Nursing students' educational experience in regional Australia: Reflections on acute events. A qualitative review of clinical incidents.

Concerns have been expressed relating to healthcare professionals' ability to manage deteriorating patients. Whilst on placement nursing students are exposed to a range of behaviours and role models that may influence their future practice. We aimed to identify events that impact upon the practice and preparedness of Australian undergraduate nursing students in the management of deteriorating patients. Methods included a Generic Qualitative Research design reviewing 224 reflective reports on clinical events submitted by 92 final year nursing students. Forty (40) patient deterioration events were identified and subjected to detailed coding and thematic analysis. A range of events impacted upon students' practice and preparation. Five themes and 15 subthemes were identified including 'Communication' - the need for adequate handover and documentation; 'Teamwork' - demonstrating the positive impact on patient outcomes; 'Workload' - the negative effects of high staff/patient ratios; 'Clinical judgement/knowledge' - the need for adequate preparation of staff for safe clinical settings; and negative outcomes relating to 'Attention Deficits'. In conclusion Australian nursing students experience a range of practice behaviours from exemplary leadership, to careless individual practices and a 'failure to rescue' deteriorating patients. Clinical experiences have a profound influence on students with potential positive and negative effects on future practice.