Simulação realística: tecnologia para consolidação de competências profissionais para segurança do paciente / Realistic simulation: technology for consolidating professional skills for patient safety

Resumo: Segurança do paciente é tema transversal na assistência e no ensino em saúde. Esta pesquisa metodológica enfoca a simulação como metodologia educacional, realizada entre abril e dezembro de 2022, com objetivo de estruturar, validar, aplicar e analisar tecnologia educativa, com vistas a consolidar competências em segurança do paciente para profissionais de enfermagem e medicina em formação nos programas de residência em saúde. O percurso metodológico ocorreu em duas fases. A primeira fase compilou competências para a formação em saúde e a segurança do paciente (etapa 1). Este material foi utilizado em reunião de grupo focal com líderes e chefias de serviços associados à qualidade e educação para subsidiar a identificação de fragilidades em segurança do paciente (etapa 2). A segunda fase correspondeu ao cenário de simulação, composta por oito etapas. A partir das fragilidades, definiram-se os objetivos de aprendizagem (etapa 1) que guiaram a elaboração de compilado teórico-prático nos subtemas educacionais (etapa 2), o qual foi discutido em workshop com os residentes (etapa 3). O cenário foi elaborado a partir de texto narrativo, concebido em ambiente assistencial hipotético, desenvolvido em ambiente simulado (etapa 4); esse foi avaliado pelos componentes do grupo focal (etapa 5). Após treinamento e orientações, ocorreram a simulação e observação crítica da cena pelos participantes (etapas 6 e 7). A oitava etapa correspondeu ao debriefing, com análise do desenvolvimento dos subtemas educacionais; e análise da simulação como recurso para o desenvolvimento e a consolidação de competências em segurança do paciente. Empregou-se a técnica de análise de conteúdo dos depoimentos transcritos; as fases foram registradas descritivamente; os resultados quantitativos foram analisados a partir de números absolutos e relativos. Para a validação do cenário foram utilizados os resultados do ranking médio e de confiabilidade. As fases e etapas sistematizadas foram compiladas em formato de Guia. As lacunas vinculadas às competências e que perfizeram os subtemas educacionais foram relativas à comunicação, adesão aos protocolos de segurança, continuidade do cuidado e trabalho em equipe. Foram objetivos educacionais: desenvolver a comunicação entre a equipe interprofissional; entender a importância dos protocolos e da inserção do paciente no processo de cuidar; desenvolver e consolidar competências profissionais relativas à segurança do paciente. Síntese da literatura subsidiou a contextualização das lacunas, guiando a compreensão e aproximação entre a teoria e a prática, a partir da discussão de casos, revisando e agregando conhecimentos. O cenário simulado foi elaborado e validado de acordo com os objetivos educacionais, observando-se os indicadores estabelecidos; a cena se desenvolveu concomitantemente à observação, propiciando análise crítica dos participantes da pesquisa. A tecnologia de modelagem educacional foi avaliada positivamente quanto às contribuições para o aprendizado e a consolidação de competências; concorreu para simular o cotidiano assistencial e fomentar a reflexão acerca de ações preventivas ao risco para o paciente. A estratégia educacional contribuiu para vigorizar competências em segurança do paciente entre profissionais em formação, cujo método para desenvolvimento e avaliação, compilado na forma de Guia, permite a replicação do percurso metodológico, com vistas à promoção da segurança do paciente.

