The accuracy of human senses in the detection of neonatal heart rate during standardized simulated resuscitation: Implications for delivery of care,training and technology design

Aim

Auscultation and palpation are recommended methods of determining heart rate (HR) during neonatal resuscitation. We hypothesized that: (a) detection of HR by auscultation or palpation will vary by more than ±15 BPM from actual HR; and (b) the inability to accurately determine HR will be associated with errors in management of the neonate during simulated resuscitation.

Subjects and methods

Using a prospective, randomized, controlled study design, 64 subjects participated in three simulated neonatal resuscitation scenarios. Subjects were randomized to technique used to determine HR (auscultation or palpation) and scenario order. Subjects verbalized their numeric assessment of HR at the onset of the scenario and after any intervention. Accuracy of HR determination and errors in resuscitation were recorded. Errors were classified as errors of omission (lack of appropriate interventions) or errors of commission (inappropriate interventions). Cochran's Q and chi square test were used to compare HR detection by method and across scenarios.

Results

Errors in HR determination occurred in 26–48% of initial assessments and 26–52% of subsequent assessments overall. There were neither statistically significant differences in accuracy between the two techniques of HR assessment (auscultation vs palpation) nor across the three scenarios. Of the 90 errors in resuscitation, 43 (48%) occurred in association with errors in HR determination.

Conclusions

Determination of heart rate via auscultation and palpation by experienced healthcare professionals in a neonatal patient simulator with standardized cues is not reliable. Inaccuracy in HR determination is associated with errors of omission and commission. More reliable methods for HR assessment during neonatal resuscitation are required.     

Basic Cardiac Life Support Providers Checking the Carotid Pulse: Performance, Degree of Conviction, and Influencing Factors

The American Heart Association recently abolished the carotid pulse check during cardiopulmonary resuscitation for lay rescuers, but not for health care providers. OBJECTIVES: The aim of the study was to evaluate health care providers' performance, degree of conviction, and influencing factors in checking the carotid pulse. METHODS:Sixty-four health care providers were asked to check the carotid pulse for 10 or 30 seconds on a computerized mannequin simulating three levels of pulse strength (normal, weak, and absent). Health care providers were asked whether they felt a pulse and how certain were they that they felt a pulse. Performance was evaluated, as well as degree of conviction about the answer, using a visual analog scale. Data were compared by using a general linear model procedure. RESULTS: In the pulseless situations, the answers were correct in 58% and 50% when checking the pulse for 10 and 30 seconds, respectively. In the situation with a weak pulse, the answer was correct in 83% when checking the pulse for 10 seconds. In situations with a normal pulse, the answers were correct in 92%, 84%, and 84%, respectively, when checking the pulse for 10 (twice) and 30 seconds. The exactitude of the answer was correlated with the pulse strength (p < 0.05). The degree of conviction about the answer was correlated with the exactitude of the answer (p < 0.01) and the pulse strength (p < 0.0001). CONCLUSIONS: These results question the routine use of the carotid pulse check during cardiopulmonary resuscitation, including for health care providers.     

Ineffective airway clearance in adult patients after thoracic and upper abdominal surgery

AimThe aim of this study is to analyze the accuracy of the defining characteristics of ineffective airway clearance (IAC) in patients after thoracic and upper abdominal surgery.BackgroundAlthough numerous studies have described the most prevalent respiratory NANDA-I diagnoses, only few investigates the precision of nursing assessments.MethodsA cross-sectional study was conducted with 192 patients in a surgical clinic. Accuracy measures were obtained by the latent class analysis method.ResultsIAC was present in 46.73% of the sample. The defining characteristics with better predictive capacity were changes in respiratory rate and changes in respiratory rhythm. However, other defining characteristics also had high specificity, such as restlessness, cyanosis, excessive sputum, wide-eyed, orthopnea, adventitious breathing sounds, ineffective cough, and difficulty vocalizing.ConclusionResults can contribute to the improvement of nursing assessments by providing information about the key clinical indicators of IAC.     

