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Background: Presently, physical inactivity is the main public health problem in many countries worldwide. Physical activity promotes the maintenance or improvement of one's physical condition. Physical fitness has been established as the main biological marker of the state of health of an individual, and therefore, there is a clear need to measure health-related physical fitness through the use of a reliable and valid instrument. This study is a continuation of the transcultural adaptation process and a new proposal of the nursing outcome Physical Fitness (2004), found in the 5 th Edition of the Nursing Outcomes Classification. The objective of this study was to examine the validity and reliability of the nursing outcome Health-Related Physical Fitness survey, proposed and transculturally adapted to the Spanish context., Methods: An instrumental study to validate the nursing outcome Physical Fitness (2004), from the 5 th Edition of the Nursing Outcome Classification was carried out. It took place between the months of May, 2016 to May, 2017. On the first stage, the instrument proposed Health-Related Physical Fitness survey was administered to 160 adults who used the Health Services of Murcia, Spain by three independent evaluators. After 4 weeks, it was administered again to 33 participants to calculate the intra-rater reliability. Lastly, the SF-12v2 Health Survey was administered to obtain external evidence of validity., Results: The inter-rater reliability of the nursing outcome proposed obtained high values (between 0.91-0.99) in the evaluations performed by the three evaluators. As for the intra-rater reliability, high values were obtained (0.94-1), except for the item "balance", which was moderate (0.56). Lastly, a positive and statistically significant correlation (p < 0.05) was obtained between the Physical Component Summary, and the dimensions Physical Functioning and General Health from the SF-12v2 Health Survey, and the global score of the Health-Related Physical Fitness proposed instrument., Conclusions: The validity and reliability results of the nursing outcome Health-Related Physical Fitness survey, proposed and transculturally adapted to the Spanish context, were adequate for its use by nurses with adults who use the Health Services of Murcia. However, this instrument must be analyzed with more diverse samples of health services users., (© 2022. The Author(s).)

Objective: Adaptation and validation of the BTI-St© to assess the level of competence in brief tobacco intervention in general practitioners and nurses in Primary Health Care., Design: Cross-sectional study of adaptation and psychometric validation of a criterion-referenced test., Setting: Primary Health Care., Participants: One hundred fifty-five general practitioners and nurses working at Primary Health Care., Interventions: Three clinical scenarios were designed. Using an online platform, participants first viewed each scenario in which brief tobacco intervention was given. Health professional had to assess whether or not the scenarios were carried out in accordance with the 5A+5R model., Main Measures: Competence in brief tobacco intervention measured by the BTI-Prof©., Results: Results related to reliability were obtained through Kuder-Richardson coefficient, being for scenario 1, 0.880, for scenario 2, 0.829, and for scenario 3, 0.826. The test-retest shows adequate temporal stability: intraclass correlation coefficient for scenario 1 0.857 (95% CI 0.734-0.923), p<0.0001, for scenario 2 0.829 (95% CI 0.676-0.909), p<0.001, and for scenario 3 0.869 (95% CI 0.76-0.928), p<0.0001., Conclusions: The BTI-Prof© is a robust tool with adequate psychometric properties to assess competence in brief tobacco intervention in Primary Health Care general practitioners and nurses., (Copyright © 2022 The Author(s). Publicado por Elsevier España, S.L.U. All rights reserved.)

