The impact of incorporating a simulation program into the undergraduate nursing curricula: A cross-sectional descriptive study.

AIM: To determine the degree of satisfaction for each academic year and according to the type of simulation performed (simulated patient actor/advanced simulator) among nursing students after the use of clinical simulation. INTRODUCTION: Clinical simulation is currently being incorporated in a cross-cutting manner throughout undergraduate nursing education. Its implementation requires a novel curricular design and educational changes throughout the academic subjects. DESIGN: A cross-sectional descriptive study was performed. METHODS: During the academic years 2018-2019 and 2019-2020, 425 students completed the High-Fidelity Simulation Satisfaction Reduced Scale for Students based on 25 questions and six factors, with a total score between 0 and 125. In total, 91 simulation sessions were performed among students who had different degrees of clinical and previous experience with simulation as well as standardized patient versus advanced simulator. A bivariate analysis was performed, comparing the total scores and the different subscales by sex, previous experience, academic year, and simulation methodology. Linear regression was used for both bivariate and multivariate analysis. RESULTS: The mean scale score was 116.8 (SD=7.44). The factor with the highest score was "F2: feedback or subsequent reflection", with a mean score of 14.71 (SD=0.73) out of 15. Fourth year students scored the highest (mean=119.17; SD=5.28). Students who underwent simulation training with a simulated patient actor presented a higher level of overall satisfaction (p<0.05) (Mean=120.31; SD=4.91), compared to students who used an advanced simulator (Mean=118.11; SD=5.75). CONCLUSIONS: Satisfaction with the simulation program was higher in fourth-year students compared to first-year students and was also higher when a simulated patient actor was used compared to an advanced simulator. The most highly valued aspect was the subsequent debriefing or reflective process.

Validation of a short version of the high-fidelity simulation satisfaction scale in nursing students.

BACKGROUND: Clinical simulation provides a practical and effective learning method during the undergraduate education of health professions. Currently there is only one validated scale in Spanish to assess nursing students' satisfaction with the use of high-fidelity simulation, therefore, our objective is to validate a brief version of this scale in undergraduate nursing students with or without clinical experience. METHOD: A cross-sectional descriptive study was performed. Between 2018 and 2020, the students from all academic courses of the Fundación Jiménez Díaz nursing school completed the satisfaction scale at the end of their simulation experiences. To validate this scale, composed of 33 items and eight dimensions, exploratory factor analysis (EFA) of the principal components was performed, the internal consistency was studied using Cronbach's alpha, and the corrected item-test correlation of each of the items of the total scale was reviewed. RESULTS: 425 students completed the scale, after the exploratory factor analysis, a scale consisting of 25 items distributed into six subscales, each containing between two and six items, explained a variance of 66.5%. The KMO test (Kaiser-Meyer-Olkin) obtained a value of 0.938, Bartlett's sphericity test was < 0.01 and Goodness of Fit Index (GFI) was 0.991. CONCLUSION: The modified ESSAF scale, reduced from 33 to 25 items and divided into six subscales, is as valid and reliable as the original scale for use in nursing students of different levels, with, or without clinical experience.

Formación de profesionales mediante simulación clínica durante la primera ola de covid-19 / Training professionals through clinical simulation during the first covid-19 wave

En este artículo se comparte la experiencia de la formación de profesionales sanitarios del Hospital General Universitario de Ciudad Real (HGUCR) mediante la formación teórico-práctica con simulación clínica y la valuación de sus resultados. Se plantearon sesiones con simulación de baja y alta compleji-dad para 40 personas y en grupos reducidos. La evolución de las necesidades hizo aumentar el número de sesiones y la supresión de la sala de simulación avanzada.Se realizó un programa de 64 sesiones entre marzo y abril de 2020 en turnos de mañana y tarde, en grupos de 15 personas.Participó el 41,5% (n= 852) del personal sanitario de la Gerencia de Atención Integrada de Ciudad Real. Respondieron el cuestionario de evaluación 91 personas que refirieron una alta satisfacción con la actividad (4,32 puntos sobre 5 a nivel global), valoraron especialmente la utilidad para el trabajo, la claridad de la información y la parte práctica de la sesión (simulación). Así mismo, el 80,6% manifestó haber aumentado su confianza y el 65,9% una disminución de la ansiedad en el manejo de pacientes con COVID. Si bien habría que analizar otras causas, el porcentaje de contagios entre los profesionales (10%) fue similar al de la población general. Disponer de espacios de formación con simulación y profesionales formados en el diseño de este tipo de actividades supone un recurso útil y flexible a las demandas sanitarias que puedan surgir.(AU)

