title: Identifying patient deterioration: using simulation and reflective interviewing to examine decision making skills in a rural hospital.
abstract: OBJECTIVE
  The study aim was to examine how Registered Nurses identify and respond to deteriorating patients during in-hospital simulation exercises.
  
  
  METHODS
  Mixed methods study using simulated actors.
  
  
  METHODS
  A rural hospital in Victoria, Australia.
  
  
  METHODS
  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.
authors.affiliation: Faculty of Health, Drake Circus, Plymouth PL4 8AA, UK. ruth.endacott@plymouth.ac.uk
authors.forename: Ruth
authors.initials: R
authors.lastname: Endacott
authors.forename: Julie
authors.initials: J
authors.lastname: Scholes
authors.forename: Simon
authors.initials: S
authors.lastname: Cooper
authors.forename: Tracy
authors.initials: T
authors.lastname: McConnell-Henry
authors.forename: Jo
authors.initials: J
authors.lastname: Porter
authors.forename: Karen
authors.initials: K
authors.lastname: Missen
authors.forename: Leigh
authors.initials: L
authors.lastname: Kinsman
authors.forename: Robert
authors.initials: R
authors.lastname: Champion
mesh_terms: D002983:Clinical Competence; D003657:Decision Making; D006780:Hospitals, Rural / Q000458:organization & administration*; D006801:Humans