Nurses are the direct line of care for patients while being treated inpatient. The Effects of Unit-Based Simulation on Nurses’ Identification of Deteriorating Patients (Disher et al., 2014) is the quasi-experimental study that is being evaluated. This journal article is a pilot research study using a quasi-experimental design with an interventional pre-post method. Disher et al. recognized that nurses historically, and frequently failed to identify when patient conditions change. This study reviewed the effects of using a high fidelity simulation to identify nurses’ ability towards the identification of deteriorating patients. This approach was best used for this review due to the ability of the researchers to evaluate the test subjects thoroughly. The purpose of the study was to evaluate whether high fidelity simulations assist nurses in recognizing when patients were experiencing an acute patient deterioration event. The problems statement for this study was that there is a lack of identification and action in a timely manner for patients that exhibit early warning signs before an acute patient deterioration event. The research questions in this article entailed the nurses’ knowledge of intervening and the nurses’ confidence level in intervening during an acute respiratory event on a cardiac step-down unit in a community hospital. This study tested the nurses’ knowledge and skill level, confidence, ability to communicate, and leadership during the pretest and posttest. The pretest would then be retested after the simulation exercise. Since the outcomes for the posttest of the simulation would indicate that the nurses’ gained knowledge that indicated that the independent variable was the use of unit based, high fidelity simulation scenario. Likewise, the dependent variables were the nurses’ knowledge and skills, confidence, communication, and leadership because these skills directly influence the outcome of the simulation. Previous research supported that using high fidelity simulations increased knowledge and confidence as well (Adamson, 2015).
Review of Literature
This study was supported by the use of fifty resources. These resources were ranged from between two thousand four through two thousand twelve. Likewise, these sources were supported through evidence in scholarly journals, and systematic reviews. This article included both theoretical research and empirical to provide evidence. Similarly, other researchers have since published articles in relation to Disher et al., which used the same high fidelity unit based simulations for research and found similar results, Smith, Chisholm, McGee & Das’s (2016) article, Effectiveness of Integrated Simulation and Clinical Experiences Compared to Traditional Clinical Experiences for Nursing Students, concludes that the subjects being tested were more confident after the use of simulation. Disher et al. journal article review cite many studies based on the efficacy of using high fidelity based simulation and unit-based simulations. Some systematic reviews showed inconsistencies that other reviews suggested nurses acquired additional skills, more knowledge, and more confidence through simulation training. However, this study supports that unit based, high fidelity simulation was successful.
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This article introduces the need for nursing intervention. The article introduction acknowledges the fact that nurses struggle to identify patient deterioration. It also identifies a complex problem based on properly training nurses to identify and intervene when patients are declining. Through these problems, the determination to promote simulations would not only educate nurses but also make them more confident. These simulations, although costly, allow for the best design for learning and also educational experience (Disher et al. 2014).
This pilot research study used a quasi-experimental design with an interventional pre-post method. The scenario used to test was based on the National League for Nursing simulation scenario, involving the use of a patient with chronic obstructive pulmonary disease (Disher et al. 2014). The framework for the study was based on Jeffries’ nursing education simulation framework, which includes five conceptual components. Jeffries’ Nursing Educations Simulation Framework has been used in multiple studies as the standard form of training incorporating simulations to study confidence and increased knowledge. The rationale for this framework is that test subjects retain knowledge and have more satisfaction from learning through the use of simulations. This newly created knowledge and self-satisfaction are commonly evidenced in the use of the Jeffries’ nursing education simulation framework five components: teacher, student, educational practice, simulation design, and expected outcomes (Adamson, 2015). The Jeffries’ framework also has been reviewed with concerns, such as gaps in learning, skill-performance in the simulation lab, learner satisfaction, critical thinking, and self-confidence as adequate evidence for the effectiveness of simulation (Adamson, 2015). Although two acute care units were used for this study, the testing did not validate that communication about the simulation was disseminated between the subjects. It was highly suggested that the groups did not reveal the scenarios, but these instances are not discernable. The article discusses that the Hawthorne effect might have contributed to better scores. A systematic review was completed showing that the Hawthorne effect is normal behavior between test subjects (McCambridge, Witton, & Elbourne, D, 2014). To reinforce the efficacy and external validity of the experiment Disher et al. also suggested following up with a third test to support the validity.
Data collection contributing to this study was collected by primarily questionnaires. The questionnaire identified the nurses’ confidence level, the level of experience, special certifications, and the type of education they received. The use of this data would also assist leaders in developing stronger teams. By spreading knowledge and experience, would likewise boost the self-confidence in less mature staff member (Fusco, & Foltz-Ramos, 2018). The pretest questionnaire involved consents and a pre-assessment. Likewise, the posttest involved questionnaires and a debriefing.
