Testing nursing students' clinical judgment in a patient deterioration simulation scenario: Development of a situation awareness instrument

• Situation awareness (SA) operationalizes what leads to nurses' clinical judgment.
• A measure of SA was developed for patient deterioration simulation scenarios.
• It measures students' perception, comprehension, and projection of a situation.
• Items mostly showed proper psychometric properties in a hypovolemic shock scenario.
• It needs to be tested with experienced nurses and in other deterioration scenarios.

SummaryBackgroundSituation awareness may be used to operationalize nursing students' clinical judgment of patient deterioration simulation scenarios.ObjectivesTo develop and test an instrument to measure bachelor-level nursing students' situation awareness in a patient deterioration simulation scenario, using the Situation Awareness Global Assessment Technique (SAGAT).DesignInstrument development and validation.SettingsA faculty of nursing of a French–Canadian university.Participants15 critical care experts and 234 bachelor-level nursing students from a critical care course.MethodsThe queries were developed from evidence and guidelines regarding nurses' assessment and response to patient deterioration and an inventory of nursing diagnosis. After expert content validation, the instrument was administered to three cohorts of nursing students in a high-fidelity simulation with a scenario of hypovolemic hemorrhagic shock. Difficulty, discrimination, and fidelity indices were computed. The impact of the instrument on student's performance was assessed with a post-simulation survey.ResultsThe instrument comprised 31 queries, which obtained high content validity indices. Most showed satisfying difficulty, discrimination, and fidelity properties. Inadequate properties of the queries may be explained by the content of the simulation scenario, the assessment practices of nursing students, and their reliance on medical assistance. Students perceived that completing the instrument helped them realize what they forgot to assess in the simulation.ConclusionsThis instrument appears as a promising research tool, although it still needs to be tested with other populations and in other patient deterioration simulation scenarios.