An integrative review of in situ simulation training: Implications for critical care nurses.

BACKGROUND: In situ simulation (ISS) is an emerging teaching strategy aimed to improve professionals' competencies and collaborative practice to increase patient safety The impact of ISS is still to be demonstrated before expanding the use of this method in our critical care settings.

PURPOSE: The objective of this paper is to explore the literature regarding ISS training and present advantages and challenges.

DESIGN AND METHOD: An integrative review was conducted, based on the preferred reporting items for systematic reviews and meta-analyses (PRISMA) statement. Online databases MEDLINE and CINAHL were searched. The main keywords used were "in situ simulation", "communication" and "interdisciplinary". We excluded studies conducted outside of the hospital or the clinic, single case studies and framework analyses.

FINDINGS: Twenty-eight articles were reviewed. Studies were mainly descriptive and exploratory. They underlined the advantages and challenges of the ISS training regarding safety, as well as the perspectives of patients, families, health care providers and administrators. CONCLUSION AND NURSING IMPLICATIONS: Although ISS is a promising educational strategy to increase patient safety, there is still a need for higher evidence level research to support its efficacy to improve competencies. With regard to patient safety improvement, ISS-based training offers opportunities to identify hazards and deficiencies of clinical systems and the provider team. Experimental studies are necessary to increase evidence about the impact of ISS training.