Checking the carotid pulse: diagnostic accuracy in students of the healthcare professions

This study evaluated the competence of students of the healthcare professions to locate the carotid pulse using a computerised manikin, within 10 s. A sample of 105 students from physiotherapy, radiography, midwifery and nursing participated in measuring diagnostic accuracy in a single attempt at pulse check using a computerised manikin, timed to an accuracy of +/-1 s. All had received basic life support instruction, and one group had advanced life support skills. The mode and median diagnostic delays were calculated for each group. Comparisons of mean rank values for the groups were determined, and comparisons of previous training and accuracy in diagnosis were calculated. Forty (38%) students were able to give an accurate diagnosis within 10 s. The results identified significant differences between the performance of the groups (chi(2) 16.74, P<0.01), with the advanced life support course students demonstrating most competence. Previous training did not affect performance in the skill (chi(2) 0.29, P=0.58). Carotid pulse check skills should be emphasised and tested as part of cardiopulmonary resuscitation instruction.     

Strategies in postoperative pain assessment: validation study.

Pain assessment and management are major clinical problems that many categories of healthcare professionals have to deal with. Although there are many potentially successful approaches available for pain management, there is still a shortage of knowledge about the strategies used by staff members for the actual assessment of pain and how reliable these strategies are. The fact that patients often undergo a great deal of suffering from pain and lack of adequate pain relief may be considered an indicator of this shortage of knowledge. Clinical studies from different parts of the world reveal that the incidence of pain reported by patients is still high, with about 75% reporting moderate pain and an additional 15% severe pain. The aim of the present study was to validate different categories used in acute pain assessment and their accuracy in a new clinical sample and to explore further different dimensions of how staff members experience pain assessment. Intensive care nurses (n = 10) were carrying out pain assessment of postoperative patients (n = 30). Each pain assessment was followed by a detailed interview and indicating the estimated pain intensity on a visual analogue scale (VAS, 0-10 cm). The pain ratings by the nurses were compared to those of the patients to assess the accuracy of the pain assessments of the staff members. A previously developed category system for describing the initial empirical material regarding criteria the nurses relied on when assessing pain, combined with what experience has taught them in this respect, was used to assess the validity of previous observations. The results indicate that similar approaches were still used by the nurses but the accuracy of pain assessment had considerably improved.     

The POCUS Pulse Check: A Case Series on a Novel Method for Determining the Presence of a Pulse Using Point-of-Care Ultrasound

BackgroundDuring cardiopulmonary resuscitation, pulse checks must be rapid and accurate. Despite the importance placed on the detection of a pulse, several studies have shown that health care providers have poor accuracy for detection of central pulses by palpation. To date, the use of point-of-care ultrasound (POCUS) in cardiac arrest has focused on the presence of cardiac standstill and diagnosing reversible causes of the arrest.ObjectiveThis case series highlights a simple, novel approach to determine whether pulses are present or absent by using POCUS compression of the central arteries.DiscussionUsing this technique, we found that a POCUS pulse check can be consistently performed in < 5 s and is clearly determinate, even when palpation yields indeterminate results.ConclusionsIn this case series, the POCUS pulse check was a valuable adjunct that helped to change management for critically ill patients. Future prospective studies are required to determine the accuracy of this technique and the impact on patient outcomes in a larger cohort.     

Nursing diagnoses, interventions and outcomes - application and impact on nursing practice: systematic review

AIM: This paper reports a systematic review on the outcomes of nursing diagnostics. Specifically, it examines effects on documentation of assessment quality; frequency, accuracy and completeness of nursing diagnoses; and on coherence between nursing diagnoses, interventions and outcomes. BACKGROUND: Escalating healthcare costs demand the measurement of nursing's contribution to care. Use of standardized terminologies facilitates this measurement. Although several studies have evaluated nursing diagnosis documentation and their relationship with interventions and outcomes, a systematic review has not been carried out. METHOD: A Medline, CINAHL, and Cochrane Database search (1982-2004) was conducted and enhanced by the addition of primary source and conference proceeding articles. Inclusion criteria were established and applied. Thirty-six articles were selected and subjected to thematic content analysis; each study was then assessed, and a level of evidence and grades of recommendations assigned. FINDINGS: Nursing diagnosis use improved the quality of documented patient assessments (n = 14 studies), identification of commonly occurring diagnoses within similar settings (n = 10), and coherence among nursing diagnoses, interventions, and outcomes (n = 8). Four studies employed a continuing education intervention and found statistically significant improvements in the documentation of diagnoses, interventions and outcomes. However, limitations in diagnostic accuracy, reporting of signs/symptoms, and aetiology were also reported (14 studies). One meta-analysis of eight trials including 1497 patients showed no evidence that standardized electronic documentation of nursing diagnosis and related interventions led to better nursing outcomes. CONCLUSION: Despite variable results, the trend indicated that nursing diagnostics improved assessment documentation, the quality of interventions reported, and outcomes attained. The study reveals deficits in reporting of signs/symptoms and aetiology. Consequently, staff educational measures to enhance diagnostic accuracy are recommended. The relationships among diagnoses, interventions and outcomes require further evaluation. Studies are needed to determine the relationship between the quality of documentation and practice.     

