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Table 2Data Extraction FormCitationDesignPurposeSampleSizeInterventionControlOutcomesAbe, 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. doi: One group, pre-test, post-testTo use scenario simulations to improve competency of cardiovascular critical care nurses24Lecture + Low Fidelity SimulationNA2The survey revealed significant increases in scores on the teamwork scale for the following subscale items: “Attitudes of the superior”(p < .001), “Job satisfaction” (p = .01), and “Confidence as a team member” (p = .004). Nurses rated themselves enhanced in technical skills after the 2nd simulation. “Simulation can bridge the gap between didactic and clinical practice.”Ballangrud, R., Persenius, M., Hedelin, B., & Hall-Lord, M. L. (2014). Exploring intensive care nurses’team performance in a simulation-based emergency situation, -expert raters’ assessments versus self-assessments: An explorative study. BMC Nursing, 13(47), 1-22. doi:10.1186/s12912-014-0047-5QuantitativeOne group, descriptive, correlationalTo explore team performance (non technical skills that contribute to safety and team efficiency) of ICU nurses in simulation based emergency situations.53High Fidelity SimulationNA2Nurses from coronary specialties had higher non-technical skill performance with cardiac arrest scenario. Higher age and experience were correlated with the helper role. MICU performed better than General ICU nurses. Self-ratings > expert ratingsBeam, E. L., Gibbs, S. G., Hewlett, A. L., Iwen, P. C., Nuss, S. L., & Smith, P. W. (2014). Method for investigating nursing behaviors related to isolation care. American Journal of Infection Control, 42, 1152-1156.QualitativeClinical behavior analysis of airborne and contact isolation precautions (personal protective equipment) implementation24High Fidelity Simulation with SPsNA2Knowledge deficit regarding PPE usage. Errors in donning and doffing isolation equipment were noted, provided “rich data” on patient care delivery. Poor compliance on gowns, respirators, and eye protection. Video feedback enhances learning and can improve isolation protocol adherence.CitationDesignPurposeSampleSizeInterventionControlOutcomesBernard, M., de Roten, Y., Despland, J., & Stiefel, F. (2012). Oncology clinicians’ defenses and adherence to communication skills training with simulated patients: An exploratory study. Journal of Cancer Education, 27, 399-403. doi:10.0117/s13187-012-0366-8.QuantitativeOne group, pre-test, post-testTo assess oncology clinicians’ (self-protective) triggered defense mechanisms on adherence to communication skills training: CST with simulated cancer patient31 High Fidelity Simulation with SPsNAClinicians who used more adaptive defense mechanisms showed better adherence to CST skills than those with less adaptive defenses. Improved communication skills was dependent on initial levels of defenses. No difference between MDs and RNs in defense mechanisms. Need for more communication skills training.Blake, D. F., Shih, E. M., Mateos, P., & Brown, L. H. (2014). The efficacy of oxygen wafting using different delivery devices, flow rates and device positioning. Australasian Emergency Nursing Journal, 17, 119-125. group, post-testTo identify the combination of oxygen delivery device, flow rate and device positioning that delivers the highest concentration of wafted oxygen85Low Fidelity SimulationNAOnly oxygen tubing and the pediatric non-rebreather mask consistently delivered wafted oxygen concentrations above 30%. The pediatric non-rebreather held below the face produced concentrations from 26.1-39.8%. At 15 L/min, tubing held in front of the face produced concentrations ranging from 31.2-56.7%; reducing the flow rate to 6-8L/min had no meaningful effect on delivered concentration.Brunker, C., & Harris, R. (2015). How accurate is the AVPU scale in detecting neurological impairment when used by general ward nurses? An evaluation study using simulation and a questionnaire. Intensive and Critical Care Nursing, 31, 69-75. group, post-testTo evaluate the effectiveness of the “AVPU scale” in non-specialist staff to distinguish pts with significant neuro impair.AVPU has poor sensitivity51Video of a High Fidelity SimulationNAOverall accuracy of scoring simulation was 82.4%. Accuracy was low for simulations depicting an orientated patient whose eyes open to speech (49%) and a confused patient with spontaneous eye opening (61.5%). AVPU had low rates of accuracy, sensitivity and agreement in distinguishing between alert and voice. Participants expressed doubts about the use of AVPU.Citation DesignPurposeSampleSizeInterventionControlOutcomesBultas, M. W., Hassler, M., Ercole, P. M., & Rea, G. (2014). Effectiveness of high-fidelity simulation for pediatric staff nurse education. Pediatric Nursing, 40(1), 27-42. QuantitativeRCT To determine if HFS improves recognition and intervention for deteriorating ped pt, knowledge retention, and teamwork performance as compared with training on static manikin.33High Fidelity SimulationLow Fidelity SimulatorsKnowledge retention maintained, improved skills, and increased teamwork performance in the experimental group. HFS effective teaching modality for pediatric staff nurses. Experimental group post test scores significantly higher on MHPTS teamwork rating than control group (p=.001). BMCT scores not significant (p=.856). Confidence scores not significant (p=.275)Calhoun, A. W., Boone, M. C., Dauer, A. K., Campbell, D. R., & Montgomery, V. L. (2014a). Using simulation to investigate the impact of hours worked on task performance in an intensive care unit. American Journal of Critical Care, 23(5), 387-395. doi: group, descriptive, correlationalTo explore the use of simulation as a method to examine the effects of work length, completion and accuracy at CC tasks.28High Fidelity SimulationNASignificant decrease (p<.001) of 5.5 minutes in mean completion time. No significant changes in accuracy were noted. CC nurses take significantly less time to complete tasks at the end of their shift. Suggests performance of simple tasks may improve over 12 hour shift and simulation may address QI issues. Mean times 17.9 beginning, 13.3 middle, 