Factors influencing nursing students' ability to recognise and respond to simulated patient deterioration: A scoping review.

AIM: The aim of this scoping review was to identify empirical literature on simulation used to develop undergraduate nursing student's clinical assessment skills to recognise and respond to patient deterioration. BACKGROUND: Early recognition and response to clinical deterioration is necessary to ensure the best outcome for the patient. Undergraduate nursing students have limited exposure to deteriorating patient situations, therefore simulation is widely implemented in nursing courses to address this educational need. It is imperative to identify the simulation modalities and features that best optimise student learning. DESIGN: Scoping review using the Joanna Briggs Institute scoping reviews methodology and the Arksey and O'Malley framework. REVIEW METHODS: Seven health databases were searched electronically for relevant literature and complemented with hand searching for additional relevant sources. A total of 344 potential articles were identified from the seven databases: Cumulative Index to Nursing and Allied Health Literature (n = 234); PubMed (n = 16); Medline (n = 51); Scopus (n = 21); Embase (n = 3); American Psychological Association PsychInfo (n = 13); and JBI (n = 6). After applying inclusion and exclusion criteria, 15 research articles were included in the review. RESULTS: Most research on clinical deterioration simulation was quantitative (n = 12), two were qualitative and one used a mixed method approach. Findings included a lack of situational awareness, distractors causing incomplete patient assessment and failure to recognise deterioration. Repeated simulation showed positive results. CONCLUSIONS: Findings of this review suggest students lack situational awareness, perform incomplete assessment and fixate on single cues rather than an entire clinical picture. The use of a variety of simulation modalities was effective in improving student performance. Repeated practice within a single simulated learning experience, was shown to improve performance and situational awareness. This approach to simulation is under-researched in nursing and needs further exploration.

End of life care education, past and present: a review of the literature.

BACKGROUND: Research on end of life care education suggests that undergraduate nursing students are largely unprepared to provide end of life care to dying patients and their families. Although there have been attempts to address the issue of lack of preparedness, little is known on how to improve this. LITERATURE REVIEW AIMS: To examine how end of life care education has been delivered to undergraduate nursing students and to critically discuss the research on modes of delivery and teaching strategies. REVIEW METHODS: An extensive literature search on end of life care education in the undergraduate nursing curriculum was conducted in CINAHL, Mosby's Index, Cochrane Database, Scopus, Eric via Proquest, and Medline. 18 research papers published between 1984 and 2012 that met the selection criteria are included in the review. FINDINGS: Findings of these 18 articles are reported under two main themes: Modes of End of Life Education Delivery and End of Life Care Education Initiatives. CONCLUSION: This review highlights issues with end of life care education and suggests that end of life care simulation is an innovative strategy that may help to prepare undergraduate nursing students to provide quality end of life care.

End of life care simulation: a review of the literature.

BACKGROUND: Simulation is an evolving pedagogical approach to teaching in many undergraduate nursing curricula, however, there is little published literature on end of life care simulation as an effective means of teaching nursing students about end of life care. LITERATURE REVIEW AIMS: To examine available literature on end of life care simulation. REVIEW METHODS: An extensive literature search on end of life care simulation in the undergraduate nursing curriculum was conducted in CINAHL, Mosby's Index, Cochrane Database, Scopus, Eric via Proquest, and Medline. 6 research articles and 10 descriptive articles published between 2009 and 2013 that met the selection criteria are included in the review. FINDINGS: Findings of these 16 articles are reported under 4 main themes: 1) Increased knowledge of end of life care through 'experiential learning'; 2) Impact of family presence on student learning; 3) the Debriefing imperative, and 4) Methodological issues raised from studies. CONCLUSION: The findings of the studies reviewed support end of life care simulation as a strong and viable pedagogical approach to learning for its positive effects on knowledge acquisition, communication skills, self-confidence, student satisfaction and level of engagement in learning. However, the important factors including psychological safety of students and the costs involved require careful consideration. Research on the use of simulation in nursing is still in its infancy, further research using various research designs is required to adequately explore the issues surrounding end of life care simulation.

The experience of end of life care simulation at a rural Australian University.

Providing end of life care is a challenging and anxiety provoking prospect for many undergraduate nursing students and many students report a lack of preparedness in providing care. The limited availability of appropriate clinical placements limits the opportunities for nursing students to gain experience in end of life care. Advances in simulation techniques using high fidelity mannequins enable the mimicking of complex patient scenarios such as cessation of life in the provision of end of life care. A group of nursing academics at a rural Australian University designed, developed and implemented end of life care simulation to a group of 3rd year nursing students. The aim of this paper is to report on the evaluation of this educational innovation. Five major themes were identified through analysis of student evaluations: 1) Linking of theory to practice; 2) Approaching families of dying patients; 3) An encounter with death; 4) 'Hands on' experience in a 'protected environment'; and 5) Importance of post simulation discussion and debriefing. End of life care simulation has provided a valuable experience that can be difficult to obtain in clinical practice settings. However, the challenges discussed in this paper need to be taken into consideration for future use.