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Standard instruction versus simulation: Educating registered nurses in the early recognition of patient deterioration
Jessica O'Leary1, Robyn Nash2, Peter Lewis3
1Paediatric Intensive Care Unit, Lady Cilento Children's Hospital, South Brisbane, QLD 4101, Australia.
Insights
High-fidelity patient simulation (HFPS) significantly improved paediatric nurses' confidence and knowledge in managing deteriorating children. This advanced training method enhances critical care skills for better patient outcomes.
Area of Science:
- Pediatric Critical Care Nursing
- Medical Simulation Education
- Nursing Professional Development
Background:
- Paediatric critical care nurses face challenges in identifying and managing deteriorating children.
- High-fidelity patient simulation (HFPS) is effective in adult critical care but understudied in paediatric nursing.
- Evidence is needed on HFPS's impact on paediatric nurses' recognition and management skills.
Purpose of the Study:
- To investigate the effect of HFPS on nurses' self-efficacy and knowledge in paediatric deterioration.
- To explore nurses' perceptions of HFPS for learning paediatric deterioration management.
- To compare HFPS with standard instruction for paediatric critical care education.
Main Methods:
- Quasi-experimental study with a pre-test/post-test control-group design.
- Registered nurses in a paediatric critical care unit were assigned to HFPS or standard instruction.
- Semi-structured interviews were conducted with participants post-intervention.
Main Results:
- HFPS intervention group showed significant increases in self-efficacy (p<0.01) and knowledge (p<0.01).
- The HFPS group's self-efficacy gain was notably higher than the control group.
- Follow-up knowledge scores were significantly higher in the HFPS group compared to standard instruction (p=0.01).
Conclusions:
- HFPS positively influences nurses' self-efficacy and knowledge in recognising and managing paediatric deterioration.
- The study supports HFPS as an effective educational tool in paediatric critical care.
- Qualitative data highlighted themes of self-awareness, hands-on learning, teamwork, and maximising learning through HFPS.
Abstract:
Identifying and stabilising deterioration in a child with significant clinical compromise is both a challenging and necessary role of the paediatric critical care nurse. Within adult critical care research, high fidelity patient simulation (HFPS) has been shown to positively impact learner outcomes regarding identification and management of a deteriorating patient; however, there is a paucity of evidence examining the use of HFPS in paediatric nursing education. The aim of this study was to investigate the effect of HFPS on nurses' self-efficacy and knowledge for recognising and managing paediatric deterioration. Further, participants' perceptions of the learning experiences specific to the identification and management of a deteriorating child were also explored. Registered nurses working in a tertiary-referral paediatric critical care unit were recruited for this quasi-experimental study. Using a pre-test/post-test control-group design, participants were assigned to one of two learning experiences: HFPS or standard instruction. Following the learning experience, nurses were also invited to participate in semi-structured interviews. 30 nurses participated in the study (control n=15, experiment n=15). Participants in the HFPS intervention were most likely to demonstrate an increase in both perceived self-efficacy (p=<0.01) and knowledge (p=<0.01). No statistically significant change was observed in control group scores. The mean difference in self-efficacy gain score between the two groups was 5.67 score units higher for the experiment group compared to the control. HFPS also yielded higher follow-up knowledge scores (p=0.01) compared to standard instruction. Ten nurses participated in semi-structured interviews. Thematic analysis of the interview data identified four themes: self-awareness, hands-on learning, teamwork, and maximising learning. The results of this study suggest that HFPS can positively influence nurses' self-efficacy and knowledge test scores specific to the recognition and management of paediatric deterioration.
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