- Email: [email protected]
First-year students as first responders: Initiating their first code
Teaching and Learning in Nursing (2016) 11, 74–78
www.jtln.org
First-year students as first responders: Initiating their first code Susan G. Bryant MSN, RN, CNE, CHSE⁎ Davidson County Community College, Lexington, NC 27293-1287, USA KEYWORDS: Nursing education; Simulation; Code scenario
Abstract First-year nursing students may care for patients with deteriorating conditions and should be able to respond appropriately to emergencies. First-year students may not have confidence or skills to initiate a code response within seconds of recognizing an event even though they are required to have certification in basic life support. Faculty of one associate-degree nursing program developed a “Code Week” with a high-fidelity simulation scenario for first-semester students to rehearse initiating a code. © 2016 Organization for Associate Degree Nursing. Published by Elsevier Inc. All rights reserved.
Nursing students during their first year clinical learning experiences may have assignments of patients with deteriorating conditions and should be able to respond appropriately to emergency situations. Go et al. (2013) estimated that there are 209,000 inhospital cardiac arrests each year. The latest American Heart Association guidelines require initiation of cardiopulmonary resuscitation (CPR) within 10 seconds of event recognition (Hazinski, 2011). Nursing students who are the first to encounter patients in cardiopulmonary arrest may improve client outcomes if they are able to respond appropriately. High-fidelity simulation can provide a safe learning environment in which students may practice skills and gain confidence in responding to emergency situations before they confront true emergencies with hospitalized patients.
Background Our southeastern United States associate degree nursing program requires all students to have current basic life support (BLS) certification. However, Leighton and Scholl (2009) observed that nursing programs do not always present curriculum content on code management and found in their literature review that students' BLS skills and knowledge decline after certification. Because of increased acuity of hospitalized patients, nursing students often care for unstable patients. The first year lead instructor of our program wanted students to be exposed early in our nursing program to content in responding to medical emergencies. She planned a “Code Week” for the end of the first semester so that the students could learn and rehearse what to do during a code situation.
Review of the Literature ⁎ Corresponding author. E-mail address: [email protected]
A search of the literature from 2009 using the terms nursing education, simulation, BLS, CPR, first responders, nursing students, code scenario, and cardiac arrest in
http://dx.doi.org/10.1016/j.teln.2016.01.001 1557-3087/© 2016 Organization for Associate Degree Nursing. Published by Elsevier Inc. All rights reserved.
First-year students as first responders various combinations resulted in no articles about first-year nursing students participating in simulated code scenarios. A number of authors did find that high-fidelity (using computerized manikins with sophisticated life-like features such as chest rise and fall) simulated code scenarios were related to improving nursing student skills and/or levels of confidence. Leighton and Scholl (2009) studied responses of senior nursing students and found that fear levels of encountering a code decreased and confidence levels in managing a code situation increased after a simulated code scenario experience. Gordon and Buckley (2009) confirmed that medical–surgical nursing graduate students reported an increase in their emergency response skills as an effect of immersive clinical simulation experiences including those of patients in cardiac arrest. As part of an elective acute patient deterioration course, Hart et al. (2014) utilized three high-fidelity simulation scenarios of a patient in cardiac arrest. The authors determined senior Bachelor of Science in Nursing students' confidence and performance levels in recognizing and responding to acute patient deterioration events improved during the course. Roh (2014) concluded that high-fidelity simulation was more effective than medium-fidelity (using computerized manikins with limited physiological responses, such as breath sounds without chest rise and fall) simulation for improving resuscitation self-efficacy scores in second-year nursing students. Bogossian et al. (2014) provided a different perspective. The authors observed during high-fidelity simulation that final-year nursing students “lacked the knowledge, clinical skills, team work and situation awareness required to competently manage a deteriorating patient either as first response leaders or team members” (p. 694). The authors recommended that nursing students be provided with opportunities to integrate knowledge and rehearse management of deteriorating patients and planned to make such simulation experiences available to all their students.
