title: Randomized, controlled trial of the effectiveness of simulation education: A 24-month follow-up study in a clinical setting.
abstract: BACKGROUND
  Critical care nurses' knowledge and skills in adhering to evidence-based guidelines for avoiding complications associated with intubation and mechanical ventilation are currently limited. We hypothesized that single simulation education session would lead to a long-lasting higher level of skills among critical care nurses.
  
  
  METHODS
  A randomized controlled trial was conducted in a 22-bed adult mixed medical-surgical intensive care unit in Finland during the period February 2012-March 2014. Thirty out of 40 initially randomized critical care nurses participated in a 24-month follow-up study. Behavior and cognitive development was evaluated through a validated Ventilator Bundle Observation Schedule and Questionnaire at the baseline measurement and repeated 3 times during simulation and real-life clinic settings.
  
  
  RESULTS
  After simulation education, the average skills score increased from 46.8%-58.8% of the total score in the final postintervention measurement (Ptime < .001, Ptime × group = .040, and Pgroup = .11). The average knowledge scores within groups did not change significantly. The average between-group difference in skills scores was significant only at the measurement taken at 6 months (P = .006).
  
  
  CONCLUSIONS
  Critical care nurses' skills in adhering to evidence-based guidelines improved in both groups over time, but the improvements between the study groups was significantly different only at 6 months and was no longer evident after 2 years following a single simulation education.
authors.affiliation: Division of Intensive Care, Department of Anesthesiology, Oulu University Hospital, Oulu, Finland; Institute of Health Science, University of Oulu, Oulu, Finland; Medical Research Center Oulu, Oulu, Finland. Electronic address: miia.jansson@oulu.fi.
authors.forename: Miia M
authors.initials: MM
authors.lastname: Jansson
authors.affiliation: Medical Research Center Oulu, Oulu, Finland; Department of Infection Control, Oulu University Hospital, Oulu, Finland.
authors.forename: Hannu P
authors.initials: HP
authors.lastname: Syrjälä
authors.affiliation: Department of Anesthesiology, Oulu University Hospital, Oulu, Finland.
authors.forename: Pasi P
authors.initials: PP
authors.lastname: Ohtonen
authors.affiliation: Division of Intensive Care, Department of Anesthesiology, Oulu University Hospital, Oulu, Finland; Medical Research Center Oulu, Oulu, Finland.
authors.forename: Merja H
authors.initials: MH
authors.lastname: Meriläinen
authors.affiliation: Institute of Health Science, University of Oulu, Oulu, Finland; Medical Research Center Oulu, Oulu, Finland; Northern Ostrobothnia Hospital District, Oulu, Finland.
authors.forename: Helvi A
authors.initials: HA
authors.lastname: Kyngäs
authors.affiliation: Division of Intensive Care, Department of Anesthesiology, Oulu University Hospital, Oulu, Finland; Medical Research Center Oulu, Oulu, Finland.
authors.forename: Tero I
authors.initials: TI
authors.lastname: Ala-Kokko
mesh_terms: D000328:Adult; D004506:Education, Nursing / Q000379:methods*; D005260:Female; D005387:Finland; D005500:Follow-Up Studies; D019983:Guideline Adherence; D006801:Humans; D007362:Intensive Care Units; D007442:Intubation, Intratracheal / Q000379:methods*; D008297:Male; D012121:Respiration, Artificial / Q000379:methods*; D000066908:Simulation Training / Q000379:methods*
keywords: Critical care; Knowledge; Mechanical ventilation; Nursing education; Skills