Learning by simulation in prehospital emergency care - an integrative literature review.
BACKGROUND
Acquiring knowledge and experience on high-energy trauma is often difficult due to infrequent exposure. This creates a need for training which is specifically tailored for complex prehospital conditions. Simulation provides an opportunity for ambulance nurses to focus on the actual problems in clinical practice and to develop knowledge regarding trauma care. The aim of this study was to describe what ambulance nurses and paramedics in prehospital emergency care perceive as important for learning when participating in simulation exercises.


METHODS
An integrative literature review was carried out. Criteria for inclusion were primary qualitative and quantitative studies, where research participants were ambulance nurses or paramedics, working within prehospital care settings, and where the research interventions involved simulation.


RESULTS
It was perceived important for the ambulance nurses' learning that scenarios were advanced and possible to simulate repeatedly. The repetitions contributed to increase the level of experience, which in turn improved the patients care. Moreover, realism in the simulation and being able to interact and communicate with the patient were perceived as important aspects, as was debriefing, which enabled the enhancement of knowledge and skills. The result is presented in the following categories: To gain experience, To gain practice and To be strengthened by others.


CONCLUSIONS
Learning through simulation does not require years of exposure to accident scenes. The simulated learning is enhanced by realistic, stressful scenarios where ambulance nurses interact with the patients. In this study, being able to communicate with the patient was highlighted as a positive contribution to learning. However, this has seldom been mentioned in a previous research on simulation. Debriefing is important for learning as it enables scrutiny of one's actions and thereby the possibility to improve and adjust one's caring. The effect of simulation exercises is important on patient outcome.
Department of Health Sciences, Karlstad University, Karlstad, Sweden.
Anna
http://orcid.org/0000-0002-1641-6321
A
Abelsson
Department of Health Sciences, Karlstad University, Karlstad, Sweden.
Ingrid
I
Rystedt
School of Health Science, University of Borås, Borås, Sweden.
Björn-Ove
BO
Suserud
Department of Health Sciences, Karlstad University, Karlstad, Sweden.
Lillemor
L
Lindwall
D004632:Emergency Medical Services / Q000458:organization & administration*; D006801:Humans; D007858:Learning; D016544:Patient Simulation
accident and emergency; acute care; advanced nursing practice; clinical nurse specialist; emergency; paramedical care