Impact of advanced exercise ECG analysis on cost of coronary artery disease management

Background Conventional analysis of exercise electrocardiogram (EX‐ECG) has limited accuracy. This study aims to evaluate the potential impact of improving EX‐ECG accuracy on costs of diagnosis and number of misdiagnoses of coronary artery disease (CAD). Methods A decision‐tree model was simulated including sequential application of diagnostic procedures for suspected CAD. The model was structured in two main branches (presence or absence of CAD). A probabilistic sensitivity analysis was then performed for several combinations of improvement in test sensitivity and specificity. Results A clear trend in cost reduction was observed at improving EX‐ECG specificity (about 8–8.5 million dollars, corresponding to a 5.6–7.6% reduction according to the prevalence level). Wrong diagnoses counted for 9–13% of test. Improvements in test parameters lead to reductions in wrong diagnoses, especially when increasing specificity (8.8–12.5%). Conclusions A proper improvement in EX‐ECG sensitivity and specificity would have a relevant impact on the costs of CAD management, while reducing the number of misdiagnoses.     

Pain intensity assessment by bedside nurses and palliative care consultants: a retrospective study

Objective To evaluate the specificity, sensitivity, and accuracy of pain intensity assessments (0–10) conducted by registered nurses (RN) and clinical nurse assistants (CAN) as compared to those conducted by the palliative care consultant (PCC).Patients and methods We performed a retrospective review of charts of patients who had received palliative care consult between April 2002 and August 2002. Data on patient demographic, date of palliative care consult, and date and intensity of pain assessment were collected. A numerical rating scale from 0 (no pain) to 10 (worst pain) was used to assess pain intensity. The data were included for analysis if the pain intensity assessment was performed during the same shift by all three care providers (RN, CNA, and PCC).Results Forty-one charts were found to include a complete pain assessment performed by the RN, CNA, and PCC. The agreement of pain intensity between the PCC and both the RN and CNA was poor. For a diagnosis of moderate-to-severe pain, the RNs intensity assessment had a specificity of 90% but a sensitivity of 45%, and the CNAs intensity assessment had a specificity of 100% but a sensitivity of only 30%. The Spearman correlation coefficient between the intensity assessments performed by the PCC and the RN was 0.56 (p=0.00) and between those by the PCC and the CNA 0.22 (p=0.15).Conclusion Lack of agreement between pain intensity assessments performed by the PCC and bedside nurse suggests possible inconsistencies in the way the assessments were performed. Better education on how to perform standard pain intensity assessment is needed.     

Breathing patterns in lambs after oleic acid lung injury utilizing respiratory inductive plethysmography

We measured breathing patterns utilizing a respiratory inductive plethysmograph (RIP) in seven healthy nonsedated lambs after an iv infusion of oleic acid (50 mg/kg) to induce acute pulmonary edema. Our single position graphic (SPG) calibration technique was employed for gain factor calculation. Accuracy was validated by the simultaneous volume measurement of RIP and integrated pneumotachography (PNT). Of a total 840 validation breaths, 467 (56%) were within 5% of PNT, 734 (87%) were within 10%, and 834 (99.9%) were within 20%. In each study baseline physiologic and breathing pattern data were collected and also at 15, 30, 60, 90, 150, and 210 min postoleic acid infusion. Validation of RIP accuracy before each data collection revealed 29% required new gain factor calculation. Recalibration was done within 5 min. Excluding respiratory frequency, which remained at 30% above baseline, variables were not significantly different than baseline measurements at the 210-min interval. Results suggest that calibration of RIP using our SPG technique is a time-efficient method and that RIP can accurately measure breathing patterns, providing an additional tool for assessment of experimental lung injury in lambs.     