12.4 end of shift time.Calhoun, A. W., Boone, M. C., Porter, M. B., & Miller, K. H. (2014b). Using simulation to address hierarchy-related errors in medical practice. The Permanente Journal, 18(2), 14-20. MethodsQualitative +Quantitative (One group, post-test)To discuss the implementation and outcomes of using HFS to address the issue of failure to address hierarchy pressures in high risk situations43High Fidelity SimulationNAThe team was unsuccessful at addressing the error in 4 of 5 cases. Trends toward lower communication scores as well as poor team self-assessment of communicative ability were noted in unsuccessful session. Learners had a positive impression of the case. Simulation is a useful means to replicate hierarchy error in an educational environment.CitationDesignPurposeSampleInterventionControlOutcomesCho, J., Chung, H. S., & Hong, S. H. (2013). Improving the safety of continuously infused fluids in the emergency department. International Journal of Nursing Practice, 19, 95-100. doi:10.1111/ijn.12022QuantitativeOne group, pre-test, post-testTo assess the effectiveness of color- coded IV labeled fluids on preventing a crisis situation/med error. Improve and optimize pt safety through simulation training69High Fidelity SimulationNATime improvement for all three groups from pre to post intervention for all three scenarios were statistically significant (p<0.001). There were no incorrect fluids indicated by all three groups of participants at post intervention analysis. Color-coded labeling system in a simulated environment significantly improved the promptness and accuracy of finding the correct fluid from multiple infused continuous fluids.Christian, A., & Krumwiede, N. (2013). Simulation enhances self-efficacy in the management of preeclampsia and eclampsia in obstetrical staff nurses. Clinical Simulation in Nursing, 9, e369-e377. . QuantitativeOne group, pre-test, post-testTo investigate the impact of high fidelity simulation (HFS) on self-efficacy of training OB staff nurses managing pre-eclampsia and also to measure satisfaction with using simulation as a learning strategy.49 High Fidelity SimulationNASelf efficacy significantly increased with HFS training (p<.001) and was sustained overtime (p<.05). Satisfaction with simulation training was positive (3.97 on 4 point likert). High risk low incidence OB emergencies suitable topics for simulation trainingCole, E. T., Harvey, G., Urbanski, S., Foster, G., Thabane, L., & Parker, M. J. (2014). Rapid paediatric fluid resuscitation: A randomized controlled trial comparing the efficiency of two provider-endorsed manual paediatric fluid resuscitation techniques in a simulated setting. BMJ Open, 4, 1-8. doi: 10.1136/bmjopen-2014-005028QuantitativeTwo group, randomized, crossoverTo compare the rate of fluid administration achieved with the disconnect-reconnect and push-pull manual syringe techniques for pediatric fluid resuscitation in a simulated setting.16Low Fidelity SimulationNAThe mean rate of fluid administration was greater for the disconnect-reconnect technique at 1.77 than it was for the push-pull technique at 1.62 with a mean difference of 015. There was no difference in mean volume administered or participant self-reported fatigue between techniques. No catheter dislodgement events occurred. The disconnect-reconnect technique allowed for the fastest rate of fluid administration, suggesting that the use of this technique may be preferable in situations requiring rapid resuscitation. CitationDesignPurposeSampleSizeInterventionControlOutcomesConnor, C. W., Saffary, R., Feliz, E. (2013). Performance of the Selleck maneuver significantly improves when residents and trained nurses use a visually interactive guidance device in simulation. Physiological Measurement, 34, 1645-1656. doi:10.1088/0967-3334/34/12/1645.QuantitativeOne group,pre-test, post-testTo examine the proper performance of the Sellick maneuver using a novel device that measures and visualizes the force applied to the cricoid cartilage using thin-film force sensitive resistors in a form suitable for in vivo use.20Low Fidelity SimulationNAOverall, the Sellick maneuver was often not applied properly with large variance between individual subjects. Performance and inter-subject consistency improved to a very highly significant degree when subjects were able to use the device as a visual guide (p<0.001). Subsequent significant improvements in performances during the last, unguided test demonstrated that the device initiated learning.Delaney, M. M., Friedman, M. I., Dolansky, M. A., & Fitzpatrick, J. J. (2015). Impact of a sepsis educational program on nurse competence. The Journal of Continuing Education in Nursing, 46(4), 179-186. doi:10.3928/002200124-20150320-03.QuantitativeOne group,pre-test, post-testTo determine the influence of a sepsis education program on nurses’ perceived ability to identify, intervene, and care for pts with sepsis.82 Video Vignettes of Nurse and Staff Encounters + High Fidelity SimulationNANo improvement in self assessed competence scores. Self perceived sepsis-specific competence behaviors improved, post test knowledge scores, and all helping role and therapeutic intervention scores improved significantly (p< .0001)Dorton, L. H., Lintzenich, C. R., & Evans, A. K. (2014). Simulation model for tracheostomy education for primary health-care providers. Annals of Otology, Rhinology & Laryngology, 123(1), 11-18.QuantitativeOne group, pre-test, post-testTo evaluate the competency of health care providers managing patients with trachs, and assess the need for education incorporating HFS87 Lecture + High Fidelity SimulationNAAverage comfort level 3.3 on a 5 point scale improved to 4.4 after training (p<.0001). Mean knowledge scores increased from 56% to 91% (p<.0001). Need for improved trach education among primary care providers. Incorporating HFS was effective in improving confidence and knowledge. Citation DesignPurposeSampleSizeInterventionControlOutcomesDowson, A., Russ, S., Sevdalis, N., Cooper, M., & de Munter, C. (2013). How in situ simulation affects paediatric nurses’ clinical confidence. British Journal of Nursing, 22(11), 610-617.Mixed MethodsQualitative +Quantitative (Two