title: Standard instruction versus simulation: Educating registered nurses in the early recognition of patient deterioration in paediatric critical care.
abstract: Identifying and stabilising deterioration in a child with significant clinical compromise is both a challenging and necessary role of the paediatric critical care nurse. Within adult critical care research, high fidelity patient simulation (HFPS) has been shown to positively impact learner outcomes regarding identification and management of a deteriorating patient; however, there is a paucity of evidence examining the use of HFPS in paediatric nursing education. The aim of this study was to investigate the effect of HFPS on nurses' self-efficacy and knowledge for recognising and managing paediatric deterioration. Further, participants' perceptions of the learning experiences specific to the identification and management of a deteriorating child were also explored. Registered nurses working in a tertiary-referral paediatric critical care unit were recruited for this quasi-experimental study. Using a pre-test/post-test control-group design, participants were assigned to one of two learning experiences: HFPS or standard instruction. Following the learning experience, nurses were also invited to participate in semi-structured interviews. 30 nurses participated in the study (control n=15, experiment n=15). Participants in the HFPS intervention were most likely to demonstrate an increase in both perceived self-efficacy (p=<0.01) and knowledge (p=<0.01). No statistically significant change was observed in control group scores. The mean difference in self-efficacy gain score between the two groups was 5.67 score units higher for the experiment group compared to the control. HFPS also yielded higher follow-up knowledge scores (p=0.01) compared to standard instruction. Ten nurses participated in semi-structured interviews. Thematic analysis of the interview data identified four themes: self-awareness, hands-on learning, teamwork, and maximising learning. The results of this study suggest that HFPS can positively influence nurses' self-efficacy and knowledge test scores specific to the recognition and management of paediatric deterioration.
authors.affiliation: Paediatric Intensive Care Unit, Lady Cilento Children's Hospital, South Brisbane, QLD 4101, Australia. Electronic address: Jessica.O'Leary@health.qld.gov.au.
authors.forename: Jessica
authors.initials: J
authors.lastname: O'Leary
authors.affiliation: Faculty of Health, Queensland University of Technology, Kelvin Grove, Brisbane, QLD, Australia. Electronic address: r.nash@qut.edu.au.
authors.forename: Robyn
authors.initials: R
authors.lastname: Nash
authors.affiliation: School of Nursing, Queensland University of Technology, Kelvin Grove, Brisbane, QLD, Australia. Electronic address: p.lewis@qut.edu.au.
authors.forename: Peter
authors.initials: P
authors.lastname: Lewis
mesh_terms: D000328:Adult; D002648:Child; D003422:Critical Care; D004509:Education, Nursing, Continuing / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D016544:Patient Simulation; D055815:Young Adult
keywords: Critical care; Nursing education; Paediatric; Patient deterioration; Simulation