Audit and feedback using the brief Decision Support Analysis Tool (DSAT-10) to evaluate nurse-standardized patient encounters.
OBJECTIVE
To evaluate the brief Decision Support Analysis Tool (DSAT-10) for auditing the quality of nurse-standardized patient encounters, structuring feedback for nurses, and testing instrument reliability.


METHODS
A systematic process was used to develop standardized patient scenarios, pilot-test scenarios, calibrate DSAT-10 coders, analyze taped telephone encounters using DSAT-10, and provide feedback. Inter-rater reliability was calculated using coder agreement, kappa, and intra-class correlation coefficients.


RESULTS
Six scenarios portrayed patients' decisional uncertainty from either: pressure from others (n=2), unclear values (n=2), or inadequate information (n=2). Scenarios were easy to use over the telephone, produced realistic role performance, and were practical for audio-recording interactions. DSAT-10 analysis of 76 nurse-standardized patient encounters revealed nurses' strengths (e.g., information provision) and their limitations (e.g., lack of discussion of values and/or support needs). Scores discriminated between trained and untrained nurses. The kappa coefficient over all items was 0.55 (95% CI: 0.49, 0.61) with higher agreement for encounters involving trained nurses (0.62; 95% CI: 0.43, 0.80).


CONCLUSIONS
Auditing nurse-standardized patient encounters using DSAT-10 and providing feedback to nurses was feasible. Although DSAT-10 items had adequate inter-rater reliability and discriminated between trained/untrained nurses, some items were problematic.


CONCLUSIONS
Providing feedback on nurse encounters with standardized patients experiencing uncertainty has the potential to enhance nurses' decision support skills.
Stacey
Dawn
D
School of Nursing, University of Ottawa, Ottawa, Ont, Canada. dstacey@uottawa.ca
Taljaard
Monica
M
Drake
Elizabeth R
ER
O'Connor
Annette M
AM
D000328:Adult; D000368:Aged; D002983:Clinical Competence / Q000592:standards; D003142:Communication; D003661:Decision Support Techniques; D016002:Discriminant Analysis; D004509:Education, Nursing, Continuing; D005240:Feasibility Studies; D030141:Feedback, Psychological; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009723:Nurse-Patient Relations; D009731:Nursing Audit / Q000379:methods* / Q000592:standards; D015403:Nursing Evaluation Research; D009740:Nursing Staff / Q000193:education / Q000523:psychology; D015588:Observer Variation; D010358:Patient Participation / Q000379:methods / Q000523:psychology; D016544:Patient Simulation; D012944:Social Support; D013689:Telephone; D035501:Uncertainty