Aim/objective: The aim of this study was to identify the main patterns of errors that 4th year nursing students made in simulated clinical practice with scenarios of care for people with Autism Spectrum Disorder (ASD)., Background: Clinical simulation currently plays a major role in the training of nursing students and provides the participants with the opportunity to practice and develop their clinical sills with a pediatric patient diagnosed with ASD., Design: A retrospective longitudinal qualitative study was performed., Methods: Content analysis of the existing debriefing records from a period of 7 academic years (2016-2022) was carried out. The scenario was simulated by a standardized patient diagnosed with ASD, with 23 groups of nursing students., Results: The results showed different patterns of errors. These patterns were grouped into 1 main category (weaknesses) and 5 major subcategories: clinical, communication, knowledge about ASD, emotions, and behavior towards parents. The most repeated errors were excessive use of verbal communication, abundant stimuli, low demand for information from primary caregivers, low demand for information about the child's emotions and interests, and a lack of knowledge of the profile of the child with ASD., Conclusion: From the findings of this study, we can highlight the lack of training that students received on the practical approach for providing care to these individuals. It has also been inferred in this study that clinical simulation is a tool that favors reflection and experiential learning for students when they are faced with caring for people with ASD., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2022 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Background: Emotional education has beneficial effects on physical and/or emotional health, resulting in a better quality of life. Thus, it is beneficial to provide prisoners with emotional education, because of the difficulties they often have, to attain these benefits., Purpose: The aim of the study was to analyze the effects of a nursing intervention program in emotional education for incarcerated persons., Methods: Experimental study with pretest-posttest repeated measures with a control group was conducted at a penitentiary center in the southeast of Spain. Forty-eight prisoners participated in the emotional education intervention program, and another 48 were part of the control group. The emotional intelligence questionnaire 24-item Trait Meta-Mood Scale, the resilience scale Connor-Davidson Resilience Scale, the Rosenberg Self-Esteem Scale, the Rathus Assertiveness Questionnaire, and the 36-item Short Form Health Survey were utilized., Findings: The intragroup, preintervention and postintervention comparisons in the study group showed improvements in self-esteem (p = 0.00, r = 0.51), resilience (p = 0.00, r = 0.42), assertiveness (p = 0.00, r = 0.46), and emotional intelligence in its dimensions of repair (p = 0.00, r = 0.32) and clarity (p = 0.02, r = 0.22) as well as in most of the quality of life dimensions. Significant intergroup differences were also found in all of these variables, except for attention and emotional clarity dimensions., Conclusion: The intervention improved the socioemotional health and quality of life of the prisoners, highlighting the importance of these interventions to be performed by the nursing personnel on a regular basis as a programmed activity within prisons., Competing Interests: The authors declare no conflict of interest., (Copyright © 2021 International Association of Forensic Nurses.)

Background: Clinical simulation learning includes a debriefing after the simulated experience. Debriefing consists of several stages. In this work we focus on the last stage (summary or transfer phase), in which the participants present the most relevant of what they learned during the session., Objectives: To analyze the perception of 4th year Nursing Degree students on the most significant aspects they learned during the simulation sessions., Method: A qualitative, cross-sectional and descriptive study was conducted, with students in their last year of the Nursing Degree at the Catholic University of Murcia. The opinions of 67 students from 5 groups, on the debriefing phase, were analyzed, by comparing them with the objectives that were initially proposed during the design of the scenarios used in the simulations., Results: A total of 78 clinical scenarios were analyzed, with 292 pre-established learning objectives, on a total sample of 67 students. The participants provided a total of 464 learning outcomes that were significant for them, of which 101 coincided with those that were initially planned (21.8%), while the rest, 363 (78.2%), were considered emergent (not planned a priori). For the most part, the learning outcomes described by the students were technical knowledge and/or skills (70.5%), as compared to non-technical knowledge and/or skills (29.5%)., Conclusion: For the most part, the learning outcomes considered by the students to be significant did not correspond with the objectives set a priori in the design of the scenarios. Most were emergent elements, especially those that referred to the technical knowledge and skills. The emergent knowledge must be considered crucial by the educators for the teaching and training of students., (Copyright © 2021 Elsevier Ltd. All rights reserved.)

Background: Most gender-based violence victims who sought help in Spain did so through health services. Training on gender-based violence with active learning methodologies promotes the management of knowledge, reflection, and adaptation to change. Nurses, along with an educator, can construct knowledge with the same strategies they will use professionally., Purpose: To evaluate the knowledge, skills, and attitudes associated of postgraduate nurses on gender-based violence before and after a reflection-based training program with dramatized problem-videos. The secondary objectives were to evaluate the knowledge in the activation of protocols, skills, and attitudes in the management of women who are victims of gender-based violence, the consolidation of learning, and the applicability to the workplace., Methods: Pre-post quasi-experimental study without a control group. A specifically validated and designed instrument was utilized to evaluate the dimensions of knowledge, skills, and attitudes when facing gender-based violence, before and after the training sessions, along with additional questions to assess if the participants possessed better tools to address gender-based violence., Results: The difference between the pre and post-tests was statistically significant for the dimensions knowledge, skills, and attitude (p < 0.05), with a smaller effect size in the dimensions skills and attitude. Also, high scores were observed in the consolidation of learning and applicability to the workplace., Conclusion: Reflection-based training with dramatized problem-videos improved the acquisition of tools necessary for the detection and management of gender-based violence of nurses., (Copyright © 2021 Elsevier Ltd. All rights reserved.)

