Harnessing simulation in advanced nurse practitioner skills in Critical Care

Introduction
The Advanced Nurse Practitioner (ANP) role is becoming more prevalent across multiple specialties within healthcare in the United Kingdom and worldwide. Northern Ireland has seen a rise in this specialist nurse programme but in September 2022 the first ANP in Critical Care programme was commenced for trainees at Queen’s University Belfast. The Curriculum is aligned with the Faculty of Intensive Care Medicine (FICM) syllabus for Advanced Critical Care Practitioners (2018). One of the key learning outcomes is that the trainees must be able to clinically demonstrate assessment and decision-making skills when caring for critically ill patients – a challenge in busy real world working environments of Critical Care.
Methods
High fidelity simulation provides a conducive learning environment that can help transform learners' skills in a psychologically safe manner. Moreover, we can adjust the cognitive load for learners, as they can be actively modified from the noise, interruptions and acuity of bedside care in situ. The trainees that are on the programme will be new to this role but have extensive experience in the critical care setting. Using our state-of-the-art facilities InterSim and with guidance from the FICM (2018) syllabus, opportunities for simulation were factored into the design of the Critical Care module undertaken as part of the programme.
Scenarios were designed in collaboration with existing experienced staff in both nursing and medical led simulation education as well as clinical nursing and medical staff with experience in the critical care setting. Such co-production design is aligned to the INASCL (2021) standards with a pre-briefing, the simulation itself and debriefing. Time was allocated to carry out a secondary ‘double’ simulation if it was felt that due to the learning needs of the students and psychological safety trainees should repeat the scenario. This is aimed at improving self-confidence and consolidation of knowledge.
Results & Discussion
As a new programme for trainees, writing the simulation was challenging to meet to learning outcomes. The simulation focuses on intra-hospital transfer- utilising their assessment, decision- making and communication skills to their fullest. Our Highly Immersive Virtual Education (HIVE) facility for simulation, transformed into a CT scanner allows for non-technical skills and human factors such as team work and self-awareness. Debriefing using the PEARLS healthcare debriefing tool (2015) aims to consolidate learning and micro-teaching opportunities led by our co-debriefing team of nursing and medical academics and clinicians.