Thesis: Simulation-based team training of non-technical skills for anaesthesia personnel – Significance and transfer of learning to clinical practice
Anne Strand Finstad’s thesis explored simulation-based team training of non-technical skills for anaesthesia personnel – Significance and transfer of learning to clinical practice.
The overall aim of this PhD project was to study anaesthesia personnel’s experiences with the use of simulation-based team training (SBTT) of non-technical skills (NTS), and the transfer of learning from simulation to clinical practice.Methods: The thesis is based on three studies, using qualitative and quantitative methods. Study I explored how anaesthesia personnel in Norway conducted SBTT of NTS with respect to four core areas: outcomes and objectives, facilitation, debriefing, and participant evaluation. A qualitative descriptive study design based on individual interviews, and a qualitative deductive content analysis was used. Study II explored anaesthesia personnel’s experiences with interprofessional in situ SBTT of NTS and its significance for transfer of learning to clinical practice. A qualitative descriptive study design based on focus group interviews, and a qualitative manifest and inductive content analysis was used. In Study III anaesthesia personnel’s NTS were observed before and after SBTT to assess the transfer of learning to clinical practice. A quasiexperimental before and after design based on video recorded observations and rating of anaesthesia teams’ NTS was used before and after SBTT. The Anaesthetists’ Non-Technical Skills System (ANTS) was used to score the teams’ performance. Paired-samples t-test was used to evaluate the impact of the intervention. Data were analysed using SPSS Statistics 28 and descriptive and comparative statistic was used to present the results. Inter-rater agreement was calculated using Weighted Kappa.Main results: Study I showed common use of objectives and facilitators, and all participants participated in debriefings, and almost all conducted evaluations, mainly formative. Preparedness, structure and time available were pointed out as issues affecting SBTT. In study II, the anaesthesia personnel experienced that interprofessional in situ SBTT motivated transfer of learning and provided the opportunity to be awareof own practice regarding NTS and teamwork. One main category, ‘interprofessional in situ SBTT as a contributor to enhance anaesthesia practice’ and three generic categories, ‘interprofessional in situ SBTT motivates learning and improves NTS’, ‘realism in SBTT is important for learning outcome’, and ‘SBTT increases the awareness of teamwork’ illustrated their experiences. In Study III, the anaesthesia teams showed statistically significant increased NTS performance after SBTT. Interrater reliability showed moderate agreement.Conclusion: The Anaesthesia personnel’s experiences in this thesis contributes to evidence based knowledge regarding SBTT and transfer of learning from SBTT to clinical practice. The anaesthesia personnel’s SBTT in Norway met the International Nursing Association for Clinical Simulation and Learning (INACSL) Standard of Best Practice: SimulationSM to a certain extent, and preparedness, structure and time available were highlighted as affecting SBTT (Study I). There was a need for more use of debriefing template to achieve outcomes and learning objectives and more structured and summative evaluation (Study I). The anaesthesia personnel were satisfied with SBTT of NTS (Studies I and II). The anaesthesia personnel in interprofessional in situ SBTT (Study II) gained experiences in coping with emotions and demanding situations, which could be significant for transfer of learning essential for clinical practice. Team communication and decision making were highlighted as important learning objectives. Furthermore, the anaesthesia personnel emphasized the importance of realism and fidelity and interprofessional and professional reflections in debriefs crucial for awareness of their own clinical practice. Observing and rating the anaesthesia personnel’s NTS in clinical practice before and after SBTT (Study III), resulted in improved NTS performance. This may indicate transfer of learning from SBTT to clinical practice.
Anne Strand Finstad is a nurse anaesthetist and holds a master’s degree in vocational pedagogy from Oslo Metropolitan University (OsloMet). She defended her thesis March. She currently works as a nurse anaesthetist, both in the clinic and with professional development and research in Oslo University Hospital (OUS).
21th, 2024.
Supervisors
Main supervisor:
Professor Randi Ballangrud, Norwegian University of Science and Technology, Gjøvik, Norway.
Co-supervisor:
Professor Conrad Arnfinn Bjørshol, Stavanger University Hospital
Professor Ingunn Aase, University of Stavanger, Norway
