Original Article The FIRST 2 ACT simulation program improves nursing practice in a rural Australian hospital Leigh Kinsman, PhD, RN, 1 Penny Buykx, PhD, GradDipAppPsych, 1 Robyn Cant, PhD, MHSC, 3 Robert Champion, PhD, 2 Simon Cooper, PhD, RN, 4 Ruth Endacott, PhD, RN, 6,7 Tracy McConnell-Henry, PhD, RN, 5 Karen Missen, MHSc, BHSc, 5 Jo Porter, MN, BN, 5 and Julie Scholes, MN, BN 8 1 School of Rural Health, Monash University, 2 School of Engineering and Mathematical Sciences, La Trobe University, Bendigo, 3 School of Nursing and Midwifery (Gippsland and Clayton), 4 School of Nursing and Midwifery (Gippsland), 5 School of Nursing and Midwifery, Monash University, Churchill, Victoria, 6 School of Nursing and Midwifery, Monash University, Melbourne, Victoria, Australia; and 7 School of Nursing and Midwifery, University of Plymouth, Plymouth, and 8 School of Nursing and Midwifery, University of Brighton, Brighton, UK Abstract Objective: To measure the impact of the Feedback Incorporating Review and Simulation Techniques to Act on Clinical Trends (FIRST 2 ACT) simulation program on nursing observations and practice relevant to patient deterioration in a rural Australian hospital. Design: Interrupted time series analysis. Setting: A rural Australian hospital. Participants: All registered nurses (Division 1) employed on an acute medical/surgical ward. Intervention: The FIRST 2 ACT simulation program. Outcome measures: Appropriate frequency of a range of observations and administration of oxygen therapy. Results: Thirty-four nurses participated (83% of eli- gible nurses) in the FIRST 2 ACT program, and 258 records were audited before the program and 242 records after. There were statistically significant reduc- tions in less than satisfactory frequency of observations (P = 0.009) and pain score charting (P = 0.003). There was no measurable improvement in the administration of oxygen therapy (P = 0.143), while the incidence of inappropriate nursing practice for other measures both before and after the intervention was too low to warrant analysis. Conclusion: FIRST 2 ACT was associated with measur- able improvements in nursing practice. KEY WORDS: nurse education, patient deterioration, rural, simulation. Introduction The detection and management of patient deterioration is a major issue in health care. 1,2 Up to 80% of cardiac arrests are predictable, and in many cases, avoidable with appropriate documentation, recognition of vital signs and early intervention. 3 Assessment of nursing practice has indicated that nurses are not always clear about what observations should be recorded and how often a patient should be reassessed. 4 There have also been gaps identified in nursing judgements relating to urgency and the applica- tion of first-line interventions such as the administration of oxygen. 5–7 Failure to identify deterioration has also been observed in smaller rural hospitals where nurses manage patients in relative professional isolation. 8 The Australian Commission on Quality and Safety in Healthcare acknowledged the importance of recognising and managing patient deterioration in their consensus statement: ‘Essential Elements for Recognising and Responding to Clinical Deterioration’. 2 Key recommen- dations included designing new observation charts, implementing medical emergency teams (MET) and developing targeted education programs. 2 To address the recommendation regarding education, we designed a clinical simulation program, Feedback Incorporating Review and Simulation Techniques to Act on Clinical Trends (‘FIRST 2 ACT’), based on pedagogi- cal principles, and targeted at the detection and man- agement of clinical deterioration. 9 The FIRST 2 ACT program has been tested with samples of final-year student nurses and student midwives with promising Correspondence: Dr Leigh Kinsman, School of Rural Health, Monash University, PO Box 666 Bendigo, Victoria, 3552, Aus- tralia. Email: leigh.kinsman@monash.edu Competing interests: The authors declare they have no com- peting interests. Accepted for publication 19 June 2012. Aust. J. Rural Health (2012) 20, 270–274 © 2012 The Authors Australian Journal of Rural Health © National Rural Health Alliance Inc. doi: 10.1111/j.1440-1584.2012.01296.x