In this article, we share the experience in training healthcare professionals from the Hospital General Universitario of Ciudad Real (HGUCR) through theoretical-practical training with clinical simulation, and the evaluation of its results.Sessions were set with high and low complexity simulation for 40 persons and in reduced groups. The evolution of needs led to an increase in the number of sessions, and the suppression of the Advanced Simulation Room.A 64-session program was held between March and April 2020, in morning and afternoon shifts and for groups of 15 persons, with participation by 41.5% (n= 852) of the healthcare staff from the Integrated Care Management of Ciudad Real. The evaluation questionnaire was answered by 91 persons, who reported high satisfaction with the activity (4.32 scores over 5 at overall level); they valued particularly its utility for work, the clarity of the information, and the practical aspect of the session (simulation). Likewise, 80.6% reported an increase in confidence, and 65.9% reported a reduction in anxiety regarding management of patients with COVID. Even though other causes should be analysed, the proportion of contagion among professionals (10%) was similar to that among the general population.The availability of training spaces with simulation and professionals trained in the design of this type of activities represents a useful and flexible resource for any healthcare demands that might arise.(AU)

Experiences and Perceptions of Nursing Students during the COVID-19 Crisis in Spain.

In the early stages of the 2019 coronavirus pandemic in Spain, the Spanish health system was overwhelmed, mainly due to a lack of personnel, and many hospital centers collapsed by following avalanche of patients with COVID-19; this meant that the National System of Health called for fourth-year nursing students to come to the hospital as health care personnel. Our aim was to describe the perceptions and experiences of a sample of nursing students during the early stages of the outbreak. We conducted a qualitative study with an empirical-phenomenological approach. Twenty nursing students in their final year of study in Spain were recruited using purposive and snowball sampling. They participated in in-depth interviews between 20 April and 10 May 2020. The interviews were transcribed and then analyzed using Haase's adaptation of Colaizzi's phenomenological method. Four main themes emerged from data analysis: "social responsibility and pride as a health worker", "pressure caused by working with COVID-19 patients", "feeling defenseless and let down", and "personal growth as a health worker". These main themes were further divided into 11 theme categories. Due to an intense work day for several days in a row, the students were tired and mentally exhausted. Even so, they managed to overcome any difficulties, demonstrating their professional dedication and resilience. Greater preparatory support should be provided to safeguard the well-being of these future healthcare providers. More intensive preparatory training is necessary for health sciences students to facilitate crisis preparedness and effective crisis management. It is necessary to implement support from healthcare systems, including sufficient personal protective equipment, as well as contracts that accurately reflect the work they do. It is necessary for nursing supervisors to have effective communication in the performance of their functions with nursing students; this dialogue helps to clearly explain which are the functions that students must perform when they are carrying out their internships. There is also a need for preparatory training in managing infectious diseases such as COVID-19.

Effectiveness of an Educational Intervention With High-Fidelity Clinical Simulation to Improve Attitudes Toward Teamwork Among Health Professionals.

BACKGROUND: Failures in teamwork are a common reason for adverse medical events. The goals of this study are to evaluate attitudes toward teamwork among an interprofessional group of health professionals and to analyze the effectiveness of an educational intervention with high-fidelity clinical simulation to improve these attitudes. METHOD: An educational intervention was developed that used a 6-hour session that included three simulated clinical cases. The Attitudes Toward Health Care Teams Scale was used for assessment. Mean difference before and after the intervention was calculated with the Wilcoxon test. RESULTS: Positive attitude toward teamwork after completion of the training activities was measured. The health care professionals who showed the most positive attitude toward teamwork were physicians (93.92, SD = 6.58) and resident physicians (95.01, SD = 6.33). The greatest increase was observed among orderlies (p < .001) and nursing assistants (p < .001). CONCLUSION: The use of clinical simulation for interprofessional training of health care professionals showed a positive effect on attitudes toward teamwork. [J Contin Educ Nurs. 2021;52(10):457-467.].