group, nonrandomized,pre-test,post-test)To determine if and how a period of simulation training in the management of pediatric emergencies improves nurses’ clinical confidence.20 High Fidelity Simulation + Low Fidelity SimulationLow Fidelity SimulationSignificant (p<.05) improvement in non technical scores of control group related to confidence following simulation training, “provision of insight and preparation for real life.” No improvement in technical confidence for control. For the intervention group, improvement in all areas, with a significant improvement in total scores (p<.01) At month 3, no difference in scores between control and intervention.Endacott, R., Scholes, J., Cooper, S., McConnell-Henry, R., Porter, J., Missen, K.,…Champion, R. (2012). Identifying patient deterioration: Using simulation and reflective interviewing to examine decision making skills in a rural hospital. International Journal of Nursing Studies, 49, 710-717. doi:10.106/j.i/nurstu.2011.11.108.Mixed Methods Qualitative +Quantitative (One group, post-test)To examine how RNs identify and respond to deteriorating patients during in hospital simulation exercises.34High Fidelity Simulation with SPsNA Video review revealed additional insights into RN’s decision making, not evident from OSCE score. Feedback from video review highly valued component of simulation mon pattern of lack of reassessment leading to incorrect actions. Value in using real actors as they can respond to the RN. Everett-Thomas, R., Valdes, B., Valdes, G., Shekhter, I., Fitzpatrick, M., Rosen, L.,…Birnbach, D. J. (2014). Using simulation technology to identify gaps between education and practice among new graduate nurses. Journal of Continuing Education in Nursing, 46(1), 34-40. doi:10.3928/00220124-20141122-01.QuantitativeOne group, post-testTo measure clinical performance during simulation training among Medical-Surgical RNs in residency program.98 Lecture + High Fidelity SimulationNATwo of the five scenarios, poor decisions and prioritization of competing tasks associated with lower performance group scores. Complex patient conditions pose a challenge for new graduates. Standardizing training during residency program valuable in transition to practice education. ANOVA showed significant (p<.001) in nurses performance for all of the groups for each week and significant (p<.001) improvement in applied knowledge of clinical skills for all scenarios and practice between week 1 and 5.CitationDesignPurposeSampleSizeInterventionControlOutcomesFranklin, A. E., & Lee, C. S. (2014). Effectiveness of simulation for improvement in self-efficacy among novice nurses: A meta-analysis. Journal of Nursing Education, 53(11), 607-614. doi:10.3928/01484834-20141023-03.Meta-AnalysisTo determine the effect of simulation on self-efficacy for novice nurses.38 studiesVariousVariousSimulation improved SE in one group (p<.001). Simulation was favored over control teaching interventions in improving SE in studies with experimental designs (p=.002). In Non experimental designs, consistent conclusions about influence of simulation were tempered by significant between study differences in effectsGray, W. A., Kesten, K. S., Hurst, S., Day, T. D., & Anderko, L. (2012). Using clinical simulation centers to test design interventions: A pilot study of lighting and color modifications. Health Environments Research & Design Journal, 5(3), 46-65.QuantitativeOne group, pre-test, post-testTo test lighting, color, and spatial color patterning on nurses’ stress, alertness, and satisfaction to provide an example of how simulation centers can be used to conduct research.10 High Fidelity SimulationNANurses were less stressed after exposure to experimental room than nurses exposed to control room. Significant reduction in stress (p=.069) and increase in alertness (p=.071) after exposure to the experimental room.Gray, J. P., Ludwig, B., Temple, J., Melby, M., & Rough, S. (2013). Comparison of a hybrid medication distribution system to simulated decentralized distribution models. American Society of Health-System Pharmacists, 70, 1322-1335. doi: 10.2146/ajhp120512.QuantitativeOne group, pre-test, post-testTo estimate the human resource and cost implications of changing the medication distribution model by evaluating the hospitals existing hybrid distribution model of dose dispensed via cart fill versus automated dispensing cabinets.Not GivenLow Fidelity SimulationNAAs the modeled percentage of doses dispensed from automated dispensing cabinets rose, the calculated pharmacy technician labor requirements decreased, with a proportionately greater increase in the nursing staff workload. Given that nurses are a higher-cost resource than pharmacy technicians, the projected human resource opportunity cost of transitioning from the hybrid to decentralized system was estimated at $229,691.00 per annum. It was decided that the transition would result in an unfavorable shift in staff skill mix and corresponding human resource costs at the medical center.CitationDesignPurposeSampleSizeInterventionControlOutcomesGrundgeiger, T., Sanderson, P. M., Orihuela, C. B., Thompson, A., MacDougall, H. G., Nunnink, L., & Venkatesh, B. (2013). Prospective memory in the ICU: The effect of visual cues on task execution in a representative simulation. Ergonomics, 56(4), 579-589. MethodsQualitative +Quantitative (One group, post-test) To determine if nurses’ memory for future tasks improve when visual cues are present and how nurses manage prospective memory demands24 High Fidelity SimulationNAThe presence of a visual cue improved recall compared to no cue (p=.03). Nurses used deliberate reminders to manage their PM demands. Visual cues increase the likelihood that future tasks are executed. 