The Code Scenario In 2013, I was simulation coordinator and collaborated with nursing faculty to develop a first responder high-fidelity scenario based on the following learning objectives listed in Fig. 1. I created a patient chart, ID wristband, provider orders, and written beginning-of-shift report to enhance the scenario. I also developed a check-off sheet of expected behaviors and a debriefing template for assessing and discussing student performance. On the first day of Code Week, the lead instructor presented a 90-minute lecture on the role of the student nurse as first responder in a medical emergency. During the following 2 days, student assignments included reviewing BLS guidelines and content. We scheduled clinical groups to participate in a 5-minute simulated code scenario with a Laerdal SimMan manikin followed by a 10- to 15-minute debriefing. Students reported to a waiting area and drew
75 numbers to randomly determine order of participation. They then waited until called to the simulation laboratory room to participate in the scenario in pairs, except for one group of three. All students were familiar with the nursing simulation laboratory room and the Laerdal SimMan manikin after participating in four noncode simulation scenarios spaced throughout the first semester prior to Code Week. They had signed confidentiality agreements at the beginning of the semester stating that they would not discuss simulation content with other students. Three nursing instructors were involved in the simulation activity: I operated the equipment, recorded events and times, and facilitated debriefing. Two first-year faculty members were confederates (actors assuming roles in the scenario): one acted as clinical instructor, and the lead instructor acted as a code team member. All students and instructors dressed for simulation in scrub uniforms per nursing program dress code requirements for clinical experiences. Before starting the scenario, I prebriefed students outside the simulation room with a beginning-of-shift report of a 60-year-old male 2 days post knee replacement surgery who had just returned to his room following physical therapy. Their assigned roles were of student nurses preparing to introduce themselves for the first time and start their initial assessment. The patient chart was available inside the room, including a photo of a 60-year-old male and a FULL CODE label on the front of the paper chart notebook. I informed the students of the location of the code cart and that the clinical instructor was available in the hallway outside the patient's room if they needed her. After answering any prescenario questions, I told the students when to start the scenario, and the students entered the room. When they assessed the manikin patient, they found that he had extremely low pulse and respiration rates on the monitor (the Laerdal SimMan program was set for 0 for these, but the monitor displayed very low, changing numbers such as 6, 8, etc.). Faculty expectations were for the students to check for breathing and carotid pulse, start compressions, call for the clinical instructor in the hallway, and to bring the code cart with the Ambu bag from the hallway into the room and start ventilating the patient. The clinical instructor guided the students in timing compressions and delivering breaths and advised them when to switch duties if the students did not do this themselves. Three minutes after the clinical instructor entered the room, the code team member (waiting around the corner in the hallway out of view of the students) rushed into the room and asked for report. The scenario ended after the students gave an Situation Background Assessment Recommendation report to the code team member while continuing to give compressions and ventilate the manikin. During the scenario, I stayed behind a screen with a one-way viewing window and completed the check-off sheet items with time of event recognition, time code blue called/ instructor summoned, time CPR initiated and whether the
76
S.G. Bryant
Fig. 1
Simulated code: First year nursing students as first responders.
correct 30:2 ratio of compressions to breaths was performed, and time code team member arrived. I also noted any unexpected student behaviors.
Debriefing Structure After each scenario ended, the students and the three nursing instructors left the simulation room and met in a nearby conference room for a debriefing session. I opened by asking, How are you feeling? After the students responded, I then reviewed the four learning objectives of the scenario and facilitated the discussions with the questions listed in Fig. 1 for each student group. Faculty identified and corrected any gaps in performance in a respectful and confidential manner. Debriefing concluded with each student sharing at least one take home point for applying new knowledge learned in the scenario to future clinical situations. Afterwards, students completed a short code report form including times of event recognition, CPR initiation, and arrival of code team member. I also reminded students to refrain from discussing their performance and scenario content with other students.