Patients’ experiences and actions when describing pain after surgery – A critical incident technique analysis

BackgroundPostoperative pain assessment remains a significant problem in clinical care despite patients wanting to describe their pain and be treated as unique individuals. Deeper knowledge about variations in patients’ experiences and actions could help healthcare professionals to improve pain management and could increase patients’ participation in pain assessments.ObjectiveThe aim of this study was, through an examination of critical incidents, to describe patients’ experiences and actions when needing to describe pain after surgery.MethodsAn explorative design involving the critical incident technique was used. Patients from one university and three county hospitals in both urban and rural areas were included. To ensure variation of patients a strategic sampling was made according to age, gender, education and surgery. A total of 25 patients who had undergone orthopaedic or general surgery was asked to participate in an interview, of whom three declined.FindingsPain experiences were described according to two main areas: “Patients’ resources when in need of pain assessment” and “Ward resources for performing pain assessments”. Patients were affected by their expectations and tolerance for pain. Ability to describe pain could be limited by a fear of coming into conflict with healthcare professionals or being perceived as whining. Furthermore, attitudes from healthcare professionals and their lack of adherence to procedures affected patients’ ability to describe pain. Two main areas regarding actions emerged: “Patients used active strategies when needing to describe pain” and “Patients used passive strategies when needing to describe pain”.Patients informed healthcare professionals about their pain and asked questions in order to make decisions about their pain situation. Selfcare was performed by distraction and avoiding pain or treating pain by themselves, while others were passive and endured pain or refrained from contact with healthcare professionals due to healthcare professionals’ large work load.     

规范病人外出检查流程管理方法与评价

目的:规范医院住院病人外出检查的流程管理,提高医疗护理服务质量,确保病人安全。方法:科室通过建立病人外出检查登记本,在护士站设置检查信息专用白板和设置病人外出检查确认本三方面途径对408例病人实施规范病人外出检查流程。结果:408例病人外出检查前准备工作成功率为100%,病人核对准确率为100%,病人家属及医护人员满意度分别为97%、100%。结论:病人外出检查规范化流程管理可有效保证病人外出检查顺利,保障病人的安全,提高病人、家属及医护人员满意度。     

Can administrative data identify active diagnoses for long-term care resident assessment?

Many veterans receive rehabilitation services in Department of Veterans Affairs (VA) nursing homes. Efficient methods for the identification of active diagnoses could facilitate care planning and outcomes assessment. We set out to determine whether diagnostic data from VA databases can be used to identify active diagnoses for Minimum Data Set (MDS) assessments. We evaluated diagnoses being considered for inclusion in MDS version 3.0 and present in at least 15% of a sample of VA nursing home residents. A research nurse following a standardized protocol identified active diagnoses from the medical records of 120 residents. A clinical nurse also identified active diagnoses in 58 of these patients. Inpatient and outpatient diagnoses from the VA National Patient Care Database were identified for the past year. We calculated kappa, sensitivity, and specificity values, considering the nurses' assessments the gold standard. We found that kappa values comparing research nurses and databases were generally poor, with only 8 of the 19 diagnoses having a value >0.60. Levels of agreement between the clinical nurse and administrative data were generally similar. We conclude that VA administrative data cannot be used to accurately identify active diagnoses for nursing home residents. How best to efficiently collect these important data remains uncertain.     

经纤维支气管镜不同取材方法对肺癌的诊断价值

目的:探讨纤维支气管镜下不同取材方法对肺癌的诊断价值。方法:采用回顾性分析法,分别统计钳检、刷检、冲洗及针吸活检4种不同取材方法对肺癌的检出率。结果:确诊的320例肺癌患者镜下分为4型:增生型、浸润型、外压型、正常型。钳检、刷检、冲洗及针吸活检的阳性率分别为81.2%、70.6%、60.9%、60.0%,联合后总阳性率为92.5%。结论:纤维支气管镜检查是肺癌的重要诊断手段之一,不同取材方法对镜下不同类型肺癌的诊断价值不同,4种取材方法中钳检的阳性率最高,联合运用多种取材方法可明显提高肺癌的诊断准确率。     

Advanced life support cardiac arrest scenario test evaluation

BACKGROUND: The cardiac arrest scenario test (CASTest) is a central component of the assessment strategy on the Advanced Life Support Course. The aim of this study was to establish equivalence between the four different CASTest scenarios and investigate the impact of profession, candidate order and course centre on the pass rate. MATERIALS AND METHODS: This was a cluster randomised study. CASTest scenarios were randomly allocated to candidates stratified by course centre. Candidate demographics and performance were recorded on the criterion referenced check list along with the final assessment outcome (pass/fail). Differences in pass rates according scenario; profession, course centre and candidate order were examined by Chi-squared and multiple logistic regression. RESULTS: Two thousand, four hundred and forty-nine assessments from 65 course centres were evaluated. There was no difference in pass rate between scenarios (average pass rate 74.4%). Pass rates according to course centre varied widely (40-93%, P<0.0001) as did professional group (42-100%, P<0.0001). The order that candidates took the test did not influence the pass rate. CONCLUSION: The CASTest assessment scenarios used during ALS testing appear equivalent in terms of difficulty. In contrast, the professional background of the candidate and centre at which the assessment is performed do significantly influence the likelihood of passing the assessment. Further evaluation of the reasons for differences between course centres is required.     

