Joanne Porter

The FIRST2ACT simulation program improves nursing practice in a rural Australian hospital

OBJECTIVE To measure the impact of the Feedback Incorporating Review and Simulation Techniques to Act on Clinical Trends (FIRST(2) ACT) simulation program on nursing observations and practice relevant to patient deterioration in a rural Australian hospital. DESIGN Interrupted time series analysis. SETTING A rural Australian hospital. PARTICIPANTS All registered nurses (Division 1) employed on an acute medical/surgical ward. INTERVENTION The FIRST(2) ACT simulation program. OUTCOME MEASURES Appropriate frequency of a range of observations and administration of oxygen therapy. RESULTS Thirty-four nurses participated (83% of eligible nurses) in the FIRST(2) ACT program, and 258 records were audited before the program and 242 records after. There were statistically significant reductions in less than satisfactory frequency of observations (P = 0.009) and pain score charting (P = 0.003). There was no measurable improvement in the administration of oxygen therapy (P = 0.143), while the incidence of inappropriate nursing practice for other measures both before and after the intervention was too low to warrant analysis. CONCLUSION FIRST(2) ACT was associated with measurable improvements in nursing practice.

Family presence during resuscitation (FPDR): Perceived benefits, barriers and enablers to implementation and practice

INTRODUCTION There are a number of perceived benefits and barriers to family presence during resuscitation (FPDR) in the emergency department, and debate continues among health professionals regarding the practice of family presence. AIM This review of the literature aims to develop an understanding of the perceived benefits, barriers and enablers to implementing and practicing FPDR in the emergency department. RESULTS The perceived benefits include; helping with the grieving process; everything possible was done, facilitates closure and healing and provides guidance and family understanding and allows relatives to recognise efforts. The perceived barriers included; increased stress and anxiety, distracted by relatives, fear of litigation, traumatic experience and family interference. There were four sub themes that emerged from the literature around the enablers of FPDR, these included; the need for a designated support person, the importance of training and education for staff and the development of a formal policy within the emergency department to inform practice. CONCLUSION In order to ensure that practice of FPDR becomes consistent, emergency personnel need to understand the need for advanced FPDR training and education, the importance of a designated support person role and the evidence of FPDR policy as enablers to implementation.

Managing patient deterioration: a protocol for enhancing undergraduate nursing students' competence through web-based simulation and feedback techniques

AimsTo describe a funded proposal for the development of an on-line evidence based educational program for the management of deteriorating patients.BackgroundThere are international concerns regarding the management of deteriorating patients with issues around the ‘failure to rescue’. The primary response to these issues has been the development of medical emergency teams with little focus on the education of primary first responders.Design/MethodsA mixed methods triangulated convergent design.In this four phase proposal we plan to 1. examine nursing student team ability to manage deteriorating patients and based upon these findings 2. develop web based educational material, including interactive scenarios. This educational material will be tested and refined in the third Phase 3, prior to evaluation and dissemination in the final phase.ConclusionThis project aims to enhance knowledge development for the management of deteriorating patients through rigorous assessment of team performance and to produce a contemporary evidence-based online training program.

Measuring situation awareness in emergency settings: a systematic review of tools and outcomes

Background Nontechnical skills have an impact on health care outcomes and improve patient safety. Situation awareness is core with the view that an understanding of the environment will influence decision-making and performance. This paper reviews and describes indirect and direct measures of situation awareness applicable for emergency settings. Methods Electronic databases and search engines were searched from 1980 to 2010, including CINAHL, Ovid Medline, Pro-Quest, Cochrane, and the search engine, Google Scholar. Access strategies included keyword, author, and journal searches. Publications identified were assessed for relevance, and analyzed and synthesized using Oxford evidence levels and the Critical Appraisal Skills Programme guidelines in order to assess their quality and rigor. Results One hundred and thirteen papers were initially identified, and reduced to 55 following title and abstract review. The final selection included 14 papers drawn from the fields of emergency medicine, intensive care, anesthetics, and surgery. Ten of these discussed four general nontechnical skill measures (including situation awareness) and four incorporated the Situation Awareness Global Assessment Technique. Conclusion A range of direct and indirect techniques for measuring situation awareness is available. In the medical literature, indirect approaches are the most common, with situation awareness measured as part of a nontechnical skills assessment. In simulation-based studies, situation awareness in emergencies tends to be suboptimal, indicating the need for improved training techniques to enhance awareness and improve decision-making.

