A study of the relationship of nursing interventions and cognitions to the physiologic outcomes of care in a simulated task environment

This study, based on the Expert Performance Approach, examined the clinical nursing performance of participants who were introduced into a simulated task environment requiring them to administer care to a client experiencing an exacerbation of Congestive Heart Failure. This was undertaken to identify cognitive and physiologic variables that differentiate performance levels among participants. Data on participant actions and verbal reports were coded to characterize their relationship with physiologic responses of the Human Patient Simulator. The results demonstrated that physiologic responses to nursing interventions reflect a reliable pattern that can be used to differentiate performance levels.

The advent of Human Patient Simulators (HPS) has been a significant development in nursing education and practice. The ability to reproduce clinical events in a uniform and realistic manner has resulted in their use for both instructional and evaluative purposes. Whereas the technology associated with these instruments is advancing rapidly, understanding of the most effective use of these instruments is considerably less advanced, resulting in underutilization of these systems in many settings (King, Moseley, Hindenlang, & Kuritz, 2008). Initially, HPS were used in academic settings; however, there is now an increased use of these systems in staff development departments within healthcare institutions (Wolf, 2008). The proliferation of clinical simulation requires a re-examination of methods used to employ this modality, particularly due to the fact that most methods involve the measurement of nurses' clinical performance.

The application of performance criteria to nursing students and nurses is not a new concept. Historically, a variety of grading rubrics, instruments and methods have been applied to measure clinical performance in nursing. A documented and ongoing concern with many of these approaches is subjectivity, which involves observations that might be interpreted in multiple ways by various evaluators (McCarthy & Murphy, 2007). The purpose of this pilot study was to examine performance criteria in the context of nursing practice in a Simulated Task Environment (STE) in order to more accurately identify high and low-level performers based on objective performance related variables.