Identifying patient deterioration: Using simulation and reflective interviewing to examine decision making skills in a rural hospital

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• 作者：Ruth Endacott^a ; ^b ; ^{ruth.endacott@plymouth.ac.uk} ; ^{ruth.endacott@monash.edu} ; Julie Scholes^c ; ^{J.Scholes@brighton.ac.uk} ; Simon Cooper^b ; ^{simon.j.cooper@monash.edu.au} ; Tracy McConnell-Henry^b ; ^{tracy.mcconnell-henry@monash.edu.au} ; Jo Porter^b ; ^{Joanne.porter@monash.edu} ; Karen Missen^b ; ^{Karen.Missen@monash.edu} ; Leigh Kinsman^d ; ^{Leigh.Kinsman@monash.edu} ; Robert Champion^e ; ^{R.champion@latrobe.edu.au}
• 关键词：Decision making ; Rural hospitals ; Safety management ; Nursing
• 刊名：International Journal of Nursing Studies
• 出版年：2012
• 期刊代码：134_00207489
• 类别：med
• 出版时间：June, 2012
• 卷：49
• 期：6
• 页码：710-717
• 文件大小：236 K

摘要

Objectives

The study aim was to examine how Registered Nurses identify and respond to deteriorating patients during in-hospital simulation exercises.

Design

Mixed methods study using simulated actors.

Setting

A rural hospital in Victoria, Australia.

Participants

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鈥?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鈥?decision-making that were not evident from OSCE scoring alone. Feedback during video review was a highly valued component of the simulation exercises.