Recognising Acute Deterioration: Active Response (RADAR) is a simulation based teaching session using simulated patients to portray acutely unwell adult hospital patients. The genesis, development and progress of RADAR will be discussed along with the findings of questionnaires and focus groups from two further cycles of action research. Readers will become aware of the impact which RADAR makes to the evidence and learning surrounding the recognition and assessment of clinical deterioration in adult hospital patients. The study investigated the impact of simulation on medical students’ confidence in recognising and responding to clinical deterioration in adult hospital patients using simulation, simulated patients and moulage (make-up).

Indiana University-Purdue University Indianapolis (IUPUI) / It is unknown whether timing of human patient simulation (HPS) in a semester, demographic (age, gender, and ethnicity), and situational (type of program and previous baccalaureate degree and experience in healthcare) variables affects students’ perceptions of their clinical reasoning abilities. Nursing students were divided into two groups, mid and end of semester HPS experiences. Students’ perceptions of clinical reasoning abilities were measured at Baseline (beginning of semester) and Time 2 (end of semester), along with demographic and situational variables. Dependent variable was Difference scores where Baseline scores were subtracted from Time 2 scores to reveal changes in students’ perceptions of clinical reasoning. Students who were older and had previous healthcare experience had higher scores, as well as students in the AS program, indicating larger changes in students’ perceptions of clinical reasoning abilities from Baseline to Time 2. Timing of HPS, mid or end of semester, had no effect on Difference scores, and thus students’ perceptions of clinical reasoning abilities.

Thesis (MPhil)--Stellenbosch University, 2014. / ENGLISH ABSTRACT: Introduction and Background High fidelity simulation (HFS) refers to a mannequin that is modeled to represent a human and is programmed to produce physiologic functions such as palpable pulses, voices and abdominal sounds through computer interfaces. Recent introduction of HFS for learning nursing skills like critical thinking and problem solving in the developing world (Lesotho) has generated debate. The debate is centered on the acceptability of HFS, its effectiveness as a learning strategy compared to its high cost, especially in resource limited settings. Its acceptability in the developing world to date is mixed, affecting its ultimate utilization. Therefore contextual differences between developing and developed countries suggest that research findings on the evaluation of acceptability of HFS in the two places could be different. Additionally, health sciences education is a highly complex discipline with huge differences in practices within and across classes, schools, sites and countries, making it difficult to generalize findings from other settings to the setting of Lesotho. Aim The purpose of this study was to explore third year diploma in nursing students’ perceptions and experiences of HFS use in learning nursing skills. Methods A qualitative descriptive design was utilized to investigate HFS use at a school of nursing. Sixteen participants took part in three separate focus group discussions in two groups of five, and one group of six participants. The data was analyzed thematically. Results Students had mixed perceptions, positive and negative, based on the nature of their experiences which were both fulfilling and frustrating. This study revealed five key themes that shaped students experiences, hence perceptions of using HFS in learning. The themes are authentic learning environment, unique learning opportunities, access, contextual factors and transfer of skills. Discussion Student nurses had both positive and negative experiences of using HFS in learning. They believe that HFS is a valuable learning strategy but that it needs to be better utilized. Student nurses perceive HFS as providing an authentic learning environment which allows learning of complex skills like critical thinking and problem solving. On the other hand, they believe that learning can be improved if HFS is more accessible for use by students and if supervisors are adequately trained and students are better oriented on the use of HFS in learning. Conclusions HFS is viewed as an effective learning strategy among nursing students in resource limited settings, although there in need to improve its utilization for better learning experiences and outcomes. / AFRIKAANSE OPSOMMING: Inleiding en Agtergrond Hoëtrou-simulasie (HTS) verwys na ’n pop wat gemodelleer is om ’n mens te verteenwoordig en geprogrammeer is om fisiologiese funksies soos tasbare polse, stemme en abdominale klanke te lewer deur rekenaar-koppelvlakke. Onlangse bekendstelling van HTS in die aanleer van verpleegvaardighede soos kritiese denke en probleemoplossing in die ontwikkelende wêreld (Lesotho) het debat laat ontstaan. Die debat sentreer om die aanvaarbaarheid van HTS en sy effektiwiteit as ’n leerstrategie in vergelyking met sy hoë koste, veral in hulpbronbeperkte omgewings. HTS se aanvaarbaarheid op verskillende plekke in die ontwikkelende wêreld tot op datum is gemeng, wat die uiteindelike gebruik daarvan raak. Daarom dui kontekstuele verskille tussen ontwikkelende en ontwikkelde lande aan dat navorsingsbevindings oor die beoordeling van aanvaarbaarheid van HTS in die twee omgewings kan wissel. Bykomend is opleiding in die gesondheidswetenskappe ’n uiters komplekse dissipline met groot verskille in praktyke binne en oor klasse, skole, omgewings en lande, wat dit moeilik maak om bevindings van ander omgewings tot die omgewing van Lesotho te veralgemeen. Doel Die doel van hierdie studie was om derdejaar-diplomaverpleegstudente se persepsies en ervarings van die gebruik van HTS vir die aanleer van verpleegvaardighede te ondersoek. Metodes ’n Kwalitatiewe gevallestudieontwerp is benut om die verskynsel van HTS by Paray Verpleegkundeskool te ondersoek. Sestien deelnemers het aan die verskillende fokusgroepbesprekings deelgeneem in twee groepe van vyf, en een groep van ses deelnemers. Die data is ontleed met die gebruik van die konstante vergelykingsanalise-model. Resultate Studente het gemengde waarnemings, positief en negatief, ervaar, gebaseer op die aard van hul ondervindings wat sowel vervullend as frustrerend was. Hierdie studie het vyf sleuteltemas geopenbaar wat studente se ondervindings, en sodoende hul waarnemings van die gebruik van HTS in opleiding gevorm het. Die temas is outentieke leeromgewing, unieke leergeleenthede, toegang, kontekstuele faktore en oordrag van vaardighede. Bespreking Studentverpleegsters aanvaar die gebruik van HTS om verpleegvaardighede te leer. Hulle glo dat HTS ’n waardevolle leerstrategie is, wat egter beter benut moet word. Studentverpleegsters beskou HTS as ʼn verskaffer van ʼn outentieke leeromgewing wat die aanleer van komplekse vaardighede soos kritiese denke en probleemoplossing toelaat. Aan die ander kant glo hulle dat opleiding verbeter kan word indien HTS meer toeganklik is vir gebruik deur studente en indien toesighouers voldoende opgelei is en studente beter voorgelig word in die gebruik van HTS as opleidingsmiddel. Gevolgtrekkings HTS is ʼn aanvaarbare leerstrategie onder verpleegstudente in omgewings met beperkte hulpbronne, hoewel daar ʼn behoefte is om die benutting daarvan vir beter leerervarings en uitkomstes te verbeter.

