Elsevier

Nurse Education Today

Volume 39, April 2016, Pages 116-121
Nurse Education Today

Piloting the feasibility of head-mounted video technology to augment student feedback during simulated clinical decision-making: An observational design pilot study

https://doi.org/10.1016/j.nedt.2016.01.012Get rights and content

Highlights

  • Head mounted video recordings were investigated in patient deterioration simulations.

  • Video recordings enhanced feedback for some participants.

  • Video recordings enhanced learning in patient simulations for some participants.

  • Student confidence and competence increased after patient deterioration simulations.

Summary

Background

Clinical decision-making is a complex activity that is critical to patient safety. Simulation, augmented by feedback, affords learners the opportunity to learn critical clinical decision-making skills. More detailed feedback following simulation exercises has the potential to further enhance student learning, particularly in relation to developing improved clinical decision-making skills.

Objective

To investigate the feasibility of head-mounted video camera recordings, to augment feedback, following acute patient deterioration simulations.

Design

Pilot study using an observational design.

Methods

Ten final-year nursing students participated in three simulation exercises, each focussed on detection and management of patient deterioration. Two observers collected behavioural data using an adapted version of Gaba's Clinical Simulation Tool, to provide verbal feedback to each participant, following each simulation exercise. Participants wore a head-mounted video camera during the second simulation exercise only. Video recordings were replayed to participants to augment feedback, following the second simulation exercise. Data were collected on: participant performance (observed and perceived); participant perceptions of feedback methods; and head-mounted video camera recording feasibility and capability for detailed audio-visual feedback.

Results

Management of patient deterioration improved for six participants (60%). Increased perceptions of confidence (70%) and competence (80%), were reported by the majority of participants. Few participants (20%) agreed that the video recording specifically enhanced their learning. The visual field of the head-mounted video camera was not always synchronised with the participant's field of vision, thus affecting the usefulness of some recordings.

Conclusion

The usefulness of the video recordings, to enhance verbal feedback to participants on detection and management of simulated patient deterioration, was inconclusive. Modification of the video camera glasses, to improve visual-field synchronisation with participants' actual visual field, is recommended to further explore this technology for enhancing student performance.

Introduction

Decisions made by health care professionals directly impact patient outcomes (Allen et al., 2004). Several studies have demonstrated that adverse events in hospitalised patients are neither sudden nor unexpected. Approximately 70%–80% of these events are preceded by derangements in vital signs for up to 12 h, with minimal or no intervention from clinicians (Bell et al., 2006, Buist et al., 1999, Nurmi et al., 2005, Schein et al., 1990). These issues emphasise the need for a response by health care and education providers, to ensure patient safety and appropriate graduate preparation (Bucknall et al., 2011, Bucknall et al., 2013, Guinane et al., 2013, The Australian Commission on Quality and Safety in Health C). The health industry has responded by setting health-service standards to guide safe practice, leaving education providers with the responsibility for supporting, coaching and teaching nursing students who, as graduates, are ultimately responsible for providing safe patient care based on sound clinical decisions (Jeffries, 2005).

Section snippets

Background

Clinical decision-making is a core capability of the professional competence framework for beginning nurses (Nursing and Midwifery Board, 2006). Clinical decisions are conducted in real-time and involve dynamic situations, which are often unclear and ambiguous (Beckie et al., 2001). Clinical decision-making is a complex cognitive activity, which includes analysis, interpretation, explanation, reasoning, evaluation and synthesis of information sourced through observation, experience and

Aim

The aim of this pilot study was to explore the feasibility and reliability of HMVC recordings to augment observational data and enhance feedback to students on their clinical decision-making behaviours in patient deterioration simulations.

Method

An observational design was used to address the study aims.

Demographics

Ten participants, of which one was male and nine were female, participated in the study. The median age of the total cohort was 23 years. Nine participants were enrolled in the Bachelor of Nursing course and one participant was enrolled in the Bachelor of Nursing/Public Health and Health Promotion course. Two participants had worked in a nursing role prior to commencing their current course and seven participants had never been employed in a nursing role prior to enrolment in the course. One

Discussion

The results of this pilot study were equivocal with respect to the HMVC recordings' augmenting feedback. The results of studies conducted in military (Omodei and McLennan, 1994) and sport and exercise environments (Brown et al., 2008, Drobnjak, 1997, Mackenzie and Kerr, 2012) suggest that video playback from cameras mounted on participant helmets enabled detailed feedback, thus facilitating student learning. However, the HMVC used in the current pilot project was situated centrally in the video

Conclusion

The primary aim of this pilot study was to evaluate whether use of HMVC recordings would augment verbal feedback provided in debriefing/feedback sessions to participants following a simulation of a deteriorating patient. It was anticipated that use of video replay would prompt student recall of decision-making during the simulation exercises and therefore facilitate more thorough task analysis. The rationale for this study was underpinned by the importance of advancing student development of

Author contributions

All authors have made a substantial contribution to (1) conception and design, acquisition of data, or analysis and interpretation of data; (2) drafting the article or revising it critically for important intellectual content, and (3) final approval of this version.

Acknowledgements

The authors wish to extend their gratitude to the nursing students who participated in the study and for sharing their time. The authors extend thanks to the School of Nursing and Midwifery, Deakin University for the provision of a departmental grant to support this study and preparation of the manuscript.

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