Abstract
In-situ simulation (ISS) has many known benefits. This systematic review examined the effectiveness of ISS in the acute care setting for registered nurses' clinical competence, as defined by cognitive, skills, and affective learning outcomes. The PRISMA 2020 guidelines were utilized and PUBMED, EMBASE, and CINAHL databases were searched to identify peer-reviewed randomized controlled trials. Inclusion criteria were peer-reviewed randomized controlled trials, acute care setting, ISS, nursing profession, and skill or knowledge learning outcomes. The exclusion criteria were nonintervention simulations, nonpeer-reviewed articles, and a population of no registered nurses or only nursing students. The search yielded 22 articles, seven of which met inclusion criteria. The articles were appraised and found to have acceptable methodology using the Joanna Briggs Institute Critical Appraisal Tool. ISS was found to overall increase clinical competence in registered nurses. ISS has been demonstrated to maintain clinical competence in registered nurses. Further research needs to be done to determine effective frequency, high-fidelity vs low-fidelity, and effectiveness compared to Off-site simulation.