Family presence during resuscitation (FPDR): A survey of emergency personnel in Victoria, Australia

BACKGROUND Family presence during resuscitation (FPDR) has been endorsed internationally by resuscitation councils since the year 2000; however, the extent to which FPDR is practiced in emergency settings requires further investigation. METHODS Emergency personnel (n=347) from 18 participating emergency departments across the state of Victoria, Australia completed a 10-page questionnaire, which was designed to develop an understanding of the current practice and implementation of FPDR and to ascertain the differences in practice between adult and paediatric resuscitations. RESULTS Emergency personnel update their adult and paediatric advanced life support qualifications annually with 87% of nurses and 65% of doctors completing adult life support and 72% of nurses and 49% of doctors completing paediatric advanced life support training. The majority of nursing staff reported support for FPDR (83%) with over 70% indicating that it is apart of their current practice. There was strong agreement from both nurses (79%) and doctors (77%) that the family have the right to be present. A family support person was deemed as essential by nurses (92%) and doctors (89%) when allowing family to be present. A factor analysis was conducted on participant statements, revealing four codes; impact on professional practice and performance, personnel beliefs about FPDR, professional satisfaction and the importance of a support person and saying goodbye. CONCLUSION A family support person was highlighted as essential to the successful implementation of FPDR, together with the development of a comprehensive training the education program for emergency personnel. FPDR continues to be a significant issue and further investigation into FPDR practice and implementation in the ED is warranted.

Family Presence During Resuscitation: A Double‐Edged Sword

Purpose To illuminate the meaning of the lived experiences of resuscitation team members with the presence of the patients family during resuscitation in the cultural context of Iran. Design An interpretative phenomenology was used to discover the lived experiences of the nurses and physicians of Tabriz hospitals, Iran, with family presence during resuscitation (FPDR). A total of 12 nurses and 9 physicians were interviewed over a 6-month period. Methods The interviews were audio recorded and semistructured, and were transcribed verbatim. Van Manens technique was used for data analysis. Findings Two major themes and 10 subthemes emerged, including destructive presence (cessation of resuscitation, interference in resuscitation, disruption to the resuscitation teams focus, argument with the resuscitation team, and adverse mental image in the family) and supportive presence (trust in the resuscitation team, collaboration with the resuscitation team, alleviating the familys concern and settling their nerves, increasing the familys satisfaction, and reducing conflict with resuscitation team members). Conclusions Participants stated that FPDR may work as a double-edged sword for the family and resuscitation team, hurting or preserving quality. It is thus recommended that guidelines be created to protect patients’ and families’ rights, while considering the positive aspects of the phenomenon for hospitals. Clinical Relevance A liaison support person would act to decrease family anxiety levels and would be able to de-escalate any potentially aggressive or confrontational events during resuscitation. Well-trained and expert cardiopulmonary resuscitation team members do not have any stress in the presence of family during resuscitation. Resuscitation events tend to be prolonged when family members are allowed to be present.

