Influence of simulation design on stress, anxiety and self-confidence of nursing students: Systematic review with meta-analysis.

AIM: To evaluate the simulation design characteristics that may influence the stress, anxiety and self-confidence of undergraduate nursing students during learning. DESIGN: Systematic review with meta-analysis. DATA SOURCES: Searchers were conducted in October 2020 and updated in August 2022 in the databases CENTRAL, CINAHL, Embase®, ERIC, LILACS, MEDLINE, PsycINFO®, Scopus and Web of Science, PQDT Open (ProQuest), BDTD, Google Scholar and specific journals on simulation. REVIEW METHODS: This review was conducted according to the recommendations of Cochrane Handbook for Systematic Reviews and reported according to the PRISMA Statement. Experimental and quasi-experimental studies that compared the effect of simulation on stress, anxiety and self-confidence of nursing students were included. The selection of studies and data extraction was performed independently by two reviewers. Simulation information was collected as prebriefing, scenario, debriefing, duration, modality, fidelity and simulator. Data summarization was performed by qualitative synthesis and meta-analytical methods. RESULTS: Eighty studies were included in the review, and most reported in detail the structure of the simulation, contemplating prebriefing, scenario, debriefing and the duration of each step. In subgroup meta-analysis, the presence of prebriefing, duration of more than 60 min and high-fidelity simulations helped reduce anxiety, while the presence of prebriefing and debriefing, duration, immersive clinical simulation modalities and procedure simulation, high-fidelity simulations and use of mannequins, standardised patients and virtual simulators, contributed to greater students' self-confidence. CONCLUSIONS: Different modulations of simulation design components imply reduction of anxiety and increased self-confidence in nursing students, especially highlighting the quality of the methodological report of simulation interventions. RELEVANCE TO CLINICAL PRACTICE: These findings help to support the need of more rigorous methodology in simulation designs and research methods. Consequently, impact on the education of qualified professionals prepared to work in clinical practice. No Patient or Public Contribution.

Breast shells for pain and nipple injury prevention: A non-randomized clinical trial.

Objective: This study aimed to analyze the effectiveness of breast shells in preventing pain and nipple injury during breastfeeding. Method: A non-randomized clinical trial was carried out with blinding to the evaluators of the study results. The study included women with ≥35 weeks of singleton pregnancy, no nipple changes, and a desire to breastfeed. Resulting in 62 lactating women. The experimental group used breast shells and health education with clinical demonstration (n = 29), whereas the control group used no breast shells (n = 33). Pain and nipple injury were assessed three times, twice prenatally and once up to 14 days postpartum. Results: Nipple injury (50.0%) and nipple pain (67.7%) presented with similar frequency in both groups (p = 1). Breast engorgement (35,5%) was associated with nipple pain (p = 0.019) and its onset was delayed in the experimental group (p = 0.001). Health education contributes to breast and nipple care and increases favorable breastfeeding patterns. Conclusion: Breast shells do not prevent nipple pain or injury. Innovation: As far as we know, this is the first clinical research evaluating the use of breast shells since the antenatal care to prevent the occurrence of nipple pain and injury.

Lanolin and prenatal health education for prevention of nipple pain and trauma: Randomized clinical trial. / Lanolina y educación para la salud en la prevención de dolor y lesiones en los pezones: ensayo clínico aleatorizado.

OBJECTIVE: To investigate the effect of lanolin on nipple pain and trauma in breastfeeding after application of a health education. METHOD: Randomized controlled clinical trial, with two arms, open, with 66 participants during prenatal care in the primary health care network in Goiania - Goias, Brazil. Participants were randomized (1:1) using computer generated numbers in both experimental group (EG) and control group (CG). The EG received lanolin and health education on breastfeeding at two different times with clinical demonstration using cloth didactic breast and illustrative album as the intervention, while the CG received standard health education. Health education was carried out by the same researchers in both groups. Measurement of pain, nipple trauma, and breastfeeding technique occurred on postpartum day eight. The analysis included descriptive statistics and inferential analysis by means chi-square or Fisher test, and Student's t-test, significance level set at 0.05. RESULTS: A majority of the participants experienced no nipple trauma (59.1%) in both groups, and 60.6% of women experienced pain. In both groups, women showed favorable breastfeeding behaviors, except in the condition of the breasts. There were no significant differences between groups in pain prevention (p=0.61), nipple lesions (p=0.21), and breastfeeding technique (p>0.05). CONCLUSION: It is not clear whether the intervention, lanolin combined with health education, has a positive effect on the prevention of nipple pain and trauma. Further research is needed to elucidate this question. Registration number: RBR-7tvhq8. Registry website: http://www.ensaiosclinicos.gov.br/.

Serious Game e-Baby Família: an educational technology for premature infant care.

