Abstract
Background: Nursing simulation is vital in Canada but practicing nurses have limited access after graduation. Simulation centres in university hospitals have made it more available, but the COVID-19 pandemic has caused severe manpower shortages, making simulation lab training impractical for clinical teams. Conducting simulation in-situ on the clinical unit, particularly at the Montreal Neurological Hospital (MNH), which is physically removed from the simulation lab, may help overcome these logistical hurdles. In-situ simulation is also an effective way to train or maintain competency for high-risk/low-frequency and high-risk/high-frequency clinical scenarios.
Objective: The aim of this project was to enhance access to simulation-based training for nursing staff at the MNH by developing and implementing an in-situ simulation program.
Description: The innovation involved developing and implementing a simulation program at the MNH, following best practice guidelines from the International Nursing Association for Clinical Simulation and Learning Standards (2022), over the course of one year. The program consisted of six scenarios commonly encountered on in-patient units and the neurocritical care unit, which were simulated in a vacant patient room. The simulation involved advanced practice nurses playing the role of patient and nurse educators acting as facilitators, while groups of 4-5 nursing staff, including registered nurses, new graduates pending licensure, and licensed practical nurses, participated in the simulations that lasted 15-20 minutes. A 20-30 minute debrief using the PEARLS Healthcare Debriefing tool was conducted to provide personalized feedback. Implementing the program required assessing logistical challenges such as organizing manpower, equipment, and training of staff to act as actors and trained facilitators/debriefers. For instance, assistant nurse managers played a significant role in scheduling nurses to ensure cross-coverage of patients during shifts to free staff to attend the simulation. Additionally, evening and night shift staff were scheduled before the start or at the end of their shift, and they were compensated for the 40-45 minutes spent attending the simulation.
Impact: The in-situ simulation program provided a safe learning environment for nurses to participate in simulation training during their shifts. Over 80% of nursing staff took part in at least one of the six simulations, and the post-simulation survey showed that nurses' confidence and perceived preparedness increased after the training. Nurses valued the simulation for providing an outlet to express their emotions, reflect on their practices, and review scenarios. The success of this program suggests that additional simulation activities in the future may help maintain nurses' competency in high-risk/low-frequency and high-risk/high-frequency clinical situations.
