ASSESSING THE IMPACT OF SIMULATION-BASED TRAINING ON NURSE COMPETENCE IN EMERGENCY CARE

Abstract

Objective: This experimental study assessed the impact of simulation-based training on nurse competence in emergency care at a tertiary hospital in Khyber Pakhtunkhwa (KPK), Pakistan, with a focus on triage, resuscitation, and systematic patient assessment.

Methods: The study was conducted in the adult emergency department of a large public-sector tertiary hospital in KPK. Registered nurses with at least six months of ED experience were randomly allocated to an intervention group receiving a structured high-fidelity simulation programme in addition to routine in-service education, or to a control group receiving routine education alone. The intervention comprised four locally contextualized simulation scenarios (polytrauma with hemorrhagic shock, acute coronary syndrome with cardiac arrest, sepsis with shock, and multi-casualty incident triage), each followed by a structured debriefing. Competence in triage, cardiopulmonary resuscitation (CPR), and primary/secondary survey was measured at baseline and four weeks after training using Objective Structured Clinical Examination (OSCE) checklists and a multiple-choice knowledge test. Self-reported confidence was assessed with a validated Likert-scale questionnaire. Data were analysed using paired and independent t-tests and analysis of covariance, adjusting for baseline scores.

Results: A total of 82 nurses completed the study (intervention n = 41; control n = 41). At baseline, groups did not differ significantly in knowledge, OSCE performance, or confidence scores. After four weeks, the intervention group showed significantly greater gains in overall OSCE scores compared with the control group (mean difference 12.8 percentage points, 95% CI 9.4–16.1; p < 0.001). The largest improvements were observed in triage accuracy, adherence to CPR algorithms, and completeness of the primary survey. Knowledge scores increased in both groups but were significantly higher in the intervention group post-test (p < 0.001). Self-reported confidence in managing unstable patients, prioritising care, and recognising deterioration also increased significantly in the simulation group, with only minimal change in the control group. No adverse events related to training were reported.

Conclusion: Simulation-based training, integrated into routine professional development, significantly improved emergency nurses’ competence and confidence in triage, resuscitation, and patient assessment in a tertiary hospital in KPK, Pakistan. These findings supported the incorporation of structured, context-specific simulation programmes with debriefing into emergency nursing education in resource-constrained settings as a strategy to strengthen patient safety and quality of care.