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      Is High Fidelity Simulation the Most Effective Method for the Development of Non-Technical Skills in Nursing? A Review of the Current Evidence

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          Abstract

          Aim:

          To review the literature on the use of simulation in the development of non-technical skills in nursing

          Background:

          The potential risks to patients associated with learning 'at the bedside' are becoming increasingly unacceptable, and the search for innovative education and training methods that do not expose the patient to preventable errors continues. All the evidence shows that a significant proportion of adverse events in health care is caused by problems relating to the application of the 'non-technical' skills of communication, teamwork, leadership and decision-making.

          Results:

          Simulation is positively associated with significantly improved interpersonal communication skills at patient handover, and it has also been clearly shown to improve team behaviours in a wide variety of clinical contexts and clinical personnel, associated with improved team performance in the management of crisis situations. It also enables the effective development of transferable, transformational leadership skills, and has also been demonstrated to improve students' critical thinking and clinical reasoning in complex care situations, and to aid in the development of students' self-efficacy and confidence in their own clinical abilities.

          Conclusion:

          High fidelity simulation is able to provide participants with a learning environment in which to develop non-technical skills, that is safe and controlled so that the participants are able to make mistakes, correct those mistakes in real time and learn from them, without fear of compromising patient safety. Participants in simulation are also able to rehearse the clinical management of rare, complex or crisis situations in a valid representation of clinical practice, before practising on patients.

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          Most cited references31

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          Error reduction and performance improvement in the emergency department through formal teamwork training: evaluation results of the MedTeams project.

          To evaluate the effectiveness of training and institutionalizing teamwork behaviors, drawn from aviation crew resource management (CRM) programs, on emergency department (ED) staff organized into caregiver teams. Nine teaching and community hospital EDs. A prospective multicenter evaluation using a quasi-experimental, untreated control group design with one pretest and two posttests of the Emergency Team Coordination Course (ETCC). The experimental group, comprised of 684 physicians, nurses, and technicians, received the ETCC and implemented formal teamwork structures and processes. Assessments occurred prior to training, and at intervals of four and eight months after training. Three outcome constructs were evaluated: team behavior, ED performance, and attitudes and opinions. Trained observers rated ED staff team behaviors and made observations of clinical errors, a measure of ED performance. Staff and patients in the EDs completed surveys measuring attitudes and opinions. Hospital EDs were the units of analysis for the seven outcome measures. Prior to aggregating data at the hospital level, scale properties of surveys and event-related observations were evaluated at the respondent or case level. A statistically significant improvement in quality of team behaviors was shown between the experimental and control groups following training (p = .012). Subjective workload was not affected by the intervention (p = .668). The clinical error rate significantly decreased from 30.9 percent to 4.4 percent in the experimental group (p = .039). In the experimental group, the ED staffs' attitudes toward teamwork increased (p = .047) and staff assessments of institutional support showed a significant increase (p = .040). Our findings point to the effectiveness of formal teamwork training for improving team behaviors, reducing errors, and improving staff attitudes among the ETCC-trained hospitals.
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            Simulation-based learning in nurse education: systematic review.

            This paper is a report of a review of the quantitative evidence for medium to high fidelity simulation using manikins in nursing, in comparison to other educational strategies. Human simulation is an educational process that can replicate clinical practices in a safe environment. Although endorsed in nursing curricula, its effectiveness is largely unknown. A systematic review of quantitative studies published between 1999 and January 2009 was undertaken using the following databases: CINAHL Plus, ERIC, Embase, Medline, SCOPUS, ProQuest and ProQuest Dissertation and Theses Database. The primary search terms were 'simulation' and 'human simulation'. Reference lists from relevant papers and the websites of relevant nursing organizations were also searched. The quality of the included studies was appraised using the Critical Appraisal Skills Programme criteria. Twelve studies were included in the review. These used experimental or quasi-experimental designs. All reported simulation as a valid teaching/learning strategy. Six of the studies showed additional gains in knowledge, critical thinking ability, satisfaction or confidence compared with a control group (range 7-11%). The validity and reliability of the studies varied due to differences in design and assessment methods. Medium and/or high fidelity simulation using manikins is an effective teaching and learning method when best practice guidelines are adhered to. Simulation may have some advantage over other teaching methods, depending on the context, topic and method. Further exploration is needed to determine the effect of team size on learning and to develop a universal method of outcome measurement.
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              The teaching of a structured tool improves the clarity and content of interprofessional clinical communication.

              Suboptimal communication between health professionals has been recognised as a significant causative factor in incidents compromising patient safety. The use of a structured method of communication has been suggested to improve the quality of information exchange. The aim of this study was to determine if the teaching of a communication tool, ISBAR (Identify, Situation, Background, Assessment, Recommendation), a modification of SBAR (Situation, Background, Assessment, Recommendation), improved the content and clarity of a telephone referral in an immersive simulated clinical scenario conducted in real time. Seventeen teams of final-year medical students were randomised into two groups. The intervention group participated in a 40 min education session about the ISBAR communication tool. A control group received no training. Each team of five students participated in a simulated clinical scenario using a patient simulator in a mocked-up clinical environment. During each scenario, one student made a telephone referral seeking assistance from a senior colleague. Audio data for the telephone referrals (n = 17 students) were captured during the scenario for both groups. During a blinded review of the data, communication was scored on both content and clarity. Communication content was higher from a mean score of 10.2 to 17.4 items (p<0.001) with the intervention. Clarity of the delivery of information on a 5-point scale was also higher in the intervention group (rho = 0.903, p<0.001). The teaching of a structured method of communication improved the communication during telephone referral in a simulated clinical setting. This research has implications for how healthcare professionals are taught to communicate with each other.
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                Author and article information

                Journal
                Open Nurs J
                Open Nurs J
                TONURSJ
                The Open Nursing Journal
                Bentham Open
                1874-4346
                27 July 2012
                2012
                : 6
                : 82-89
                Affiliations
                [1 ]Centre for Health & Social Care Research, Collegiate Crescent Campus, Sheffield Hallam University, Sheffield, UK
                [2 ]Montagu Clinical Simulation Centre, Adwick Road, Mexborough, S Yorks, UK
                Author notes
                [* ]Address correspondence to this author at the Centre for Health & Social Care Research, Collegiate Crescent Campus, Sheffield Hallam University, Sheffield, UK; Tel: +44 (0) 114 225 5858; Fax: +44 (0) 114 225 2394; E-mail: r.p.lewis@ 123456shu.ac.uk
                Article
                TONURSJ-6-82
                10.2174/1874434601206010082
                3415625
                22893783
                5ab8f549-04dd-4a7e-95e3-9a2ad19bc2ee
                © Lewis et al.; Licensee Bentham Open.

                This is an open access article licensed under the terms of the Creative Commons Attribution Non-Commercial License ( http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted, non-commercial use, distribution and reproduction in any medium, provided the work is properly cited.

                History
                : 3 January 2012
                : 15 March 2012
                : 17 May 2012
                Categories
                Article

                Nursing
                decision-making,non-technical skills,simulation,interprofessional.,communication,teamwork,team training,nurse education,situation awareness

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