57% average performance on PM tasks indicates nurses cannot easily achieve all required nursing tasks even under routine conditions. PM performance increased from 50 to 64% average with visual cues and influenced how they handled interruptions.Hallenbeck, V. J. (2012). Use of high-fidelity simulation for staff education/development. Journal for Nurses in Staff Development, 28(6), 260-269. doi:10.1097/NND.0b013e31827259c7Systematic review To analyze if high fidelity simulation (HFS) increases skills and knowledge and translates into safe patient care16 studiesVariousVariousThe data do not clearly show that HFS is the best practice for the orientation and education of staff nurses. Overall, HFS is recognized as a safe way to learn, and most nurses like participating in HFSs. However, before the healthcare industry continues on this journey of widespread adoption of HFSs, more research needs to be done to show that the increased skills and knowledge of the nurse obtained through simulation does translate into safer patient care and better patient outcomes.Henneman, P. L., Marquard, J. L., Fisher, D. L., Bleil, J., Walsh, B., Henneman, J. P., Blank, F. S.,…Henneman, E. A. (2012). Bar-code verification: Reducing but not eliminating medication errors. The Journal of Nursing Administration, 42(12), 562-566. doi:10.1097/NNA.0b013e318274b545.QuantitativeOne group, post-testTo study the impact of bar-code verification on error identification and recovery during medication administration using observation, eye tracking, and clinical simulation with embedded errors.25Low Fidelity SimulationNAData supported that bar-code verification may reduce but does not eliminate patient identification and medication errors during clinical simulation of medication administration. This study demonstrates that further human and technological improvements are needed to ensure that the right patient receives the right medication.CitationDesignPurposeSampleSizeInterventionControlOutcomesHensel, D., Kathman, J., Hendricks, R., & Ball, S. (2012). Building partnerships using student role models for neonatal resuscitation simulation. Journal of Continuing Education in Nursing, 43(12), 550-554. doi:10.3928/00220124-20120904-33QuantitativeTwo group, post-testTo explore how students could contribute to the clinical unit by supporting learning among experienced RN who were new to simulation.88 Pencil-Paper Exam + Video of High Fidelity Simulation + High Fidelity SimulationNAParticipants viewed simulation as positive experience. No significant difference in satisfaction or confidence with the simulation between groups. May be opportunity for students to impact staff education through simulation on units. Hommes, T. (2014). Implementation of simulation to improve staff nurse education. Journal for Nurses in Professional Development, 30(2), 66-69. doi:10.1097/01.NND.0000433144.66804.4cQuantitativeOne group, pre-test, post-test To measure the effects of simulation experiences during orientation on perceived confidence and competence 9 High Fidelity SimulationNA100% had Improved confidence (p=.001). and competence (p=.005) from pre to post test Ultimately hope to lower attrition rates in newly hired RNs.Hsu, L., Huang, Y., & Hsieh, S. (2014). The effects of scenario-based communication training on nurses’ communication competence and self-efficacy and myocardial infarction knowledge. Patient Education and Counseling, 95, 356-364. QuantitativeRCTTo determine the effects of a simulated communication training on nurses competence, self-efficacy (SE), communication performance, myocardial infarction (MI) knowledge and satisfaction122 Video of a High Fidelity SimulationCase StudyExperimental group improved in competence and SE from pre to post test 2 when compared with control (p<.0001). Both group satisfaction increased from post-test 1 to post-test 2. Experimental more satisfied, no difference in communication performance (p=.093) or MI knowledge (p=.159).CitationDesignPurposeSampleSizeInterventionControlOutcomesHuibers, L., Giesen, P., Smits, M., Mokkink, H., Grol, R., & Wensing, M. (2012). Nurse telephone triage in Dutch out-of-hours primary care: The relation between history taking and urgency estimation. European Journal of Emergency Medicine, 19, 309-315. doi:10.1097/MEJ.0b013e32834d3e67QuantitativeOne group, post-testTo examine the relationship between comprehensive history taking and the appropriate estimation of urgency.304 High Fidelity Simulation with SPsNADiscrimination questions 4.4 and general questions 3.2 per telephone contact. Incomplete asking of recommended questions was not associated with underestimation of urgency. Triage nurses asked less than ? of the questions recommended by national triage guidelines. Suggests pattern recognition, further research needed.Huseman, K. F. (2012). Improving code blue response through the use of simulation. Journal for Nurses in Staff Development, 28(3), 120-124. doi: 10.1097/NND.0b013e3182551506.QuantitativeOne group, pre-test, post-testTo investigate if performing mock codes improves response time to real codes178High Fidelity Simulation NAResponse times for start of chest compressions (p=.0079) and epinephrine administrations (p=.0001) improved significantly. Response time to defibrillation not significant (p=.1008).Huser, A., Muller, D., Brunkhorst, V., Kannisto, P., Musch, M., Kropfl, D., 7 Groeben, H. (2014). Simulated life-threatening emergency during robot-assisted surgery. Journal of Endourology, 28(6), 717-722. doi: 10.1089/end.2013.0762QuantitativeOne group, pre-test, post-testTo test the management of an acute emergency in an OR setting with full size simulator in 6 complete times36High Fidelity SimulationNATime to start compressions significantly improved at the 2nd simulation (p=.0054).CitationDesignPurposeSampleSizeInterventionControlOutcomesJansson, M. M., Ala-Kokko, R. I., Ohtonen, P. P., Merilainen, M. H., Syrjala, H. P., & Kyngas, H. A. (2014). Human patient simulation education in the nursing management of patients requiring mechanical ventilation: A randomized, controlled trial. American Journal of Infection Control, 42, 271-278. RCTTo evaluate the effectiveness of high fidelity patient simulation (HPS) education in nursing management of patients requiring mechanical ventilation30 High Fidelity Simulation with debriefing and verbal feedbackHigh Fidelity Simulation without debriefing and verbal feedbackAfter HPS education, skill scores in the intervention group increased significantly (p<.001) . No change over time, no change in knowledge scores. Significant transfer of learned skills to clinical practice following HPS.Jayaweera, D., Mitter, S., Grouse, A., Strachan, L., Murphy, M., Douglass, D., …Gunja, N. (2014). A