Niveles de ansiedad de los equipos interprofesionales durante el entrenamiento con simulación clínica / Anxiety levels in interprofessional teams during training with clinical simulation

Objetivo: analizar el efecto de la simulación clínica en el nivel de ansiedad pre/post-actividad formativa en varios grupos profesionales y en estudiantes de Enfermería, y evaluar la autoconfianza percibida antes/después de la simulación en cada grupo.Métodos: estudio cuasi-experimental en profesionales sanitarios (enfermeras, técnicos en cuidados auxiliares de Enfermería o TCAE y médicos) y estudiantes de Enfermería (4º curso) sometidos por primera vez a una intervención de simulación clínica en el Hospital General Universitario de Ciudad Real. Se evaluó el nivel de ansiedad estado antes/después de la simulación mediante el cuestionario STAI de Spielberg, y se valoró la autoconfianza percibida antes/después de la simulación. Se realizó análisis descriptivo. Se usó la t de Student para la comparación de medias. Se estableció significación estadística si p< 0,05.Resultados: participaron 53 sujetos, 43 (81,2%) profesionales y 10 (18,8%) estudiantes de Enfermería. Edad media (DE) fue 39 (11,8) años; 84,9% (n= 45) mujeres. El nivel de ansiedad medio (DE) al inicio de la simulación fue mayor en los estudiantes de Enfermería 24,6 (5,4) y menor en los médicos 14,4 (5,8). Tras la intervención se redujo la media (DE) del nivel de ansiedad-estado en todos los grupos, siendo significativo (p< 0,001) en TCAE -13,1 (6,9) y enfermeras -12,5 (8,4). Hubo un aumento del nivel de autoconfianza de todos los participantes al finalizar la actividad.Conclusiones: los profesionales que participaron por primera vez en una actividad de simulación clínica presentaron alto grado de ansiedad, aunque en médicos fue inferior. Hubo un descenso de la ansiedad y aumento de la confianza al final de la simulación clínica.(AU)

Objective: to analyze the effect of clinical simulation in the level of anxiety pre- and post- training activity in different professional groups and Nursing students, and to assess the self-confidence perceived before/after the simulation in each group.Methods: a quasi-experimental study in healthcare professionals (nurses, assistant nursing technicians or TCAE, and doctors), and Nursing students (4th year), who underwent for the first time a clinical simulation intervention at the Hospital General Universitario de Ciudad Real. The level of anxiety was evaluated before/after the simulation, through Spielberger’s STAI questionnaire, and the level of self-confidence perceived was also evaluated before / after the simulation. Descriptive analysis was conducted, and Student’s t test was used for mean comparison. Statistical significance was established at p< 0.05.Results: the study included 53 subjects: 43 (81.2%) were professionals and 10 (18.8%) were Nursing students; their mean age (SD) was 39 (11.8) years; and 84.9% (n= 45) were female. The mean anxiety level (SD) at the start of the simulation was higher in Nursing students, with 24.6 (5.4), and lower in doctors, with 14.4 (5.8). After the intervention, the mean (SD) level of anxiety-status was reduced in all groups; it was significant (p< 0.001) in the TCAE group, with -13.1 (6.9) and nurses, with -12.5 (8.4). There was an increase in the level of self-confidence in all participants by the end of the activity.Conclusions: the professionals who participated for the first time in a clinical simulation activity presented a high level of anxiety, though this was lower among doctors. There was a reduction in anxiety and increase in confidence by the end of the clinical simulation.(AU)

Nursing students' experience and training in healthcare aid during the COVID-19 pandemic in Spain.

