Simulation in Nurses Knowledge Training and Improvement Proposal

Rationale

The unpredictable nature of disasters and the numerous effects that they have on local communities makes it impossible for a single entity, be it an agency or an organisation, to claim full responsibility¹. The issue of disaster management remains topical in the Kingdom of Saudi Arabia (KSA).² Therefore, KSAN ED nurses must be aware of the array of areas that they must be able to address and control when it comes to meeting the needs of the patients who have suffered from disasters (including manmade and natural ones)³.

In KSA, possible terrorist attacks, car crashes, and accidents during the Ramadan and Hajj seasons can be viewed as possible sources of manmade disasters that require appropriate management.2 However, the unpredictability of the subject matter makes it difficult for ED nurses to immediately conjure a strategy that would help meet the needs of the target population within the shortest time possible⁴. Therefore, KSAN ED nurses must be equipped with the knowledge and skills that will allow them to manage the relevant issues fast and design appropriate strategies successfully⁵. Simulations, which have proven to be quite successful as the means for training ED nurses’ skills in other areas, should be tested for efficiency as interventions for improving ED nurses’ level of proficiency and knowledge of managing people’s health needs during disasters⁶.

Herein lies the rationale for the study; it is crucial to test whether simulations can be used to promote more efficient management of the needs of the people who have suffered from disasters. Thus, nursing service quality and patient outcomes will be improved significantly.

Evidence Review

Disasters and Patients’ Needs

During disasters, patients require guidelines from ED nurses regarding clinical, administrative, and communication-related issues.⁷ The current situation regarding disaster communication remains quite deplorable: “There have been problem areas consistently identified in trauma centres’ responses to previous MCIs, including leadership, hazard planning, the sustainability of peak operations, communication, education, interagency cooperation and regional integration.”⁸

Therefore, ED nurses must develop the relevant communication skills allowing them to provide the necessary information in a manner as fast and efficient as possible. Given the levels of stress and panic among the target population, the task Furthermore, it is imperative that ED nurses should develop leadership abilities that will allow them to carry out the required administrative tasks, e.g., coordinate patient care, conduct patient transfers, etc. To be more specific, it is crucial to make sure that the patient should be located in the right facility, which is often a problem during a disaster. The administrative responsibilities of an ED nurse, therefore, must include the coordination of the processes associated with patient relocation.⁹

Similarly, a KSA ED nurse must make sure that the search, rescue, and first-aid operations should be carried out flawlessly.¹⁰ Likewise, the leadership skills that will allow an ED nurse to guide the affected population and provide them with the necessary instructions making sure that the vulnerable citizens will follow them exactly are required.¹¹ Therefore, ED nurses must train extensively in order to develop the qualifications and skills that will help them deliver the required services efficiently and within the shortest amount of time possible.

Current Approaches

There are several tools for training ED nurses’ knowledge as far as meeting patients’ needs during disasters is concerned; these include the development of a triage drill toolkit¹², the prevention-preparation-response-recovery approach 6, exercises with injects (i.e., challenging exercises requiring an immediate response)¹³, to name a few. Simulations rank high on the list of tools that are deemed as the most efficient for training disaster management skills in ED nurses 3.

Implementation Problems

Studies show that at present, there is a range of issues with the successful management of patients’ needs during disasters because of the lack of appropriate skills and competencies among KSA ED nurses.¹⁴ For instance, a recent analysis of disaster levels preparedness in the setting of Iranian hospitals indicated that most ED nurses were “unfamiliar with ICS, reporting methods, and access to data resources”¹⁵.The fact that KSA ED nurses’ ability to distinguish between different epidemiological and biological agents that affect the development of the relevant symptoms should also be listed among the main concerns.

Simulations and Their Effects

When considering the benefits of simulations as the means of training ED nurses’ skills for managing disaster situations, one must first bring up the fact that simulations recreate the situations that are typically viewed as rare and, therefore, cannot be viewed as easy to imitate in the context of a typical nursing environment 5. Therefore, the use of simulations, in general, and VRS, in particular, must be considered one of the essential training tools for increasing the levels of competence among ED nurses as far as the management of people’s needs during disasters is concerned.