Background: Motivation is a fundamental element of human behavior and learning. We believe that this aspect has not been sufficiently addressed in the field of simulation-based learning in nursing., Purpose: The aim of this study was to explore the views and perspectives of students involved in simulation-based learning related to their process of motivation. Also, to identify the motivational elements they perceived, as well as the aspects that could reduce their motivation in the simulation sessions., Methods: A qualitative study was conducted based on content analysis from 7 focus groups composed of simulation students (n = 101)., Results: The study obtained 26 subcategories, 10 categories, and 2 emerging themes (in total, 17 motivational elements and 7 demotivational elements)., Conclusion: The motivational elements were related with the non-directive/imposing style of the facilitator, the adequate structure and planning of the sessions, the possibility of transferring what was learned to the real world, and especially the atmosphere created in the simulation session. The main demotivational elements were directed simulation, an uncomfortable environment, and the planning and structure of the sessions (with an excessive theoretical content or with stringent evaluations)., (Copyright © 2021 Elsevier Ltd. All rights reserved.)

Objective: To describe the Evidence-Based Practice (EBP) competency level in Primary Care (PC) nurses in Spain and to determine the associated factors., Design: Cross-sectional, national survey design, carried out between January and March 2020., Setting: PC in Spain., Participants: Seven hundred eighty PC active nurses in the National Health Service with at least one year of professional experience., Main Measurements: (1) Sociodemographic, professional and access to scientific information variables; (2) outcome variable: EBP competency (attitude, knowledge, skills and utilization) assessed through the EBP-COQ Prof© questionnaire. Bivariate and multiple lineal regression analyses were carried out., Results: The mean score for the EBP competency of the PC nurses was 131.5 (standard deviation [SD] 17.0), according to dimensions: attitude 36.8 (SD 3.6); knowledge 38.2 (SD 8.9); skills 23.0 (SD 3.5); and utilization 33.3 (SD 6.1). The number of articles read in the last month has showed the most influence on all the EBP-COQ Prof© dimensions, followed by EBP training (more than 150h) and nursing students mentoring. The education level (master, specialist and doctorate) is associated with knowledge and skills dimensions, meanwhile belonging to a BPSO® center is associated with the EBP utilization., Conclusions: These findings can guide PC service managers to plan strategies that improve the EBP competency level of the nurses, aimed mainly at achieving real application in clinical practice. However, it is necessary to consider the possible impact of selection bias on the results., (Copyright © 2021 The Author(s). Publicado por Elsevier España, S.L.U. All rights reserved.)

Objectives: The main objective was to describe physicians’ perception of their knowledge, skill, and safety before and after training to perform videolaryngoscopy while using the Intubox barrier system when managing the airway of a patient with the coronavirus 2019 disease (COVID-19). The secondary objective was to assess the safety afforded by the barrier by means of visually evaluating particle dispersion during intubation., Material and Methods: Single-arm clinical simulation trial. The participants were physicians who received training in both a lowfidelity and a high-fidelity simulation zone. The participants assessed their knowledge, skill, and safety when using the Intubox before and after training using a specially designed and validated questionnaire. Droplet contamination was estimated visually., Results: Twenty-seven physicians with a mean (SD) age of 40 (10.8) years participated; 63% were women. They perceived their knowledge, skill, and safety to be significantly higher after training. Droplet contamination was seen to decrease when airway management maneuvers were done with the barrier in place., Conclusion: After simulation training the emergency physicians judged their knowledge, skill, and safety to be greater when they used the barrier during airway management in patients with COVID-19. The combined use of a laryngoscope and the Intubox barrier resulted in less particle dispersion during intubation.

Background/Objective: To assess the differential efficacy between mindfulness-based interventions and cognitive-behavioral Therapy (CBT) on chronic pain across medical conditions involving pain. Method: ProQuest, Science Direct, Google Scholar, Pubmed, and Embase databases were searched to identify randomized clinical trials. Measurements of mindfulness, pain, mood, and further miscellaneous measurements were included. Results: 18 studies met the inclusion criteria (fibromyalgia, n = 5; low back pain, n = 5; headache/migraine, n = 4; non-specific chronic pain, n = 4). In fibromyalgia, mindfulness based stress reduction (MBSR) was superior to the usual care and Fibroqol, in impact and symptoms. In low back pain, MBSR was superior to the usual care, but not to CBT, in physical functionality and pain intensity. There were no studies on differential efficacy between mindfulness and CBT for headache and non-specific chronic pain, but Mindfulness interventions were superior to the usual care in these syndromes. Conclusions: Mindfulness interventions are superior to usual cares in all diagnoses, but it is not possible to conclude their superiority over CBT. Comparisons between mindfulness interventions are scarce, with MBSR being the most studied. In central sensitization syndromes, variables associated with pain tend to improve with treatment. More research is needed to differentiate diagnosis and intervention., (© 2020 Asociación Española de Psicología Conductual. Published by Elsevier España, S.L.U.)

