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

R Endacott, J Scholes, S Cooper, T McConnell-Henry, J Porter, K Missen, L Kinsman, R Champion

Research output: Contribution to journalArticlepeer-review

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.
Original languageEnglish
Pages (from-to)710-717
Number of pages0
JournalInt J Nurs Stud
Volume49
Issue number6
DOIs
Publication statusPublished - Jun 2012

Keywords

  • Clinical Competence
  • Decision Making
  • Hospitals
  • Rural
  • Humans

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