Future directions for simulation in healthcare: A critical review.

There was a widespread discontinuation of simulation programs during and after the COVID-19 pandemic. The objective is to explore how to facilitate greater integration of simulation in healthcare organizations. A literature review was conducted in PubMed, MEDES, IBECS and DOCUMED databases. Twenty-three articles published after the pandemic were selected, categorized in seven themes and critically reviewed. In order to consistently and fully integrate simulation into the organizational culture it is recommended to prioritize the development of new strategies that enhance the efficiency and safety of healthcare delivery. And also strategies that enhance the satisfaction and well-being of all stakeholders.

[Interprofessional team training with in situ simulation to improve the quality of cardiopulmonary resuscitation]. / Entrenamiento de equipos interprofesionales con simulación in situ para mejorar la calidad de la reanimación cardiopulmonar.

INTRODUCTION: In situ simulation facilitates training in clinical settings under similar emotional pressure that occurs in real life situations. The objective of the present study was to assess the feasibility, implementation, facilitators self-confidence and teaching challenges of a training program of cardiopulmonary resuscitation through an in situ simulation plan. METHOD: A training program was designed for the facilitators. The number of professionals trained and in situ simulations performed were recorded, as well as the logistical challenges. An ad hoc survey was designed to assess facilitators self-confidence and educational challenge which were classified using the debriefing assessment for simulation in healthcare©. RESULTS: During a period of 3 years, 95 trained facilitators implemented 378 in situ simulations that allowed to train 1281 nursing professionals working at inpatient units. Integration of in situ simulations with daily activities and availability of facilitators were the main logistical challenges. Stablishing and maintaining a stimulating learning environment and structuring the debriefing in an organized way were the main educational challenges. CONCLUSIONS: In situ simulation helps to train the coordination of nursing teams taking care of patients in cardiorespiratory arrest and to identify the risks that may affect patient safety. Identifying the educational challenges during the implementation of in situ simulation facilitates the design of specific educational and monitoring strategies.

Linguistic Validation of the Debriefing Assessment for Simulation in Healthcare in Spanish and Cultural Validation for 8 Spanish Speaking Countries.

INTRODUCTION: Debriefing Assessment for Simulation in Healthcare (DASH) is an instrument to assist in developing and evaluating faculty debriefing and instructional skills that, in the context of trained raters, yields reliable data and internal consistency. Support for its validity is grounded in both its content and the scores arising from its use. The utilization of this and other assessment tools, guidelines, and protocols is expanding internationally, but most of them are available only in English and there is not a single established methodology for translation. The objectives of this study were to demonstrate a translation technique and conduct a linguistic validation of the translation of the DASH from English to Spanish and to demonstrate and conduct a cultural validation across 8 Spanish-speaking countries. METHODS: A forward translation and review of the DASH score sheets and Rater's Handbook defined the consensus harmonized version. A backward translation was reviewed by the original authors and discussed with the translators to produce the approved harmonized version. This was then tested through a questionnaire to assess clarity, comprehensiveness, appropriateness, and cultural relevance among 5 monolingual subjects from 8 Spanish-speaking countries. RESULTS: During the forward translation, 16 discrepancies were detected in the Spanish DASH. Sixty-two participants were sent the Spanish cultural questionnaire and 48% responded. A total of 82 different interpretations and 57 extra recommendations (42% terms, 16% concepts, and 42% syntax) were made. Twenty-seven percent of them were applied. CONCLUSIONS: The translated DASH has undergone a linguistic validation into Spanish, and a cultural validation across 8 Spanish-speaking countries. It may be used to assess debriefings in healthcare settings in these countries. The methodology used is applicable for translating and assessing a cross-cultural validation of assessment instruments.

Simulation as a Tool to Facilitate Practice Changes in Teams Taking Care of Patients Under Investigation for Ebola Virus Disease in Spain.

INTRODUCTION: We analyzed the impact of simulation-based training on clinical practice and work processes on teams caring for patients with possible Ebola virus disease (EVD) in Cantabria, Spain. METHODS: The Government of Spain set up a special committee for the management of EVD, and the Spanish Ministry of Health and foreign health services created an action protocol. Each region is responsible for selecting a reference hospital and an in-house care team to care for patients under investigation. Laboratory-confirmed cases of EVD have to be transferred to the Carlos III Health Institute in Madrid. Predeployment training and follow-up support are required to help personnel work safely and effectively. Simulation-based scenarios were designed to give staff the opportunity to practice before encountering a real-life situation. Lessons learned by each team during debriefings were listed, and a survey administered 3 months later assessed the implementation of practice and system changes. RESULTS: Implemented changes were related to clinical practice (eg, teamwork principles application), protocol implementation (eg, addition of new processes and rewriting of confusing parts), and system and workflow (eg, change of shift schedule and rearrangement of room equipment). CONCLUSIONS: Simulation can be used to detect needed changes in protocol or guidelines or can be adapted to meet the needs of a specific team.

The Principles of Magic Applied to Healthcare Simulation.

STATEMENT: Five principles of magic are described that directly relate to enhancing participant engagement in the healthcare simulation setting. The principles discussed are the following: reality is in the mind of the participant, attention is easily misdirected, perception can be manipulated, various cognitive biases can be exploited, and focus must be captured. Using these principles in a healthcare simulation can help fill gaps in fidelity and bring a participant to a point where the situation and events make sense to them, they feel that they are in an appropriate environment, and they are willing to forgive the natural flaws of the simulation itself. Misuse of illusions beyond the purpose of filling fidelity gaps can break trust with the teacher and lead to disengagement of the participant.

La simulación clínica como herramienta para facilitar el cambio de cultura en las organizaciones de salud: aplicación práctica de la teoría avanzada del aprendizaje / Clinical simulation as a tool to facilitate culture change in healthcare: Practical application of advanced learning theory

RESUMEN Introducción: Las organizaciones sanitarias continúan aumentando su complejidad. La mayoría de efectos adversos son causados por problemas inherentes a los procesos utilizados. Objetivo: Comprender el valor del entrenamiento de equipos con simulación para promover un enfoque orientado al sistema, centrado en el paciente y conducido por equipos interprofesionales. Metodología: Reflexión sobre estrategias de simulación para afrontar cambios organizativos. Resultados: Equipos interprofesionales fueron capaces de proporcionar sedación de modo seguro para procedimientos de colonoscopia, y para promover el diagnóstico precoz y el rápido tratamiento de pacientes con sepsis severa. Conclusión: La simulación clínica proporciona un entorno seguro para reorganizar el cuidado en salud y entrenar profesionales a trabajar en equipo.

ABSTRACT Introduction: Healthcare continues to grow in complexity. Numerous publications have confirmed that most adverse events are caused by inherent problems within the processes being used, which implies that reengineering the systems can reduce the incidence of error. Objective: To understand the value of team education with clinical simulation to promote a systems-oriented, multidisciplinary team-driven, patient-centered approach for optimal patient outcomes. Methodology: We present several simulation-based strategies as an example on how to cope with changes at the organizational level. Results: After simulation based training inter-professional teams were able to safely provide sedation for colonoscopy, and to enhance teamwork for early detection and goal-directed treatment of sepsis in the surgical ward. Conclusion: Clinical simulation provides a safe environment to reorganize care and train professionals to work in teams.