The Impact of face-to-face and web-based simulation training for ward nurses regarding patient deterioration and patient safety.

Nurses in medical wards will complete a simulation-based training program on recognition and management of patient deterioration, either via face-to-face simulation (FIRST2ACT) or via a web-based training program (FIRST2ACTWeb). Nurses will be allocated to an intervention program according to the site of their employment. The training for both groups takes between 1.5 to 2 hours to complete and both include five key components: developing core knowledge; assessment (learning stimulus); simulation; reflective review; and performance feedback. Members of the research team who are senior nurse clinicians will administer and support both forms of training on site at the participating hospitals, assisted by local clinical nurse specialists/educators. Group 1: Web-based training is completed individually on a personal computer or in a ward training room. The web-hosted ‘e-simulation’ version FIRST2ACTWeb (see http://first2actweb.com/) incorporates three interactive scenarios (myocardial infarction, shock ,and respiratory cases) where patient actors deteriorate (over eight minutes) with participants required to ‘click’ on various potential actions – such as measuring blood pressure or inserting an intravenous line - resulting in further pop-up videos of each action. Detailed performance feedback is then provided to a participant on completion and an explanatory Course Manual is downloadable for reflection and review . Group 2: The face-to-face version of the program mirrors the web based program. After an introductory briefing, participants work in teams of three with a patient actor and research ‘support’ staff member, in a ward setting to assess and manage the 'patient' who role-plays three clinical deterioration episodes, as described for Group 1.. At the conclusion, a debriefing is conducted by a clinical researcher and nurse participants complete evaluation surveys. An explanatory Course Manual is made available for each participant's reflection and review. For both groups, prospective program evaluation is conducted through pretest and post-test surveys of nurses' clinical knowledge, performance evaluation using a structured checklist, and post-test satisfaction and feedback.. The web-based version collects evaluation data via a remote server, including which screen-based buttons were clicked and when (to enable scoring of performance), self-completed survey data and analytical data from the website.