Objective: To analyse the differences in the quality of the basic cardiopulmonary resuscitation (CPR) between the algorithms of compressions with rescue ventilation (CPR [30:2]) and chest compressions only (CPR [C/O]). In addition, the specific objective was to study the effectiveness of the physical manoeuvre of mouth-to-mouth ventilations performed by nursing students after the completion of a simulation training program in Basic Life Support (BLS) standardized in the study plan approved for the Nursing Degree at a Spanish university., Research Methodology: analytical, quasi-experimental, cross-sectional study with clinical simulation of 114 students enrolled in the third year of the Nursing Degree., Results: the mean depth of chest compressions was 47.6 mm (SD 9.5) for CPR [30:2] and 45 mm (SD 8.8) when CPR [C/O] was performed (t = 5.39, p < 0.0001, CI95% 1.69-3.65). The compressions with complete chest re-expansion were 106 (SD 55) for CPR [30:2] and 138 (SD 85) for CPR [C/O] [t = -4.75, p < 0.0001, CI95% -44.6 - (-18.4)]. Of the participants, 28.1% correctly ventilated with the head-tilt/chin-lift manoeuvre (Fisher: p < 0.0001)., Conclusions: As a whole, CPR with only chest compressions offers great advantages with respect to standard CPR, minimizing interruptions in compressions, maintaining coronary and cerebral perfusion and thus increasing the likelihood of return of spontaneous circulation. The problem of rescuers fatigue could be reduced with a greater number of relays between rescuers. We believe that is important to improve the acquisition of competencies in the management of the airway and the ventilation devices (such as the bag-valve mask)., (Copyright © 2020 Elsevier Ltd. All rights reserved.)

Purpose: The AIS scale is a measurement tool for single injuries. The ISS is considered the gold standard for determining the severity of injured patients, and the NISS was developed to improve the ISS with respect to loss of information, as well as to facilitate its calculation. The aim of this study was to analyse what injury severity measure, calculated according to the Abbreviated Injury Scale (AIS), 1998 and 2005 (update 2008) versions, performs better with mortality, cost and hospital length of stay healthcare indicators., Methods: This cross-sectional observational study was carried out between February 1st 2012 and February 1st 2013. Inclusion criteria were injured patients due to external causes admitted to trauma service through the emergency department. Manual coding of all injuries was performed and ISS and NISS scores were calculated for both versions of the AIS scale. Severity was then compared to mortality (in-hospital and at 30 days), healthcare cost, and length of hospital stay., Results: The index with the best predictive capability for in-hospital mortality was NISS 05 (AUC = 0.811). There was a significant increase in hospital stay and healthcare cost in the most severe patients in all indexes, except for ISS 05., Conclusions: NISS is found to be an index with higher predictive capability for in-hospital mortality and correlates better to length of hospital stay and healthcare cost.

Background: Some studies suggest that children and adolescents with intellectual disability (ID) are at elevated risk of obesity. The objective was to determine the prevalence of and factors associated with overweight and obesity among students attending special education schools in Cantabria, Spain., Methods: Cross-sectional design. A sample of n = 220 students with intellectual disability attending seven special education schools was selected using convenience sampling. Body mass index was classified into four categories according to the International Obesity Task Force (IOTF) criteria: underweight; normal weight; overweight; obesity., Results: The prevalence of overweight/obesity was 40.9% (95% CI: 34.6-47.5). Obesity was more frequent among females (26.0%) than males (9.8%), with an OR = 3.23 (95% CI: 1.53-6.85). Participants with Down syndrome showed an increased risk of obesity compared to other conditions (p = .005)., Conclusions: The prevalence of overweight/obesity among children, adolescents and young adults with intellectual disability was remarkably high, with females in general and students of both sexes with Down syndrome at particularly high risk., (© 2019 John Wiley & Sons Ltd.)

