Partial Restriction. Restriction lift date: 2028-05-31
Simulation-based training to enhance situation awareness and communication proficiency in deteriorating patient situations: the SIMUSAD study
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Date
2024
Authors
Walshe, Nuala
Journal Title
Journal ISSN
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Publisher
University College Cork
Published Version
Abstract
Introduction: Early signs of clinical deterioration are frequently missed, not understood, or not communicated, resulting in adverse clinical outcomes and failure to rescue events. Inaccurate, or incomplete situation awareness is an important root cause of failure to rescue events. Newly graduated nurses’ situation awareness skills are poorly developed and potentially inadequate to recognise and respond to deteriorating patients. Simulation-based training can provide repeated and consistent opportunities to enhance situation awareness.
Aim: To develop and examine the feasibility, acceptability, and preliminary effectiveness of SIMUSAD; a Simulation-based training intervention aimed at enhancing final year undergraduate nursing students’ Situation Awareness and communication proficiency in the context of Deteriorating patient situations
Methods: The Medical Research Council framework guided the development and testing of the SIMUSAD intervention which was conducted in six phases. 1) The evidence base was identified by conducting a systematic review of the effectiveness of existing situation awareness training interventions (n=39 included papers), and 2) a meta-narrative review exploring how situation awareness has been conceptualised and researched in healthcare (n=120 included papers). 3) A mixed methods cognitive task analysis was then conducted to examine factors influencing final year nursing students’ (n=33), situation awareness and communication proficiency during the escalation of care. 4-5) Intervention design was informed by an underlying programme theory which draws on situation awareness theory, deliberate practice, and mastery learning principles. 6) A randomised comparative feasibility trial was then conducted to examine the feasibility, acceptability and preliminary effectiveness of the SIMUSAD intervention. Pre- to post-test changes in final year nursing students’ (n=57), knowledge, communication proficiency and situation awareness were evaluated. Mean score changes from pre- to post-test were compared across two conditions: SIMUSAD-M (SIMUSAD with mastery-based communication proficiency training, [n=29]) versus SIMUSAD-NM (SIMUSAD without mastery-based communication proficiency training, [n=26]).
Results: Findings from phase one-three informed intervention design. In the reviewed literature, simulation-based training emerged as the most common and potentially most effective situation awareness training modality. Multiple factors were found to influence and constrain situation awareness including task complexity, a lack of mental models and schema, and inexperience. In the mixed methods cognitive task analysis, final year nursing students were found to have poorly developed situation awareness skills and limited clinical exposure to deteriorating patients.
The SIMUSAD intervention was developed to be delivered over a ten-week period. The delivery was primarily via immersive clinical simulation supplemented with one mastery-based component focussed on communication proficiency. The primary underlying assumption was that repeated, deliberate practice simulation exposures can work to support the development of the cognitive, disciplinary and communication skills on which SA relies.
Study results support the feasibility and acceptability of the SIMUSAD intervention. The results also provide evidence of preliminary effectiveness with significant improvements in situation awareness and communication proficiency scores from pre- to post-test for both intervention groups. There were no significant differences in mean SA score changes from pre- to post-test in SIMUSAD-M versus SIMUSAD-NM conditions. However, SIMUSAD-M participants were three times more likely to achieve the communication proficiency benchmark post-test as compared to SIMUSAD-NM participants. There were no significant changes in knowledge relating to deteriorating patients in either intervention group.
Conclusions: The SIMUSAD intervention was shown to be acceptable and feasible. The results also provide preliminary evidence of effectiveness for both situation awareness and communication proficiency outcomes. In addition, the results indicate that the addition of mastery-based communication training exerted an additional positive effect on communication proficiency during the escalation of care, but not on situation awareness.
Based on these results and in accordance with the Medical Research Council guidance, full scale testing of the SIMUSAD intervention is warranted. An adequately powered longitudinal, randomised controlled trial drawing on more diverse samples is recommended in order to evaluate the short and long-term effects of the intervention and enhance the generalisability of findings. A process evaluation and economic evaluation built into the main trial are also recommended to examine the processes surrounding delivery and cost effectiveness of the SIMUSAD intervention.
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Partial Restriction
Keywords
Situation awareness , Simulation-based training , Deteriorating patients , Deliberate practice , Mastery learning
Citation
Walshe, N. C. 2024. Simulation-based training to enhance situation awareness and communication proficiency in deteriorating patient situations: the SIMUSAD study. PhD Thesis, University College Cork.