In Japan, nursing education is being reformed to improve nurses' competency. Interest in use of simulation-based education to increase nurses' competency is increasing.


To examine the effectiveness of simulation-based education in improving competency of cardiovascular critical care nurses.


A training program that consisted of lectures, training in cardiovascular procedures, and scenario simulations was conducted with 24 Japanese nurses working at a university hospital. Participants were allocated to 4 groups, each of which visited 4 zones and underwent scenario simulations that included debriefings during and after the simulations. In each zone, the scenario simulation was repeated and participants assessed their own technical skills by scoring their performance on a rubric. Before and after the simulations, participants also completed a survey that used the Teamwork Activity Inventory in Nursing Scale (TAINS) to assess their nontechnical skills.


All the groups showed increased rubric scores after the second simulation compared with the rubric scores obtained after the first simulation, despite differences in the order in which the scenarios were presented. Furthermore, the survey revealed significant increases in scores on the teamwork scale for the following subscale items: “Attitudes of the superior” (P < .001), “Job satisfaction” (P = .01), and “Confidence as a team member” (P = .004).


Our new educational approach of using repeated scenario simulations and TAINS seemed not only to enhance individual nurses' technical skills in critical care nursing but also to improve their nontechnical skills somewhat.

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