International Journal of Healthcare Simulation

Background:

Simulation-based education is well established as a teaching strategy but is often taught in dedicated simulation centres. In-situ simulation had previously been less prominent as a teaching tool within the Trust due to lack of awareness of its benefits and versatility. The aim of this project was to utilise in-situ simulations to increase knowledge and implementation of Trust processes, encourage self-reflection, collaboration, and communication within the clinical teams [1].

Methods:

As part of a year-long collaborative project between our nursing education and simulation teams, an in-situ simulation programme was designed for delivery to established teams. Simulation topics came from various sources including local patient safety agenda, patient safety incidents, curricular requirements, and educational priorities. The simulations were undertaken in their native clinical setting and sessions were supported by subject-matter experts to ensure accuracy and appropriate complexity. These sessions were aimed to reach all members of the multidisciplinary team with the focus on nursing workforce and allied healthcare professionals. Over a period of four months, thirty sessions were delivered, at approximately thirty minutes per session, in five clinical areas. These sessions encompassed key priorities including care of the deteriorating patient, falls, end of life care, and tissue viability. This included a pre-simulation discussion and a debriefing immediately after.

Results:

Feedback was gathered from the 113 participants using a post-course survey, featuring both quantitative and qualitative questions to analyse pre- and post-simulation experience, confidence, and knowledge of how to care for patients with a focus on the identified key priorities. The results collected showed a 25% increase in confidence partaking in simulation again, 10% increase of confidence working and communicating within a multidisciplinary team, 14% increase in confidence assessing patients, and 6% increased awareness of personal/professional limitations. The main themes reported by participants were increased awareness of Trust protocols and incident reporting, improved value of self-reflection through the debriefings, and increased awareness of effective team communication to support patient safety. Additionally, the delivery of more regular sessions would aid with exploring different topics in greater detail and further solidify their knowledge. Participants valued the provision of live actors and authentic learning experiences in the workplace.

Conclusion:

In-situ simulation is an effective method of delivering multidimensional, realistic scenarios allowing participants the opportunity to continuously explore various clinical priorities and human factors. Regular, reoccurring simulation sessions in the clinical setting would prove more effective in improving patient safety along with staff’s confidence and competence.

References

1. Martin A, Cross S, Attoe C. The Use of in-situ Simulation in Healthcare Education: Current Perspectives. Adv Med Educ Pract. 2020;11:893–903.