When faced with a critical incident, such as a patient in anaphylactic shock, nurses must make quick decisions despite in the complex, dynamic circumstances . They must have situational awareness and automation so that they can perceive important information, comprehend present events, project future events, and avoid patients’ harm caused by some preventable errors . The present study describes a simulated scenario of anaphylactic shock. In this scenario, new graduated nurses were allowed to evaluate and manage a critically ill patient presenting with anaphylaxis in a safe environment that did not put a patient at risk. Following the simulation, the learners reported an improved understanding of their roles and responsibilities during the rescue of a patient with anaphylactic shock. Consistent with these findings, healthcare providers in a pediatric emergency unit provided a simulation-based training in the management of anaphylaxis by using a high-fidelity patient simulator mannequin and the training was better able to use epinephrine and refer patients to the allergy unit for evaluation , while nurses participating in clinical simulations of anaphylaxis in a hospital setting reported enhanced confidence in patient assessment skills, recognition of a problem, and accurate communication of findings to others on the healthcare team .
In healthcare, simulation-based training provides learner-centered educational opportunities that are designed to demonstrate procedures in an environment that mimics the reality of a clinical setting. Simulation allows an educator to control the learning environment, give immediate feedback, and promote learners’ decision making and critical thinking skills. Simulation-based training provides a relatively safe teaching environment in which new learners can gain knowledge from their mistakes, develop the ability to complete tasks intuitively, and enhance their clinical competency [17, 18]. Several studies have shown simulation-based training is superior to didactics and demonstration for teaching technical and nontechnical skills in healthcare providers [19–21].
In the present study, instructors’ assessment of learners’ clinical competency pre- and post-simulation showed significant improvements in learners’ assessment skills and their ability to place the patient in the correct position, call the RRT, maintain an airway, and administer oxygen and other therapies. The learners developed the ability to recognize anaphylaxis, identify and remove the antibiotic, which was necessary to prevent clinical decompensation in the patient. They also realized the importance of promptly calling the RRT whose role is to intervene as early as possible in a deteriorating patient to avoid further, preventable critical events and so reduce the inhospital morbidity and mortality . At present, multidisciplinary RRT have been successfully integrated into many hospitals resulting in improved resuscitation rates, increased morale and empowerment among nurses, redistribution of workload for nurses (reducing neglect of non-acutely ill patients during emergencies), and immediately access to expert help [23, 24]. The learners became familiar with the resuscitation steps, including giving oxygen by face mask and aiming for an oxygen saturation above 92%, and the treatment options for a patient with anaphylaxis, such as epinephrine, H1 antihistamines, H2 blockers for immunoglobulin E mediation, and administration of steroids.
The learners’ evaluations of the simulation were very positive. Simulation-based training provided a realistic clinical experience that facilitated learners’ professional development and increased their self-confidence as members of a practicing healthcare team [25, 26]. Most learners believed that the simulation mimicked the clinical environment and enhanced their understanding of early, rapid recognition and treatment of anaphylactic shock. 99.04% of the learners reported that the instructors had been helpful, while 97.12% of the learners reported that the instructors were supportive. This was especially important as some learners felt overwhelmed and helpless when faced with a patient who was having difficulty breathing, even during simulation. Previous studies have reported the efficacy of simulation-based training in nurses, indicating that simulation builds confidence, makes learners aware of the aspects of care that need to be improved through deliberate practice, increases nurses’ motivation to learn and transfer their knowledge, and strengthens communication among team members [25, 27–28].
This study had some limitations. Firstly, the sample size was not calculated prior to performing the study as a literature search revealed no similar research for a reference. However, all new registered nurses contracted to work at the hospital for one year participated in this study. Secondly, this study did not include a control group. The study aimed to improve the clinical competency of new registered nurses; therefore, a pretest posttest study design was adopted. Thirdly, learners’ self-reports were used to evaluate the program of the training. Although their self-reports were easy to obtain, the approach is associated with response bias due to false reporting and variations in learners’ capacity to interpret questions and their introspective ability. Fourthly, the Chinese version of the SDS has some limitations. The scale is not widely used, so its reliability may be questioned. A few items have factor loadings < 0.4, which may have an impact on validity . Lastly, the scenario was not validated as a reliable simulation of anaphylactic shock. However, the outcomes of this study suggest this simulation is applicable for training new registered nurses and warrants further development.