Dear Ms. Cason,

I certainly understand your concern because the conclusions in my article suggest that we need more research before investing more dollars in simulations for staff development activities, because you are a partner in a Health Care Simulation organization.

As you mentioned, a systematic review is designed to summarize the evidence by using a rigorous methodology to overcome possible biases (DiCenso, Guyatt, & Ciliska, 2005). I agree that there would be more value to the review if I had searched more databases, but this was a single author venture, so my resources and time were limited. The key words used were nursing and high-fidelity simulation (stated at the beginning of the literature review). Moreover, exclusion criteria were clearly listed.

As to the tool used to evaluate the research, it was developed by Dr. P. Gaspar (2009) at the University of Toledo. As a student in a combined DNP program sponsored by the University of Toledo and Wright State University, it is a tool that I was familiar with and one that many of the students use. I apologize for not including the citation in my references. The key concept in a systematic review is that a consistent set of criteria is used to determine if there are flaws in the studies. Although the tool may not be as well known as others, it was originally developed in 2005 and has been revised, validated, and refined since.

Thank you for the opportunity to respond to your concerns.

Virginia J. Hallenbeck, DNPc, RN, ACNS-BC

Clinical Nurse Specialist

The Ohio State University Hospital East

Newark, OH

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