Furthermore, virtual reality simulations (VRSs) allow for not only training of new skills but also the retention of the ones that were acquired a while ago, as Farra’s¹¹ study indicates. The fact that, during simulations, no possible harm can be done to patients even in case an ED nurse fails to perform the necessary tasks and deliver the required services should also be listed among the primary advantages of deploying the identified tools into the training process⁹.

Simulations also contribute to active knowledge acquisition based on the experience acquired in the process. As a result, the foundation for lifelong learning and regular update of the relevant skills and competencies will be built. Thus, ED nurses will be able to deliver the services of the finest quality to the victims of disasters.¹⁶

Several studies point to the fact that collaboration between military ED nurses and the staff operating in the context of a typical nursing facility is crucial to make sure that the required services should be provided to the target population during disasters immediately: “The development of collaborative military and civilian training platforms in the United States has generated active exchange of expertise and can lead to improved preparation for MCI response.”4

In other words, the importance of disaster preparedness is often brought up as a crucial skill that ED nurses must develop in order to prevent injuries and address people’s needs in the identified circumstances.¹⁷ The traditional tools for promoting knowledge and skills acquisition among ED nurses to handle the needs of people suffering from natural and manmade disasters, in their turn, have proven inefficient or lacking efficacy.4 The use of the field environment as the setting in which the process of training occurs, in its turn, has a tangible effect on the acquisition of the skills necessary to cater to the target demographics.¹⁸

Furthermore, simulations have proven to be very efficient in helping ED nurses train flexibility. There is no need to stress that predicting the possible scenario development in case of a calamity is barely a possibility; therefore, ED nurses must be capable of making the right decision within a restricted amount of time. Simulations, in their turn, expose ED nurses to the situations in which they are encouraged to think fast and critically to choose between the available options to produce the best results possible.¹⁹

At this point, the issue of diversity and tending to the needs of multicultural population needs to be discussed. Disasters may affect any population, which means that there is a high probability that an ED nurse may have to address the needs of a multicultural demographic. Thus, it is crucial that an ED nurse should be ready for intercultural dialogue. Simulations can be used successfully for training the ED nurses’ skills to converse with a diverse population successfully and provide the necessary support skills.²⁰

For instance, a recent study addressing the issue of disaster management among the residents of Australia and New Zealand showed that taking the specifics of the Maori culture into account was crucial to maintain the safety levels high: “The Maori community-led recovery network linked with mainstream emergency managers, government agencies and other responders to ensure that resources and support were readily available to the culturally diverse communities of Christchurch.”²¹

It should be borne in mind, though, that the use of simulations has its problems and limitations. For instance, when attempting to enhance the educational outcome in ED nurses as far as their ability to approach a disaster-related situation is concerned, one should use the case-based learning (CBL) framework as the foundation, according to a recent study.²² Despite the fact that both approaches serve the purpose of satisfying andragogy assumptions, the CBL tool forecasts the possible outcome a bit better: “Both CBL and simulation satisfy the andragogic assumptions; however, contemporarily simulation has become the more commonly used modality across multiple venues of medical education.”¹⁵

However, the specified characteristic of simulations is only applicable to the situations in which the skills for managing a specific type of a disaster are trained.¹⁵ To help ED nurses develop the skills that will allow them to manage any disaster and meeting the needs of a diverse population, one must use simulations as one of the most efficient tools in existence.^{23, 24}

Project Description

The project will explore the effects of simulations as the tool for improving the quality of nursing services in the context of a disaster. Particularly, different aspects of disaster management, including clinical and administrative steps to be taken by ED nurses to facilitate safety and fast management of people’s needs, will be considered. The project will involve a quantitative analysis of the effects that simulations have on the ED nurses’ ability to reduce the number of injuries received by the target population and tend to the needs of the people that have received physical and emotional traumas.

It is expected that the project will shed light on the benefits of using simulations, and well as help determine the problems that the application of the specified framework entails. Furthermore, the project will presumably help define the means of managing the limitations that simulations imply.

