Clinical simulation fidelity and nurses' identification of critical event risk: a signal detection analysis

This article is a report of a study exploring the effect of increasing fidelity on nurses' risk detection in clinical simulation and the effect of clinical experience on nurses' risk detection ability.

Clinical environments can be recreated successfully using simulation. However, how judgement changes as simulation fidelity increases is unknown. Knowledge of the effects of increased fidelity on judgement may help in the design of educational interventions seeking to improve clinical judgement in nurses.

Quasi experimental signal detection study.

During 2008-2009, using a quasi experimental signal detection design, 63 nursing students and 34 experienced nurses were presented with 25 paper and 25 human simulator 'cases' based on real patient records from a single UK National Health Service hospital. Nurses judged whether a simulated case was 'at risk' or 'not at risk' of a critical event. Clinical judgement performance was measured using standard signal detection measures.

Judgement performance, as measured by hit rates and signal detection ability were significantly lower in higher fidelity clinical simulations. False alarm rates and bias (β) did not differ according to the fidelity of simulation. Clinical experience did not predict the ability to detect risk.

As fidelity of simulation increased, both novice and experienced nurses' were less likely to be able to separate important clinical risk from clinical noise in a simulated clinical environment.