Abstract: Patient safety is a cross-cutting theme in health care and education. This methodological research focuses on simulation as an educational methodology, carried out between April and December 2022, with the objective of structuring, validating, applying and analyzing educational technology, with a view to consolidating competences in patient safety for nursing and medical professionals in training in the programs residency in health. The methodological course took place in two phases. The first phase compiled competences for training in health and patient safety (step 1). This material was used in a focus group meeting with leaders and heads of services associated with quality and education to support the identification of weaknesses in patient safety (stage 2). The second phase corresponded to the simulation scenario, consisting of eight stages. Based on weaknesses, learning objectives were defined (stage 1) that guided the elaboration of a theoretical-practical compilation on educational subthemes (stage 2), which was discussed in a workshop with residents (stage 3). The scenario was elaborated from a narrative text, conceived in a hypothetical care environment, developed in a simulated environment (step 4); this was evaluated by the components of the focus group (step 5). After training and guidance, the participants simulated and critically observed the scene (steps 6 and 7). The eighth stage corresponded to the debriefing, with analysis of the development of educational subtopics; and simulation analysis as a resource for the development and consolidation of patient safety skills. The technique of content analysis of the transcribed testimonies was used; phases were descriptively recorded; the quantitative results were analyzed from absolute and relative numbers. For the validation of the scenario, the results of the average ranking and reliability were used. The systematized phases and steps were compiled in a Guide format. The gaps linked to competences and that made up the educational subtopics were related to communication, adherence to safety protocols, continuity of care and teamwork. The educational objectives were: to develop communication between the interprofessional team; understand the importance of protocols and the insertion of the patient in the care process; develop and consolidate professional skills related to patient safety. Literature synthesis subsidized the contextualization of the gaps, guiding the understanding and approximation between theory and practice, from the discussion of cases, revising and adding knowledge. The simulated scenario was elaborated and validated according to the educational objectives, observing the established indicators; the scene developed concurrently with the observation, providing a critical analysis of the research participants. Educational modeling technology was evaluated positively in terms of contributions to learning and skills consolidation; contributed to simulate daily care and encourage reflection on preventive actions to risk for the patient. The educational strategy contributed to strengthening patient safety skills among professionals in training, whose method for development and evaluation, compiled in the form of a Guide, allows the replication of the methodological path, with a view to promoting patient safety.

Bood transfusion knowledge among clinical staffs / 中国输血杂志

【Objective】 To investigate the clinical staffs′ knowledge about blood transfusion and their demands, so as to provide evidence for arranging the content for continuing education of blood transfusion medicine. 【Methods】 A self-designed questionnaire was used to investigate the blood transfusion related knowledge of 652 clinical staffs from other cities or counties/districts in Shaanxi Province, who came to our hospital to attend meetings, further training and study from July to August 2019. 【Results】 Clinical stsffs investigated lacked a deep understanding of blood transfusion and blood donation related knowledge, and even were ignorant of certain knowledge. The awareness rate of relevant knowledge was the highest among doctors, followed by laboratory technicians and the lowest among nurses. 【Conclusion】 The awareness rate of blood transfusion related knowledge among medical staffs is relatively low, suggesting the training of blood transfusion related knowledge should be enhanced.

Influenza vaccination and its influencing factors among clinical staff of the hospitals in 2016-2017 season, Xining, Qinghai province, China / 中华流行病学杂志

Objective To investigate the influenza vaccination and its influencing factors among the clinical staff in Xining,Qinghai province,in the 2016-2017 influenza season,and to explore the promoting strategies to encourage the target population for influenza vaccination.Methods Four sample hospitals were randomly selected from the total 11 tertiary hospitals in Xining city.Clinical staff that worked in the four hospitals and agreed to participate were recruited for investigation via a self-administered questionnaire.Results During the 2016-2017 influenza season,the coverage rate of influenza vaccines among the clinical staff was 5.14％ (95％ CI:4.80％-5.49％).Multivariate logistic regression showed that knowing the priority of vaccination,the frequency of vaccination,effect of vaccination,and possessing higher professional qualifications were major influencing factors for influenza vaccination.The intention on recommendation of seasonal influenza vaccine was higher in vaccinated group than that in the unvaccinated group (x2=99.57,P＜0.001).Conclusion The lower coverage rate was primarily associated with the lack of knowledge about influenza vaccine among the clinical staff of the hospital.Tailored information should be provided to the clinical staff through effective methods to improve vaccination and the recommendation of influenza vaccine.

