From Subtle to Serious: Sharpening Your Response to Patient Decompensation

Introduction: Patient decompensation in acute care often begins subtly but can quickly escalate to life-threatening emergencies. Despite experience, many nurses' report uncertainty in managing early warning signs. Simulation is known to improve recognition, communication, and confidence in emergencies (INACSL, 2021; Koukourikos et al., 2023; Lee et al., 2020). Early intervention reduces cardiac arrests and improves outcomes (Chan et al., 2023). At our academic medical center, rapid response data identified altered mental status, respiratory distress, and hemodynamic instability as common activation triggers and top education needs. The objective of this project was to evaluate whether a focused simulation-based workshop could improve nurses' preparedness to respond effectively to early signs of decompensation.


Methods: Using the NLN Jeffries Simulation Theory, a 4-hour Decompensation Workshop was developed and led by rapid response nurses. Initially intended for experienced acute care nurses (≥18 months), enrollment was not restricted. ICU, progressive care, and interventional radiology nurses also participated and reported gains. The course included pre-work tip sheets, brief didactic content, hands-on skills stations, and three scenario-based simulations: altered mental status, respiratory distress (trach/chest tube), and septic shock progressing to a full medical emergency. Each simulation was followed by structured debriefing. When possible, scenarios were repeated to reinforce learning. CEUs were awarded. The authors used ChatGPT to assist in refining abstract language. Final content was reviewed and approved by the authors, who take full responsibility for its accuracy.


Results: Post-session evaluations showed 92% strongly agreed the session was a worthwhile investment. All participants (100%) felt more prepared to manage the first five minutes of a medical emergency. Qualitative feedback emphasized realistic scenario design, improved communication, and increased clinical confidence. Learners also valued interdisciplinary discussion during debriefings.


Conclusions: The Decompensation Workshop significantly improved confidence and emergency preparedness across nursing roles. This scalable model supports institutional goals for resuscitation quality, early intervention, and nurse development.