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Aim: The aim of this review was to synthesise current knowledge of high‐fidelity simulation practices and its impact on nurse clinical competence in the acute care setting. Background: There is no consensus or standardisation surrounding best practices for the delivery of high‐fidelity simulation in the acute care setting. This is an understudied area. Design: An integrative review using Johns Hopkins Nursing Evidence‐Based Practice Model. Methods: Medical subject heading terms 'Clinical Competence', AND 'High Fidelity Simulation Training', AND 'Clinical Deterioration' were systematically searched in PubMed, CINAHL and Embase databases for peer‐reviewed literature published through September 2020. The current study was evaluated using PRISMA checklist. Results: Seven studies met the inclusion criteria. Three main concepts were identified: modes of delivery, approach to learner participation and outcome measurement. Conclusions: This review substantiated the use of high‐fidelity simulation to improve acute care nurses' early identification and management of clinical deterioration. Global variations in course design and implementation highlight the need for future approaches to be standardised at the regional level (i.e., country‐centric approach) where differing scopes of practice and sociocultural complexities are best contextualised. Relevance to clinical practice: These findings add to the growing body of evidence of simulation science. Important considerations in course planning and design for nursing clinical educators were uncovered. This is especially relevant given the current COVID‐19 pandemic and urgent need to train redeployed nurses safely and effectively from other units and specialties to acute care. [ABSTRACT FROM AUTHOR]

Aims and Objectives: To examine the non‐linear dose‐response associations between nurse staffing levels and patient outcomes using a nationwide inpatient database in Japan. Background: Previous studies showed that higher nurse staffing levels were associated with better patient outcomes. However, it remains unclear whether there are thresholds for the associations between higher nurse staffing levels and improved patient outcomes. Designs: Retrospective observational study design following the STROBE guideline. Methods: We identified all patients aged ≥20 years who underwent one of six major cancer surgeries between July 2010 and March 2018 using data from the Diagnosis Procedure Combination database, a nationwide database for acute‐care inpatients in Japan. Restricted cubic spline regression analyses, the statistical method that allows non‐linear functional form, were performed with several scenarios of cut‐off points to examine the dose‐response associations between patient‐to‐nurse ratio per shift and failure to rescue, 30‐day in‐hospital mortality and postoperative complications. Results: Among 645,687 patients, restricted cubic spline regression analyses showed insignificant associations of patient‐to‐nurse ratio with failure to rescue and 30‐day in‐hospital mortality with no threshold, but a reverse J‐shaped association with postoperative complications with a threshold of patient‐to‐nurse ratio per shift of 5.4. Conclusions: In terms of postoperative complications, additional registered nurses were associated with decreased postoperative complications. However, this incremental benefit of additional registered nurses may disappear if hospitals allocate five to six number of registered nurses in general wards. Relevance to Clinical Practice: This study suggested that additional registered nurses over one per five to six patients may not bring the incremental benefit to decrease postoperative complications. [ABSTRACT FROM AUTHOR]

Aims and objectives: To present a concept analysis of clinical deterioration and introduce an operational definition. Background: Hospitalised patients who endure cardiopulmonary arrest and unplanned intensive care unit admissions often exhibit physiological signs preceding these events. Clinical deterioration not promptly recognised can result in increased patient morbidity and mortality. A barrier to recognising and responding to clinical deterioration stems from practice variations among healthcare clinicians. Design: Concept analysis. Methods: Eight‐step method of concept analysis proposed by Walker and Avant. Results: Defining attributes include dynamic state, decompensation and objective and subjective determination. Antecedents identified include clinical state, susceptibility, pathogenesis and adverse event. Increased mortality, resuscitation, implementation of higher level of care and prolonged hospital admission were the consequences identified. Defining attributes, antecedents and consequences identified led to an operational definition of clinical deterioration as a dynamic state experienced by a patient compromising hemodynamic stability, marked by physiological decompensation accompanied by subjective or objective findings. Conclusions: Clinical deterioration is a key contributor to inpatient mortality, and its recognition is often underpinned by contextual factors and practice variances. Variation in the uniformity of the concept of clinical deterioration causes a gap in knowledge and necessitated clarification of this phenomenon for nursing research and practice. Relevance to clinical practice: Identifying and intervening on clinical deterioration plays a vital role in the inpatient setting demonstrated by the dynamic nature of a patients' condition during hospitalisation. It is anticipated that this concept analysis on clinical deterioration will contribute to further identification of clinically modifiable risk factors and accompanying interventions to prevent clinical deterioration in the inpatient setting. [ABSTRACT FROM AUTHOR]

