Situation awareness in undergraduate nursing students managing simulated patient deterioration
Introduction
Nursing work environments are complex and potentially hazardous as the work is cognitively demanding and also interdependent. Such work requires effective formulation of priorities and focused attention, with little margin for human error. In such environments, recognising and responding to the deteriorating patient can be difficult. Non-technical aspects such as social and cognitive skills, including situation awareness (SA), are paramount for timely clinical decision-making, appropriate management and quality patient care outcomes. However, to date little focus in undergraduate nursing education has been placed on the development of SA skills.
Section snippets
Background
Situation awareness has been defined as “one's perceptions of the elements of the environment, the comprehension of their meaning, and the projection of their status in the near future” (Wright and Fallacaro, 2011). According to Flin et al. (2008), SA is simply “knowing what is going on around you.” SA is the first step in decision-making because it provides an understanding of what is happening and what is likely to occur next, and has been described as an inherent model for safe
Methods
The larger study, of which this research was a part, employed mixed methods to gather data on nursing students' assessment and management of a deteriorating simulated patient while working in teams of three. The study employed a triangulated convergent design involving a structured multiple choice knowledge questionnaire (MCQ), three video recorded team-based simulations, and video review to facilitate reflective performance review. Data collection tools included the MCQ, OSCE evaluations of
Results
In total, 97 students participated across all sites: 34 from University A, 32 from University B and 31 from University C. Hence, representation was relatively even across the three sites. Of these, 92% (n = 89) were enrolled in a Bachelor of Nursing programme, and others were enrolled in a double degree, which included nursing or graduate-entry pre-registration nursing degree. Of the participants, 93% (n = 90) were female, most were in their third year (92%), while the remainder were in their
Discussion
This research aimed to explore how nursing students from three universities managed deteriorating patients in a simulated setting, in particular, to measure their situation awareness in these situations, building on previous research (Cooper et al., 2010, Endacott et al., 2010). Participants in the current study were all final year nursing students. Results showed that low levels of SA across the cohort were at 41% overall with physiological ‘perception’ at its lowest at 26%. In their study,
Conclusion
Situation awareness is a key aspect in enhancing responsiveness to clinical situations and ensuring patient safety. However, in this study it was not well demonstrated by student participants and may not be a specific consideration in undergraduate course delivery. Curriculum designers need to incorporate opportunities for students to develop this attribute throughout their courses for graduates to have well developed SA for optimal performance in clinical situations.
Acknowledgements
The Australian Government, Office for Learning and Teaching funded this project. The research team is especially grateful to the students who participated in the study. The authors acknowledge the contributions of other members of the FIRST2ACT research team: Leigh Kinsmen, Jo Porter, Ruth Endacott, Brett Devries, Helen Forbes, Nicki Phillips, Vicki Kain, Alison Beauchamp and Susan Young.
References (28)
- et al.
Patient deterioration simulation experiences: impact on teaching and learning
Collegian
(2012) - et al.
‘Patients of concern’ to nurses in acute care settings: a descriptive study
Aust. Crit. Care
(2009) - et al.
Beyond monitoring: distributed situation awareness in anaesthesia
Br. J. Anaesth.
(2010) - et al.
Thinking ahead of the surgeon. An interview study to identify scrub nurses' non-technical skills
Int. J. Nurs. Stud.
(2011) - et al.
Communication and team situation awareness in the OR: implications for augmentative information display
J. Biomed. Inform.
(2011) - et al.
Deterioration in hospital patients: early signs and appropriate actions
Nurs. Stand.
(2008) The clinical landscape of critical care: nurses' decision making
J. Adv. Nurs.
(2003)- et al.
FIRST2 ACT: educating nurses to identify patient deterioration — a theory-based model for best practice simulation education
Nurse Educ. Today
(2011) - et al.
Managing deteriorating patients: registered nurses' performance in a simulated setting
Open Nurs. J.
(2011) - et al.
Managing the deteriorating patient in a simulated environment: nursing students' knowledge, skill and situation awareness
J. Clin. Nurs.
(2010)