High-fidelity simulation and safety: an integrative review.

Previous reviews of simulation relating to critical thinking and efficacy called for more research on the effects of simulation and safety. Safety, as a skill performance outcome of high-fidelity simulation, is reviewed. Data included studies of nursing education that linked safety dimensions with high-fidelity simulation at all student levels. Only primary sources published since 2007 were included. This integrative review evaluates data using scores to assign value to the evidence, analyzes data within categories defined as safety behaviors, and compares evidence using a matrix of factors and outcomes. Definitions of safety and measurement tools are critiqued. Findings reveal that simulation-enhanced clinical experiences may decrease medication errors. Any evidence about perceived improvement in safer communication has not been translated into practice. Knowledge and attitudes of safety may be improved with simulation, depending on the students' educational levels. More comparative studies are needed to support theoretical models of simulation.