comparison of emergency triage scales in triaging poisoned patients. Australasian Emergency Nursing Journal, 17, 184-189.QuantitativeTwo group, post-testTo compare two emergency department triage systems used in Australia, the Australasian Triage Scale (ATS) and the Manchester Triage System (MTS), in triaging patients presenting with poisoning and envenoming.30Low Fidelity Simulation (table top case studies)NAMTS nurses triaged all 8 scenarios with a lower acuity triage category, though statically significant for only 3 scenarios. ATS nurses scored higher acuity triage category in all 4 “rare” highly toxic presentations, whereas MTS nurses scored higher acuity when vital signs were abnormal. MTS showed wider variance in triage scores in both scenario groups when compared to the ATS. Triage nurses without access to local toxicology services chose to contact PIC in most cases.Kalisch, B. J., Aebersold, M., McLaughlin, M., Tschannen, D., & Lane, S. (2015). An intervention to improve nursing teamwork using virtual simulation. Western Journal of Nursing Research, 37(2), 164-179. doi: 10.1177/0193945914531458.QuantitativeOne group, pre-test, post-testTo test virtual simulation to improve staff nursing teamwork.43 Low Fidelity Simulation (Avatar) NAOverall mean teamwork scores improved from pre to post intervention (p<.012). Teamwork knowledge scores not significantly different (p<.301).CitationDesignPurposeSampleInterventionControlOutcomesKinsman, L., Buykx, P., Cant, R., Champion, R., Cooper, S., Endacott, R., McConnell-Henry, R.,…Scholes, J. (2012). The FIRST2ACT simulation program improves nursing practice in a rural Australian hospital. Australian Journal of Rural Health, 20, 270-274. doi: 10.1111.j.1440-1584.2012.01296xQuantitativeOne group, pre-test, post-testTo measure the impact of FIRST ACT simulation program on nursing observations and practice related to patient deterioration.34 High Fidelity Simulation with SPsNA Statistically significant reduction in less than satisfactory frequency of observations (p=.009) and pain score charting (p=.003). No measurable improvement in the administration of 02 therapy (p=.143). “Persistent positive changes up to 10 weeks.”Liaw, S.Y., Wong, L., Chan, S. W., Ho, J.T.Y., Mordiffi, S. Z., Ang, S. B. L., …Kim Ang, E. N. (2015). Designing and evaluating an interactive multimedia web-based simulation for developing nurses’ competencies in acute nursing care: Randomized controlled trial. Journal of Medical Internet Research, 17(1), 1-14.Mixed MethodsQuantitative + Qualitative (RCT)To describe the design, development, and evaluation of an interactive multimedia Web-based simulation for developing nurses’ competencies in acute care nursing70 High Fidelity Simulation + Web-based simulation (virtual patient simulation)High Fidelity SimulationThe clinical performance posttest scores of the experimental group improved significantly (p<.001) from the pretest scores after the Web-based simulation. Compared to the control group, the experimental group had significantly higher clinical performance posttest scores (p<.001) after controlling the pretest scores. Participants in the experimental group were satisfied with the learning experience. Themes included relevance to practice, instructional strategies, and fostering problem solving.Lucisano, K. E., & Talbot, L. A. (2012). Simulation training for advanced airway management for anesthesia and other healthcare providers: A systematic review. AANA Journal, 80(1), 25-31.Systematic ReviewTo review of the current literature (1990-2009) on human patient simulation for preparing anesthesia and other healthcare providers for advanced airway management.34 studiesVariousVariousFew studies have analyzed the effects of this modality on trainer skills and patient safety. There is a clear need for well-designed studies to examine these effects.CitationDesignPurposeSample SizeInterventionControlOutcomesMacNeela, P., Scott, P. A., Treacy, M., Hyde, A., & O’Mahony, R. (2012). A risk to himself: Attitudes toward psychiatric patients and choice of psychosocial strategies among nurses in medical-surgical units. Research in Nursing & Health, 35, 200-213. doi: 10.1002/nur.21466QualitativeTo explore attitudes toward caring for psychiatric patients among 13 nurses working in general hospitals in Ireland13 Video of a High Fidelity Simulation + Paper Case StudyNAFindings support a view of nursing knowledge about psychiatric patients as more stereotyped than specialized.Makic, M. B. F., Lovett, K., Azam, M. F. (2012). Placement of an esophageal temperature probe by nurses. AACN Advanced Critical Care, 23(1), 24-31. doi: 10.1097/NCI.0b013e31823324f3Quantitative One group pre-test, post-testTo demonstrate and evaluate accurate placement of an esophageal temperature probe (ETP) 32 High Fidelity Simulation NALiterature is lacking to guide ETP placement. RNs overestimated the depth for ETP placement. Confidence in knowledge and skill increased significantly (p=.000).Maneval, R., Fowler, K. A., Kays, J. A., Boyd, T. M., Shuey, J., Harne-Britner, S., & Mastrine, C. (2012). The effect of high-fidelity patient simulation on the critical thinking and clinical-decision making skills of new graduate nurses. The Journal of Continuing Education in Nursing, 43(3), 125-134. doi: 10.3928/00220124-20111101-02Quantitative RCTTo determine if the addition of high-fidelity patient simulation to new nurse orientation26 High Fidelity SimulationStandard orientation (No high-fidelity simulation)Compared with the control group, the high-fidelity patient simulation group did not show significant improvement in mean critical thinking (p=.70) or clinical decision-making scores (p>.05).CitationDesignPurposeSample SizeInterventionControlOutcomesMaruyama, K., Morohashi, S., Fukakura, Y., Takeuchi, H., Miyaji, T., Hasegawa, T.,... Andoh, T. (2014). Preliminary development and evaluation of the support system for care of mechanically ventilated patients. British Journal of Anaesthesia, 113(3), 491-500. doi: 10.1093/bja/aeu097Quantitative One group post-test To determine if providing graphical information of the site of a respirator-related problem on a display would improve