Student Performance Student performance in the code situation was inconsistent between groups despite the known content of the scenario and the assigned review of BLS material. This observation correlated with Leighton and Scholl's (2009) research demonstrating that although students are required to take BLS courses, they do not always use those skills as taught. While all groups quickly identified that the monitor showed an extremely low heart rate, student participants responded differently to this information. Some did not check for carotid pulse and/or respirations before starting CPR. Several groups either delayed starting compressions by more than 10 seconds after event recognition or did not resume compressions immediately after switching places while doing CPR. Others stopped compressions or bag-mask ventilations while giving report. If performance gaps were not addressed by the clinical instructor within the scenario, I corrected these afterwards during debriefing. Many students did exhibit effective CPR performance. The code team member did need to coach several students through the SBAR handoff report. Some of the students demonstrating
First-year students as first responders the best performance shared afterwards that they had had previous code experience.
Postscenario Debriefing and Verbal Feedback Many students communicated that the immersive scenario was very different from their BLS training classes. Most reported that the scenario felt real and that they thought it was a valuable learning experience. Participants who were certified nursing assistants and very confident in their performance of CPR because of previous code experiences discussed how different this emergency situation was as students learning the role of nurses responsible for handoff report to the code team member while performing CPR. Others shared that although they had learned about SBAR in class, this format presented a continuing challenge and that they needed more practice. In response to the question If you had the chance to do the scenario over, is there anything you would do differently, various students answered that they would check for carotid pulse/respirations before starting CPR, call for help earlier, initiate CPR sooner within 10 seconds, resume compressions immediately after switching roles during CPR, or continue compressions/ventilations while giving SBAR handoff report. Many students stated that as a result of participating in the scenario, they now had increased confidence in their ability to call for help immediately and start CPR within several seconds of recognition of a cardiopulmonary arrest.
Student Evaluation of Simulation At the end of the course, students completed one 17-item evaluation for all first-semester simulation experiences. This tool covered five scenarios including the final first responder scenario. It was adapted from evaluation tools and documents obtained with permission from Simulation Innovation Resource Center (National League for Nursing SIRC) and included questions regarding simulation components such as learning objectives, realism of scenarios, support for students, and debriefing. Although there were no specific questions regarding individual scenarios, student responses to first-semester simulation were overwhelmingly positive.
Future Considerations and Plans Several students stated that they would like the chance to repeat the scenario to improve their performance. While scheduling constraints did not permit this at that time, it is a consideration for future planning. Students and faculty returned very positive feedback about this learning experience, and we plan to continue including Code Week and this simulation scenario in first-semester classes. I also plan to
77 incorporate more opportunities using SBAR handoff communication into scenarios throughout the curriculum to give students additional practice with this format. As funding becomes available, we may be able to purchase equipment that records depth and rate of compressions to further evaluate effectiveness of the students' performance of compressions during CPR.
Conclusion First-year nursing students in our southeastern United States community college associate degree nursing program start their clinical learning experiences during the first semester. Hospitalized patients can experience medical emergencies, and their survival may depend on the timely recognition and response of those caring for them. First-year nursing students should be able to recognize and respond to a cardiopulmonary arrest within 10 seconds of event recognition by starting CPR and calling for help to initiate a code. Nursing faculty developed a Code Week at the end of first semester in order to enhance student learning as first responders. Learning activities of the week started with a lecture on the role of first-year nursing students during a medical emergency. We followed this with an immersive high-fidelity simulated cardiopulmonary arrest scenario in which students could practice their knowledge and skills in a safe environment and receive constructive feedback during debriefing. Faculty and students responded positively to these experiences, and we plan to continue to offer these learning opportunities to our first-year students so that they may be better prepared for medical emergencies in the clinical setting.
Conflict of Interest Statement The author received no extramural funding or any commercial financial support for this project.
Acknowledgments The author gratefully acknowledges the contributions of Kaye Fuson for proposing the idea for the simulation and Samantha Combs Ogle for her assistance in the development of the scenario.
