title: Doing the Right Thing at the Right Time: Assessing Responses to Patient Deterioration in Electronic Simulation Scenarios Using Course-of-Action Analysis.
abstract: International studies indicate that the recognition and management of deteriorating patients in hospitals are poor and that patient assessment is often inadequate. Face-to-face simulation programs have been shown to have an impact on educational and clinical outcomes; however, little is known about performance in contemporary healthcare e-simulation approaches. Using data from an open-access Web-based patient deterioration program (FIRSTACTWeb), the performance of 367 Australian nursing students in identification of treatment priorities and clinical actions was analyzed using a military model of Course of Action Simulation Analysis. Participants' performance in the whole program demonstrated a significant improvement in knowledge and skills (P ≤ .001) with high levels of participant satisfaction. Course of Action Simulation Analysis modeling identified three key participant groupings within which only 18% took the "best course of action" (the right actions and timing), with most (70%) completing the right actions but in the wrong order. The remaining 12% produced incomplete assessments and actions in an incorrect sequence. Contemporary approaches such as e-simulation do enhance educational outcomes. Measurement of performance when combined with Course of Action Simulation Analysis becomes a useful tool in the description of outcomes, an understanding of decision making, and the prediction of future events.
authors.affiliation: Author Affiliations: Federation University Australia, Gippsland, Victoria, Australia; School of Nursing, The University of Hong Kong; and School of Nursing and Midwifery, University of Brighton, United Kingdom (Dr Cooper); School of Nursing and Midwifery, Monash University, Melbourne, Victoria (Dr Cant); School of Nursing and Midwifery, The University of Queensland Herston Campus, Brisbane, Queensland (Dr Bogossian); and School of Nursing and Midwifery, Deakin University (Dr Bucknall); and Faculty of Information Technology, Monash University (Mr Hopmans), Melbourne, Victoria, Australia.
authors.forename: Simon
authors.initials: S
authors.lastname: Cooper
authors.forename: Robyn P
authors.initials: RP
authors.lastname: Cant
authors.forename: Fiona
authors.initials: F
authors.lastname: Bogossian
authors.forename: Tracey
authors.initials: T
authors.lastname: Bucknall
authors.forename: Ruben
authors.initials: R
authors.lastname: Hopmans
mesh_terms: D000293:Adolescent; D000328:Adult; D001315:Australia; D002983:Clinical Competence; D003194:Computer-Assisted Instruction; D018450:Disease Progression; D004506:Education, Nursing / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D019212:Multimedia; D048108:Nursing Informatics; D000066908:Simulation Training / Q000379:methods*; D013338:Students, Nursing; D055815:Young Adult