Procedure Manual-Based Simulation Training to Improve Operating Room Nurses' Core Competencies

The Impact of Procedure Manual-Based Simulation Training on Operating Room Nurses' Core Competencies in a Cambodian National Hospital: A Quasi-Experimental Study

This study aims to evaluate the effectiveness of a procedure manual-based simulation training program in improving the core competencies of operating room nurses in a Cambodian national hospital. Operating room nurses play a critical role in maintaining patient safety, assisting the surgical team, and ensuring efficient surgical workflow.

This study will use a single-group quasi-experimental pre-post design. Baseline data will be collected before the intervention to assess operating room nurses' core competencies, interprofessional collaboration, job satisfaction, and surgical procedure duration.

Participants will receive structured educational sessions and simulation-based training based on standardized surgical procedure manuals. After the training phase, nurses will implement the procedure manuals during real surgical procedures for six weeks. End-line data will be collected to evaluate improvements in competency levels, teamwork, job satisfaction, and surgical efficiency.

Study Overview

• Status: Not yet recruiting
• Conditions: Patient Safety; Job Satisfaction; Surgical Outcome; Core Competency; Interprofessional Collaboration
• Intervention / Treatment: Behavioral: Procedure Manual-Based Simulation Training

Detailed Description

• Background and Rationale Nurses in Cambodia face significant challenges in achieving the government's goal of Universal Health Coverage, specifically regarding the quality of care and competency levels. This study addresses the need for standardized procedure manuals in the operating room (OR) to minimize practice variation, reduce adverse outcomes, and enhance the core competencies of OR nurses at the Cambodia-China Friendship Preah Kossamak Hospital (CCFKH).
• Study Design This is a quasi-experimental study utilizing a one-group pre- and post-test design. There is no control group or randomization involved. The study aims to recruit approximately 49 registered nurses currently working in the intraoperative phase at CCFKH.
• Intervention Protocol

The intervention is divided into three distinct phases:

1. Preparation: Standardized surgical procedure manuals and training videos were developed for two specific procedures: Total Hip Replacement (THR) in orthopedics and Retrograde Intrarenal Surgery (RIRS) in urology.
2. Training Phase (2 weeks): Participants are divided into six small groups of approximately eight members. Each group attends two sessions biweekly. Each session consists of a 1-hour lecture and 2 hours of simulation practice. An E-manual is provided for continuous self-study.

3. Implementation Phase (6 weeks): Following training, participants implement the standardized protocols during real surgical procedures. During this time, the research team provides follow-up support and consultation to address clinical concerns.

   • Data Collection and Outcomes

Data will be collected at baseline (pre-intervention) and after the intervention period (end-line) with primary outcome and secondary outcomes:

1. Primary Outcome: Core competency is measured using a 20-item researcher-developed questionnaire based on a 5-point Likert scale (total score range: 20-100).

2. Secondary Outcomes: These include Interprofessional Collaboration (Relational Coordination Survey), Job Satisfaction (Short Index of Job Satisfaction), and Surgical Outcome (measured as procedure duration/surgical time).

   • Analysis Statistical evaluation will include descriptive statistics and paired t-tests to analyze changes between baseline and end-line data.

• Study Type: Interventional
• Enrollment (Estimated): 49
• Phase: Not Applicable

Contacts and Locations

• Study Contact: Name: LEANG E LEN, RN, BSN, Master Student; Phone Number: +85598735350; Email: leangent13@gmail.com
• Study Contact Backup: Name: Michiko Moriyama, RN, MSN, Ph.D, FAAN; Phone Number: +81-82-257-5365; Email: morimich@hiroshima-u.ac.jp

Study Locations

• Cambodia
  • Phnom Penh
    • Phnom Penh, Phnom Penh, Cambodia, 170000
      • Cambodia-China Friendship Preah Kossamak Hospital

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult; Older Adult
• Accepts Healthy Volunteers: Yes

Description

Inclusion Criteria:

• Registered nurses who are appointed to work in the intraoperative phase of Cambodia-China Friendship Preah Kossamak Hospital.
• Registered nurses at Cambodia-China Friendship Preah Kossamak Hospital who are willing to participate in the study.

Exclusion Criteria:

• Registered Nurses Cambodia-China Friendship Preah Kossamak Hospital who are unable to participate in intervention requirements.
• Registered Nurses Cambodia-China Friendship Preah Kossamak Hospital who are scheduled to participate in hospital mission assignments.

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Health Services Research
• Allocation: N/A
• Interventional Model: Single Group Assignment
• Masking: None (Open Label)

Number of Arms

1

Arms and Interventions

Participant Group / Arm

Intervention / Treatment

Experimental: Simulation Training Group; Registered Operating Room (OR) nurses at the Cambodia-China Friendship Preah Kossamak Hospital (CCFKH) who participate in a standardized procedure manual-based simulation training program. This group undergoes a two-week training phase followed by a six-week clinical implementation phase.