References Bogossian, F., Cooper, S., Cant, R., Beauchamp, A., Porter, J., Kain, V., ... & The FIRST2ACTTM Research Team (2014). Undergraduate nursing students’ performance in recognizing and responding to sudden patient deterioration in high psychological fidelity simulated environments: An
78 Australian multi-centre study. Nurse Education Today, 34, 691−696, http://dx.doi.org/10.1016/j.nedt.2013.09.015. Go, A., Mozaffarian, D., Roger, V., Benjamin, E., Berry, J., Borden, W., ... & Turner, M. (2013). Heart disease and stroke statistics—2013 update: A report from the American Heart Association. Circulation, 127, e6−e245, http://dx.doi.org/10.1161/CIR.0b013e31828124ad. Gordon, C., & Buckley, T. (2009). The effect of high-fidelity simulation training on medical-surgical graduate nurses’ perceived ability to respond to patient clinical emergencies. The Journal of Continuing Education in Nursing, 40(11), 491−498, http://dx.doi.org/10.3928/ 00220124-20091023-06. Hart, P., Maguire, M., Brannan, J., Long, F., Robley, L., & Brooks, B. (2014). Improving BSN students’ performance in recognizing and
S.G. Bryant responding to clinical deterioration. Clinical Simulation in Nursing, 10, e25−e32 (http://dx.doi.org/10/1016/j.ecns.2013.06.00). Hazinski, M. F. (Ed.). (2011). BLS for healthcare providers: Student manual US: American Heart Association. Leighton, K., & Scholl, K. (2009). Simulated codes: Understanding the response of undergraduate nursing students. Clinical Simulation in Nursing, 5, e187−e194, http://dx.doi.org/10.1016/j.ecns.2009.05.058. National League for Nursing Simulation Innovation Resource Center (SIRC) (). Retrieved from www.sirc.nln.org. Roh, Y. (2014). Effects of high-fidelity patient simulation on nursing students’ resuscitation-specific self-efficacy. CIN: Computers, Informatics, Nursing, 32(2), 84−89, http://dx.doi.org/10.1097/CIN. 0000000000000034.
www.jtln.org
First-year students as first responders: Initiating their first code Susan G. Bryant MSN, RN, CNE, CHSE⁎ Davidson County Community College, Lexington, NC 27293-1287, USA KEYWORDS: Nursing education; Simulation; Code scenario
Abstract First-year nursing students may care for patients with deteriorating conditions and should be able to respond appropriately to emergencies. First-year students may not have confidence or skills to initiate a code response within seconds of recognizing an event even though they are required to have certification in basic life support. Faculty of one associate-degree nursing program developed a “Code Week” with a high-fidelity simulation scenario for first-semester students to rehearse initiating a code. © 2016 Organization for Associate Degree Nursing. Published by Elsevier Inc. All rights reserved.
Nursing students during their first year clinical learning experiences may have assignments of patients with deteriorating conditions and should be able to respond appropriately to emergency situations. Go et al. (2013) estimated that there are 209,000 inhospital cardiac arrests each year. The latest American Heart Association guidelines require initiation of cardiopulmonary resuscitation (CPR) within 10 seconds of event recognition (Hazinski, 2011). Nursing students who are the first to encounter patients in cardiopulmonary arrest may improve client outcomes if they are able to respond appropriately. High-fidelity simulation can provide a safe learning environment in which students may practice skills and gain confidence in responding to emergency situations before they confront true emergencies with hospitalized patients.
Background Our southeastern United States associate degree nursing program requires all students to have current basic life support (BLS) certification. However, Leighton and Scholl (2009) observed that nursing programs do not always present curriculum content on code management and found in their literature review that students' BLS skills and knowledge decline after certification. Because of increased acuity of hospitalized patients, nursing students often care for unstable patients. The first year lead instructor of our program wanted students to be exposed early in our nursing program to content in responding to medical emergencies. She planned a “Code Week” for the end of the first semester so that the students could learn and rehearse what to do during a code situation.
