Monash University, School of Nursing and Midwifery, 100 Clyde Rd, Berwick, Victoria 3806, Australia.
Emerg Med J. 2013 May;30(5):377-81. doi: 10.1136/emermed-2012-201312. Epub 2012 May 19.
To assess the ability of rural Australian nurse teams to manage deteriorating patients.
This quasi-experimental design used pre- and post-intervention assessments and observation to evaluate nurses' simulated clinical performance. Registered nurses (n=44) from two hospital wards completed a formative knowledge assessment and three team-based video recorded scenarios (Objective Structured Clinical Examinations (OSCE)). Trained patient actors simulated deteriorating patients. Skill performance and situation awareness were measured and team performance was rated using the Team Emergency Assessment Measure.
Knowledge in relation to patient deterioration management varied (mean 63%, range 27-100%) with a median score of 64%. Younger nurses with a greater number of working hours scored the highest (p=0.001). OSCE performance was generally low with a mean performance of 54%, but performance was maintained despite the increasing complexity of the scenarios. Situation awareness was generally low (median 50%, mean 47%, range 17-83%, SD 14.03) with significantly higher levels in younger participants (r=-0.346, p=0.021). Teamwork ratings averaged 57% with significant associations between the subscales (Leadership, Teamwork and Task Management) (p<0.006), the global rating scale (p<0.001) and two of the OSCE measures (p<0.049). Feedback from participants following the programme indicated significant improvements in knowledge, confidence and competence (p<0.001).
Despite a satisfactory knowledge base, the application of knowledge was low with notable performance deficits in these demanding and stressful situations. The identification and management of patient deterioration needs to be taught in professional development programmes incorporating high fidelity simulation techniques. The Team Emergency assessment tool proved to be a valid measure of team performance in patient deterioration scenarios.
评估澳大利亚农村护士团队管理病情恶化患者的能力。
本准实验设计采用干预前后评估和观察，评估护士的模拟临床表现。来自两个医院病房的注册护士（n=44）完成了形成性知识评估和三个基于团队的视频记录场景（客观结构化临床考试（OSCE））。经过训练的患者演员模拟病情恶化的患者。使用团队紧急评估量表（TEAM）测量技能表现和情景意识，并对团队表现进行评分。
与患者恶化管理相关的知识差异很大（平均 63%，范围 27-100%），中位数为 64%。年轻、工作时间较长的护士得分最高（p=0.001）。尽管场景的复杂性不断增加，但 OSCE 表现通常较低，平均表现为 54%，但表现保持不变。情景意识普遍较低（中位数 50%，平均 47%，范围 17-83%，SD 14.03），年轻参与者的水平明显更高（r=-0.346，p=0.021）。团队合作评分平均为 57%，领导力、团队合作和任务管理子量表之间存在显著相关性（p<0.006），全球评分量表（p<0.001）和两个 OSCE 指标之间存在显著相关性（p<0.049）。方案结束后，参与者的反馈表明知识、信心和能力有了显著提高（p<0.001）。
尽管知识基础令人满意，但知识的应用程度较低，在这些要求高、压力大的情况下，表现明显存在缺陷。需要在专业发展计划中教授患者恶化的识别和管理，该计划纳入高保真模拟技术。在患者恶化场景中，团队紧急评估工具被证明是团队表现的有效衡量标准。