Behavioral: Procedure Manual-Based Simulation Training; The intervention consists of a simulation training program of procedure manuals focused on two surgical procedures: Total Hip Replacement (THR) and Retrograde Intrarenal Surgery (RIRS). Training Phase (2 weeks): Participants attend two sessions (one per procedure). Each session includes a 1-hour lecture and 2 hours of hands-on simulation practice. Self-Study: Participants are provided with a digital E-manual for continuous review. Implementation Phase (6 weeks): Participants apply the standardized procedure manuals in real surgical settings with follow-up support from the research team.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Core Competencies of Operating Room (OR) Nurses	Measured using a 20-item researcher-developed intraoperative core competency scale. It uses a five-point Likert scale (1: never to 5: always). The total score ranges from 20 to 100, where a higher score indicates a higher level of nursing competency in the operating room.	Baseline (Day 0) and End-line (8 weeks), immediately following the 2-week training and 6-week implementation phase.

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Interprofessional Collaboration	Measured by the Relational Coordination Survey (RCS). This 7-item tool uses a five-point Likert scale. The total score ranges from 7 to 35, where a higher score represents better collaboration between surgeons, anesthetists, and nurses.	Baseline (Day 0) and End-line (8 weeks), immediately following the 2-week training and 6-week implementation phase.
Job Satisfaction	Measured by the Short Index of Job Satisfaction (SIJS). This 5-item tool uses a five-point Likert scale. The total score ranges from 5 to 25, where a higher score indicates greater job satisfaction among OR nurses.	Baseline (Day 0) and End-line (8 weeks), immediately following the 2-week training and 6-week implementation phase.
Surgical Outcome	Mean duration of the total time from "skin incision" to "skin closure" for the targeted procedures (Total Hip Replacement and Retrograde Intrarenal Surgery).	Comparison of the 1 month prior to intervention (baseline) versus 1 month after the total intervention period.

Collaborators and Investigators

• Sponsor: Hiroshima University
• Investigators: Study Director: Michiko Moriyama, RN, MSN, Ph.D, FAAN, Hiroshima University

Publications and helpful links

General Publications

• Brayfield, A. H., & Rothe, H. F. (1951). An Index of Job Satisfaction. Journal of Applied Psychology, 35, 307-311. https://doi.org/10.1037/h0055617
• 15. Gillespie, B. M., Polit, D. F., Hamlin, L., & Chaboyer, W. (2012). Developing a model of competence in the operating theatre: psychometric validation of the perceived perioperative competence scale-revised. International journal of nursing studies, 49(1), 90-101. https://doi.org/10.1016/j.ijnurstu.2011.08.001
• Gittell JH, Fairfield KM, Bierbaum B, Head W, Jackson R, Kelly M, Laskin R, Lipson S, Siliski J, Thornhill T, Zuckerman J. Impact of relational coordination on quality of care, postoperative pain and functioning, and length of stay: a nine-hospital study of surgical patients. Med Care. 2000 Aug;38(8):807-19. doi: 10.1097/00005650-200008000-00005.

Helpful Links

• Hiroshima University - Graduate School of Biomedical and Health Sciences
• Cambodia-China Friendship Preah Kossamak Hospital (CCFKH)

Study record dates

Study Major Dates

• Study Start (Estimated): April 20, 2026
• Primary Completion (Estimated): July 20, 2026
• Study Completion (Estimated): March 31, 2027

Study Registration Dates

• First Submitted: April 7, 2026
• First Submitted That Met QC Criteria: April 7, 2026
• First Posted (Actual): April 14, 2026

Study Record Updates

• Last Update Posted (Actual): April 16, 2026
• Last Update Submitted That Met QC Criteria: April 13, 2026
• Last Verified: April 1, 2026

More Information

Terms related to this study

• Keywords: Job Satisfaction; Cambodia; Surgical Outcomes; Nursing Education; Simulation Training; Quasi-Experimental Study; Operating Room Nurses; Procedure Manual; Interprofessional Collaboration
• Other Study ID Numbers: Version 1.0-28/01/2026; NECHR-2026-175 (Other Identifier: National Ethics Committee for Health Research (NECHR), Cambodia)

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO
• IPD Plan Description: Individual participant data (IPD) will not be shared publicly to maintain the confidentiality and privacy of the operating room nurses involved in the study, as required by the National Ethics Committee for Health Research (NECHR) in Cambodia. Results will be disseminated through a Master's thesis and peer-reviewed publications using aggregated data only.

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No