The research will be conducted as a quantitative study in the context of a local nursing facility. The participants of the organisation will be offered a series of simulation-based training session with the following assessment of their disaster management skills. By comparing their previous records to the ones delivered by the control group, where no simulations will be provided, one will be able to determine the efficacy of the latter.

Aim and Research Question

The goal of the study is to explore the effects that simulations have on the acquisition of disaster management knowledge by ED nurses. Apart from the outcomes of using simulations, the limitations of the identified approach will be determined. Consequently, the development of the questionnaire that will help address the identified problems will be the third objective of the study.

The research question is as follows: “Can simulation assist in improving knowledge on disasters among the ED nurses working in a metropolitan hospital in KSA?” It is expected that, upon the completion of the said objectives, one will have a set of arguments supporting the development of a simulation-based framework for improving ED nurses’ skills of disaster managing. Creating the environment in which patients are provided with the required services in a manner as efficient and expeditious as possible will contribute to a significant drop in mortality rates among the victims of disasters, including both natural and manmade ones.²⁵ Furthermore, the approval of the Ministry of Health in Saudi Arabia will be necessary.

Ethics

Seeing that the current research requires recruiting human subjects as the participants of the simulation, it will be required to receive the approval of MUHREC. To be more exact, the use of the material that may be culturally sensitive, e.g., the description of the cultural specifics of patients, should be supervised based on the MUHREC guidelines. The application for a mixed method research has been chosen. Therefore, the approval of the Monash University Human Research Ethics Committee will be required.²⁶

Participants and Data

Seeing that the study will require that the information about the professional experiences of the participants, as well as their responses to the identified situations, should be used in the course of the study, it is essential that an informed consent form should be signed by all people taking part in the research. Therefore, it will be necessary to make sure that all volunteers should sign the appropriate informed consent form. Thus, the integrity of the study will remain high. It is expected that a total of 200 ED nurses will participate in the study.

It is also crucial that the participants should meet the exclusion and inclusion criteria set for the research. Particularly, seeing that the focus of the study will be on the KSA facilities, it is required that the ED nurses should work in the Saudi Arabian hospitals. Furthermore, only ED nurses with background knowledge and no specific experience of disaster management will be eligible for participation. Once the participants with a similar level of proficiency are selected, the opportunity for producing homogenous and reliable results will be created. The participant of the research will be recruited from local Saudi Arabian nursing facilities.

Data Collection

To collect the relevant data, one will have to consider questionnaires. The identified tool for data collection will help collect the quantitative data that will allow determining the efficacy of simulations as the framework for training the skills of KSAN ED nurses in the area of disaster management.

The data will be collected by assessing the participants’ skills before and after the simulations. Seeing that two types of information will have to be collected, one will have to make sure that the relevant information should be categorised accordingly. Since the possibility of the research bias is rather high in the identified scenario, it will be necessary to use random sampling as the means of diversifying the samples. The chart below shows that the process of data collection will have to be twofold:

Risks

Since the study will be conducted in the environment of a healthcare facility and controlled closely by the researchers, no physical risks to participants are expected to be observed. Possible risks will be minimized by researchers by improving the process of communication with the participants. Psychological risks may become a problem since the study will focus on extensive training of disaster management skills and, therefore, will imply that the people taking part in the study will be put under considerable emotional strain. Therefore, one should consider the activities that will help reduce the stress levels will have to be used as risk mitigation tools. Thus, the possibility of the research participants developing health issues such as PTSD during the study will be reduced to a minimum.

Te study does not feature any dependent or unequal relationships. In the context of a simulation, all participants will have equal chances at succeeding, and neither will be provided with any advantages that will help them succeed without making any effort. Thus, the foundation for research integrity will be created.

Feasibility

It is expected that the project will be completed within 9 months. During the first two months, the preliminary data will be gathered. The participants will attend simulation sessions for four months so that they could develop the required skill and competencies. During the next two months, the data will be processed and arranged. Finally, it will take one more month to arrange the data and represent the key findings.

It is assumed that the project will not require extra funding. The required information will be accessed after the permission to use the information from the databases will be granted by the facilities. It is expected that the simulation technique will prove to have a significant positive effect on ED nurses’ ability to address patients’ needs during disasters.

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