14
Spring 2013
We Discover
Journal Club: Repeated Scenario Simulation to Improve Nursing Competency Xiaobo Hu, BSN, RN, CCRN-CSC, Senior Clinical Nurse I, Cardiac Surgery Intensive Care Unit Pat Woltz, MS, RN, Director of Nursing Research
About 30 nurses were present for the March 2013 journal club that was facilitated by Xiaobo Hu, BSN, RN, CCRN-CSC, Senior Clinical Nurse I, Cardiac Surgery Intensive Care Unit, who reviewed a study by Abe, Kawahara, Yamashina, and Tsuboi (2013). The study evaluated the use of simulation training as an educational approach to develop clinical competencies in nurses that require critical thinking skills. Demands such as a rapidly aging society, advances in medical science and technology, and the focus on healthcare quality and safety have resulted in an increasing gap between traditional nursing education and the advanced critical thinking skills needed by competent critical care nurses.1 Simulation based education provides hands on experiences and allows for easy verification of learning outcomes based on nurses’ actions. The study used a quasi-experimental time-series crossover design to evaluate the effectiveness of repeated scenario simulation training among 24 Japanese nurses at the Tokyo Medical University Hospital. Study outcomes were selfassessed nurse competency and perception of teamwork and non-technical skill. All
Find News&Views
nurses received six months of didactic training on cardiovascular critical care nursing and were divided into four groups for simulation training in four zones. Each group rotated through the four zones, where the order of the scenarios in each zone was randomly determined. In each zone, scenarios were repeated once and debriefing occurred during and after each scenario. Half the group participated in a scenario, followed by the second half of the group as the scenario was repeated. After each scenario, participants scored their own performance using a rubric. Participants also scored teamwork and nontechnical skill using the Teamwork Activity Inventory in Nursing Scale (TAINS).2 Results showed that regardless of the order in which groups, or the participants within a group, progressed through the various scenarios, all competency scores increased: 1) after the second simulation in a zone; and 2) as repetitions increased across zones. The TAINS survey showed significant improvement in three out of six subscale scores for “Job Satisfaction,” “Confidence as a Team Member,” and “Attitudes of the Superior” (all p’s <.05). The authors concluded that repeated scenario simulation enhanced individual nurses’ technical skill (competency) and somewhat improved their teamwork and non-technical skills. The authors acknowledged that small sample size, single site, and bias due to the voluntary nature of the participants were study limitations. Group discussion: ◗◗ The group agreed that this study supported previous research and simulation training among Japanese critical care nurses. Findings that
simulation improved nurses’ nontechnical skills, including job satisfaction, are of particular interest. Larger, multiinstitutional studies are recommended with a control group to compare didactic only to didactic plus simulation training. ◗◗ UMMC is a large academic institution with many staff, a relatively quick turnover, and different nurse experience levels coupled with cutting-edge technology and a complex patient case mix. Thus, staff education and clinical competency validation is an important part of practice. Simulation based education as an evidence-based practice for competency and critical thinking skill acquisition seems underutilized for nurses at UMMC. ◗◗ The implications of the study were highlighted by the introduction of Maryland Advanced Simulation Technology, Research & Innovation (MASTRI) Center’s Training & Curriculum Specialist and Clinical Educator, Sheree Chase, MSN/MBA, RN. Sheree answered questions about the use of scenariobased simulation in the MASTRI Center, which is located on the 7th floor of South Hospital building, and how to better use MASTRI Center resources for nurse competency training. 1
Abe, Y., Kawahara, C., Yamashina, A. & Tsuboi, R. (2013). Repeated scenario simulation to improve competency in critical care: A new approach for nursing education. American Journal of Critical Care, 22(1), 33-40.
2
Takayama, M. & Takeo, K. (2009). Structure of teamwork and relevant factors in nursing activities. Journal of Nurse Studies NCNJ, 8, 1-9.
online at http://www.umm.edu/nursing/newsletter.htm on the UMM Intranet at intra.umm.edu/ummc/nursing-dept/newsviews.htm