Review of the Literature ⁎ Corresponding author. E-mail address: [email protected]
A search of the literature from 2009 using the terms nursing education, simulation, BLS, CPR, first responders, nursing students, code scenario, and cardiac arrest in
http://dx.doi.org/10.1016/j.teln.2016.01.001 1557-3087/© 2016 Organization for Associate Degree Nursing. Published by Elsevier Inc. All rights reserved.
First-year students as first responders various combinations resulted in no articles about first-year nursing students participating in simulated code scenarios. A number of authors did find that high-fidelity (using computerized manikins with sophisticated life-like features such as chest rise and fall) simulated code scenarios were related to improving nursing student skills and/or levels of confidence. Leighton and Scholl (2009) studied responses of senior nursing students and found that fear levels of encountering a code decreased and confidence levels in managing a code situation increased after a simulated code scenario experience. Gordon and Buckley (2009) confirmed that medical–surgical nursing graduate students reported an increase in their emergency response skills as an effect of immersive clinical simulation experiences including those of patients in cardiac arrest. As part of an elective acute patient deterioration course, Hart et al. (2014) utilized three high-fidelity simulation scenarios of a patient in cardiac arrest. The authors determined senior Bachelor of Science in Nursing students' confidence and performance levels in recognizing and responding to acute patient deterioration events improved during the course. Roh (2014) concluded that high-fidelity simulation was more effective than medium-fidelity (using computerized manikins with limited physiological responses, such as breath sounds without chest rise and fall) simulation for improving resuscitation self-efficacy scores in second-year nursing students. Bogossian et al. (2014) provided a different perspective. The authors observed during high-fidelity simulation that final-year nursing students “lacked the knowledge, clinical skills, team work and situation awareness required to competently manage a deteriorating patient either as first response leaders or team members” (p. 694). The authors recommended that nursing students be provided with opportunities to integrate knowledge and rehearse management of deteriorating patients and planned to make such simulation experiences available to all their students.
The Code Scenario In 2013, I was simulation coordinator and collaborated with nursing faculty to develop a first responder high-fidelity scenario based on the following learning objectives listed in Fig. 1. I created a patient chart, ID wristband, provider orders, and written beginning-of-shift report to enhance the scenario. I also developed a check-off sheet of expected behaviors and a debriefing template for assessing and discussing student performance. On the first day of Code Week, the lead instructor presented a 90-minute lecture on the role of the student nurse as first responder in a medical emergency. During the following 2 days, student assignments included reviewing BLS guidelines and content. We scheduled clinical groups to participate in a 5-minute simulated code scenario with a Laerdal SimMan manikin followed by a 10- to 15-minute debriefing. Students reported to a waiting area and drew
75 numbers to randomly determine order of participation. They then waited until called to the simulation laboratory room to participate in the scenario in pairs, except for one group of three. All students were familiar with the nursing simulation laboratory room and the Laerdal SimMan manikin after participating in four noncode simulation scenarios spaced throughout the first semester prior to Code Week. They had signed confidentiality agreements at the beginning of the semester stating that they would not discuss simulation content with other students. Three nursing instructors were involved in the simulation activity: I operated the equipment, recorded events and times, and facilitated debriefing. Two first-year faculty members were confederates (actors assuming roles in the scenario): one acted as clinical instructor, and the lead instructor acted as a code team member. All students and instructors dressed for simulation in scrub uniforms per nursing program dress code requirements for clinical experiences. Before starting the scenario, I prebriefed students outside the simulation room with a beginning-of-shift report of a 60-year-old male 2 days post knee replacement surgery who had just returned to his room following physical therapy. Their assigned roles were of student nurses preparing to introduce themselves for the first time and start their initial assessment. The patient chart was available inside the room, including a photo of a 60-year-old male and a FULL CODE label on the front of the paper chart notebook. I informed the students of the location of the code cart and that the clinical instructor was available in the hallway outside the patient's room if they needed her. After answering any prescenario questions, I told the students when to start the scenario, and the students entered the room. When they assessed the manikin patient, they found that he had extremely low pulse and respiration rates on the monitor (the Laerdal SimMan program was set for 0 for these, but the monitor displayed very low, changing numbers such as 6, 8, etc.). Faculty expectations were for the students to check for breathing and carotid pulse, start compressions, call for the clinical instructor in the hallway, and to bring the code cart with the Ambu bag from the hallway into the room and start ventilating the patient. The clinical instructor guided the students in timing compressions and delivering breaths and advised them when to switch duties if the students did not do this themselves. Three minutes after the clinical instructor entered the room, the code team member (waiting around the corner in the hallway out of view of the students) rushed into the room and asked for report. The scenario ended after the students gave an Situation Background Assessment Recommendation report to the code team member while continuing to give compressions and ventilate the manikin. During the scenario, I stayed behind a screen with a one-way viewing window and completed the check-off sheet items with time of event recognition, time code blue called/ instructor summoned, time CPR initiated and whether the
76
S.G. Bryant
Fig. 1
Simulated code: First year nursing students as first responders.
