Using Simulation With Deliberate Practice to Improve Pediatric ICU Nurses' Knowledge, Clinical Teamwork, and Confidence.

Journal Article (Journal Article)


The purpose of this quality improvement project was to implement an educational intervention involving High-Fidelity Simulation (HFS) with deliberate practice for low-frequency, high-impact events in a Pediatric Intensive Care Unit (PICU), with the goal of improving nurses' crisis management skills.

Design and methods

Four interprofessional simulation education sessions with scenarios were created for this project. A list of knowledge and skills points was used to guide debriefings. All scenarios were based on low-frequency, high-impact events that required the use of Pediatric Advanced Life Support algorithms. Participants included 24 PICU nurses with less than two years of nursing experience. Knowledge and confidence were measured at three timepoints: pre-simulation, one-week post-simulation, and one-month post-simulation series. Clinical teamwork performance was measured twice, during the first and second scenario of each simulation session.


Scores for knowledge, confidence, and clinical teamwork performance improved from pre- to post-simulation, with confidence scores showing the largest increase.


Regular simulation training with deliberate practice can improve PICU nurses' knowledge, clinical teamwork skills, and confidence when managing low-frequency, high-impact events.

Practice implications

Regular in-situ simulation training with deliberate practice can improve nursing comfort with managing high-impact, low-frequency events in the PICU. This could lead to improved management of actual events, especially for novice nurses with less than one year of PICU experience.

Full Text

Duke Authors

Cited Authors

  • Karageorge, N; Muckler, VC; Toper, M; Hueckel, R

Published Date

  • September 2020

Published In

Volume / Issue

  • 54 /

Start / End Page

  • 58 - 62

PubMed ID

  • 32544800

Electronic International Standard Serial Number (EISSN)

  • 1532-8449

International Standard Serial Number (ISSN)

  • 0882-5963

Digital Object Identifier (DOI)

  • 10.1016/j.pedn.2020.05.020


  • eng