Designing and implementing full immersion simulation for use in clinical research studies

Dr Belinda Munroe1,2, Associate Professor Thomas Buckley2, Professor Kate Curtis1,2, Dr Richard Morris3

1Emergency Services, Illawarra Shoalhaven Local Health District, Balgownie, Australia, 2Sydney Nursing School, University of Sydney, Camperdown, Australia, 3St George Hospital, Department of Anaesthesia, Kogarah, Australia

Background: Simulation is a valuable research tool used to evaluate the clinical performance of devices, people and systems. The simulated setting may address concerns unique to complex clinical environments such as the Emergency Department (ED), which make the conduct of research challenging. There is limited evidence available to inform the development of simulated clinical scenarios for the purpose of evaluating practice in research studies.

Aim: To develop two standardised simulated clinical scenarios to enable the evaluation of emergency nursing performance as part of a clinical research study.

Design/Methods: Existing evidence on simulation design was reviewed and a standardised scenario design template devised. Two clinical scenarios were developed based on common presentations to the ED and real clinical cases (abdominal pain and shortness of breath). These scenarios were validated by content experts, piloted and refined prior to implementation. Thirty eight emergency nurses from five Australian hospital EDs participated in both scenarios. Scenario realism was rated on an 11-point Likert Scales ‘0’ indicating very unrealistic and ‘10’ very realistic. Participants’ experiences of the simulations were assessed via interviews and focus groups. Quantitative data were analysed using descriptive statistics and qualitative data using inductive content analysis.

Results: Two standardised clinical simulated scenarios were devised and were rated to generate a high degree of realism (median (IQR) = 7.50 (2.75)).  Factors including the patient, scenario duration and differences between the simulated and clinical environment were described to influence the fidelity of the scenarios.

Conclusion: This study presents a new clinical scenario design template for the evaluation of clinical performance for clinical research studies, as part of a systematic scenario development and validation process. The scenario development and validation processes undertaken, provides an evidence-informed guide to scenario development for future clinical research studies.


Belinda works an Emergency Clinical Nurse Consultant for the Illawarra Shoalhaven Local Health District. She completed her PhD in 2016, which included validating the first emergency nursing assessment tool internationally. Belinda also holds a peer nominated board position with the College of Emergency Nursing Australasia NSW, and is a Clinical Senior Lecturer at Sydney Nursing School.