The Impact of Hospital-Based In Situ Simulation on Nurses’ Recognition and Intervention of Patient Deterioration

Abstract

Preparing nurses to recognize the signs and symptoms of a deteriorating patient and to provide appropriate initial interventions is essential. Hospital-based in situ simulation education is an effective evidence-based method that supports adult learning in a safe environment. The purpose of this article is to discuss the development, implementation, and evaluation of an in situ simulation program and the positive impact on nurses’ confidence level in the recognition and initiation of interventions for a deteriorating patient.

<p>The Use of in situ Simulation in Healthcare Education: Current Perspectives</p>

“…19 Non-anesthetists practiced sedation skills in pediatric emergency settings. 32 A study in a mental health triage ward focused on medically deteriorating patients in a mental health setting, choosing priority training needs for the staff with scenarios such as respiratory distress, diabetic • Paediatric ED 1,12,13,16,22,23,27,28,32 • Adult ED 11,18,24,25,29, • Neonatal resuscitation 39 • Obstetrics and gynaecology 20,21,26,30,31 • Mental health 33 • Neurology 37 • ICU 35 • Anaesthetics 17,32 • Primary care 34 • General 14,36 Aim • Low-fidelity 11,27 • Medium fidelity 13 • High-fidelity 15,33,39 • Multi-centre design 12,22,23,25,34,36,39 Scheduling…”

“…15,17 The content of the briefing most commonly involved orientating participants to the manikin and the simulation practice. 22,29,33,36 In some cases, this was taken a step further by clarifying the objectives the participants have, and highlighting core concepts fundamental for good practice such as teamwork, communication. 15,22 While in other cases, clinical education was the priority, such as one study on pediatric resuscitation, which highlighted the differences in managing pediatric and adult crises and another study on cricothyroidotomy used briefing to train participants, who were able to practice the clinical skills before the simulation took place.…”

“…33 A few studies directed nurses specifically, focusing on their training of skills alone rather than the full multidisciplinary team. [36][37][38] Debrief All studies had a debrief session which lasted from 10 to 60 minutes. In most studies, debriefs were facilitated by an experienced instructor.…”

“…13,16,30 A number of studies adopted a multi-center approach, involving from 3 to 20 centers to carry out the same in situ simulations in their own centers. 12,22,23,25,34,36,39 Representative from each site attended an orientation lasting 1-2 days where they received training on the project and on using the manikin. 12,23 The representatives then went on to implement the simulations in their site.…”

“…22,39 One group had a flexible approach with scenario design, in which the needs of each center were individually considered. 36…”