BACKGROUND: During the COVID-19 pandemic health crisis, in some countries such as Spain, nursing students have offered to provide health assistance, but the role they have played, their degree of preparedness to face the situation, and what must be improved in their training to be ready for these situations is unknown. OBJECTIVE: Describe the experience and perceptions of students of the Nursing university degree during their participation as health support in the COVID-19 health crisis in Spain. DESIGN: We conducted a cross-sectional survey study. METHOD: 503 students enrolled in the 4th course of the Nursing degree in Spain during the months of March and April 2020. An online questionnaire was developed, based on a pilot study and distributed through the Nursing Association, students' unions and students' associations. Variables were used to describe their participation, degree of preparedness and training needs to determine how to improve training through descriptive statistics, as well as nonparametric tests to analyse the relationship between training and degree of preparedness nursing students. Results are reported according to the STROBE Statement. RESULTS: 73.2% (368) of students offered to participate in healthcare aid, of which 225 were actively involved. 27.8% carried out nursing tasks without supervision, and 47.7% assisted COVID-19 patients as any other nurse. Only 3.4% felt very prepared to work in the field of intensive care, finding that those students who perceived a higher degree of preparedness had received previous training in personal protective equipment and mechanical ventilation (p < 0.005). The highest scores for training activities that may improve their preparedness were simulations to improve levels of anxiety and stress when managing critical patients, simulation in ventilatory support and mandatory practices in services where ventilators are used. CONCLUSIONS: Although three out of four students were willing to provide health assistance, they recognise that they were not specially prepared in the field of intensive care and demand training with simulation to improve anxiety and stress levels in the management of critical patients and simulation in ventilatory support. RELEVANCE TO CLINICAL PRACTICE: Students have been vital resources for our health system and society when they have been needed. It is now up to us, both teachers and health authorities, to share their efforts by implementing the necessary improvements in training and safety measures not only because these affects the health and safety of the patient, but because they will be essential parts in future pandemics.

[Clinical simulation as a training tool for clinical teams and care change facilitator]. / La simulación clínica: entrenamiento de equipos clínicos y facilitador de cambios asistenciales.

OBJECTIVE: The objective of this article is to describe and show the results of a simulation training interprofesional program to meet a training need of Surgical area professionals in management in cardiovascular surgery emergencies in Valdecilla Hospital. MATERIAL: The activity was aimed to train at the 42 nurses in rotation in the surgical area, nursing assistances, cardiovascular surgeons and anesthetists. For it was made a study of the training needs and were designed clinical simulation escenarios, theoretical sessions as well in workshops usual workplace. RESULTS: The training project was conducted in four phases between May 21 to June 18, 2012, within which were 3 clinical cases for multidisciplinary training in emergency usual CCV. With the full participation of 65 professionals and 17 instructors, after further analysis to cases, results were achieved improved teamwork, and picked up, several changes to be made in the organization of the service. CONCLUSIONS: Clinical simulation mode responds to adult learning, based on their own experience and personal reflection, and all in an environment that does not risk to patients or professionals. It is really helpful and flexible to meet different institutional challenges and where participants highlighted two key aspects in this activity such as the multidisciplinary team where they could train the professional standard and the possibility of analysis and reflection after the event to share experiences and look for areas of improvement among all the clinical team.

La simulación clínica. Entrenamiento de equipos clínicos y facilitador de cambios asistenciales / Clinical simulation as a training tool for clinical teams and care change facilitator

