www.easternhealth.org.au

Results

Self reported improvement in confidence in all assessed areas of recognition and response to clinical deterioration, see figures 1 and 2.

Aims

To explore the effectiveness of SBET with self rated measurements of confidence with identifying and responding to observable clinical deterioration:pre and post SBET (current pilot project)post observable clinical deterioration in the clinical setting (planned extension to project for 2014).

Conclusion and Discussion

The pilot study has demonstrated improvements in self reported levels of confidence in recognising and responding to clinical deterioration based on assessment pre and post SBET. However these results were obtained with a small cohort of participants as a pilot project.

There are mixed results presented in the literature in relation to confidence and competence of nurses pre and post SBET.2 The authors will continue with a larger cohort in 2014 to determine if the results are consistently obtained with a greater number of participants.

A review of the literature has identified a gap in the measure of confidence post SBET in the clinical area following events of clinical deterioration. This is a planned extension of the existing project for 2014 and the results of which may help to inform practice and more directly answer the question of the benefit of SBET and its transferability to the clincial environment.

Background and Purpose

Recognising and responding to clinical deterioration in acute health care is an essential component of safe and high quality care and one of the ten National Safety and Quality Health Service Standards.1

More than 100 graduate nurses per year at a large metropolitan health service in Victoria Australia have historically received didactic education during study day compulsory programs with respect to recognition and response to the deteriorating patient.

With new simulation facilities, and nurse educators trained in simulation, a governance project was initiated focusing on graduates recognising and responding to the deteriorating patient with two hour simulation based education and training (SBET).

Method

Population

Graduate nurses in their first 3 months of their graduate year at a large metropolitan health service in Victoria Australia. Pilot study included 29 participants.

Research DesignSurvey design - to assess graduate nurses self reported level of confidence with recognising and reporting clinical deterioration pre and post SBET.

Questionnaire Access to an online questionnaire via:

Handheld electronic device (iPad) or

a URL link which was emailed to all participants

Standard 9Recognising and responding to clinical deterioration in acute health care

References1.Australian Commission on Safety and Quality in Health Care. National Safety and Quality Health Service Standards. Sydney. ACSQHC, 20112.Yuan H.B., Williams B.A., and Fang J.B. The contribution of high fidelity simulation to nursing students’ confidence and competence: a systematic review. International Nursing Review. Vol 59, pp. 26-33.

The effectiveness of deteriorating patient simulation training with graduate nurses, on improving confidence and self reported recognition and response, in the real world setting.

M. Curtis, M. Grice, K. Jarvis, G. Mitchell, M. Rutherford Eastern Health, Victoria Australia

Figure 1: Confidence in recognising and responding to the deteriorating patient PRIOR to SBET

Figure 2: Confidence in recognising and responding to the deteriorating patient POST SBET

0 5 10 15 20 25

I felt confident using ISOBAR to communicate details of the clinical situation to the emergency responders

After identifying continued clinical deterioration and the need to escalate care, I felt confident in communicating my clinical concerns to

more senior nursing and medical staff

I felt confident in reassessing the outcomes of the intervention and identifying the need for further escalation of care

I felt confident in initiating nursing interventions in response to clinical deterioration in a patient

I felt confident in assessing my patients, to identify signs and symptoms of clinical deterioration

Completely disagree

Somewhat disagree

Somewhat agree

Completely agree

0 5 10 15 20

I will feel more confident using ISOBAR to communicate details of the clinical situation to the emergency responders

After identifying continued clinical deterioration and the need to escalate care, I will feel more confident in communicating my clinical concerns to more senior nursing and medical staff

I will feel more confident in reassessing the outcomes of the intervention and identifying the need for further escalation of

care

I will feel more confident in initiating nursing interventions in response to clinical deterioration in a patient

I will feel more confident in identifying signs and symptoms of clinical deterioration in a patient

Completely disagree

Somewhat disagree

Somewhat agree

Completely agree

Correspondence: Michelle Rutherford Practice Development Manager Eastern Health Level 3, 5 Arnold St Box HillVICTORIA 3133 Australia michelle.rutherford@easternhealth.org.au

This project was possible due to funding made available by Health Workforce Australia.