Review of systems for recognising and responding to clinical deterioration in Singapore hospitals: a nationwide cross-sectional study.

INTRODUCTION: The Rapid Response System for recognising and responding to clinically deteriorating patients has been progressively implemented in acute care hospitals across the globe. This study sought to review the implementation of this system in acute public hospitals in Singapore. METHODS: A cross-sectional study using a face-to-face survey questionnaire was conducted. RESULTS: Five out of seven invited hospitals completed the questionnaire and rated the Rapid Response System as either high priority or essential, and indicated its importance over other patient safety indicators. Sensitivity and specificity of the triggering criteria and non-adherence to the escalation protocol were highlighted issues. Only two hospitals had a dedicated response team for providing emergency help to deteriorating ward patients. Limited manpower resources, unclear roles between the primary and response teams, and the potential deskilling of ward staff were reported barriers that inhibited the uptake of a response team. All hospitals had a committee that oversaw its system operation, provided training to ward staff, and used information technology to support the implementation. CONCLUSION: A variety of approaches have been taken to support the system of recognising and responding to clinical deterioration. This calls for a national approach to enable the standardisation of clinical processes, sharing of educational resources and multi-site evaluation.

Play and Learn with Patients-Designing and Evaluating a Serious Game to Enhance Nurses' Inhaler Teaching Techniques: A Randomized Controlled Trial.

Objective: To describe the development and evaluation of a nurse-patient interactive serious game in improving nurses' self-efficacy and performances in teaching the correct inhaler technique. Materials and Methods: The technology, pedagogy, and content knowledge (TPACK) framework was applied to guide the development of the serious game. The learning effectiveness of the serious game was evaluated through a randomized controlled trial that involved 46 registered nurses. Participants in the experimental group were asked to teach the inhaler technique to a standardized patient using the serious game as a teaching tool, whereas participants in the control group were asked to provide their own usual teaching to a standardized patient without the serious game. The performances of both groups were assessed based on their feedback to a standardized patient who made several errors while demonstrating the inhaler technique. Self-efficacy levels of teaching the inhaler technique were examined before and after the intervention. Results: A significantly higher number of participants from the experimental group obtained perfect performance scores than those in the control group (65.21% vs. 21.74%, χ2 = 15.18, P < 0.01). The posttest self-efficacy mean scores for the experimental group improved significantly (P < 0.001) after the intervention, and significantly higher (P < 0.05) compared to the posttest mean scores of the control group. Conclusion: The study provided evidence on the effectiveness of a serious game in improving the self-efficacy and immediate postintervention performances of nurses teaching the inhaler technique. This game provides a practical and accessible learning tool to help nurses ensure effective patient education.

Multiuser virtual worlds in healthcare education: A systematic review.

BACKGROUND: The use of multiuser virtual worlds (MUVWs) for collaborative learning has generated interest among healthcare educators. Published evidence to support its use is growing, but none has synthesized the evidence to guide future work. OBJECTIVE: This study sought to provide a comprehensive and systematic evaluation of MUVWs in healthcare education. DESIGN: A systematic review METHODS: A systematic search of five databases including CINAHL, Cochrane library, EMBASE, PubMed, and Scopus, was conducted from inception up to January 2017. Two independent researchers selected studies that met the inclusion criteria and assessed for methodological quality using the Medical Education Research Study Quality Instrument (MERSQI). A total of 18 studies were reviewed and their data were synthesized narratively using a 3-P model (presage-process-product). RESULTS: Average scores in the MERSQI for methodological quality are 10/18, which is modest. A rally by the government or professional bodies towards more collaborative working among healthcare professionals is a key driver behind implementing MUVWs. Funding is important for its development and evaluation. Team training in acute care and communication training were the most frequent learning objectives, and predominant learning activities include practice on simulation scenario and debriefing. Two-thirds of the studies did not explain their theoretical framework that underpinned their design and implementation of MUVWs. While MUVWs in healthcare education is generally well-received, learning outcomes remain inconclusive. CONCLUSION: Despite a growth of studies on the use of MUVW in healthcare education, there is a need for more understanding of the application of theories to inform the learning activities. Therefore, we suggest educators to incorporate a theoretical model to explain the learning processes behind MUVWs. To improve the quality of evidence, we call for researchers to employ a more rigorous and broader approach to evaluation that explicates longer-term outcomes, including cost benefit analyses.