Medisinsk fullskala simulering som undervisningsmetode for sykepleiere som håndterer kritisk syke pasienter: En randomisert kontrollert studie

Abstract

Background: Severe sepsis and septic shock contribute to the high mortality in the Intensive Care Unit (ICU). Standardized guidelines and good Non-Technical Skills (NTS), as team working and situation awareness, are elements that improve quality in patient care. Medical full scale simulation has been implemented as a teaching method in medical education. Onsite simulation provides expanding research opportunities in ICU’s.

Objective:  The aim of the study was to see if simulation training was better than traditional instruction when teaching a structured guideline for receiving critically ill patients in the ICU.

Methods:  A randomized controlled trial. 54 nurses in an ICU received either traditional instruction or training in a simulation centre. Outcomes regarding reception of a septic patient were assessed by observing on-site simulation in the ICU. Team Working and Situation Awareness were assessed by two blinded raters from video recordings.

Results:  Nurses trained by simulation recalled more elements from the guideline regarding preparations (p = 0,02). They also tended to prioritize more correctly. In general the simulation trained nurses assessed themselves higher than the nurses instructed by traditional instruction. Blinded assessment of video recordings showed a reasonable agreement between two raters, but there were no significant difference between the traditional instructed group and the simulation trained group.

Conclusion: Although medical full scale simulation has gained widespread acceptance as a promising educational tool, this study however has not been able to show differences in learning outcomes following a short instructional session. ANTS seem to be a good basis for developing a NTS assessment tool in intensive care. Assessing knowledge in action, during on-site simulation needs further investigation.