What are the barriers and facilitators to high fidelity in situ simulation from a New Zealand Clinical Nurse Educators' perspective?

Abstract

Increasingly in situ high fidelity simulation (IHFS) is being used within clinical environments to meet the ongoing learning needs of nurses and interdisciplinary teams in order to improve patient outcomes. The objective of this research study is to explore the barriers and facilitators to in situ high fidelity simulation from a New Zealand Clinical Nurse Educator (CNE) perspective. This study takes a mixed method approach to examine practice amongst CNEs in New Zealand at one point in time. It involves two phases of data collection; one a quantitative online survey involving CNEs from five New Zealand District Health Boards (DHBs) to gather perspectives from a wider audience. The second phase was a qualitative focus group from the researchers’ own DHB to explore in more detail concepts arising from the survey results. The survey was developed for this study by the researcher and questions were based on a review of the literature. The focus group was semi structured with a series of open ended questions to ensure the beliefs and opinions of the CNEs were captured. Results demonstrated that many CNEs are using IHFS, but for some its use is still in its infancy with a number of distinct barriers apparent. For the CNEs with embedded IHFS in their practice there was substantial leadership, interdisciplinary support and collaboration within their organisation for this type of training. These CNEs report the availability of funding, training, well-developed frameworks and local support networks to better facilitate IHFS. Despite a desire by all to undertake IHFS barriers exist for many CNEs. These barriers encompass all aspects of IHFS from resource availability, interdisciplinary support, time, professional development for instructors, technical expertise, funding, lack of structured frameworks, lack of quality review processes and the lack of a standardised approach within the organisation for implementation. Discussion generated using this research approach led to the identification of several implications for practice with recommendations for CNEs. Practice implications incorporated the need for a clear change management process to ensure all members of the team and organisational management buy into IHFS. This study found that demonstrating benefits of IHFS improves engagement and can assist in promoting the need to fund the development of a professional, structured IHFS program. IHFS must be realistic, learner focused and run by experts to ensure learning is converted into actual clinical behaviours to improve patient safety.