Elsevier

Resuscitation

Volume 82, Issue 11, November 2011, Pages 1434-1439
Resuscitation

Simulation and Education
Rescuing A Patient In Deteriorating Situations (RAPIDS): An evaluation tool for assessing simulation performance on clinical deterioration

https://doi.org/10.1016/j.resuscitation.2011.06.008Get rights and content

Abstract

Aim

This article is a report of a study which developed and tested the validity and reliability of the RAPIDS-Tool to measure student nurses’ simulation performance in assessing, managing and reporting of clinical deterioration.

Background

The importance for nurses to recognize and respond to deteriorating patients has led educators to advocate for increasing use of simulation for developing this competency. However, there is a lack of evaluation tools to objectively evaluate nurses’ simulation performance on clinical deterioration.

Method

The study was conducted in three phases. Phase 1 began with development of items for the RAPIDS-Tool from the basis of a literature review and a panel of national experts’ consensus. Phase 2 established the content validity of the RAPIDS-Tool by a panel of international experts and by undertaking a pilot test. Phase 3 involved testing the psychometric properties of the RAPIDS-Tool, on 30 video-recorded simulation performances, for construct validity, inter-rater reliability, and correlation between two scoring systems.

Results

The process of development and validation produced a 42-item RAPIDS-Tool. Significant differences (t = 15.48, p < 0.001) in performance scores among participants with different levels of training supported the construct validity. The RAPIDS-Tool demonstrated a high inter-rater reliability (ICC = 0.99) among the three raters and a high correlation between the global rating and checklist scores (r = 0.94, p < 0.001).

Conclusion

The RAPIDS-Tool provides a valid and reliable tool to evaluate nurses’ simulation performances in clinical deterioration. This may prove useful for future studies that investigate outcomes of simulation training.

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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    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.

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