Team competence among nurses in an intensive care unit: the feasibility of in situ simulation and assessing non-technical skills.

OBJECTIVES: Nursing competence affects quality of care in intensive care units (ICUs). Team competence is particularly important for preventing errors. This paper focuses on the feasibility of using an in situ simulation model to explore team competence in the ICU, and on using parts of the Anaesthetists' Non-Technical Skills (ANTS) taxonomy for assessing Non-Technical Skills (NTS) in nursing teams. METHODOLOGY/DESIGN: Seventy-two nurses were randomised into two groups and introduced to a new guideline via either lecture-based or simulation-based teaching. A preprogrammed patient simulator and a video camera were installed inside the ICU, and a scenario was enacted to simulate the admission of a patient with septic shock. All available facilities in the ICU were used. Two blinded raters evaluated "Team Working" and "Situation Awareness" via video recordings using the ANTS taxonomy. RESULTS: Due to high activity in the ICU, 54 nurses completed the in situ simulation. Assessments of the video recordings revealed moderate agreement between the two raters. Observations revealed issues deviating from expected standards of competence. CONCLUSION: In situ simulation may be feasible for assessing competence in ICUs. The ANTS appears to be a promising foundation for developing a team assessment tool for ICUs.