Study Method / Design
Quantitative research is conducted when there is a need for the most accurate numerical data, and this method involves the collection and thorough analysis of primary information. In their study, Disher et al. (2014) utilize the quantitative / quasi-experimental design to explore the impact of a unit-stimulation on nurses’ ability to recognize deteriorating patients. The essence of this quantitative research is composed of clear mathematical and statistical models, which allows having precise quantitative values of the studied indicators (LoBiondo-Wood, Haber, Berry, & Yost, 2013). The key advantage of such a method that also related to the given study is a large sample of respondents to quantify the behaviors of nurses and patients as well as their reactions to interventions. Even though a structured questionnaire is provided to obtain information quantitatively determining the number and percentage of respondents for each specific category, respondents’ lack of opportunity to clarify some questions may be regarded as a disadvantage.
Problem Statement
Recently, the review of a community hospital revealed that patients are often transferred from step-down cardiovascular units to intensive care units. It was suggested that proper self-care and nursing management are the main prerequisites of such a situation. Furthermore, the cause of these transitions – respiratory distress – was discovered. The question regarding the early identification of deteriorating patients became evident. Nursing professional development (NPD) specialists organized special training for nurses working with patents having cardiovascular disease. In particular, they were educated to identify the first signs of breathing worsening and other respiratory health concerns. The need to assess the results of education and its role in managing patients provides the basis for conducting this study.
Purpose Statement
In the view of the discussed problem statement, the specified quasi-experimental was initiated with the aim of revealing the role of nurses. The unit-based and high-fidelity simulation was initiated to conduct the study and determine the impact of this intervention on nurses’ ability to assist patients when they encounter health deterioration. It should also be stressed that the cardiovascular unit was selected as the target setting, while simulation impact evaluation was put in the core of the research. The purpose statement seems to be relevant to the needs of the mentioned healthcare organization as it is likely to address the mentioned problem.
Independent Variable
The independent variable in this study is a unit-based simulation that implies the use of technology to create the realistic environment as a means of staff training and further intervention planning. As noted by Disher et al. (2014), the unit-based simulation develops decision-making skills and allows eliminating the existing errors. The utilized simulation may also be regarded as a low- to medium fidelity simulation with the focus in a special area. One more study that also used this variable shows its importance and feasibility, as reported by Fore, Sculli, Albee, and Neily (2013). Most importantly, the issue of patient safety is also implemented within the mentioned variable – informed consent and other related confidentiality terms were considered.
Discussing the unit-based simulation in the context of the given study, one should state that the meaning of this method is that a number of specific aspects are combined into one or more generalized situations (Fore et al., 2013). In the study under discussion, optimal decision-making and practical action program are the results of working with the unit-based simulation. In particular, conducting experiments, proposing solutions, and evaluating their results, nurses acquire new knowledge and skills. Thus, the simulation used in this study seems to be a method that effectively ensures the optimal achievement of the objectives set by the previous research.
Dependent Variable
Along with the planning of the characteristics of independent variables, the researcher should determine dependent variables. In other words, what exactly should change in the behavior of the subjects under the influence of the independent variable. In the given study, nurses’ identification of deteriorating patients is a dependant variable. Since a specific case scenario was prepared, and the participants received pertinent training, it was expected that the recognition of early signs of patient deterioration will be improved. If an independent variable is set by the researcher and controlled in the study, the dependent variable should be measured (Parahoo, 2014). The more accurately the dependent variable is analyzed, the more precise is the answer to the question whether the change in the independent variable leads to a change in the dependent variable or not. As for this study, one may confidently state that both variables are identified appropriately since they reflect both the problem and its potential solution.
Intervention
The implementation of a simulation-based approach is the intervention of the study under discussion. After preparing the simulation model, nurses were gathered to take part in the experiment, namely, education intervention procedure. The latter was offered to nurses of step-down cardiovascular units and was conducted during the night shift. Several assessment and debriefing sessions were performed to analyze how nurses would act in terms of the simulated conditions. The fact that specialists worked in groups of two participants is especially important since they had the opportunity to track the progress. During the learning process, all participants were involved in the process of cognition, having the opportunity to understand and reflect on what they know and think, as well as exchange valuable information.
An important advantage of the described simulation is the emotional involvement – the participants rejoice, make errors, and correct them in the process of training. The sincere experience of the most diverse and often unexpected feelings creates a high level of both engagement and mastery of knowledge and skills (Thompson, Aitken, Doran, & Dowding, 2013). This level seems to be difficult to achieve with another tool – a seminar or training since the latter cannot provide a full penetration into the education process. In this regard, the safety of the decisions taken should be noted. This aspect is an advantage of simulation as participants can try the most incredible scenario, test their hypotheses in action, and the worst that can happen to them – the awareness of the fallibility of their decisions.
It is rather important to give participants the opportunity to weigh and understand the relationship between their ideas, decisions, and results. It is critical to provide enough time to work with a large amount of data and discussions in the group. The managers of the given study closely monitored the process of the experiment. Training of medical workers is becoming more and more difficult as nurses have to manage patients in different difficult conditions. Scholars find it increasingly difficult to find suitable conditions for imitating professional situations in order to prepare nurses for practices that require professional knowledge and skills. There is an obvious failure between the clinical practice and the theoretical knowledge that is given in the primary training of nurses, but it can be filled with simulation.
It goes without saying that simulation technologies cannot completely replace clinical practice, and the conditions of any modeling differ from the actual situation. However, by providing an opportunity for constant and safe training of students, these technologies can significantly improve the level of their preparation. In the future, this will affect the quality of medical care, reduce the number of errors in the diagnosis and treatment of patients, and increase their level of competitiveness and relevance. Thus, this study proves that the simulation is a rapidly evolving trend in modern nursing education. In the process of simulation, nurses demonstrated their skills and reflected on their shortcomings, mistakes, and ways to resolve them. Discussing their strengths and the formation of professional competencies, they acquired practical experience.
Hypothesis / Research Question
Even though the authors of the discussed study do not clearly identify the hypothesis, the readers may formulate it based on the article. It is expected that high-fidelity simulation would positively impact the ability of nurses to identify early signs of patients’ deteriorating condition. Two research questions presented by the authors seem to be contributing to the study as they provide its direction. The first question asks about the potential role of simulation in nurses’ knowledge and increased awareness. The second question focuses on using the same method as an instrument to educate nurses. Both questions seem to be important in the context of the given topic, which makes the study comprehensive and scholarly.
References
Disher, J., Burgum, A., Desai, A., Fallon, C., Hart, P. L., & Aduddell, K. (2014). The effect of unit-based simulation on nurses’ identification of deteriorating patients. Journal for Nurses in Professional Development, 30(1), 21-28.
Fore, A. M., Sculli, G. L., Albee, D., & Neily, J. (2013). Improving patient safety using the sterile cockpit principle during medication administration: A collaborative, unit‐based project. Journal of Nursing Management, 21(1), 106-111.
LoBiondo-Wood, G., Haber, J., Berry, C., & Yost, J. (2013). Study guide for nursing research: Methods and critical appraisal for evidence-based practice (8th ed.). St. Louis, MO: Elsevier Health Sciences.
Parahoo, K. (2014). Nursing research: Principles, process and issues (3rd ed.). New York, NY: Macmillan International Higher Education.
Thompson, C., Aitken, L., Doran, D., & Dowding, D. (2013). An agenda for clinical decision making and judgement in nursing research and education. International Journal of Nursing Studies, 50(12), 1720-1726.