A comparison between clinicians' assessment and the Manchester Self-Harm Rule: a cohort study

As identifying patients at risk of subsequent suicidal behaviour is a key goal of assessment, a cohort study of presentations to five emergency departments following episodes of self-harm was carried out. We compared the accuracy of the prediction of subsequent self-harm within 6 months between global clinical assessments and the Manchester Self-harm Rule. Sensitivity, specificity, and positive and negative predictive values with 95% confidence intervals (CI) were calculated. Global clinical assessments and the rule had a sensitivity of 85% (CI 83 to 87) versus 94% (CI 92% to 95%), specificity of 38% (CI 37% to 39%) versus 26% (CI 24% to 27%), a positive predictive value of 22% (CI 21% to 23%) versus 21% (CI 19% to 21%) and a negative predictive value of 92% (CI 91% to 93%) versus 96% (CI 94% to 96%). The accuracy of predicting short-term repetition of self-harm by clinicians could be improved by incorporating this simple rule into their assessment.     

Informal risk assessment strategies in health care staff: an unrecognized source of resilience?

Rationale Recent reports indicate that approximately 10% of in-patients in UK hospitals are involved in an adverse event (these reports also state that 50% of these events are preventable). This is indeed a worrying finding, and indicates the need to look at how these incidents are handled or indeed, what is done to minimize their occurrence. The Department of Health, via the National Patient Safety Agency (NPSA) published a guide which is aimed at encouraging accurate reporting, learning from past events and changing the attitudes of key stakeholders (healthcare managers, frontline staf etc) towards risk taking and risk management. Aims and objectives Our aim was to compare informally-learned and used risk assessment strategies volunteered by staff with the 'how to do it' guide published by the NPSA. We have compared each step of the NPSA guide with our empirical data relating to that activity. Methods We interviewed forty-eight healthcare professionals (doctors from several specialties; nurses from a variety of settings; and an array of allied healthcare professionals). We used semi-structured interviews in order to discuss participants' views on their everyday working life, working relationships and patient safety. Results Our results indicate that healthcare professionals develop their own unique way to approach the issue of patient safety and risk, based on their professional raining, seniority and role within the hospital. They did share the conviction that frontline and support staff need to have immediate and easy access to information about past adverse events. They see this as a powerful tool in minimizing the reoccurrence of the same errors/problems, as well as a vehicle to improve staff morale by feeling valued and having their opinion heard. Conclusions We believe that patient safety and welfare can benefit from the adoption of a more flexible and person-centred approach to how risk assessments are carried out. Enriching formal guidelines such as the 'Risk Assessment made easy' document with successful techniques and strategies which healthcare staff have informally developed has the potential to not only improve patient safety (since it will be based on the accumulated experience and knowledge of such staff) but also foster higher levels of self esteem amongst healthcare professionals.     

Discharge diagnoses versus medical record review in the identification of community-acquired sepsis

