An integral component of health service delivery, both internationally and within Ireland, is the focus upon safe and effective care to all individuals. National Clinical Guidelines have been developed to facilitate early detection of patient deterioration and prompting staff to follow a definitive escalation plan. To evaluate final year nursing students detection of patient deterioration in clinical simulation, the DARE2 (Detect Deterioration, Accurate Assessment, Rapid Response, Effective Escalation) patient safety rubric was developed. DARE2 contains four domains of competency; systematic patient assessment, clinical response, clinical-psychomotor skills and communication proficiency.
The aim of this research was to investigate the inter-rater reliability of data from the DARE2-Patient Safety Rubric.
Archived recorded performances of students (n=34) were independently evaluated by nurse educators (n=4), using the DARE2 –patient safety rubric. Students were individually evaluated over the course of thirty–six minutes as they managed a deteriorating clinical situation.
Percentage agreement for the overall rubric was 59% highlighting the difference between consensus and consistency estimates of inter-rater reliability. Internal consistency was also good achieving a Cronbachs alpha of 0.82. Correlation Coefficients (ICCr) were greater than 0.70 for three of the four domains of practice and 0.58 for the fourth (clinical-psychomotor skills). An ICCr of 0.75 for the overall rubric score is indicative of excellent reliability.
The DARE2-Patient Safety Rubric was developed to ensure objectivity and consistency in the evaluation of nursing students’ management of the deteriorating patients in the simulated environment. Analysis of data from the DARE2-Patient Safety Rubric indicates excellent consistency estimates and average consensus estimates of inter-rater reliability.
The DARE2-patient safety rubric was specifically developed to evaluate performance outcomes in the management of deteriorating patients which is integral to National Clinical Guidelines. It is imperative that nurse educators use a reliable instrument to evaluate student performance in the assessment of patient deterioration.