title: Recognizing, responding to and reporting patient deterioration: transferring simulation learning to patient care settings.
abstract: BACKGROUND
  A simulation program was implemented in a pre-registration nursing curriculum for developing nursing students' performances in assessing, managing and reporting in relation to patients with physiological deterioration.
  
  
  OBJECTIVE
  To explore nursing students' experiences of how a simulation programme has prepared them to transfer their performance to clinical practice, in their encounters with deteriorating patients in ward.
  
  
  METHODS
  A qualitative study using a critical incident technique was conducted. After they had undertaken a simulation program, fifteen undergraduate nursing students, who had encountered deteriorating patients in their clinical practicum in wards were interviewed using semi-structured questionnaires. Content analysis was used to analyse the data.
  
  
  RESULTS
  Four main themes emerged describing key factors influencing the transfer of simulation learning to clinical practice; memory, involving simulation learning enhanced storage and retrieval of knowledge; mnemonics as transfer tools for performing systematic physical assessment and reporting a patient's deterioration to a doctor; recognizing similar situations, where students used experiences from similar simulation situation to identify problems and initiate nursing interventions for their patients; and finally, emotional responses, that have both negative and positive impacts on transferring their simulation learning. Two other main themes emerged regarding strategies to facilitate transfer; self-directed learning for promoting the retention of simulation learning; and, realism, where simulated patients could be used to provide real-life clinical experiences.
  
  
  CONCLUSIONS
  The findings provide an understanding of how a simulation program may impact on the nursing students' performances in clinical practice, which is useful information for future improvement of programmes to optimize learning and transfer effective care to patient care settings.
authors.affiliation: Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore. nurliaw@nus.edu.sg
authors.forename: Sok Ying
authors.initials: SY
authors.lastname: Liaw
authors.forename: Sally Wai-chi
authors.initials: SW
authors.lastname: Chan
authors.forename: Albert
authors.initials: A
authors.lastname: Scherpbier
authors.forename: Jan-Joost
authors.initials: JJ
authors.lastname: Rethans
authors.forename: Gim Gim
authors.initials: GG
authors.lastname: Pua
mesh_terms: D000328:Adult; D003194:Computer-Assisted Instruction; D003479:Curriculum; D018450:Disease Progression; D004508:Education, Nursing, Baccalaureate / Q000379:methods*; D004644:Emotions; D005260:Female; D006801:Humans; D007858:Learning; D008568:Memory; D009730:Nursing Assessment / Q000379:methods*; D016544:Patient Simulation; D011361:Professional Competence; D017010:Reminder Systems; D011795:Surveys and Questionnaires; D013647:Task Performance and Analysis; D055986:Vital Signs