Using Simulation Training to Improve Nurses' Recognition of Clinical Deterioration
Characteristics of simulation training
Simulation training has been used over the years by different assessment centers, teachers, schools, and the like. It is much more preferred than classroom-based instructions in terms of providing a more experiential or situational-type of learning. Studies have shown that this type of training effectively hones job-related skills and tests the mastery of students and employees of their given field effectively.
Training through simulation essentially duplicates real-life work situations while testing past learning and adding more information to the people that are part of the training process. There are different types of simulations that are currently available that are designed to fit a given career present in society. For example, healthcare simulations make use of dummy models as patients. There are also other methods used in such simulation training such as virtual patients, standardized patients, human patient simulators and even screen-based simulation. For trainees to effectively learn and retain acquired learning from the training, the training itself should have clear objectives and goals set for students or employees to achieve.
Simulation has become very widely used in the field of nursing. It helps them achieve the proficiency to efficiently respond to emergencies, recognize and respond to clinical problems, along with other skills such as stress-management and interpersonal relations. With regard to simulation training in the clinical field, specifically for nurses, it is best to set goals that focus on patient safety and care. Success through this training can become very beneficial, especially for successfully responding to health problems such as clinical deterioration.
Clinical deterioration in hospitalized patients
Over the years, there has not been an established definition of clinical deterioration. According to Jones et al, clinical deterioration in patients occurs when their clinical state worsens, which makes them more vulnerable to dysfunctions, morbidity, or even death. A lot of hospitalized patients who suffer from cardiac arrest or who require intensive care from medical staff have high chances of experiencing clinical deterioration. If there is a delay in the recognition of the patient's’ signs and symptoms or poor management from medical staff, negative outcomes may arise such as prolonged hospital stays and morbid prognoses.
According to one study that questions undergraduate medical training, there has been a deficiency on the focus of confidence and competence in the recognition and management of patients with deteriorating signs and symptoms.
The importance of simulation training in nursing
Due to the alarming rise in morbidity and mortality in hospitalized patients, training nurses for further competence and specialization has been deemed necessary. Clinical deterioration of patients can highly occur due to late identification of the deterioration and poor management from hospital staff. The use of simulation in training nurses attempts to address the situation by placing them in controlled environments that aim to enhance their capability in such conditions and the further improvement of recognition and response systems. The trainees are to handle scenarios that are plausible in real-life events and are given feedback and reinforcement afterward for further improvement. Simulation training also offers an extensive list of advantages in comparison to actual clinical experiences such as being able to make use of rare and critical situations for trainees, ensuring a secure and safe environment for patients and the capacity of the situation to be reproduced.
The expected outcome of the simulation training for nurses is a heightened level of competence and knowledge in safety, recognition, and management of clinical deterioration in patients. It is crucial for patients that are deteriorating to be handled with expertise and to be given appropriate care and attention from medical staff.
Simulations help improve clinical systems and nurses by effectively teaching them to have a minimum to zero tolerance for errors in treatment or medication. Furthermore, they also help nurses to develop critical thinking skills that are highly useful in making clinical decisions once they are in the field.
Related studies
Different movements on the improvement of hospital systems have been made in order to effectively give out the needed help and fully comply the needs of deteriorating hospitalized patients. Some researchers have proposed the usage of simulation in training nurses. In meta-analyses conducted and published by the BMJ Journal, it shows that the treatment given (the simulation training) between pre-tests and post-tests, showed a significant effect on the performance of the participants in recognizing and managing clinical deterioration. A total of 19 empirical research studies were conducted for the meta-analyses, measuring different types of simulation. Further findings of the research suggest that face-to-face simulation training showed a more significant increase in knowledge based on the effect size of the data in comparison to web-based simulation programs.
Due to the heterogeneity of the results, a standardized treatment was then created. The standardized simulated programs included concepts such as Airway, Breathing, Circulation, Disability, and Exposure or Situation Background. This systematized concept was then used to formulate a tool, which will be used in measuring the performance of the nurses during simulation training, which is known as RAPIDS. Furthermore, studies on outcome-based results or the impact of simulation training in the performance of nurses in actual clinical settings are highly needed. For huge populations, web-based simulations are much more preferable in comparison to face-to-face simulations as they save the time and effort of assessors while still attaining the goal of delivering knowledge to nurses.
In another study by Hogg and Miller, a questionnaire survey was used, containing three sections. The sections captured (1) the student’s perceptions of the learning experience (2) confidence of students and (3) gathered responses through open-ended questions. The respondents of the study were third-year medical students in the North East of Scotland who went through an enhanced simulation exercise called Recognising Acute Deterioration: Active Response (RADAR).
The results of the study showed a positive and significant outcome of the simulation-based training in terms of educational learning. The sessions that the medical students experience were active and had a suitable amount of level of challenge and stress. Results also showed that the amount of confidence for students to recognize clinical deterioration also increased significantly after training. In the third part of the survey, the students were able to list down numerous benefits of the RADAR exercise. Overall, the study shows that the simulation program that was introduced to medical students proved to have a significant impact on knowledge and performance which can then be replicated or transferred in actual clinical practice.
In 2015, another study was conducted by researchers at Eastern Kentucky University. The 40 participants of the study were nurses whose ages ranged from 21 to 55 years old. The results of the study show simulation to be an effective teaching strategy in helping nurses recognize early symptoms of clinical deterioration. Furthermore, it also efficiently teaches nurses proper intervention of patients whose clinical conditions are deteriorating. The overall training showed a significant increase in the confidence and knowledge of nurses.
An article was published by Elsevier, which made use of a simulation-based program called STEPS, which stands for Simulated Training for Enhancing Patient Safety. A 19 item pre-post within-subject designed was used to gather data to measure the effect of the STEPS intervention on the nurses’ knowledge and clinical judgment. The participants of the study were registered nurses at a progressive care unit at a Midwestern medical center. Similar to the findings of the previous studies, the participants of the study were highly pleased with the training. However, a unique finding of this study showed that there seemed to be no significantly statistical difference over time with scores.
Conclusion
All of the studies that have been conducted show the positive and significant impact of simulation-based training in the increase of confidence and knowledge of nurses in the recognition and management of clinical deterioration. So, training in the medical field that utilizes simulation programs should be encouraged. Further research on the impact and comparison of specific types of simulation-based programs, such as human patient simulators, standardized patients, or web-based programs is also recommended across the world.