Influenza vaccination and its influencing factors among clinical staff of the hospitals in 2016-2017 season, Xining, Qinghai province, China / 中华流行病学杂志

Objective To investigate the influenza vaccination and its influencing factors among the clinical staff in Xining,Qinghai province,in the 2016-2017 influenza season,and to explore the promoting strategies to encourage the target population for influenza vaccination.Methods Four sample hospitals were randomly selected from the total 11 tertiary hospitals in Xining city.Clinical staff that worked in the four hospitals and agreed to participate were recruited for investigation via a self-administered questionnaire.Results During the 2016-2017 influenza season,the coverage rate of influenza vaccines among the clinical staff was 5.14％ (95％ CI:4.80％-5.49％).Multivariate logistic regression showed that knowing the priority of vaccination,the frequency of vaccination,effect of vaccination,and possessing higher professional qualifications were major influencing factors for influenza vaccination.The intention on recommendation of seasonal influenza vaccine was higher in vaccinated group than that in the unvaccinated group (x2=99.57,P＜0.001).Conclusion The lower coverage rate was primarily associated with the lack of knowledge about influenza vaccine among the clinical staff of the hospital.Tailored information should be provided to the clinical staff through effective methods to improve vaccination and the recommendation of influenza vaccine.

Conhecimentos e atitudes de cirurgiões frente aos conceitos de terapia nutricional / Surgeons' knowledge and attitude regarding concepts of nutritional therapy

OBJETIVO: comparar o conhecimento e percepção em terapia nutricional (TN) de residentes de cirurgia e cirurgiões. MÉTODOS: foram aplicados dois questionários padronizados sobre conhecimentos, atitudes e condutas em TN de 50 médicos (35 residentes e 15 cirurgiões) de 12 áreas cirúrgicas distintas. Utilizando-se o teste exato de Fisher, com significância de 5% com p<0,05, foi comparada a proporção de acertos, de acordo com a percepção a respeito do assunto de cada grupo. RESULTADOS: mais de 80% não se sentiram seguros frente à TN e 46% negaram conhecimento de equipe multiprofissional de TN (EMTN). Houve maior percentual de acertos, dentre os residentes, nos itens: trauma operatório e sua influência nutricional no paciente (p=0,047); IMC normal (p=0,036); e TN no pré-operatório (p=0,007) e indicação da TN pré-cirúrgico no grupo que diz que interagem com EMTN (p=0,02). Dentre os cirurgiões: complicações da TN e TN em pacientes previamente desnutridos (p=0,044); e Métodos de avaliação nutricional no pré-operatório no grupo que diz que interagem com EMTN (p=0,01). CONCLUSÃO: há falhas na educação médica. Apenas 13,3% estavam seguros quanto à TN, sendo que os seus conhecimentos não justificaram tal confiança. Não houve diferenças entre os acertos dos confiantes e não confiantes em TN na maioria dos assuntos. Destacaram-se melhores resultados no grupo que afirmou ser assistido por alguma EMTN. Baseando-se nos resultados, a indicação de melhores programas médicos educacionais deve ser objetivo para esta universidade.

OBJECTIVE: To compare the knowledge of nutritional therapy (NT) of surgery residents and surgeons. METHODS: We applied two standardized questionnaires on knowledge, attitude and behavior regarding NT to 50 physicians (35 residents and 15 surgeons) of 12 different surgical areas. We compared the proportions of hits according to the perception on the subject of each group using the Fisher exact test, with 5% significance and p < 0.05. RESULTS: More than 80% did not feel safe regarding NT and 46% denied knowledge of the NT multidisciplinary team (NTMT). There was a higher percentage of correct answers among residents in the items: surgical trauma and its nutritional influence on the patient (p = 0.047); normal BMI (p = 0.036); preoperative NT (p = 0.007); and indication of preoperative NT in the group that referred that to interact with the NTMT (p = 0.02). Among surgeons: complications of NT and NT in previously malnourished patients (p = 0.044); and methods for assessing preoperative nutritional status in the group that referred to interact with the NTMT (p =0.01). CONCLUSION: there are gaps in medical education. Only 13.3% were confident about NT, and their knowledge did not justify such confidence. There were no differences between the successes of confident and non-confident about NT in most subjects. The best results came from the group that claimed to be assisted by any NTMT. Better medical educational programs should be goal for this university.