the healthcare provider’s ability to identify the site of a leak in a simulation environment.15 High Fidelity Simulation NAThe support system for care of mechanically ventilated patients (SCMVP) decreased the troubleshooting time and improved the success rate to identify simulated leaks during mechanical ventilation using a manikin.McGraw, L. K., Out, D., Hammermeister, J. J., Ohlson, C. J., Pickering, M. A., & Granger, D. A. (2013). Nature, correlates, and consequences of stress-related biological reactivity and regulation in Army nurses during combat casualty simulation. Psychoneuroendocrinology, 38, 135-144. One group pre-test, post-test To validate the Combat Casualty Stress Scenario (CCSS) as a realistic, stressful simulation environment 38 High Fidelity SimulationNAThe CCSS was associated with increased levels of peripheral indices of hypothalamic-pituitary-adrenal axis and autonomic nervous system activity in novice and experienced Army nurses. The magnitude of the effects was large.Merchant, D. C. (2012). Does high-fidelity simulation improve clinical outcomes? Journal for Nurses in Staff Development, 28(1), E1-E8. doi: 10.1097/NND.0b013e318240a728Systematic ReviewTo describe the effects of high-fidelity, scenario-based simulation in hospital education programs on performance and clinical practice outcomes among hospital staff8 studiesVariousVariousMore high-quality research is needed to measure the effect of simulation-based education on actual provider behaviors and clinical outcomes.CitationDesignPurposeSample SizeInterventionControlOutcomesMeyer, E. C., Lamiani, G., Foer, M. R., & Truog, R. D. (2012). “What would you do if this were your child?”: Practitioners’ responses during enacted conversations in the United States. Pediatric Critical Care Medicine, 13(6), e372-e376. doi: 10.1097/PCC.0b013e31825b84e2.QualitativeTo describe how pediatric practitioners respond when parents ask, “What would you do if this were your child?”25High Fidelity Simulations with SPsNASix themes emerged: acknowledgment, discomfort and/or reluctance, values and decision making approaches, focus on medical information, emotional and practical support, and personal responses and self disclosure.Meystre, C., Bourquin, C., Despland, J., Stiefel, F., & de Roten, Y. (2013). Working alliance in communication skills training for oncology clinicians: A controlled trial. Patient Education and Counseling, 90, 233-238. Two groups, nonrandom,pre-test, post-testTo evaluate the impact of communication skills training (CST) on working alliance and to identify specific communicational elements related to alliance for two professional groups, nurses and physicians.113High Fidelity Simulation with SPsNAThere was no significant improvement in alliance after CST.1) Alliance - higher for control group at Time 1 (p=.013), but not Time 2 (p=.720).2) Alliance and Verbal Communication- No significant effect of time (p=.217) and professional group (p=.364). Muller-Juge, V., Cullati, S., Blondon, K. S., Hudelson, P., Maitre, F., Vu, N. V., …Nendaz, M. R. (2014). Interprofessional collaboration between residents and nurses in general internal medicine: A qualitative study on behaviors enhancing teamwork quality. PLOS ONE, 9(4), 1-8.QualitativeTo describe resident physicians’ and nurses’ actual behaviors contributing to teamwork quality 14 pairs High Fidelity SimulationNAPairs generally functioned within their roles; truly shared leadership was infrequently seen.CitationDesignPurposeSample SizeInterventionControlOutcomesO’Hagan, S., Manias, E., Elder, C., Pill, J., Woodward-Kron, R., McNamara, T.,…McColl, G. (2013). What counts as effective communication in nursing? Evidence from nurse educators’ and clinicians’ feedback on nurse interactions with simulated patients. Journal of Advanced Nursing, 70(6), 1344-1356. doi: 10.1111/jan.12296QualitativeTo identify aspects of communication that nurse educators and clinicians consider to be relevant for effective nurse-patient interactions in clinical practice15 Low Fidelity Simulation (video)NAFour major themes: approach to patients and patient care, manner towards patients, techniques used for interacting with patients and generic aspects of communicationPemberton, J., Rambaran, M., & Cameron, B. H. (2013). Evaluating the long-term impact of the Trauma Team Training course in Guyana: an explanatory mixed-methods approach. The American Journal of Surgery, 205, 119-124. Methods Qualitative +Quantitative (Two groups, nonrandomized, pre-test, post-test)To evaluate the retention and impact of trauma knowledge and skills after an interprofessional Trauma Team Training (TTT) course 47Low Fidelity SimulationNA-Multiple Choice Questions: Significant increases in knowledge at Time 2 (p<.0001) and Time 3 (p<.0001)-Skills: Simple skills “well retained”, but complex skills had a lower level of retention-TTAT: Overall decline at 4 months (p<.0001)-Themes that emerged: improved empowerment, knowledge, teamwork, and patient carePeterson, B. L. (2012). The effect of computer interactive simulation on situational decisionmaking and competency development of experienced staff nurses (Doctoral dissertation). Available from ProQuest Dissertations and Theses database. (UMI No. 3498197)QuantitativeRCTTo determine if computer interactional simulation is more effective than the traditional classroom setting in promoting clinical competency inexperienced staff nurses32Computer SimulationLectureHypotheses not supportedthat computer interactive simulation is more effective than traditional classroom instruction in regards to the critical thinking/situational understanding, knowledge subscales, and overall competency.The didactic group had a significantly higher increase in knowledge scores on the posttest than the computer group. The power analysis on this result indicated a small effect size of d = 0.29, which could indicate that a difference did not actually exist between the two groups.CitationDesignPurposeSample SizeInterventionControlOutcomesPurling, A., & King, L. (2012). A literature review: graduate nurses’ preparedness for recognizing and responding to the deteriorating patient. Journal of Clinical Nursing, 21, 3451-3465. doi: 