Purpose: The purpose of this pilot study was to describe situation awareness (SA) among licensed practical nurses (LPNs) working in direct patient care. Specific Aims: The specific aims for this study are 1) to examine SA scores, as measured by the Situation Awareness Global Assessment Technique (SAGAT), in LPNs working in direct patient care and compare to published data on SA in registered nurses (RNs), 2) to examine the relationship between SA scores and years of LPN experience, 3) to examine differences in SA scores by type of workplace setting and 4) to describe the relationship between levels of satisfaction with simulation, as measured by the Satisfaction with Simulation Experience Scale (SSES) and SA scores among LPNs. Framework: Situation Awareness Theory, as described by Endsley, was used as the framework for this study. Design: A cross-sectional, descriptive design using the Situation Awareness Global Assessment Technique was used to gather data from a convenience sample of LPNs. Results: LPNs (N=24) participated in the study and achieved an average SAGAT score of 72.6%. There were no differences in scores between those LPNs enrolled in an RN program and those who were not enrolled. Individual scores on the SAGAT were comparable or better than scores in a similar study of RNs. Conclusion: LPNs in this study demonstrated adequate situation awareness. Key Words: Situation awareness, licensed practical nurse, patient deterioration, clinical simulation

The purpose of the present study were to (a) explore the relationship between the frequency of use of Rapid Response Teams (RRTs) by hospital staff nurses and the support received from RRTs; (b) to investigate staff nurses’ perceptions of their individual level, group level and organizational level learning as a result of single or multiple exposures to the RRT; (c) to identify predictors of learning outcomes and (d) to identify overall impressions and advantages and disadvantages of the RRT. A mail survey was used to collect data. The response responses rate was 33%, 131 registered nurses responded to the survey (pre-test = 12, study = 119). The results of Pearson r correlation suggest that a high frequency of access of RRTs was positively related to process support (r = .25, p < .01). Also, perceived content and process support from RRTs was positively related to maintenance and building of staff nurses’ mental models regarding patient deterioration pertaining to self, group and organization. Multiple regression analyses show that sociodemographic and independent variables predict organizational learning outcomes (mental model maintenance and building). Overall impressions of the RRTs were high. A content analysis of nurses’ comments indicated that there were more advantages to having the RRTs than disadvantages. This study suggests that RRTs are influential in changing nurses’ perceptions about managing patient deterioration. Training programs for RRTs should include both content and process support, which may enhance building and maintaining mental models. / Thesis (Master, Nursing) -- Queen's University, 2008-09-25 21:27:44.682

Hospitalized patients increasingly present with complex health issues that place them at risk for acute patient deterioration (APD). Novice nurses are ill-equipped with the critical clinical skills to function competently in recognizing APD, placing patients at risk for negative health outcomes. This project addressed the need to educate novice nurses to recognize APD and answered the project focused questions that asked if an educational intervention with high-fidelity simulation (HFS) would improve nurse knowledge and clinical confidence in recognizing APD. Benner's novice-to-expert and the constructivism theory were used to guide the project. Based upon a review of the literature, the HFS was developed to provide scenarios in which participants would view APD evolving case studies and demonstrate knowledge and skill for caring for patients with APD. A convenience sample of 11 novice nurses participated in the pre- and posttest design project to determine if knowledge and clinical competence increased. Data from the HFS program were analyzed; results showed no statistically significant change in knowledge or confidence post intervention (p = 0.441). A larger sample size is recommended for future HFS interventions at the site to determine if the program of education will increase knowledge and clinical confidence with future iterations of HFS. The project has the potential to promote positive social change as novice nurses learn to recognize and respond to APD and as APD events are reduced.

To date, outcome research suggests that providing clinicians with patient progress feedback and problem-solving tools is effective in improving therapeutic outcome for clients who are predicted to have a negative treatment outcome. To expand upon this body of research, the current study examined the efficacy of using these problem-solving tools (Clinical Support Tools; CST) to reduce the risk of treatment failure and enhance positive outcome with 118 clients who were not identified as at -risk for a negative outcome. Results of this study indicated that the intervention failed to lower the rate of becoming an at-risk case or to enhance treatment outcome. A possible explanation for the null results observed is poor treatment compliance. Based on the findings of this study, the CST cannot be recommended as an intervention across the broad range of clients who enter treatment. However, qualitative analysis results reflect positive indicators for continued research with at-risk cases.

Outcome research has documented worsening among a minority of the patient population (5 to 10%). In this study a psychotherapy quality assurance system intended to enhance outcomes in patients at risk of treatment failure was reviewed through the use of meta-analytic, mega-analytic, and multilevel analytic techniques. A pooled dataset from six major studies conducted at a large university counseling center and a hospital outpatient setting (N = 6151, mean age = 23.3 years, female = 63.2%, Caucasian = 85%) were re-analyzed to examine the effects of progress feedback on patient outcome. In this quality assurance system, the Outcome Questionnaire-45 was routinely administered to patients to monitor their therapeutic progress and was utilized as part of an early alert system to identify patients at risk of treatment failure. Patient progress feedback based on this alert system was provided to clinicians to help them intervene before treatment failure occurred. Intent-to-treat and efficacy analyses of the effects of feedback interventions were conducted to obtain the estimates of effects expected from implementation of this quality assurance system as a policy as well as in clinical trials. Three forms of feedback interventions—integral elements of this quality assurance system—were effective in enhancing treatment outcome, especially for signal alarm patients. Two of the three feedback interventions were also effective in preventing treatment failure (Clinical Support Tools and the provision of patient progress feedback to therapists). The Clinical Support Tool intervention was effective not only in terms of the amount of outcome enhancing effect, but also in the rate of patient recovery. The current state of evidence appears to support the efficacy and effectiveness of feedback interventions in enhancing treatment outcome.

In-patient deterioration is a global phenomena and timely recognition and action improves outcome. Intensive care facilities are scarce and expensive and therefore patient care must be optimal. A retrospective health record analysis was used for this study. The findings indicated that nursing personnel do not recognize patient deterioration timeuously. However, the implementation of an outreach team and clinical markers training program improved the recognition of patient deterioration in general wards with three hours and 40 minutes. It is recommended to implement a comprehensive hospital program that addresses the basic knowledge and skills of general ward personnel to observe, recognize, assess and intervene to patients with clinical deterioration. Together with an extensive training program, a basic physiological parameters guideline to activate a team of experts to the bedside, such as an Outreach team, assist nursing personnel to recognize and manage those patients timeuously and ensure treatment in an appropriate level of care. / Health Studies / M. A. (Health studies)

In-patient deterioration is a global phenomena and timely recognition and action improves outcome. Intensive care facilities are scarce and expensive and therefore patient care must be optimal. A retrospective health record analysis was used for this study. The findings indicated that nursing personnel do not recognize patient deterioration timeuously. However, the implementation of an outreach team and clinical markers training program improved the recognition of patient deterioration in general wards with three hours and 40 minutes. It is recommended to implement a comprehensive hospital program that addresses the basic knowledge and skills of general ward personnel to observe, recognize, assess and intervene to patients with clinical deterioration. Together with an extensive training program, a basic physiological parameters guideline to activate a team of experts to the bedside, such as an Outreach team, assist nursing personnel to recognize and manage those patients timeuously and ensure treatment in an appropriate level of care. / Health Studies / M. A. (Health studies)

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