Defense Date

3-14-2023

Graduation Date

Spring 5-5-2023

Availability

One-year Embargo

Submission Type

dissertation

Degree Name

PhD

Department

Nursing

School

School of Nursing

Committee Chair

Joan Such Lockhart

Committee Member

Linda M. Goodfellow

Committee Member

Nancy J. Cooke

Committee Member

Janine E. Hinton

Committee Member

James B. Schreiber

Keywords

situation awareness, cognitive load, deteriorating patient, novice, nursing student, virtual reality, simulation

Abstract

Background: When a patient’s baseline clinical state shifts to a worse clinical state requiring a transfer to a higher level of care within the healthcare system, it is the hallmark of a deteriorating patient situation. Up to 37% of newly licensed nurses fail to identify and manage a deteriorating patient partly due to inexperience and a lack of expertise, contributing to lower situation awareness (SA), specifically in cue perception. Long-term memory schema development leads to expertise that allows individuals to develop higher SA necessary to identify and effectively manage patient deterioration. Expert nurses access long-term memory schema in managing deteriorating patients, but there is limited research on novice nurses’ long-term memory schema development specific to managing simulated deteriorating patients.

Aims: This study compared baccalaureate student nurses (BSNs) SA, CL, and time differences to initiate and prioritize the priority key performance indicator of a simulated 2D computer-based virtual reality (VR) deteriorating patient scenario.

Method: An exploratory after-only study was conducted with 14 nursing students enrolled in their final semester of a BSN program.

Results: Results indicate a difference in SA and CL based on the type of simulated 2D computer-based VR deteriorating patient scenario. The key performance indicator was prioritized by 28% of the participants first, delayed by 21.4%, and not initiated by 50%.

Limitations & Implications: The small sample size with unbalanced groups made statistical analysis difficult. As an after-only design, potential extraneous factors were not controlled. The outcomes of this study may not reflect pre-COVID conditions. This limits the results to BSN students in their final clinical experience in the research setting during a pandemic. The study provides a solid protocol for future research in post-pandemic conditions.

Conclusion: Using 2D computer-based VR platforms offers an ability to integrate context factors into CL-guided simulation scenarios, possibly contributing to long-term memory schema development in novices to gain expertise for the development of higher SA in the identification and management of a deteriorating patient.

Language

English

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