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Student nurses show poor skills in treating deteriorating patients


Final year student nurses have performed poorly in an experiment designed to test their understanding of and ability to deal with deteriorating patients.

The simulation involved 51 final-year student nurses and combined quantitative measures of the trainees’ knowledge, skill and situation-awareness, as well as a qualitative review of how decisions were made.

The video-recorded scenarios involved hypovolaemic and septic shock on mannequins. Each simulation was stopped at random points and students were asked questions to measure their level of awareness of what was taking place.

The researchers found that when the condition of the “patient” deteriorated, so did the students’ own response.

How a patient’s condition ended up seemed heavily dependent how well staff identified and managed the deterioration.

The mean knowledge score was 74% (range 46-100%) and the mean skill-performance score across both scenarios was 60% (range 30-78%).

Student performance markedly improved for the second scenario, but when the condition of the patients in both scenarios got worse, the students’ skill performance worsened significantly during the tests.

The mean situation-awareness score for the two scenarios was 59% (range 38-82%).

Students were more inclined to identify physiological causes for the deterioration (77%) but scored badly on their understanding of what went on (44%).

The findings, which are published in the Journal of Clinical Nursing, showed that the students’ ability to manage patient deterioration is poor.


Readers' comments (35)

  • I'm not surprised at this; and don't get me wrong this is not an attack on the students themselves who work damn hard and try to teach themselves everything they know, it is an attack on the state of Nurse education at the moment.

    I agree wholeheartedly with the move toward degree level Nursing, but I do not agree with the superfluous, pointless modules that have been 'tacked on' as a result! 75% of the course is utterly pointless, and ths is made even worse when the placements are often hit and miss. There needs to be a deeper and more thourough base of modules based around A&P, pathophysiology, illness and pharmacology, as well as regular weekly skills labs.

    If that were the case, then what to do with a deteriorating patient would be second nature to a student Nurse, which they can then expand upon and perfect with their own learning and experience.

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  • I am just about to commence my 2nd year and quite frankly, I do not feel that this subject is taught adequately either.

    We have received two 1/2 hour lectures and zero sim man practicals on this very important subject, we make collages In our learning groups in stead!
    As an adult learner I would rather be hammering out pharmacology, and real time 'situations' instead of pink and fluffy 'add ons'

    Luckily for me, I have been shown by my experienced mentors and further 'home study' on deteriorating patients.

    I agree with the comment above, there are some modules that are, in my opinion, not relevant (and I am a mature student) and the very essence of basic nursing care is often overlooked with the idea of 'you will learn it on the job' .

    May I add to that many students do not have the best matched mentor or working environment or time to put in extra study because they may be supplementing this time to work extra hours to pay their way.

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  • I have been saying for years that we need to adopt a course that contains more A&P etc and less phycho-babble. Many of the degree nurses that I now work with trained in the US and seem to know so much more than their British counterparts. The NMC and universities need to pull their fingers out and follow the US on this one.

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  • Maz Wilson

    I must say that I find this article totally misleading and wonder if those that have already commented accessed the research article. the study was NOT conducted in the UK, but in Australia where the education and health care systems differ from those in the UK.
    At the University where I work as a nurse educator we take the subject of 'The Deteriorating Patient' very seriously and work closely with the critical care outreach teams within the trusts that we serve. The students get the ABCDE approach and the use of Early warning Scores drummed into them and are expected to manage sick patient scenarios by the time they reach their 3rd year. We strongly believe in teaching the students how to manage peri-arrest situations and encourage them to use the SBAR and RSVP models of communication when dealing with patients who are unwell. Maybe thats why this University is 1st in England for student satisfaction.

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  • maybe

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  • Marion I have to say I wasn't aware that this was based in Oz, and I was remiss in that, but my comments still stand for English universities.

    I cannot comment on your specific university, however I do not think you speak for the majority of Nursing courses, none of which have a unified cirriculum and the majority of which I think is as bad as I said earlier.

    My own course had lectures on the deteriorating patient and so on using the ABCDE approach etc, just as yours did. We were 'taught' them, yes. The problem is these were hour or two hour long lectures and then that was it, they constituted such a small proportion of the overall module content with the staff holding the attitude that it was 'our responsibility to go away and learn it ourselves!' If that is really the case what is the point in us attending university for three years?

    A few hour long lectures over a three year course is not enough.

    Let me give you an example from another field that I think Nursing can learn from. In the Army we are given a rifle; we are not taught mettalurgy because that is what the bullet casings are made of, we are not taught the physics of how a bullet travels through the air, nor the chemical make up of gunpowder, we are just taught how to shoot the bloody rifle. Over and over and over. It is TRULY drilled into us. And guess what? At the end of the training (which is significantly shorter than Nurse training), soldiers are damn good at what they do.

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  • I agree with you Mike. Nurse education should be about teaching the theory of A&P, health, disease and treatment of the whole person, followed up by applying that theory in practice situations (both real and simulated) and repeating the practice over and over until the response to the patient's changing condition is informed, prompt and thorough.
    Nursing has got to be about theory applied in practice, dare I say it, as it used to be.
    This approach should incorporate the fact that nurses have taken on extended roles and so if anything, their response to the deteriorating patient ought to be better and more effective than it was years ago. For example, when I trained we would have had a delay in giving IV drugs to a deteriorating patient as only few and far between nurses could give them- now any nurse should be able to give them as soon as prescribed.
    A nurse in training needs have a firm grasp of the basic essentials by the time he/she qualifies; the 'add-ons' can be developed later.

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  • Bed side nurses should be able to detect a deteriorating patient before they get to the point that a code blue needs to be called. Then a doctor needs to be called and orders received to treat the patient according to what is wrong. In our hospital in Canada we have a RRT (Rapid Response Team) which is staffed by the ICU nurses and Respiratoy therapists. The ward nurses can call us if they suspect a patient is deteriorating and we are given authority to start IV's, doing ECG's, give volume, do bloodwork and then the Doctor is called. We can also admit patients to ICU if their condition warrants. This works really well in our small community hospital.

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  • This article might be about Australia but Mike and others are correct. The clinical skills of many nurses in the UK is dire. Basic care skills are missing let alone being able to detect subtle changes and a deterioration in condition.
    "Education" is to blame and more emphasis is needed on the clinical needs of people in our care

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  •'s not entirely the fault of the universities. Don't students spend half of their time on placements?

    I don't prescribe to the too posh to wash hocum either. I remeber being a patient 25 years ago and receiving abysmal nursing care after an operation.

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