Study Design: Cross-sectional., Introduction: The muscle strength has been studied in different populations in relation with individual and other factors., Purpose of the Study: The purpose of this study was to determine values of grip strength in adolescents and to examine its association with sex, age, weight, height, nutritional status, handedness, and academic performance., Methods: A total of 452 adolescents (246 men and 206 women) aged 12 to 17 years were included in the study. Grip strength was measured using a Takei dynamometer., Results: Boys were significantly stronger than girls with both the dominant hand (33.1 kgf vs 25.0 kgf; mean difference = 8.1 kgf; P < .001) and the nondominant hand (30.9 kgf vs 23.1 kgf; mean difference = 7.8 kgf; P < .001), and there was a significant increase in strength values as the age rises in both sexes (P < .001). The dominant hand was stronger than the nondominant one (29.4 kgf vs 27.3 kgf; mean difference = 2.1 kgf; P < .001), except for left-handed subjects who were significantly stronger than right-handed ones in their nondominant hand. Furthermore, strength was positively associated with nutritional status and negatively associated with academic performance in men., Conclusions: Sex, age, handedness, nutritional status, and academic performance have a significant influence on the grip strength values. There seems to be a sexual dimorphism in the relationship between strength and both nutritional status and academic performance., (Copyright © 2018 Hanley & Belfus. Published by Elsevier Inc. All rights reserved.)

Study Design: Mixed-methods study., Objective: Evaluate the knowledge that family caregivers of individuals with spinal cord injuries acquired through the use of a high-fidelity simulation-based learning (SBL) program., Setting: The study was comprised of three phases: a previous qualitative research study detecting training needs, one in which clinical simulation scenarios were designed, and a final quasi-experimental phase in which ten caregivers of individuals with spinal cord injuries were trained in their care using simulations at the Toledo National Hospital for Paraplegics (Spain)., Methods: The competences acquired by the family were evaluated before and after the simulation training. A researcher-validated tool for each scenario was utilized for this evaluation., Results: Four learning scenarios were designed based on the needs identified through the caregiver interviews. Following the training of the caregivers with SBL, an increase in their knowledge and skills was identified. For all the scenarios, the caregivers obtained a higher average score on the post test than on the pre test, and these differences were significant (p < 0.001)., Conclusions: Simulation training is a useful and efficient learning tool for caregivers of individuals with a spinal cord injury.

Background: One of the main challenges faced by nursing educator is using the best strategy for students to learn. In MAES© (Self-learning methodology in simulated environments), the students are guided by a facilitator, and perform their simulations in a knowledge-specific area in a self-directed learning manner., Method: The performance by the students in the MAES© simulation was compared to traditional Simulation-based learning (SBL). With this aim in mind, a study was conducted which quantitatively analyzed and compared the scores in SBL and MAES© scenarios from 274 students enrolled in the 4th year of the nursing degree. The students were assessed with the Clinical Simulation in Nursing Assessment Questionnaire (CLISINAQ) and the Knowledge Management Scale (KMS)., Results: The students received a higher score in the scenarios with the MAES© methodology in clinical and non-technical skills., Conclusions: When compared to SBL, MAES© granted students a better degree of performance in learning with simulation., (Copyright © 2019 Elsevier Ltd. All rights reserved.)

Introduction: Socio-emotional competencies positively influence academic performance and clinical practice of students enrolled in a Nursing degree. However, there is a lack of studies that relate these competencies with performance in a high-fidelity clinical simulation training scenario., Objectives: To analyze the relationship between socio-emotional competencies and performance in simulated clinical practices of a sample of 4 th -year Nursing degree students., Methods: Transversal descriptive study conducted in Spain. A sample of 91 students enrolled in their last academic year of the Nursing degree, who were undergoing clinical practices along with simulation sessions. Socio-emotional competencies (communication skills, coping with stress, self-efficacy, engagement, etc.) were analyzed through the use of self-administered questionnaires and their performance in high-fidelity clinical simulation sessions., Results: The socio-emotional competencies had a positive and statistically-significant correlation (p < 0.05) with performance in simulated clinical practices. A relationship between socio-emotional competencies and performance in simulated practices was observed [R 2  = 0.502; F (20.55) = 2.827; p = 0.01]., Conclusions: The socio-emotional competencies of 4 th -year nursing students were associated to their performance in simulated clinical practices., (Copyright © 2018 Elsevier Ltd. All rights reserved.)

