Exploring the crisis decision making processes of students of baccalaureate and higher diploma nursing programmes using the patient simulator

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Exploring the crisis decision making processes of students of baccalaureate and higher diploma nursing programmes using the patient simulator


Author: Lam, Wan-choi Dave
Title: Exploring the crisis decision making processes of students of baccalaureate and higher diploma nursing programmes using the patient simulator
Degree: M.Phil.
Year: 2001
Subject: Clinical medicine -- Decision making
Nursing students
Hong Kong Polytechnic University -- Dissertations
Department: Dept. of Nursing and Health Sciences
Pages: 186, [33] leaves : ill. (some col.) ; 30 cm
Language: English
InnoPac Record: http://library.polyu.edu.hk/record=b1604200
URI: http://theses.lib.polyu.edu.hk/handle/200/557
Abstract: Clinical decision making (CDM) had been researched in the past thirty years with diverse aims, target populations, methods and results. A common definition is lacking however. Documentation of the use of prescriptive and descriptive theories in researching nurses' CDM was scarce, and the decision making process in nursing students is not well understood after decades of research. This study was conducted using an interpretative approach to explore the CDM process of students from two pre-registration nursing programmes. Thirteen baccalaureate (BSN) and 8 higher diploma (HD) nursing students were recruited by convenience sampling. They were required to take care of a simulated patient, being acted by a high fidelity mannequin. The case scenario was developed after consultations with nurses working in acute clinical settings and textbooks. The scenario and the materials used were validated by experts in emergency and intensive care nursing. The condition of the patient was made worse during the scenario and the actions performed by the subject were recorded by the researcher. After the scenario, each subject was interviewed by the researcher on the decisions made during the simulation, and perceptions of CDM were also explored. A pilot study was carried out with 4 students, two from each programme. The presentation of the simulation materials, the overall setting of the laboratory, as well as the aspects of CDM to be explored were modified before the main study was being carried out. Data from the interview was thematically analyzed. Both the BSN and HD students shared a similar mean age, having no prior health related training, and had clinical experience in the common specialties in acute hospitals except the Intensive Care Unit. The major differences among the two programmes were that HD students had to attend 672 more clinical hours before they could complete their training. Most of the clinical hours were in blocks with no direct supervision as the students were also full time staff in the training hospital. The objectives of the BSN programme, on the other hand, aimed at fostering the student's critical thinking and self-evaluation, preparing them for ongoing personal development. It also encouraged the students to participate in research. The term "clinical decision making" (CDM) was not new to the students, who shared 4 common elements in their definitions. All acknowledged the importance of this skill in nursing, which they perceived to be an action-bearing process. Their different conception of CDM, however, had led them to report varying frequencies of perceived opportunities in making decisions during their clinical time. They also described their decisions as 'low level' as compared with the registered nurses. Most of the BSN students reported a 'fear of incompetence' when they first approached the patient, while the HD students conceived such patient's condition as a source of heavy workload. For the process of the CDM, the BSN students had shown diverse foci when compared to their HD counterparts, who were more job-driven, following a daily work pattern. Field experience effects, particularly critical incidents, were prominent in the BSN students. The diversity between their CDM patterns converged when the condition of the patient deteriorated. Although the students reported difficulties in taking care of the patient, handling interpersonal relationships, instead of caring for patients in crisis situations, was most difficult for them. The students seldom recalled their clinical experience or knowledge during the simulation, a phenomenon contradictory to the literature findings. The BSN students' CDM were particularly being influenced by the frequent change of clinical mentors as well as bearing the name of the University. On the other hand, the HD students were constantly being affected by the identity of being a labour force in the hospital. This had shaped their work habits, and in turn, their CDM pattern, to the culture of the ward environment. Nevertheless, they reported lesser human influence upon their CDM process as compared to the BSN counterparts. Finally, most of them had heard of the term 'Virtual Reality' (VR) though they could not articulate clearly the meaning. They often related this concept to the development of computer games, though some students could cite examples of treatment of phobias using VR technology. All students welcomed more simulation training in their programmes after participating in this study. They quoted the advantages of sharpening their CDM skills in a well controlled environment, suiting the pace of individual improvement. This study revealed that CDM is an important skill in nursing which should be imparted early during the preparation period of a registered nurse. Further studies using a more fine tuned scenario and other means of collecting data are recommended. Also it is worthwhile exploring the major influencing factors of CDM among the students and how they adapt the skills into the real clinical world upon their graduation. More simulated drills using the VR technology should be included in undergraduate programmes, with discussion and debriefing of critical incidents. Finally the need to minimize change of supervisors during students' field practice, as well as teaching them how to handle interpersonal relationships, are also suggested.

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