Results and Discussion
The results of this study were similar to other studies in which there was more knowledge learned using high fidelity simulation than previous classroom methods. The outcomes were evaluated and compared to pretest and posttest. The data were analyzed using descriptive and inferential statistics via Windows SPSS (Disher et al, 2014). Within this programming, special formulations assisted in calculating pre-intervention, post-intervention means, and the standard deviation for knowledge and self-confidence scores. The research concluded the p interval as .005 for knowledge and .004 for self-confidence. Both of these variables also showed improvement in the standard deviation from the pretest and posttest as well. Controversially, other researchers believed that there was little improvement in high fidelity simulations. A similar review also proved that high fidelity training on med students grossly improved their knowledge and showed marked improvement between pretest and posttest scores due to the success of high fidelity simulations (Cortegiani, et al. 2016).
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Although, there showed to be improvements not only in knowledge and confidence but also in nurses’ ability to assess does not contribute to facilities ability to afford simulations. The cost of simulations may not always be within budgets for smaller, remote facilities. Likewise, the specialized trainers required to evaluate nurses may not be available for smaller facilities. This article interestingly suggested the need for a nursing professional development specialist to arrange for specialized simulations by networking with other institutions.
Another problem was also presented in this study, the cost of high fidelity simulations. Small community hospitals may not have the funds available, or the qualified staff available to provide high fidelity simulations. The cost of a simulation manikin ranges from twenty thousand to sixty thousand dollars. In order to counter these funding barriers the smaller, remote facilities should collaborate with other institutions to make these training simulations available to the staff (Disher et al. 2018).
The literature that was used to support this study was current at the time, combined with the use of theoretical and empirical works. Disher et al. presented evidence through research suggesting that providing training and educational instruction using unit-based, high fidelity simulations as a tool, will enhance nurses’ knowledge and confidence in identifying deteriorating patients. Also, the use of a quasi-experimental quantitative study provided a purposeful choice for the design for this experiment, considering the lack of a control group. Contrarily, there was no evidence that any threat from external contributors counted towards the validity as similar studies have been concluded. Disher et al. article also held reliability based on the concept of stability, equivalence, and Internal consistency. (Schmidt, & Brown, 2019). The stability and evidence instrument was accounted for through other research previously performed having similar outcomes. Likewise, internal consistency was adhered to by the questionnaire administered, was the same to all subjects being evaluated.
To conclude, Disher et al. provided a credible study that showed the use of unit-based, high fidelity simulations assist nurses in the early identification of deteriorating patients and improves nurses’ self-confidence. By improving nurses’ knowledge and self-confidence it will provide nurses with the ability and tools to take earlier action to intervene. Increasing nurses’ ability to act early and intervene may decrease acute events, therefore leading to more positive patient outcomes. Disher et al. also proved, that identifying unit-focused problems and developing unit specific fidelity simulations prepared nurses to care for the complex patients that they tend to. Providing an applicable scenario provided more positive results. Also using unit specific situations encouraged not only participation but also the best learning strategy.
- Adamson, K. (2015). A systematic review of the literature related to the NLN/Jeffries simulation framework. Nursing Education Perspectives (National League for Nursing), 36(5), 281–291. doi;10.5480/15-1655
- Cortegiani, A., Russotto, V., Montalto, F., Iozzo, P., Palmeri, C., Raineri, S. M., & Giarratano, A. (2015). Effect of high-fidelity simulation on sedical students’ knowledge about advanced life support: A randomized study. PLoS ONE, 10(5), 1–12. doi:10.1371/journal.pone.0125685.
- Curl, E. D., Smith, S., Chisholm, L. A., McGee, L. A., & Das, K. (2016). Effectiveness of integrated simulation and clinical experiences compared to traditional clinical experiences for nursing students. Nursing Education Perspectives (National League for Nursing), 37(2), 72–77. doi: 10.5480/15-1647
- Disher, J., Burgum, A., Desai, A., Fallon, C., Hart, P. L., & Aduddell, K. (2014). The effect of unit-based simulation on nurses’ identification of deteriorating patients. Journal for Nurses in Professional Development, 30(1), 21-28. doi:10.1097/nnd.0b013e31829e6c83
- Fusco, N. M., & Foltz-Ramos, K. (2018). Measuring changes in pharmacy and nursing students’ perceptions following an interprofessional high-fidelity simulation experience. Journal of Interprofessional Care, 32(5), 648–652. doi:10.1080/13561820.2018.1496073
- McCambridge, J., Witton, J., & Elbourne, D. R. (2014). Systematic review of the Hawthorne effect: New concepts are needed to study research participation effects. Journal of Clinical Epidemiology, 67(3), 267–277. doi:10.1016/j.jclinepi.2013.08.015
- Schmidt, N. A. & Brown, J. M. (Eds.). (2019) Evidence-based practice for nurses: Appraisal and application of research (4th ed.). Burlington, MA: Jones & Bartlett
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