Objectives: To explore differences in severity classifications according to 2 versions of the Abbreviated Injury Scale (AIS): version 2005 (the 2008 update) and the earlier version 98. To determine whether possible differences might have an impact on identifying severe trauma patients., Material and Methods: Descriptive study and cross-sectional analysis of a case series of patients admitted to two spanish hospitals with out-of-hospital injuries between February 2012 and February 2013. For each patient we calculated the Injury Severity Score (ISS), the New Injury Severity Score (NISS), and the AIS scores according to versions 98 and 2005., Results: The sample included 699 cases. The mean Severity (SD) age of patients was 52.7 (29.2) years, and 388 (55.5%) were males. Version 98 of the AIS correlated more strongly with both the ISS (2.6%) and the NISS (2.9%)., Conclusion: The 2008 update of the AIS (version 2005) classified fewer trauma patients than version 98 at the severity levels indicated by the ISS and NISS.

Objectives: The aim of this study was to analyse the communication skills of students in interactions with simulated critically-ill patients using a new assessment tool to study the relationships between communication skills, teamwork and clinical skills and to analyse the psychometric properties of the tool., Methods: A cross-sectional study was conducted to assess the communications skills of 52 students with critically-ill patients through the use of a new measurement tool to score video recordings of simulated clinical scenarios., Results: The 52 students obtained low scores on their skills in communicating with patients. The reliability of the measuring instrument showed good inter-observer agreement (ICC between 0.71 and 0.90) and the validity yielded a positive correlation (p<0.01)., Conclusions: The results provide evidence that nursing students lack skills when communicating with critically ill patients in simulated scenarios. The measuring instrument used is therefore deemed valid and reliable for assessing nursing students through a clinical simulation., (Copyright © 2017 Elsevier Ltd. All rights reserved.)

Objectives: To determine whether the Emergency Severity Index (ESI) is valid for triage according to evidence based on classifying real patients in a general referral hospital's emergency department., Material and Methods: Observational, cross-sectional descriptive study carried out in the emergency department of Hospital Clínico Universitario Virgen de la Arrixaca in Murcia. Thirty-two nurses used the ESI algorithm to triage 410 patients as they arrived seeking care. The results were compared to a gold standard (a triage expert's opinion, which was later confirmed by an expert committee after discussion, if necessary, of cases for which opinions were not unanimous). We calculated sensitivity, specificity, under- and over-triage rates, as well as descriptive statistics about resource assignment, exitus, patients who left without being seen, destination on discharge, and times., Results: ESI was highly correlated with resources (ρ = -0.717, P < .01) and moderately correlated with destination on discharge (ρ = -0.437, P < .01). Regarding time spent in the department, we found that patients assigned ESI levels 1 and 2 had significantly longer stays, and those assigned ESI levels 4 and 5 had significantly shorter stays (p < 0,001). Interobserver agreement was good or very good, indicating that this triage tool is reliable., Conclusion: This pilot of the ESI triage algorithm in the emergency department of a referral hospital found evidence supporting the system's validity.

Objectives: To design and validate a clinical simulation method for training nurses to use the Emergency Severity Index (ESI) for triage., Material and Methods: Descriptive, cross-sectional study carried out in the emergency department of Hospital Clínico Universitario Virgen de la Arrixaca in Murcia, Spain. The educational intervention had 3 phases focused on theory, skills, and application. The participants, who were nurses with at least a year's experience in the emergency department, numbered 55, 43, and 32 in each phase, respectively. They undertook training in ESI for triage (phase 1), participated in simulations with patient-actors (phase 2), and applied their acquired skills (phase 3). We used Cohen's K and the intraclass correlation coefficient (ICC) to compare the nurses' triage assignments to gold-standard triage assignments., Results: We had data for 1100, 799, and 410 observations of performance in each phase, respectively. Agreement statistics between the nurses' performance and the gold standard were 0.68, 0.67, and 0.68 (Cohen's K) and 0.870, 0.836, and 0.811 (ICC) in each phase, respectively. These results reflect good agreement., Conclusion: This study supports the relevance of clinical simulations for training nurses to implement structured triage, and in particular to use the ESI. We can state that this study opens the door to further research into whether the reliability of triage can be improved by using this approach, specifically whether it can facilitate better interobserver agreement.