Aim and Objective To explore new graduate nurses' experiences with recognition and prevention of failure to rescue. Background Failure to rescue is recognised as a quality-of-care indicator, a core measure of nursing care in hospitals, and a determinant for staffing in acute care facilities. Clinical reasoning is an essential component in preventing failure to rescue and should be emphasised in nursing education and new graduate orientation. Many nurses graduate without the ability to use clinical reasoning in providing patient care which can lead to adverse patient outcomes. Design A descriptive phenomenological design was used. Methods A purposive sample of 14 new graduate nurses from a nursing programme in the south-eastern USA, in practice for no more than eighteen months, was recruited. Individual one-on-one interviews were conducted from January-June 2016 and audio-recorded for accuracy. Data were evaluated using the consolidated criteria for reporting qualitative research ( COREQ) guidelines. Recordings were professionally transcribed and reviewed. Results Using Giorgi's methods for data analysis, five main themes were discerned in the data: clinical preparation in school; experience with emergent situations; development of clinical reasoning; low confidence as a new graduate; and responding to emergencies. Within each theme, subthemes emerged. Conclusion The words of the participants provided rich detail into the preparation of new graduate nurses and how nurse educators, managers and preceptors can better focus learning opportunities to prepare them for practice. Experiential learning combined with collaboration among education stakeholders will lead to a better prepared and more confident nursing work force. Relevance to clinical practice Better preparation and continued support of new graduate nurses lead to positive patient outcomes and more satisfaction with their choice of nursing as a profession. [ABSTRACT FROM AUTHOR]

Aims and objectives To develop and validate a modified Situation-Background-Assessment-Recommendation communication tool incorporating components of the Cape Town modified early warning score vital signs chart for reporting early signs of clinical deterioration. Background Reporting early signs of physiological and clinical deterioration could prevent 'failure to rescue' or unexpected intensive care admission, cardiac arrest or death. A structured communication tool incorporating physiological and clinical parameters allows nurses to provide pertinent information about a deteriorating patient in a logical order. Design Mixed methods instrument development and validation. Methods We used a sequential three-phase method: cognitive interviews, content validation and inter-rater reliability testing to validate a self-designed communication tool. Participants were purposively selected expert nurses and doctors in government sector hospitals in Cape Town. Results Cognitive interviews with five experts prompted most changes to the communication tool: 15/42 (35.71%) items were modified. Content validation of a revised tool was high by a predetermined ≥70% of 18 experts: 4/49 (8.2%) items were modified. Inter-rater reliability testing by two nurses indicated substantial to full agreement (Cohen's kappa .61-1) on 37/45 (82%) items. The one item achieving slight agreement (Cohen's kappa .20) indicated a difference in clinical judgement. The high overall percentage agreement (82%) suggests that the modified items are sound. Overall, 45 items remained on the validated tool. Conclusion The first modified early warning score-linked Situation-Background-Assessment-Recommendation communication tool developed in South Africa was found to be valid and reliable in a local context. Relevance to clinical practice Nurses in South Africa can use the validated tool to provide doctors with pertinent information about a deteriorating patient in a logical order to prevent a serious adverse event. Our findings provide a reference for other African countries to develop and validate communication tools for reporting early signs of clinical deterioration. [ABSTRACT FROM AUTHOR]