Effectiveness of a Web-Based Simulation in Improving Nurses’ Workplace Practice With Deteriorating Ward Patients: A Pre- and Postintervention Study

Abstract

BackgroundNurses play an important role in detecting patients with clinical deterioration. However, the problem of nurses failing to trigger deteriorating ward patients still persists despite the implementation of a patient safety initiative, the Rapid Response System. A Web-based simulation was developed to enhance nurses’ role in recognizing and responding to deteriorating patients. While studies have evaluated the effectiveness of the Web-based simulation on nurses’ clinical performance in a simulated environment, no study has examined its impact on nurses’ actual practice in the clinical setting.ObjectiveThe objective of this study was to evaluate the impact of Web-based simulation on nurses' recognition of and response to deteriorating patients in clinical settings. The outcomes were measured across all levels of Kirkpatrick’s 4-level evaluation model with clinical outcome on triggering rates of deteriorating patients as the primary outcome measure.MethodsA before-and-after study was conducted on two general wards at an acute care tertiary hospital over a 14-month period. All nurses from the two study wards who undertook the Web-based simulation as part of their continuing nursing education were invited to complete questionnaires at various time points to measure their motivational reaction, knowledge, and perceived transfer of learning. Clinical records on cases triggered by ward nurses from the two study wards were evaluated for frequency and types of triggers over a period of 6 months pre- and 6 months postintervention.ResultsThe number of deteriorating patients triggered by ward nurses in a medical general ward increased significantly (P<.001) from pre- (84/937, 8.96%) to postintervention (91/624, 14.58%). The nurses reported positively on the transfer of learning (mean 3.89, SD 0.49) from the Web-based simulation to clinical practice. A significant increase (P<.001) on knowledge posttest score from pretest score was also reported. The nurses also perceived positively their motivation (mean 3.78, SD 0.56) to engage in the Web-based simulation.ConclusionsThis study provides evidence on the effectiveness of Web-based simulation in improving nursing practice when recognizing and responding to deteriorating patients. This educational tool could be implemented by nurse educators worldwide to address the educational needs of a large group of hospital nurses responsible for patients in clinical deterioration.

Comparative value of a simulation by gaming and a traditional teaching method to improve clinical reasoning skills necessary to detect patient deterioration: a randomized study in nursing students

“…In Australia, a web-based esimulation program suggested an improvement of clinical knowledge of patient deterioration and enhanced students' self-assessed of knowledge, skills, confidence, and competence [19]. Similar results were obtained by Liaw et al in nurses working on surgical wards [21,22] and another team also used a serious game to explore the learning process of nursing Fig. 3 SCT score immediately and 1 month after the session in SG group and TT group students 'clinical reasoning, using a self-assessment questionnaire [20].…”

“…The education of nurses, who are frontline healthcare providers, is essential to improve the detection of patient deterioration. Serious games dedicated to the same learning objective have already been created by others [19][20][21][22]. In Australia, a web-based esimulation program suggested an improvement of clinical knowledge of patient deterioration and enhanced students' self-assessed of knowledge, skills, confidence, and competence [19].…”

“…Comparative analysis between the educational value of a serious game and a traditional course is already available for cardiac arrest management, trauma triage and other domains, but it is uncertain whether results obtained in one field apply to the others [13][14][15][16][17][18] . In addition, several studies have used a serious game to train nurses in the detection of patient deterioration, but are characterized by a high level of heterogeneity and sometimes provide neutral results [19][20][21][22]. One randomized study, aiming to compare the assessment and the management of clinical deterioration, in which either a virtual patient or a mannequin was used, found that both simulation methods (serious game and highfidelity) could be effective in improving nursing-student score performance, with no difference between the two methods [23].…”

Assessing the performance and satisfaction of medical residents utilizing standardized patient versus mannequin-simulated training

“…Moreover, IM residents must be ready to treat catastrophic medical events, some of which they read about, but may never physically encounter during the course of their residency training. To achieve this goal, SBT is a safe and effective method for teaching crisis resource management for a variety of medical and surgical learners, as well as practicing physicians and other medical personnel 11–13. Regular participation in simulated deteriorating patients’ scenarios translates into earlier recognition and treatment of such emergencies in the hospital setting 14.…”

Simulation training appears to improve nurses’ ability to recognise and manage clinical deterioration

“…Only one study in the review evaluated the impact of simulation on nurses’ actual practice in the clinical setting 5. More robust outcome evaluation on the transfer of simulation learning to clinical practice, such as evaluating the impact of simulation on patient outcomes is needed.…”