Hegland Pål A, Aarlie Hege, Strømme Hilde, Jamtvedt Gro
Western Norway University of Applied Sciences, Department of Health Studies, Norway - and - Centre of Evidence-Based Practice, Western Norway University of Applied Sciences, Norway.
Western Norway University of Applied Sciences, Department of Health Studies, Norway - and - Centre of Evidence-Based Practice, Western Norway University of Applied Sciences, Norway.
Nurse Educ Today. 2017 Jul;54:6-20. doi: 10.1016/j.nedt.2017.04.004. Epub 2017 Apr 19.
Simulation-based training is a widespread strategy to improve health-care quality. However, its effect on registered nurses has previously not been established in systematic reviews. The aim of this systematic review is to evaluate effect of simulation-based training on nurses' skills and knowledge.
We searched CDSR, DARE, HTA, CENTRAL, CINAHL, MEDLINE, Embase, ERIC, and SveMed+ for randomised controlled trials (RCT) evaluating effect of simulation-based training among nurses. Searches were completed in December 2016. Two reviewers independently screened abstracts and full-text, extracted data, and assessed risk of bias. We compared simulation-based training to other learning strategies, high-fidelity simulation to other simulation strategies, and different organisation of simulation training. Data were analysed through meta-analysis and narrative syntheses. GRADE was used to assess the quality of evidence.
Fifteen RCTs met the inclusion criteria. For the comparison of simulation-based training to other learning strategies on nurses' skills, six studies in the meta-analysis showed a significant, but small effect in favour of simulation (SMD -1.09, CI -1.72 to -0.47). There was large heterogeneity (I 85%). For the other comparisons, there was large between-study variation in results. The quality of evidence for all comparisons was graded as low.
The effect of simulation-based training varies substantially between studies. Our meta-analysis showed a significant effect of simulation training compared to other learning strategies, but the quality of evidence was low indicating uncertainty. Other comparisons showed inconsistency in results. Based on our findings simulation training appears to be an effective strategy to improve nurses' skills, but further good-quality RCTs with adequate sample sizes are needed.
基于模拟的培训是提高医疗质量的一种广泛应用的策略。然而，其对注册护士的影响此前尚未在系统评价中得到证实。本系统评价的目的是评估基于模拟的培训对护士技能和知识的影响。
我们检索了CDSR、DARE、HTA、CENTRAL、CINAHL、MEDLINE、Embase、ERIC和SveMed+，以查找评估基于模拟的培训对护士效果的随机对照试验（RCT）。检索于2016年12月完成。两名 reviewers 独立筛选摘要和全文，提取数据，并评估偏倚风险。我们将基于模拟的培训与其他学习策略、高保真模拟与其他模拟策略以及模拟培训的不同组织方式进行了比较。通过荟萃分析和叙述性综合分析对数据进行了分析。采用GRADE评估证据质量。
15项RCT符合纳入标准。在将基于模拟的培训与其他学习策略对护士技能的影响进行比较时，荟萃分析中的6项研究显示出有利于模拟的显著但较小的效果（标准化均数差-1.09，可信区间-1.72至-0.47）。存在较大异质性（I² 85%）。对于其他比较，研究结果之间存在较大的研究间差异。所有比较的证据质量均被评为低质量。
基于模拟的培训效果在不同研究之间差异很大。我们的荟萃分析显示，与其他学习策略相比，模拟培训有显著效果，但证据质量较低，表明存在不确定性。其他比较显示结果不一致。根据我们的研究结果，模拟培训似乎是提高护士技能的一种有效策略，但需要进一步开展具有足够样本量的高质量RCT。
