Examining perceptions from in situ simulation-based training on interprofessional collaboration during crisis event management in post-anesthesia care.

Due to the potentially life-threatening conditions and risk of severe complications, post-anesthesia care units (PACU) require prompt team interventions. Miscommunication among professionals during crisis event management may directly affect patient safety. Therefore, developing strategies to enhance interprofessional collaboration (IPC) among critical care teams should be prioritized. In situ simulation (ISS) can be valuable in improving patient safety because it allows the practice of care team dynamics within a real clinical environment. However, its impact on IPC has yet to be demonstrated. The aim of this study was to evaluate the effect of in situ simulation-based training on interprofessional collaboration and satisfaction toward co-workers during crisis event management in post-anesthesia care. A quasi-experimental study, pretest and post-test design with a paired control group was performed. A convenience sample (N = 69) was recruited from the healthcare professionals of the regular PACU team. The intervention group (N = 33) underwent a 6-hour ISS-based interprofessional training session. Three scenarios of deteriorating cases encountered in critical care settings were used, each followed by a debriefing period. The measured outcomes were evaluated by the Collaborative Work Questionnaire and the Satisfaction Towards Coworkers Questionnaire. Questionnaires were answered by the two groups before the intervention (T1), immediately after (T2) and six to eight weeks later (T3). We found that the change from baseline (T1) was different between the groups for global IPC (F = 3.88; p = 0.025) and for communication (F = 4.09; p = 0.021). Regarding global IPC, we observed a significant group effect from T1 to T2 (F = 5.65; p = 0.021) and from T1 to T3 (F = 5.34; p = 0.024). Furthermore, we observed a significant time effect for the experimental group (F = 4.06; p = 0.027). Regarding communication, we observed a significant group effect from T1 to T2 (F = 7.5; p = 0.001). In conclusion, ISS-based training had a slight impact on self-assessed IPC and communication during crisis event management in the PACU. The use of ISS should be promoted among critical care teams to enhance IPC and contribute to patient safety.

Using High-Fidelity Simulation to Teach Ethics Related Non-Technical Skills: Description of an Innovative Model.

This article describes a high-fidelity (Hi-Fi) simulation-based innovative educational strategy intended to introduce anesthesiology residents to key ethical considerations and how they apply to their practice. Three Hi-Fi simulation scenarios involving situations with various ethical issues are described with their debriefing objectives and the trainees' subjective feedback. Three high-fidelity simulation scenarios are described: (a) teaching critical incident disclosure, (b) disclosing and discussing patient awareness during general anesthesia, and (c) would physicians override a do-not-resuscitate (DNR) order if the cause of a cardiac arrest is iatrogenic? We used Hi-Fi simulation in an innovative way to teach these principles of ethics. Simulation, through carefully crafted debriefing, can contribute to the acquisition of essential non-technical ethical skills. How best to integrate simulation in an existent ethics curriculum and how it compares with more traditional teaching methods are questions that need to be addressed.

An integrative review of in situ simulation training: Implications for critical care nurses.

BACKGROUND: In situ simulation (ISS) is an emerging teaching strategy aimed to improve professionals' competencies and collaborative practice to increase patient safety The impact of ISS is still to be demonstrated before expanding the use of this method in our critical care settings. PURPOSE: The objective of this paper is to explore the literature regarding ISS training and present advantages and challenges. DESIGN AND METHOD: An integrative review was conducted, based on the preferred reporting items for systematic reviews and meta-analyses (PRISMA) statement. Online databases MEDLINE and CINAHL were searched. The main keywords used were "in situ simulation", "communication" and "interdisciplinary". We excluded studies conducted outside of the hospital or the clinic, single case studies and framework analyses. FINDINGS: Twenty-eight articles were reviewed. Studies were mainly descriptive and exploratory. They underlined the advantages and challenges of the ISS training regarding safety, as well as the perspectives of patients, families, health care providers and administrators. CONCLUSION AND NURSING IMPLICATIONS: Although ISS is a promising educational strategy to increase patient safety, there is still a need for higher evidence level research to support its efficacy to improve competencies. With regard to patient safety improvement, ISS-based training offers opportunities to identify hazards and deficiencies of clinical systems and the provider team. Experimental studies are necessary to increase evidence about the impact of ISS training.