Simulation and EducationRescuing A Patient In Deteriorating Situations (RAPIDS): An evaluation tool for assessing simulation performance on clinical deterioration☆
Introduction
The acute care initiatives including medical emergency team (MET) or Rapid Response Team (RRT) were developed to reduce hospital cardiopulmonary arrest events.1 Their effectiveness could be enhanced by more frequent monitoring and timely activation of MET/RRT in response to patient deterioration, which are components of nurses’ roles.2, 3 Nurses play an important role in performing physical assessment to detect patient's signs of deterioration.4, 5 In response to the assessment findings, the nurses are in a pivotal position to provide timely and appropriate nursing interventions to prevent progression of life-threatening complications.6, 7
Educational programmes have been implemented to train medical and nursing staff to recognise and manage critically ill patients.8, 9 Supported by the Resuscitation Council (2006),10 these interprofessional programmes utilize the mnemonic “ABCDE” (Airway, Breathing, Circulation, Disability & Exposure/Examine) as a systematic approach to assess and manage ward deteriorating patient.8, 11, 12 Although this mnemonic has also been recommended as a tool to guide nurses to perform nursing assessment and initiate immediate nursing intervention before the arrival of appropriate help,7, 13 there appears to be a lack of evidence-based recommendation of a standardized ABCDE mnemonic within the scope of nursing practice.
After assessing that a patient is acutely ill, nurses play an important role in reporting their findings effectively to the doctor or the MET.4 Nurses are encouraged to use the mnemonic SBAR (Situation, Background, Assessment & Recommendation) when reporting about a patient's condition (Joint Commission Resources 2008). The SBAR is described as communicating about a patient's present situation (S), providing clinical background (B) information, the assessment (A) of the problem and making possible recommendations (R).14, 15 This SBAR mnemonic was identified as the most frequently cited handoff mnemonic16 and is used as a tool to train effective communication within interprofessional teams on patients’ deterioration.8, 17
The ABCDE and SBAR mnemonics could be incorporated into simulation programmes as frameworks for nursing assessment, management and reporting of patients’ deterioration. To evaluate the effectiveness of the simulation programme, there is a need for a reliable and valid evaluation to measure the nurses’ performances. Only two studies were identified in nursing education that developed and tested an instrument to measure simulation performance. Arnold et al.18 developed an emergency response performance tool (ERPT) for evaluating nurses’ performances during a simulated cardiac arrest event. Todd et al.19 developed a Simulation Evaluation Instrument (SEI) that evaluated simulation performances in four nursing domains (assessment, communication, critical thinking and technical skills). While the ERPT mnemonic is used specifically for a simulated cardiac arrest event, the SEI is used for evaluating any simulation scenario. As a result of its non-specificity, the SEI did not achieve acceptable inter-rater reliability ratings for some items.
A recent review of published evaluation instruments for simulation highlighted that a lack of reliable and valid instruments to measure simulation learning outcomes has impeded the progression of simulation in nursing education.20 With the increasing use of simulation in developing nurses’ abilities in identifying and managing “at risk” patients,11, 21, 22 a reliable and valid instrument to assess the learning outcome would be valuable to nursing education.
Section snippets
Aim
The aim of the study was to develop and test the validity and reliability of the RAPIDS-Tool to measure student nurses’ simulation performances in assessing, managing and reporting of clinical deterioration.
Methods
This methodological study was conducted in three phases from June to December 2009. Prior to data collection, the study was approved by a University Institutional Review Board (IRB). Phase 1 began with identifying items within the ABCDE and SBAR domains from the basis of a literature review and a panel of national experts. Phase 2 focused on testing the content validity of the items by a panel of international experts and by a pilot testing. Phase 3 involved testing the psychometric properties
Discussion
There has been an increasing use of simulation in developing nurses’ roles in recognizing, responding to and reporting patients’ deteriorating conditions within nursing education. Given the lack of a tool to objectively evaluate the simulation performance, our study undertook a systematic and comprehensive methodology involving peer-reviewed literature, expert consensus and psychometrics testing to develop and validate a tool known as RAPIDS-Tool.
Inclusion of the multidisciplinary experts from
Conclusion
Utilizing the ABCDE and SBAR mnemonics as organizing frameworks, a 42-item RAPIDS-Tool was developed to evaluate nurses’ performances in assessing, managing and reporting of a deteriorating patient in a simulated clinical environment. The RAPIDS-Tool proved useful for future studies that investigate the effect of simulation training on nurses’ performances. As the tool was developed to reflect clinical practice, it could be used to evaluate nurses’ performances in actual clinical settings and
Conflict of interest statement
No conflict of interest to declare.
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Cited by (18)
Development and psychometric testing of a Clinical Reasoning Evaluation Simulation Tool (CREST) for assessing nursing students' abilities to recognize and respond to clinical deterioration
2018, Nurse Education TodayCitation Excerpt :The RAPIDS-tool, which was developed to measure nurses' simulation performance in assessing and managing a deteriorating patient, was used in the study to evaluate the predictive validity of the CREST. The psychometric properties of the RAPIDS-tool, including content validity, construct validity, and interrater reliability, had been established in a previous study (Liaw et al., 2011b). Descriptive statistics were computed for the demographic data.
The impact of simulation based education on nursing confidence, knowledge and patient outcomes on general medicine units
2018, Nurse Education in PracticeCitation Excerpt :Permission to use the scale for this project was granted (Hicks, personal communication, December 17, 2015). For the knowledge section, a multiple choice 17 item questionnaire was developed and piloted using research and existing tools (Cooper et al., 2014; Liaw et al., 2011a,b; Liaw et al., 2011a,b). The questionnaire was reviewed by clinical nurse educators and medicine clinical nurse specialists for content validity.
Mental Rehearsal Strategy for Stress Management and Performance in Simulations
2017, Clinical Simulation in NursingStandard instruction versus simulation: Educating registered nurses in the early recognition of patient deterioration in paediatric critical care
2016, Nurse Education TodayCitation Excerpt :Extensive discussion exists within the literature regarding the effectiveness of these approaches and their failure to adequately prepare nurses to recognise and manage the early warning signs of patient deterioration (Australian Commission on Safety and Quality in Health Care, 2008; Lim, 2009; Queensland Health Patient Safety and Quality Improvement Service, 2010). In contrast to instructional approaches, high fidelity patient simulation (HFPS) has been suggested as an innovative learning strategy which may foster improved learner and patient outcomes in the context of the deteriorating patient (Cioffi, 2001; Cooper et al., 2011a; Liaw et al., 2011b). As HFPS training has evolved within healthcare provider education, several researchers have demonstrated advantages of simulation learning in comparison to conventional techniques (Alinier et al., 2006; Ford et al., 2010; Wayne et al., 2008).
Comparison of standardized patients with high-fidelity simulators for managing stress and improving performance in clinical deterioration: A mixed methods study
2015, Nurse Education TodayCitation Excerpt :Both the use of SPs and HFS has advantages and limitations. However, frequent practice in realistic environments, such as in simulations with SPs, not only engages participants emotionally, but also enables them to adequately appraise existing resources, hence preparing them for similar cases during their actual nursing practice (Liaw et al., 2011). These realistic and repetitive simulation experiences are crucial to patient management.
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A Spanish translated version of the summary of this article appears as Appendix in the final online version at doi:10.1016/j.resuscitation.2011.06.008.