Interprofessional in situ simulation to improve non-technical skills among nurses: A systematic review

Abstract

Purpose: This study aimed to systematically review interprofessional in situ simulation education to improve non-technical skills (NTS) among nurses working in hospital settings.Methods: A systematic literature review was conducted and reported in accordance with the PRISMA 2020 (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) statement and registered with PROSPERO (CRD420251070859). Five electronic databases were searched. Studies were included if they involved interprofessional in situ simulations, included nurses as participants, and reported NTS outcomes measured. Risk of bias was assessed using RoB 2 for randomized controlled trials (RCTs) and ROBINS-I (Risk Of Bias In Non-randomized Studies of Interventions) for non-randomized studies.Results: One RCT and 18 quasi-experimental studies were included. Simulation locations included emergency departments, operating rooms, intensive care units, obstetric wards, and outside the wards. Teamwork was the most frequently assessed NTS domain, followed by communication and leadership. Most studies reported significant short-term improvements in NTS following simulation training, although findings on long-term sustainability were inconsistent. Improvements in NTS were observed regardless of simulator fidelity, and no significant differences were identified between in situ and off-site simulations. Only one study reported identification of latent safety threats.Conclusion: Interprofessional simulation is an effective educational strategy for improving nurses’ NTS, particularly teamwork, communication, and leadership, regardless of simulator or environmental fidelity. However, evidence regarding sustained effects and system-level outcomes remains limited. Future research should incorporate repeated simulation training, profession-specific outcome reporting, and systematic approaches to identifying and mitigating latent safety threats.