Using high fidelity simulation to increase confidence in rehabilitation nurses

Abstract

Purpose: The purpose of this study was to explore nurses' reactions, competence and confidence levels before and after exposure to clinically relevant situations that could be addressed in simulation or in traditional learning environments.

Methods: A nonrandomized controlled study consisting of forty rehabilitation nurses was conducted at the VA Palo Alto Hospital in Palo Alto California. Nurses were placed in to either a control (C=Control) or intervention (I=Intervention) group. Each group of twenty would complete pre and post questionnaires using a Likert scale designed to test their level of confidence and comfortability after exposure to three scenarios found in the rehabilitation setting. The control group would receive information in a traditional format of power point lecture and interactive discussion, and the intervention group would be immersed in a reality-based environment using the simulation lab and a high fidelity mannequin. The intervention group would be filmed and debriefed after their experience. Data collected from the questionnaires would be collected and coded into an Excel spreadsheet to allow for export to a statistical software program to determine confidence interval and degree of change mean scores and effect size. A twelve month follow up was conducted to assess retention.

Results: Expected results differed from actual outcomes as there was little measurable difference between the intervention and control groups, although each group reported increased scores after both traditional and simulation learning. However, the twelve month follow up showed measurable increase in retention among the intervention group. Ordinal data was used with two independent groups. Non-parametric tests of significance were compared using a Wilcoxon test since normality could not be assumed. For comparison purposes, two sample t-tests were run, and the results were comparable to the Wilcoxon analysis. Power could not be determined because no true difference was known. Effect size of the possible benefit when introducing a new teaching method was calculated when appropriate.

Conclusions: The findings provide evidence that high fidelity simulation versus traditional problem based learning provides a greater sustained effect on confidence, competence and comfort levels among experienced rehabilitation nurses.

Clinical Relevance: Competent nurses are associated with improved patient outcomes and competent care arises from knowledge applicable to practice. This study supports the importance of simulation training in increasing clinical competence and confidence.