correct 30:2 ratio of compressions to breaths was performed, and time code team member arrived. I also noted any unexpected student behaviors.
Debriefing Structure After each scenario ended, the students and the three nursing instructors left the simulation room and met in a nearby conference room for a debriefing session. I opened by asking, How are you feeling? After the students responded, I then reviewed the four learning objectives of the scenario and facilitated the discussions with the questions listed in Fig. 1 for each student group. Faculty identified and corrected any gaps in performance in a respectful and confidential manner. Debriefing concluded with each student sharing at least one take home point for applying new knowledge learned in the scenario to future clinical situations. Afterwards, students completed a short code report form including times of event recognition, CPR initiation, and arrival of code team member. I also reminded students to refrain from discussing their performance and scenario content with other students.
Student Performance Student performance in the code situation was inconsistent between groups despite the known content of the scenario and the assigned review of BLS material. This observation correlated with Leighton and Scholl's (2009) research demonstrating that although students are required to take BLS courses, they do not always use those skills as taught. While all groups quickly identified that the monitor showed an extremely low heart rate, student participants responded differently to this information. Some did not check for carotid pulse and/or respirations before starting CPR. Several groups either delayed starting compressions by more than 10 seconds after event recognition or did not resume compressions immediately after switching places while doing CPR. Others stopped compressions or bag-mask ventilations while giving report. If performance gaps were not addressed by the clinical instructor within the scenario, I corrected these afterwards during debriefing. Many students did exhibit effective CPR performance. The code team member did need to coach several students through the SBAR handoff report. Some of the students demonstrating
First-year students as first responders the best performance shared afterwards that they had had previous code experience.
Postscenario Debriefing and Verbal Feedback Many students communicated that the immersive scenario was very different from their BLS training classes. Most reported that the scenario felt real and that they thought it was a valuable learning experience. Participants who were certified nursing assistants and very confident in their performance of CPR because of previous code experiences discussed how different this emergency situation was as students learning the role of nurses responsible for handoff report to the code team member while performing CPR. Others shared that although they had learned about SBAR in class, this format presented a continuing challenge and that they needed more practice. In response to the question If you had the chance to do the scenario over, is there anything you would do differently, various students answered that they would check for carotid pulse/respirations before starting CPR, call for help earlier, initiate CPR sooner within 10 seconds, resume compressions immediately after switching roles during CPR, or continue compressions/ventilations while giving SBAR handoff report. Many students stated that as a result of participating in the scenario, they now had increased confidence in their ability to call for help immediately and start CPR within several seconds of recognition of a cardiopulmonary arrest.
Student Evaluation of Simulation At the end of the course, students completed one 17-item evaluation for all first-semester simulation experiences. This tool covered five scenarios including the final first responder scenario. It was adapted from evaluation tools and documents obtained with permission from Simulation Innovation Resource Center (National League for Nursing SIRC) and included questions regarding simulation components such as learning objectives, realism of scenarios, support for students, and debriefing. Although there were no specific questions regarding individual scenarios, student responses to first-semester simulation were overwhelmingly positive.