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La simulation est largement utilisée et étudiée dans plusieurs disciplines en santé, mais son intégration dans la formation professionnelle en nutrition demeure une pratique émergente. Cette étude mixte visait à évaluer le développement des compétences professionnelles des étudiant.e.s débutant.e.s en nutrition en contexte de simulation et à connaître leur perception. Trois simulations de cinq stations chacune (dont une avec patients simulés acteurs et deux avec patients simulés étudiants) suivies d’un débreffage ont eu lieu. Les compétences des participant.e.s (n = 35) ont été évaluées par vidéo pour la première et la dernière simulation grâce à un outil inspiré des compétences intégrées pour l'enseignement et la pratique de la diététique et des groupes de discussion virtuels ont permis de nuancer les résultats et d’approfondir les perceptions des participant.e.s (n = 13). Toutes les compétences liées au professionnalisme, à la communication et aux soins nutritionnels se sont améliorées de façon statistiquement significative entre les deux temps de mesure. En plus de la démonstration des compétences, l’analyse qualitative a montré que la simulation a permis aux participant.e.s de mieux comprendre et d’appliquer les notions apprises en cours, de réaliser que le patient doit être au cœur des interventions, de se mettre dans la peau d’un.e professionnel.le et d’être bien préparé.e pour les stages cliniques en milieu externe. Ces résultats montrent que la simulation en nutrition améliore les compétences des débutant.e.s et semble consolider leurs apprentissages antérieurs, améliorer leur compréhension de l’approche centrée sur le patient et initier la formation de leur identité professionnelle. / Simulation is widely used and studied in several healthcare disciplines, but its integration into dietetics training remains an emerging practice. This mixed-methods study aimed to assess the development of professional competencies of beginner dietetics students during simulations and to understand their perceptions. Three simulations of five stations each (including one with actor-simulated patients and two with student-simulated patients) followed by a group debriefing took place. The competencies of the participants (n = 35) were assessed by video for the first and the last simulation using an evaluation tool inspired by the national Integrated Competencies for Dietetic Education and Practice, whereas virtual focus groups helped to nuance the results and deepen participants’ perceptions (n = 13). Student t tests showed that all competencies related to professionalism, communication and nutritional care improved statistically significantly between the two measurement times. In addition to the improvement of skills, the qualitative analysis showed that simulation enabled participants to better understand and apply the concepts previously learned in class, to realize that all interventions should be patient-centered, to enact a professional dietitian role and to feel prepared for their clinical placement in an external environment. These results show that simulation as a pedagogy approach improves beginners’ competencies and seems to consolidate their previous learnings, improve their understanding of the patient-centered approach and initiate the formation of their professional identity.

This descriptive case study examines the use of medical simulation technology in the three-year Thompson Rivers University respiratory therapy training program. Qualitative analysis of data gathered from 78 participants through interviews, observations, and discussion groups reveal a wide variety of low- intermediate- and high-fidelity technologies used for education and evaluation. Deliberate practice is the predominant learning theory informing the use of simulation for safe and ethical training in competencies that would otherwise pose significant risk to patients. Recommendations include enhancements of the existing technology with psychological and environmental fidelity, and for optimal curriculum placement of high-fidelity simulators at hospital sites for student development of critical thinking and team training. Further research into learning with high-fidelity simulation specifically within the context of a student respiratory therapist as an embedded hospital team member is needed. Keywords: respiratory therapy, patient simulation, critical thinking, learning, critical care, deliberate practice