10.1111/j.1365-2702.2012.04348.xSystematic ReviewTo explore research literature to establish factors that influence graduate nurse preparedness for recognition and response to patient deterioration in the acute care setting.17 studiesVariousVariousSignificant deficit in the existing literature regarding graduates’ levels of preparation for patient deterioration. Graduates require support and guidance from colleagues in decision-making and gaining appropriate action for deteriorating patients. Educational strategies are needed to prepare grads.Raurell-Torreda, M., Olivet-Pujol, J., Romero-Collado, A., Malagon-Aguilera, M. C., Patino-Maso, J., & Baltasar-Bague, A. (2014). Case-based learning and simulation: Useful tools to enhance nurses’ education? Nonrandomized controlled trial. Journal of Nursing Scholarship, 47(1), 34-42. doi: 10.1111/jnu.12113Quantitative3 groups: 2 intervention groups (traditional lecture + case based learning and traditional lecture) and a control groupTo compare the communication and critical thinking skills of undergraduate students in the control group with the intervention group and to compare communication and critical thinking skills of undergraduate and continuing professional education (CPE) nurses.160 High Fidelity simulationLecture Controls scored lower than the intervention group on patient assessment (6.3+2.3 vs 7.5+1.4, p=.04, mean difference, -1.2 [95% confidence interval (CI) -2.4 to -0.03]) but the intervention group did not differ from CPE nurses (7.5+1.4 vs 8.8+1.5, p=.06, mean difference, -1.3 [95% CI -2.6 to 0.04]). Roh, Y. S., Lee, W. S., Chung, H. S., & Park, Y. M. (2013). The effects of simulation-based resuscitation training on nurses’ self-efficacy and satisfaction. Nurse Education Today, 33, 123-128. doi: 10.1016/j.nedt.2011.11.008Quantitative Two group, randomized, pretest, posttest Evaluate the efficacy of simulation-based resuscitation training between computer-based simulation versus mannequin-based simulation with practicing nurses38Computer based simulation or High Fidelity SimulationNANo significant differences between groups. The computer-based simulation group had significant higher satisfaction ratings in “Setting priorities for nursing intervention’ and “Implementing nursing skills as protocol’ compared to the mannequin-based simulation group.CitationDesignPurposeSample SizeInterventionControlOutcomesScholtz, A. K., Monachino, A. M., Nishisaki, A., Nadkarni, V. M., & Lengetti, E. (2013). Central venous catheter dress rehearsals- Translating simulation training to patient care and outcomes. Simulation in Healthcare, 8, 341-349. doi: 10.1097/SIH.0b013e3182974462Quantitative One group pre-test, post-testTo investigate nurses’ knowledge, confidence, and psychomotor performance on mannequins, improved procedural competence on real patients and CLABSI rates.524 Low Fidelity SimulationNAKnowledge and self-confidence improved significantly (p<.001; p<.001). CLABSI rates decreased significantly (p<.001).Sedgwick, M. G., Grigg, L., & Dersch, S. (2014). Deepening the quality of clinical reasoning and decision-making in rural hospital nursing practice. Rural and Remote Health, 14, 1-12).QualitativeTo explore how rural RNs reason through clinical problems and assess the quality of such reasoning15 High Fidelity Simulations with SPsNAThe ability to engage in deep clinical reasoning varied considerably among participants despite being given the same information under the same circumstances. The number of years of experience did not seem to be directly linked to the ability to engage in sound clinical reasoning.Severson, M. A., Maxson, P. M., Wrobleski, D. S., & Dozois, E. J. (2014). Simulation-based team training and debriefing to enhance nursing and physician collaboration. Journal of Continuing Education in Nursing, 45(7), 297-303. doi: 10.3928/00220124-20140620-03.QualitativeTo examine video-taped simulation-based team training (SBTT) and debriefing experiences from the perspectives of nursing staff and physicians 19 High Fidelity Simulation NAThemes:1) Leadership is key, 2) Use closed/loop communication, 3) Clearly defining roles in important, 4) Develop situational awareness and mutual supportShen, J. J., Xu, Y., Staples, S., Bolstad, A. L. (2014). Using interpersonal skills tool to assess interpersonal skills of internationally educated nurses. Japan Journal of Nursing Science, 11, 171-179. doi:10.1111/jjns.12018Quantitative One group, descriptiveTo examine interpersonal communication skills of IEN (International Educated Nurses) 52 High Fidelity Simulation with SPs NAOn 10 of the 17 items, nurses received scores under 3 (Counseling, Closure, Small Talk, Physical Exam).CitationDesignPurposeSample SizeInterventionControlOutcomesSpan, P. M. (2015). Content analysis of applied learning from high fidelity patient simulation orientation to critical care.Qualitative To understand the experiences of advanced beginner criticalcare nurses regarding their application of knowledge and skills gained from high fidelity simulation8 High Fidelity SimulationNAThe 8 themes that emerged are consistent with previous research studies that point to the steep learning curve faced by newly licensed nurses in critical care. Straka, K. L., Ambrose, H. L., Burkett, M., Capan, M., Flook, D., Evangelista, T., Houck, P.,…Thornton, M. (2014). The impact and perception of nursing certification in pediatric nursing. Journal of Pediatric Nursing, 29, 205-211.Quantitative Two group, cross-sectional descriptive correlationTo investigate the care provided by both certified and non-certified nurses when responding to a pediatric patient experiencing a crisis90High Fidelity Simulation NAThere was no significant difference in the amount of time between groups to identify an abnormality or perform a critical task. There was a significant difference in 7 items on the Perceived Value of Certification Tool. There was no significant difference on knowledge tests except between certified and non-certified critical care nurses with certified scoring higher (p=.02).CitationDesignPurposeSample SizeInterventionControlOutcomesSquare, N. D. (2012). High fidelity simulation in nursing practice:? The impact on nurses’ knowledge acquisition, satisfaction, and