Emergency Medicine · Medical Literature
Developing and evaluating an in situ, simulated emergency training course for nurses with low seniority.
Abstract
This study aimed to construct and implement an in situ simulated emergency training (SET) course for nurses with low seniority and evaluate its effectiveness. This was an experimental study, and a purpose-sampling method was adopted. We selected 82 nurses with less than 5 years of experience working in a grade - III Class A hospital in Hubei province from August to December 2023 as the research objects, and randomly divided them into intervention group (n = 37) and control group (n = 45). The control group underwent routine stratified training, whereas the intervention group underwent in situ SET based on routine stratified training. Before and after training, we compared differences in the scores of the intervention and control groups in terms of critical thinking (CT), clinical communication (CC), clinical reasoning (CR), and first aid (FA). The constructed in situ simulated emergency training course consisted of nine courses, each of which covered one theme. The nine themes were acute myocardial infarction, diabetic ketoacidosis, secondary shock due to acute transfusion anaphylaxis, post-operative respiratory depression combined with pulmonary edema, unplanned extubation, impulsive violence, chemotherapeutic drug extravasation, patient suicide, and acute pulmonary embolism. The results of the empirical study showed that before training, there were no differences between the intervention and control groups in the scores for the following abilities: CT, CC, CR, and FA (p > 0.05). After training, the scores for CR and FA in the intervention group were higher than those in the control group (p 0.05). The content of the in situ SET course is comprehensive, which is helpful in improving junior nurses' CC and FA abilities and can serve as a reference for establishing a training course for them. However, the effects on the CT and CC were not significant. Further empirical studies are required to explore the targeted training courses.
Clinical relevance
Junior nurses (fewer than 5 years of experience) represent a high-risk workforce segment in acute care settings, where deficiencies in clinical reasoning and first aid competency can directly impact patient outcomes during emergencies. This study addresses the gap in structured, context-specific emergency training for low-seniority nurses by implementing an in situ simulated emergency training (SET) curriculum across nine high-acuity, real-world clinical scenarios. Given global nursing workforce shortages and the disproportionate burden of emergency care falling on inexperienced staff, evidence-based training models of this kind are of immediate operational relevance to hospital educators and nursing leadership.
Key findings
1. Study population: 82 nurses with fewer than 5 years of experience at a Grade III Class A hospital in Hubei Province (August–December 2023) were randomized to in situ SET plus routine stratified training (intervention, n=37) versus routine stratified training alone (control, n=45). 2. Baseline equivalence: Pre-training scores for all four competency domains — critical thinking (CT), clinical communication (CC), clinical reasoning (CR), and first aid (FA) — were statistically comparable between groups (p > 0.05 for all), confirming adequate randomization. 3. Clinical reasoning (CR): Post-training CR scores were significantly higher in the intervention group versus the control group (p 0.05 for both), representing a key limitation of the current curriculum design. 6. Curriculum scope: The SET course comprised nine themed modules covering high-acuity emergencies including acute myocardial infarction, diabetic ketoacidosis, acute pulmonary embolism, post-operative respiratory depression with pulmonary edema, and patient suicide, among others; no additional quantitative effect sizes, confidence intervals, or NNT/NNH values were reported in the abstract.
Practice implications
Hospital nursing education departments should consider integrating in situ simulated emergency training into onboarding and continuing education programs for nurses with fewer than 5 years of experience, particularly targeting clinical reasoning and first aid competencies across high-acuity scenarios such as acute MI, pulmonary embolism, and post-operative respiratory failure. Because this curriculum did not produce significant gains in critical thinking or clinical communication, future program iterations should supplement simulation with targeted pedagogical strategies — such as Socratic debriefing, communication frameworks (e.g., SBAR), and reflective practice modules — specifically designed to address these domains. Further randomized studies with larger sample sizes, longer follow-up periods, and objective performance metrics (e.g., direct clinical observation, patient outcome proxies) are needed before this model can be broadly generalized across institutions.