IntroductionWe evaluated the accuracy of hospital discharge diagnoses in the identification of community-acquired sepsis and severe sepsis.MethodsWe reviewed 379 serious infection hospitalizations from 2003 to 2012 from the national population-based reasons for geographic and racial differences in stroke (REGARDS) cohort. Through manual review of medical records, we defined criterion-standard community-acquired sepsis events as the presence of a serious infection on hospital presentation with ≥2 systemic inflammatory response syndrome criteria. We also defined criterion-standard community-acquired severe sepsis events as sepsis with >1 sequential organ failure assessment organ dysfunction. For the same hospitalizations, we identified sepsis and severe sepsis events indicated by Martin et al. and Angus et al. International Classifications of Diseases 9th edition discharge diagnoses. We evaluated the diagnostic accuracy of the Martin and Angus criteria for detecting criterion-standard community-acquired sepsis and severe sepsis events.ResultsAmong the 379 hospitalizations, there were 156 community-acquired sepsis and 122 community-acquired severe sepsis events. Discharge diagnoses identified 55 Martin-sepsis and 89 Angus-severe sepsis events. The accuracy of Martin-sepsis criteria for detecting community-acquired sepsis were: sensitivity 27.6%; specificity 94.6%; positive predictive value (PPV) 78.2%; negative predictive value (NPV) 65.1%. The accuracy of the Angus-severe sepsis criteria for detecting community-acquired severe sepsis were: sensitivity 42.6%; specificity 86.0%; PPV 58.4%; NPV 75.9%. Mortality was higher for Martin-sepsis than community-acquired sepsis (25.5% versus 10.3%, P = 0.006), as well as for Angus-severe sepsis than community-acquired severe sepsis (25.5 versus 11.5%, P = 0.002). Other baseline characteristics were similar between sepsis groups.ConclusionsHospital discharge diagnoses show good specificity but poor sensitivity for detecting community-acquired sepsis and severe sepsis. While sharing similar baseline subject characteristics as cases identified by hospital record review, discharge diagnoses selected for higher mortality sepsis and severe sepsis cohorts. The epidemiology of a sepsis population may vary with the methods used for sepsis event identification.

Electronic supplementary material

The online version of this article (doi:10.1186/s13054-015-0771-6) contains supplementary material, which is available to authorized users.     

Differentiating transudative from exudative pleural effusion: should we measure effusion cholesterol dehydrogenase?

INTRODUCTION: Pleural effusions are often classified into transudates and exudates based on Light's criteria. In this study, the diagnostic properties of Light's criteria were compared to those of several other analytes for the classification of pleural fluids into transudative and exudative. METHODS: A total of 471 patients with pleural effusions were evaluated. In pleural effusions and simultaneously drawn blood samples, lactate dehydrogenase (LDH), total protein, albumin, cholesterol, amylase, glucose, pH and the cell number were measured. Retrospectively, the clinical records were used to establish a clinical diagnosis. The diagnostic properties of the biochemical tests were calculated using the clinical diagnoses as gold standard. RESULTS: By clinical diagnosis, 108 patients had transudative and 300 patients had exudative pleural effusions. In addition to pleural LDH activity (accuracy 89%, sensitivity 86%, specificity 97%) and fluid to serum LDH ratio (accuracy 89%, sensitivity 91%, specificity 85%), pleural cholesterol concentration readily identified exudates (accuracy 82%, sensitivity 76%, specificity 98%). Combination of these three parameters achieved a higher overall accuracy (accuracy 95%, sensitivity 93%, specificity 100%) than the Light's criteria (accuracy 93%, sensitivity 100%, specificity 73%). Combination of effusion cholesterol concentration and effusion LDH activity had the highest discriminatory potential (accuracy 98%, sensitivity 98%, specificity 95%). CONCLUSIONS: Including effusion cholesterol, concentration in the routine biochemical work-up of pleural fluid allows for correct classification of more pleural effusions than achieved by use of Light's criteria. Combination of cholesterol and LDH had the highest discriminatory potential and the added advantage that no patient plasma is needed for correct classification.     

Comparing the effectiveness of video-assisted oral debriefing and oral debriefing alone on behaviors by undergraduate nursing students during high-fidelity simulation

Complex healthcare, less resources, high-level medical equipment, and fewer available clinical settings have led many health professionals to use simulation as a method to further augment educational experiences for nursing students. While debriefing is recommended in the literature as a key component of simulation, the optimal format in which to conduct debriefing is unknown. This pre- and posttest two-group randomized quasi-experimental design compared the effectiveness of video-assisted oral debriefing (VAOD) and oral debriefing alone (ODA) on behaviors of 48 undergraduate nursing students during high-fidelity simulation. Further, this study examined whether roles (e.g., team leader, medication nurse), type of scenarios (i.e., pulmonary and cardiac scenarios), and student simulation team membership (i.e., VAOD and ODA groups) influenced these behaviors. Behaviors observed in this study related to patient safety, communication among team members, basic- and problem-focused assessment, prioritization of care, appropriate interventions, and delegation to healthcare team members. Both human patient simulator practice and guidance using video-assisted oral debriefing and oral debriefing alone appeared to be comparable regarding behaviors, regardless of roles, type of scenarios, and student simulation team membership. These findings suggest that nurse educators may use either video-assisted oral debriefing or oral debriefing alone to debrief undergraduate nursing students during high-fidelity simulation.