self-confidence (Doctoral dissertation). Available from ProQuest Dissertations and Theses database. (UMI No. 3523451)Mixed MethodsQualitative +Quantitative (Two groups, nonrandom-ized, pre-test, post-test)To examine the effects on learning of adding a simulation component to an established continuing education program for neonatal nurses48 High Fidelity SimulationCase Study (standard education)The difference in mean change scores from pre- to post-test for the two groups was not stat significant. Participants with less experience had greater gains in mean post-test scores than participants with three years of more experience. Nurses were satisfied and confident in simulation activity. Talwar, S. R., Arora, S., & Tamang E. L. (2012). Effectiveness of a simulation based teaching program on dysrhythmias: A pre-experimental study. International Journal of Nursing Education, 4(1), 83-86.Quantitative One group, pre-test post-testTo assess and evaluate the effectiveness of a simulation based teaching program (SBTP) in the interpretation and management of dysrhythmias 30 High Fidelity SimulationNAA significant difference was found in the pretest and posttest knowledge (p=.00) and skill (p=.00) of the staff nurses related to management of dysrhythmias before and after the administration of SBTP. There was no significant correlation between posttest knowledge and skill scores (p=0.87). Thompson, C., Yang, H., & Crouch, S. (2012). Clinical simulation fidelity and nurses’ identification of critical event risk: A signal detection analysis. Journal of Advanced Nursing, 68(11), 2477-2485. doi:10.1111/j.1365-2648.2012.05945.xQuantitativeTwo group, post-test To determine if increasing the fidelity of a simulation will lead to differences in nurses identification of relevant signals in simulated noisy clinical settings97High Fidelity Simulation NAJudgment performance, as measured by hit rates and signal detection ability were significantly lower in higher fidelity clinical simulations. False alarm rates and bias did not differ according to the fidelity of simulation. CitationDesignPurposeSample SizeInterventionControlOutcomesWallston, K. A., Slagle, J. M., Speroff, T., Nwosu, S., Crimin, K., Feurer, I. D.,…Weinger, M. B. (2014). Operating room clinicians’ rating of workload: A vignette simulation study. Journal of Patient Safety, 10(2), 95-100.QuantitativeOne group, pretest, posttestTo determine whether clinical vignettes based solely on actual clinical documentation would be sufficient to accurately and reliably reflect the workload of operating room teams.36Low Fidelity Simulation (case study vignettes)NASurgeons had higher interrater reliability on the Quality and Workload Assessment Tool than did nurses or anesthesia providers. For the anticipated individual and team workload ratings, there were no statistically significant difference between the actual rating and the ratings obtained from vignettes. There were differences for the 3 provider types in perceived individual workload for the median difficulty cases and in the perceived team workload for the median and more difficult cases.Wehbe-Janek, H., Pliego, J., Sheather, S., & Villamaria, F. (2014). System-based interprofessional simulation-based training program increases awareness and use of rapid response teams. The Joint Commission Journal on Quality and Patient Safety, 40(6), 279-287.QuantitativeOne group, pretest, posttestTo evaluate the efficacy of an interprofessional simulation-based training program for rapid response and cardiac arrest emergencies359 High Fidelity SimulationNA1) Reaction- all training participants responded favorably2) Learning-nurses, rapid response team (RRT) members, code blue team (CBT) had significant reduction of self-perceived anxiety; nurses, CBT members had significant changes in self-perceived confidence3) Transfer- RRT increased before training, decreased after training; CBT decreased before training, increased after training4) Outcomes- decreased hospital mortality ratesWilson, R. D., & Hagler, D. (2012). Through the lens of instructional design: Appraisal of the Jeffries/National League for Nursing Simulation Framework for us in acute care. Journal of Continuing Education in Nursing, 43(9), 428-432. QuantitativeTwo groups, non-randomized, pre-test, post-testTo describe the outcomes of an external validation study of the Jeffries/NLN Simulation Framework 33High Fidelity SimulationNAThe model provides a strong framework for developing high-fidelity clinical simulations.CitationDesignPurposeSample SizeInterventionControlOutcomesXu, Y., Staples, S., & Shen, J. J. (2012). Nonverbal communication behaviors of international educated nurses and patient care. Research and Theory for Nursing Practice: An International Journal, 26(4), 290-308.Mixed MethodsQualitative + Quantitative (One group, post-test only)To determine how and to what extent nonverbal behaviors affect patient care52 High Fidelity Simulation with SPsNAInternationally educated nurses received average scores under 2 in 5 of the 12 nonverbal behaviors.Yang, H., Thompson, C., & Bland, M. (2012). The effect of clinical experience, judgment task difficulty and time pressure on nurses’ confidence calibration in a high fidelity clinical simulation. BMC Medical Informatics and Decision Making, 12(113), 1-9.QuantitativeTwo group, post-test To determine the effect of clinical experience, judgment task difficulty, and time pressure on nurses’ confidence calibration97High Fidelity SimulationNAStudents were underconfident and nurses were overconfident. No significant differences in calibration and resolution were found between the two groups (p=0.80 and p=0.51, respectively). There was a significant interaction between time pressure and task difficulty on confidence (p=0.008); time pressure increased confidence in easy cases but reduced confidence in difficult cases. Time pressure had no effect on confidence or accuracy. Judgment task difficulty impacted significantly on nurses’ judgmental accuracy and confidence. A ‘hard-easy’ effect was observed: nurses were overconfident in difficult judgments and underconfident in easy judgments. ................
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