was seen in the critical areas of patient assessment and approaching others for help. These results provide evidence of the positive impact such learning experiences can offer students in preparing them for the RN role.

Australian Commission on Safety and Quality in Health Care 2011, Windows into safety and quality in health care 2011, Sydney.

Gantt, L. & Webb-Corbett, R. 2010, 'Using simulation to teach patient safety behaviors in undergraduate nursing education', Journal of Nursing Education, vol. 49, no. 1, p. 48.