title: Undergraduate nursing students' performance in recognising and responding to sudden patient deterioration in high psychological fidelity simulated environments: an Australian multi-centre study.
abstract: BACKGROUND
  Early recognition and situation awareness of sudden patient deterioration, a timely appropriate clinical response, and teamwork are critical to patient outcomes. High fidelity simulated environments provide the opportunity for undergraduate nursing students to develop and refine recognition and response skills.
  
  
  OBJECTIVE
  This paper reports the quantitative findings of the first phase of a larger program of ongoing research: Feedback Incorporating Review and Simulation Techniques to Act on Clinical Trends (FIRST2ACTTM). It specifically aims to identify the characteristics that may predict primary outcome measures of clinical performance, teamwork and situation awareness in the management of deteriorating patients.
  
  
  METHODS
  Mixed-method multi-centre study.
  
  
  METHODS
  High fidelity simulated acute clinical environment in three Australian universities.
  
  
  METHODS
  A convenience sample of 97 final year nursing students enrolled in an undergraduate Bachelor of Nursing or combined Bachelor of Nursing degree were included in the study.
  
  
  METHODS
  In groups of three, participants proceeded through three phases: (i) pre-briefing and completion of a multi-choice question test, (ii) three video-recorded simulated clinical scenarios where actors substituted real patients with deteriorating conditions, and (iii) post-scenario debriefing. Clinical performance, teamwork and situation awareness were evaluated, using a validated standard checklist (OSCE), Team Emergency Assessment Measure (TEAM) score sheet and Situation Awareness Global Assessment Technique (SAGAT). A Modified Angoff technique was used to establish cut points for clinical performance.
  
  
  RESULTS
  Student teams engaged in 97 simulation experiences across the three scenarios and achieved a level of clinical performance consistent with the experts' identified pass level point in only 9 (1%) of the simulation experiences. Knowledge was significantly associated with overall teamwork (p=.034), overall situation awareness (p=.05) and clinical performance in two of the three scenarios (p=.032 cardiac and p=.006 shock). Situation awareness scores of scenario team leaders were low overall, with an average total score of 41%.
  
  
  CONCLUSIONS
  Final year undergraduate nursing students may have difficulty recognising and responding appropriately to patient deterioration. Improving pre-requisite knowledge, rehearsal of first response and team management strategies need to be a key component of undergraduate nursing students' education and ought to specifically address clinical performance, teamwork and situation awareness.
authors.affiliation: The School of Nursing & Midwifery, The University of Queensland, Herston Campus, QLD, Australia. Electronic address: f.bogossian@uq.edu.au.
authors.forename: Fiona
authors.initials: F
authors.lastname: Bogossian
authors.affiliation: The School of Nursing & Midwifery, Monash University, Berwick Campus, VIC, Australia.
authors.forename: Simon
authors.initials: S
authors.lastname: Cooper
authors.affiliation: The School of Nursing & Midwifery, Monash University, Berwick Campus, VIC, Australia.
authors.forename: Robyn
authors.initials: R
authors.lastname: Cant
authors.affiliation: The School of Nursing & Midwifery, Monash University, Berwick Campus, VIC, Australia; Population Health Strategic Research Centre, Deakin University, Burwood Campus, VIC, Australia.
authors.forename: Alison
authors.initials: A
authors.lastname: Beauchamp
authors.affiliation: The School of Nursing & Midwifery, Monash University, Gippsland Campus, VIC, Australia.
authors.forename: Joanne
authors.initials: J
authors.lastname: Porter
authors.affiliation: The School of Nursing & Midwifery, The University of Queensland, Herston Campus, QLD, Australia.
authors.forename: Victoria
authors.initials: V
authors.lastname: Kain
authors.affiliation: School of Nursing and Midwifery Deakin University, Burwood Campus, VIC, Australia.
authors.forename: Tracey
authors.initials: T
authors.lastname: Bucknall
authors.affiliation: School of Nursing and Midwifery Deakin University, Burwood Campus, VIC, Australia.
authors.forename: Nicole M
authors.initials: NM
authors.lastname: Phillips
mesh_terms: D001315:Australia; D006801:Humans; D009730:Nursing Assessment; D016544:Patient Simulation; D012720:Severity of Illness Index; D013338:Students, Nursing
keywords: Clinical decision making; Clinical performance; Education; Nursing; Patient deterioration; Simulation; Situation awareness; Team work