Vol. 2 No. 2 (2023): infermieristica journal: with you, not aganist

Learning teamworking and non-technical skills: a pilot study of a postgraduate course at the University of Florence

Veronica Verde
RN, CCN, Emergency Department, Nursing Home “Villa Fiorita”, Prato - Italy
Yari Bardacci
RN, CCN, Emergency and Trauma Intensive Care Unit, Careggi University Hospital, Florence - Italy
Lorenzo Ballerini
RN, CCN, Emergency Department, Careggi University Hospital, Florence – Italy
Samuele Baldassini Rodriguez
RN, CCN, Emergency and Trauma Intensive Care Unit, Careggi University Hospital, Florence - Italy
Chiara Balestri
Pedagogist, PhD, Research Fellow, Department of Health Science, University of Florence - Italy
Paolo Iovino
RN, MSN, PhD, Assistant Professor, Department of Health Science, University of Florence - Italy
Simone Belli
RN, MSN, PhD, Emergency and Trauma Intensive Care Unit, Careggi University Hospital, Florence - Italy
Stefano Bambi
RN, CCN, MSN, PhD, Associate Professor, Department of Health Science, University of Florence - Italy

Published 2023-07-31


  • Simulation,
  • Non-technical Skills,
  • Training,
  • Healthcare,
  • Gaming,
  • Virtual Simulation
  • ...More


Non-technical skills (NTS) are the cognitive and social skills that integrate the technical skills of a worker. In healthcare systems, NTS exert positive effects on patients’ safety and healthcare professionals’ efficiency.
Aim: This study aims to assess the degree of NTS knowledge, before and after a workshop administered to a group of 17 nursing students attending a critical care nursing postgraduate course at the University of Florence.
Methods: A cross-over design study was conducted. The workshop was composed of short lectures on “fundamentals of teamworking” and “team building and communication”, followed by team activities and gaming. At the end of the day a medical “escape room” about a shock scenario, was developed and run by the students. A questionnaire investigating participants’ entertainment and self-evaluation of NTS use, was administered at the end of the simulation sessions.
Results: A sample of 17 nurses was enrolled. Pre-posttests were completed by 16 participants. Seventy-five % (n=12) of the respondents found the team working activities exciting. Most of the participants (62.5%, n=10) considered the “escape shock room game” enjoyable and stimulating and would recommend the learning activities to other healthcare professionals (75%, n=12). Compared to pre-test scores, statistically, significant improvements in NTS understanding were found on the topics of “team building” (p<0.001; r= -0.60), “teamworking” (p= 0.001; r= -0.56), “membership” (p= 0.001; r= -0.56), “hard skills” (p= 0.001; r= -0.57), “soft skills” (p=0.001; r= -0.56) and “situational awareness” (p< 0.001; r= -0.61) items.
Conclusions: The process of NTS training is well accepted by critical care nursing students and can improve their competencies. Therefore, simulation based NTS training programs and gaming activities should be periodically implemented as part of Critical Care Nursing Postgraduate Courses.


  2. Rhona Flin, Paul O’Connor. Safety at the Sharp End: A Guide to Non-Technical Skills. (Taylor & Francis Ltd, ed.).; 2008.
  3. Prati G, Pietrantoni L. COMPETENZE NON TECNICHE E MARCATORI COMPORTAMENTALI STEPbySTEP: Systematic Test of Exoskeleton Products by a Stairs-Based Testbed Evaluation Protocol View Project. https://www.researchgate.net/publication/237646799
  4. Flin R, Maran N. Identifying and training non-technical skills for teams in acute medicine. Qual Saf Health Care. 2004;13(SUPPL. 1). doi:10.1136/qshc.2004.009993
  5. University of Aberdeen. Framework for Observing and Rating Anaesthetists’ Non-Technical Skills Anaesthetists’ Non-Technical Skills (ANTS) System Handbook v1.0 TEAM WORKING TASK MANAGEMENT SITUATION AWARENESS DECISION MAKING Acknowledgement.; 2012. www.abdn.ac.uk/iprc/ANTS
  6. Dieckmann P, Zeltner LG, Helsø AM. “Hand-it-on”: an innovative simulation on the relation of non-technical skills to healthcare. Advances in Simulation. 2016;1(1). doi:10.1186/s41077-016-0031-0
  7. Rosenkrantz O, Jensen TW, Sarmasoglu S, et al. Priming healthcare students on the importance of non-technical skills in healthcare: How to set up a medical escape room game experience. Med Teach. 2019;41(11):1285-1292. doi:10.1080/0142159X.2019.1636953
  8. Gómez-Urquiza JL, Gómez-Salgado J, Albendín-García L, Correa-Rodríguez M, González-Jiménez E, Cañadas-De la Fuente GA. The impact on nursing students’ opinions and motivation of using a “Nursing Escape Room” as a teaching game: A descriptive study. Nurse Educ Today. 2019;72:73-76. doi: 10.1016/j.nedt.2018.10.018
  9. Seo YH, Cho KA. Effect of Korean advanced life support education on non-technical and technical skills of nursing students: A pilot study. Healthcare (Switzerland). 2021;9(10). doi: 10.3390/healthcare9101253
  10. Dante A, la Cerra C, Caponnetto V, et al. Dose–Response Relationship between High-Fidelity Simulation and Intensive Care Nursing Students’ Learning Outcomes: An Italian Multimethod Study. Int J Environ Res Public Health. 2022;19(2):617. doi:10.3390/ijerph19020617
  11. Boling B, Hardin-Pierce M. The effect of high-fidelity simulation on knowledge and confidence in critical care training: An integrative review. Nurse Educ Pract. 2016;16(1):287-293. doi: 10.1016/j.nepr.2015.10.004
  12. Fletcher G, Flin R, McGeorge M, Glavin R, Maran N, Patey R. Anaesthetists’ non-technical skills (ANTS): Evaluation of a behavioural marker system. Br J Anaesth. 2003;90(5):580-588. doi:10.1093/bja/aeg112
  13. Filomeno L, Renzi E, Insa-Calderón E. Effectiveness of clinical simulation on nursing student’s improving critical care knowledge: A pretest-posttest study. Clinica Terapeutica. 2020;171(6):E501-E508. doi:10.7417/CT.2020.2264
  14. Currey J, Oldland E, Considine J, Glanville D, Story I. Evaluation of postgraduate critical care nursing students’ attitudes to, and engagement with, Team-Based Learning: A descriptive study. Intensive Crit Care Nurs. 2015;31(1):19-28. doi: 10.1016/j.iccn.2014.09.003
  15. Ballangrud R, Hall-Lord ML, Hedelin B, Persenius M. Intensive care unit nurses’ evaluation of simulation used for team training. Nurs Crit Care. 2014;19(4):175-184. doi:10.1111/nicc.12031