Cooper Simon, McConnell-Henry Tracy, Cant Robyn, Porter Jo, Missen Karen, Kinsman Leigh, Endacott Ruth, Scholes Julie
Monash University, School of Nursing (Gippsland), Churchill, Victoria, 3842, Australia.
Open Nurs J. 2011;5:120-6. doi: 10.2174/18744346011050100120. Epub 2011 Nov 18.
To examine, in a simulated environment, rural nurses' ability to assess and manage patient deterioration using measures of knowledge, situation awareness and skill performance.
Nurses' ability to manage deterioration and 'failure to rescue' are of significant concern with questions over knowledge and clinical skills. Simulated emergencies may help to identify and develop core skills.
An exploratory quantitative performance review. Thirty five nurses from a single ward completed a knowledge questionnaire and two video recorded simulated scenarios in a rural hospital setting. Patient actors simulated deteriorating patients with an Acute Myocardial Infarction (AMI) and Chronic Obstructive Pulmonary Disease (COPD) as the primary diagnosis. How aware individuals were of the situation (levels of situation awareness) were measured at the end of each scenario.
KNOWLEDGE OF DETERIORATION MANAGEMENT VARIED CONSIDERABLY (RANGE: 27%-91%) with a mean score of 67%. Average situation awareness scores and skill scores across the two scenarios (AMI and COPD) were low (50%) with many important observations and actions missed. Participants did identify that 'patients' were deteriorating but as each patient deteriorated staff performance declined with a reduction in all observational records and actions. In many cases, performance decrements appeared to be related to high anxiety levels. Participants tended to focus on single signs and symptoms and failed to use a systematic approach to patient assessment.
Knowledge and skills were generally low in this rural hospital sample with notable performance decrements as patients acutely declined. Educational models that incorporate high fidelity simulation and feedback techniques are likely to have a significant positive impact on performance.
在模拟环境中，通过知识、态势感知和技能表现等指标，考察乡村护士评估和处理患者病情恶化的能力。
护士处理病情恶化及“未能挽救”的能力备受关注，存在知识和临床技能方面的问题。模拟紧急情况可能有助于识别和培养核心技能。
进行一项探索性定量绩效评估。来自同一病房的35名护士完成了一份知识问卷，并参与了在乡村医院环境中录制的两个视频模拟场景。患者扮演者模拟以急性心肌梗死（AMI）和慢性阻塞性肺疾病（COPD）为主要诊断的病情恶化患者。在每个场景结束时，测量个体对情况的知晓程度（态势感知水平）。
病情恶化管理知识差异很大（范围：27%-91%），平均得分为67%。两个场景（AMI和COPD）的平均态势感知得分和技能得分较低（50%），许多重要的观察和行动被遗漏。参与者确实识别出“患者”病情在恶化，但随着每个患者病情恶化，工作人员的表现下降，所有观察记录和行动都减少。在许多情况下，表现下降似乎与高度焦虑有关。参与者倾向于关注单一的体征和症状，未能采用系统的方法进行患者评估。
在这个乡村医院样本中，知识和技能普遍较低，随着患者病情急剧恶化，表现明显下降。纳入高保真模拟和反馈技术的教育模式可能对表现产生显著的积极影响。
