Managing Deteriorating Patients: Registered Nurses’ Performance in a Simulated Setting

Simon Cooper*, 1, Tracy McConnell-Henry1, Robyn Cant1, Jo Porter1, Karen Missen1, Leigh Kinsman2, Ruth Endacott3, Julie Scholes4
1 Monash University, School of Nursing (Gippsland), Churchill, Victoria, 3842, Australia
2 School of Rural Health, Monash University, PO Box 666, Bendigo Victoria, 3552, Australia
3 Faculty of Health and Social Work, Drake Circus, Plymouth, PL4 8AA, UK
4 Centre for Nursing and Midwifery Research, University of Brighton, Village Way, Falmer, Brighton, BN1 9PH, UK

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© Cooper et al.; Licensee Bentham Open.

open-access license: This is an open access article licensed under the terms of the Creative Commons Attribution Non-Commercial License ( which permits unrestricted, non-commercial use, distribution and reproduction in any medium, provided the work is properly cited.

* Address correspondence to this author at the School of Nursing and Midwifery (Berwick), Room 1126, Building 903, Berwick Campus, 100 Clyde Road, Monash University, Victoria, 3806, Australia; Tel: 03 99047268; E-mail:



To examine, in a simulated environment, rural nurses’ ability to assess and manage patient deterioration using measures of knowledge, situation awareness and skill performance.


Nurses’ ability to manage deterioration and ‘failure to rescue’ are of significant concern with questions over knowledge and clinical skills. Simulated emergencies may help to identify and develop core skills.


An exploratory quantitative performance review. Thirty five nurses from a single ward completed a knowledge questionnaire and two video recorded simulated scenarios in a rural hospital setting. Patient actors simulated deteriorating patients with an Acute Myocardial Infarction (AMI) and Chronic Obstructive Pulmonary Disease (COPD) as the primary diagnosis. How aware individuals were of the situation (levels of situation awareness) were measured at the end of each scenario.


Knowledge of deterioration management varied considerably (range: 27%-91%) with a mean score of 67%. Average situation awareness scores and skill scores across the two scenarios (AMI and COPD) were low (50%) with many important observations and actions missed. Participants did identify that ‘patients’ were deteriorating but as each patient deteriorated staff performance declined with a reduction in all observational records and actions. In many cases, performance decrements appeared to be related to high anxiety levels. Participants tended to focus on single signs and symptoms and failed to use a systematic approach to patient assessment.


Knowledge and skills were generally low in this rural hospital sample with notable performance decrements as patients acutely declined. Educational models that incorporate high fidelity simulation and feedback techniques are likely to have a significant positive impact on performance.

Keywords: Education, nursing, patient deterioration, simulation, situation awareness.