Objetivo. Describir y mostrar los resultados de un programa de formación interprofesional basado en simulación clínica para para dar respuesta a una necesidad formativa de los profesionales del área quirúrgica del Hospital Valdecilla en el manejo de las urgencias vitales en cirugía cardiovascular (CCV). Material. La actividad fue dirigida para entrenar a las 42 enfermeras de turno rotatorio del área quirúrgica junto con personal auxiliar, cirujanos cardiovasculares y anestesistas. Para ello se realizó un estudio de las necesidades formativas y se diseñaron jornadas de entrenamiento mediante simulación clínica, además de sesiones teóricas y talleres in situ en el lugar habitual de trabajo. Resultados. El proyecto formativo se realizó en cuatro fases entre el 21 de mayo al 18 de junio del 2012, dentro de las cuales se efectuaron tres casos clínicos para el entrenamiento multidisciplinar de urgencias habituales en CCV, con la participación total de 65 profesionales y 17 instructores; gracias a los análisis posteriores a los casos, se alcanzaron resultados de mejora del trabajo en equipo y se recogieron diferentes cambios a realizar en la organización clínica del servicio. Conclusiones. La simulación clínica responde al modo de aprendizaje de los adultos, basado en la propia experiencia y la reflexión personal, y todo ello en un entorno que no pone en riesgo a pacientes, ni a profesionales. Es realmente útil y flexible para hacer frente a diferentes retos institucionales; y los participantes resaltaron dos aspectos clave: el caracter multidisciplinar, pudiendo entrenar el equipo habitual de profesionales, y la posibilidad del análisis y reflexión posterior al caso para compartir experiencias y buscar áreas de mejora entre todo el equipo clínico (AU)

Objective: The objective of this article is to describe and show the results of a simulation training interprofesional program to meet a training need of Surgical area professionals in management in cardiovascular surgery emergencies in Valdecilla Hospital. Material: The activity was aimed to train at the 42 nurses in rotation in the surgical area, nursing assistances, cardiovascular surgeons and anesthetists. For it was made a study of the training needs and were designed clinical simulation escenarios, theoretical sessions as well in workshops usual workplace. Results: The training project was conducted in four phases between May 21 to June 18, 2012, within which were 3 clinical cases for multidisciplinary training in emergency usual CCV. With the full participation of 65 professionals and 17 instructors, after further analysis to cases, results were achieved improved teamwork, and picked up, several changes to be made in the organization of the service. Conclusions: Clinical simulation mode responds to adult learning, based on their own experience and personal reflection, and all in an environment that does not risk to patients or professionals. It is really helpful and flexible to meet different institutional challenges and where participants highlighted two key aspects in this activity such as the multidisciplinary team where they could train the professional standard and the possibility of analysis and reflection after the event to share experiences and look for areas of improvement among all the clinical team (AU)

La simulación en Enfermería, un nuevo reto docente / Simulation in Nursing, a new teaching challenge

La simulación clínica es una herramienta docente que está empezando a abrirse camino en la formación enfermera en España. Los nuevos planes formativos en las Escuelas o Facultades de Enfermería y el reto de las instituciones sanitarias de mejorar la seguridad de los pacientes han provocadoun cambio en la cultura de la formación de pregrado y postgrado.Los simuladores para el entrenamiento y la evaluación de profesionales sanitarios están muy asentados en muchos países como, por ejemplo,EE. UU., donde existen más de 300 centros de simulación. El crecimiento es mundialmente imparable y España no es un caso aparte, donde ya existen más de 15 centros que utilizan esta herramienta dentro de sus programas docentes. Debido a su potencia formativa y el carácter multidisciplinar de estos centros, es necesario que los profesionales de la Enfermería española sean responsables en la utilización de esta herramienta, que requiere una formación especial y adecuada, para poder mantenerse al frente de la enseñanza de profesionales sanitarios de una forma segura para los docentes, los profesionales y, lógicamente, para los pacientes (AU)

Clinical simulation is a teaching tool that is beginning to make its wayin nursing education in Spain. The new training plans in Nursing schools and the challenge of health institutions to improve patient safety haveled to a change in the training of undergraduate and postgraduate levels.Simulators for training and evaluation of health care professionals are deeply rooted in many countries, for example, in the United States, with more than 300 simulation centers. This growth is unstoppable worldwide and Spain is not different, with already more than 15 centers that use this tool in their teaching programs. Due to its training power and the multidisciplinary nature of these centers, it is necessary for Spanish nursing professionals to be responsible in the use of this tool, which requires special and adequate training, to stay a breast in the education of health professionals in a manner that is safe for teachers, professionals and, of course, for patients (AU)