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Stress and anxiety management strategies in health professions' simulation training: a review of the literature
  1. Jeanette Ignacio1,
  2. Diana Dolmans2,
  3. Albert Scherpbier2,
  4. Jan-Joost Rethans2,
  5. Sally Chan3,
  6. Sok Ying Liaw1
  1. 1Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
  2. 2Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
  3. 3Faculty of Health and Medicine, School of Nursing and Midwifery, University of Newcastle, Newcastle, New South Wales, Australia
  1. Correspondence to Dr Jeanette Ignacio, Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Level 2, Clinical Research Centre, Block MD11, 10 Medical Drive, Singapore 117597, Singapore; nurimjj{at}


Introduction Simulation training has been used to teach clinical skills to health profession trainees. Stress and/or anxiety occur in high-acuity scenarios in the clinical environment, and affect clinician performance and patient outcomes. To date, strategies that have been used in conjunction with simulation training for healthcare professionals that address stress management are limited. This paper reports a literature review conducted to explore strategies used with simulations to enhance the ability of health profession trainees in reducing acute stress and/or anxiety during high-acuity clinical events.

Methods Databases searched included Scopus, PubMed, CINAHL, Web of Knowledge and Science Direct. The examples of the literature chosen were those published in the English language from January 2005 to March 2015, and were peer-reviewed empirical papers that focused on the strategies addressing stress and/or anxiety during simulation training for healthcare profession trainees.

Results Eight studies using various forms of stress/anxiety management strategies with simulations demonstrated varying degrees of effectiveness. Themes that emerged from these eight studies were excessive stress and clinical performance in simulation, emotional training strategies in simulation, and factors contributing to stress and anxiety reduction during simulation.

Conclusions Excessive stress and/or anxiety in the clinical setting have been shown to affect performance and could compromise patient outcomes. Health profession training curricula might benefit from a stress/anxiety reduction strategy integrated into the simulation programmes. This review showed that the stress/anxiety management strategies that have been used with simulations, mostly in surgical training, have various degrees of effectiveness.

  • Emotional training
  • Stress management
  • Anxiety management
  • Health professions education
  • Simulation training

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