Future Considerations and Plans Several students stated that they would like the chance to repeat the scenario to improve their performance. While scheduling constraints did not permit this at that time, it is a consideration for future planning. Students and faculty returned very positive feedback about this learning experience, and we plan to continue including Code Week and this simulation scenario in first-semester classes. I also plan to
77 incorporate more opportunities using SBAR handoff communication into scenarios throughout the curriculum to give students additional practice with this format. As funding becomes available, we may be able to purchase equipment that records depth and rate of compressions to further evaluate effectiveness of the students' performance of compressions during CPR.
Conclusion First-year nursing students in our southeastern United States community college associate degree nursing program start their clinical learning experiences during the first semester. Hospitalized patients can experience medical emergencies, and their survival may depend on the timely recognition and response of those caring for them. First-year nursing students should be able to recognize and respond to a cardiopulmonary arrest within 10 seconds of event recognition by starting CPR and calling for help to initiate a code. Nursing faculty developed a Code Week at the end of first semester in order to enhance student learning as first responders. Learning activities of the week started with a lecture on the role of first-year nursing students during a medical emergency. We followed this with an immersive high-fidelity simulated cardiopulmonary arrest scenario in which students could practice their knowledge and skills in a safe environment and receive constructive feedback during debriefing. Faculty and students responded positively to these experiences, and we plan to continue to offer these learning opportunities to our first-year students so that they may be better prepared for medical emergencies in the clinical setting.
Conflict of Interest Statement The author received no extramural funding or any commercial financial support for this project.
Acknowledgments The author gratefully acknowledges the contributions of Kaye Fuson for proposing the idea for the simulation and Samantha Combs Ogle for her assistance in the development of the scenario.
References Bogossian, F., Cooper, S., Cant, R., Beauchamp, A., Porter, J., Kain, V., ... & The FIRST2ACTTM Research Team (2014). Undergraduate nursing students’ performance in recognizing and responding to sudden patient deterioration in high psychological fidelity simulated environments: An
78 Australian multi-centre study. Nurse Education Today, 34, 691−696, http://dx.doi.org/10.1016/j.nedt.2013.09.015. Go, A., Mozaffarian, D., Roger, V., Benjamin, E., Berry, J., Borden, W., ... & Turner, M. (2013). Heart disease and stroke statistics—2013 update: A report from the American Heart Association. Circulation, 127, e6−e245, http://dx.doi.org/10.1161/CIR.0b013e31828124ad. Gordon, C., & Buckley, T. (2009). The effect of high-fidelity simulation training on medical-surgical graduate nurses’ perceived ability to respond to patient clinical emergencies. The Journal of Continuing Education in Nursing, 40(11), 491−498, http://dx.doi.org/10.3928/ 00220124-20091023-06. Hart, P., Maguire, M., Brannan, J., Long, F., Robley, L., & Brooks, B. (2014). Improving BSN students’ performance in recognizing and
S.G. Bryant responding to clinical deterioration. Clinical Simulation in Nursing, 10, e25−e32 (http://dx.doi.org/10/1016/j.ecns.2013.06.00). Hazinski, M. F. (Ed.). (2011). BLS for healthcare providers: Student manual US: American Heart Association. Leighton, K., & Scholl, K. (2009). Simulated codes: Understanding the response of undergraduate nursing students. Clinical Simulation in Nursing, 5, e187−e194, http://dx.doi.org/10.1016/j.ecns.2009.05.058. National League for Nursing Simulation Innovation Resource Center (SIRC) (). Retrieved from www.sirc.nln.org. Roh, Y. (2014). Effects of high-fidelity patient simulation on nursing students’ resuscitation-specific self-efficacy. CIN: Computers, Informatics, Nursing, 32(2), 84−89, http://dx.doi.org/10.1097/CIN. 0000000000000034.