E-simulation: preregistration nursing students’ evaluation of an online patient deterioration program

This study explores preregistration nursing students’ views of a Web-based simulation program: FIRST2 ACTWeb (Feedback Incorporating Review and Simulation Techniques to Act on Clinical Trends-Web). The multimedia program incorporating three videoed scenarios portrayed by a standardized patient (human actor) aims to improve students’ recognition and management of hospital patient deterioration. Participants were 367 final-year nursing students from three universities who completed an online evaluation survey and 19 students from two universities who attended one of five focus groups. Two researchers conducted a thematic analysis of the transcribed narratives. Three core themes identified were as follows: “ease of program use,” “experience of e-Simulation,” and “satisfaction with the learning experience.” The Web-based clinical learning environment was endorsed as functional, feasible, and easy to use and was reported to have high fidelity and realism. Feedback in both focus groups and surveys showed high satisfaction with the learning experience. Overall, evaluation suggested that the Web-based simulation program successfully integrated elements essential for blended learning. Although Web-based educational applications are resource intensive to develop, positive appraisal of program quality, plus program accessibility and repeatability, appears to provide important educational benefits. Further research is needed to determine the transferability of these learning experiences into real-world practice.

Family Presence During Resuscitation (FPDR): Observational case studies of emergency personnel in Victoria, Australia

INTRODUCTION Family Presence During Resuscitation (FPDR), although not a new concept, remains inconsistently implemented by emergency personnel. Many larger metropolitan emergency departments (ED) have instigated a care coordinator role, however these personnel are often from a non-nursing background and have therefore limited knowledge about the clinical aspects of the resuscitation. In rural emergency departments there are simply not enough staff to allocate an independent role. A separate care coordinator role, who is assigned to care for the family and not take part in the resuscitation has been well documented as essential to the successful implementation of FPDR. METHODS One rural and one metropolitan emergency department in the state of Victoria, Australia were observed and data was collected on FPDR events. The participants consisted of resuscitation team members, including; emergency trained nurses, senior medical officers, general nurses and doctors. The participants were not told that the data would be recorded around interactions with family members or team discussions regarding family involvement in the resuscitation, following ethical approval involving limited disclosure of the aims of the study. RESULTS Seventeen adult presentations (Metro n=9, Rural n=8) were included in this study and will be presented as resuscitation case studies. The key themes identified included ambiguity around resuscitation status, keeping the family informed, family isolation and inter-professional communication. CONCLUSION During 17 adult resuscitation cases, staff were witnessed communicating with family, which was often limited and isolation resulted. Family were often uninformed or separated from their family member, however when a family liaison person was available it was found to be beneficial. This research indicated that staff could benefit from a designated family liaison role, formal policy and further education.

Developing team based acute care scenarios: A rural hospital experience

BACKGROUND Health professionals work in teams in a variety of health care settings especially in medical emergency teams at times of crisis. However, Registered Nurses (RNs) rarely have the chance to partake in educational programs designed for teams of nurses to practice working together in life-threatening situations. Further RNs employed in rural setting have less opportunities for professional development than their city based counterparts. Simulated scenarios with a patient actor in a rural hospital have been utilised in this study to provide nurses with the opportunity to work as a team in the early recognition and management of patients with acute medical conditions. AIM This discussion paper focuses on one aspect of a larger research project with the aim of describing the development of team based scenarios for a rural hospital setting, focusing on the detection and management of a deteriorating patient. METHODS Three team based scenarios, the related assessments and feedback techniques are all described. CONCLUSION Team based simulation provides a unique opportunity to assist registered nurses in rural settings in re-skilling or maintaining their emergency management skills.

Development of an undergraduate nursing clinical evaluation form (CEF)

A clinical placement evaluation form for undergraduate nursing students was developed to address the need for evaluating success in clinical teaching support and provide a feedback loop to the University, clinical educators and clinical venues. A 21-item, with five domains, (orientation, clinical educator/teacher, ward staff and environment, clinical hurdles, and university) Clinical Evaluation Form (CEF) was developed. The form was live tested with 178 year 1 and 2 undergraduate nursing students. The CEF scale was reliable (alpha=0.90) and has good face and content validity approved by an expert panel. Further research is recommended to validate the CEF for use multi-professionally and across all year levels.