OBJECTIVES: to develop and assess the serious game e-Baby Família with parents of premature infants. METHODS: a methodological study regarding the development of the serious game, with participatory design in scope definition, starting from parents' learning needs about premature infant care. A qualitative approach was performed in the assessment stage with parents, with content analysis of the speech of the eight participants. RESULTS: the following categories emerged: Realistic appearance of the virtual setting and game content and Gameplay implications for the use of e-Baby Família. The game was satisfactorily assessed regarding content, appearance and dynamics use, motivating participants to learn. FINAL CONSIDERATIONS: in the context of prematurity as a public health problem in Brazil and the need to strengthen family health education for care, the serious game was assessed as motivating and appropriate for health learning.

The effectiveness on health education to prevent nipple trauma from breastfeeding: a systematic review / A eficácia da educação em saúde na prevenção do trauma mamilar na amamentação: revisão sistemática

Abstract Objectives: to analyze the effectiveness on health education to prevent nipple trauma in breastfeeding compared to other interventions. Methods: systematic literature review was carried out in January 2019, according to PRISMA recommendations. The searches were conducted in Cinahl, PubMed, Web of Science, Scopus, and in the references cited in the selected articles. The studies were assessed for quality and level of evidence according to the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE). Results: twelve studies were selected, all conducted at the maternities. The interventions were classified in two categories: health education on breastfeeding and the use of nipple covers. Health education on breastfeeding presents a moderate level of evidence on the prevention of nipple trauma. There is a moderate to high level of evidence on the positive effects of guaiazulene, gel or peppermint water applied in the postpartum period to prevent nipple trauma. Conclusion: health education on breastfeeding with clinical demonstration is an important strategy to prevent nipple trauma and requires more than one educational approach. The use of nipple covers requires some consideration, since they must be removed prior to breastfeeding. All interventions were conducted in the postpartum period, which points out for the necessity of clinical research to prevent nipple trauma in prenatal care.

Resumo Objetivos: analisar a eficácia da educação em saúde para a prevenção do trauma mamilar na amamentação comparado a outras intervenções. Métodos: revisão sistemática realizada em janeiro de 2019, segundo recomendações PRISMA. As buscas foram realizadas na Cinahl, PubMed, Web of Science, Scopus e referências citadas nos artigos selecionados. Os estudos foram avaliados quanto à qualidade e nível de evidência conforme o sistema Grading of Recommendations, Assessment, Development and Evaluation. Resultados: foram selecionados 12 estudos, todos executados em maternidades. As intervenções foram representadas em duas categorias: educação em saúde sobre amamentação e uso de coberturas mamilares. A educação em saúde sobre amamentação apresenta moderada evidência na prevenção do trauma mamilar. As coberturas de gel ou água de hortelã-pimenta, de guaiazulene, aplicadas no pós-parto, têm efeito positivo na prevenção do trauma mamilar, com moderada a alta evidência. Conclusão: a educação em saúde sobre amamentação, com demonstração clínica, configura-se importante estratégia para prevenção do trauma mamilar, devendo ser realizada mais de uma abordagem educativa. A implementação de coberturas mamilares precisa ser ponderada, pois todas exigiram remoção antes da mamada. Todas as intervenções foram conduzidas no pós-parto, o que aponta para a necessidade de pesquisas clínicas sobre a prevenção do trauma mamilar no pré-natal.

Serious Game e-Baby Família: an educational technology for premature infant care / Serious Game e-Baby Família: tecnologia educacional para el cuidado del recién nascido premature / Serious Game e-Baby Família: tecnologia educacional para o cuidado do recém-nascido premature

ABSTRACT Objectives: to develop and assess the serious game e-Baby Família with parents of premature infants. Methods: a methodological study regarding the development of the serious game, with participatory design in scope definition, starting from parents' learning needs about premature infant care. A qualitative approach was performed in the assessment stage with parents, with content analysis of the speech of the eight participants. Results: the following categories emerged: Realistic appearance of the virtual setting and game content and Gameplay implications for the use of e-Baby Família. The game was satisfactorily assessed regarding content, appearance and dynamics use, motivating participants to learn. Final Considerations: in the context of prematurity as a public health problem in Brazil and the need to strengthen family health education for care, the serious game was assessed as motivating and appropriate for health learning.

RESUMEN Objetivos: desarrollar y evaluar el serious game e-Baby Família junto a los familiares de los bebés prematuros. Métodos: estudio metodológico en cuanto al desarrollo del juego, con diseño participativo en la definición del tema, partiendo de las necesidades de aprendizaje de los padres sobre los cuidados con el bebé prematuro. Enfoque cualitativo en la etapa de evaluación junto a los familiares, con análisis de contenido de las hablas de los ocho participantes. Resultados: en la evaluación surgieron las categorías: A. Apariencia realista del escenario virtual y contenido del juego, y B. Implicaciones de la jugabilidad para el uso del e-Baby Familia. El juego fue evaluado satisfactoriamente con relación al contenido, apariencia y dinámica de uso, motivando a los participantes al aprendizaje. Consideraciones Finales: en el contexto de la prematuridad como problema de salud pública en Brasil, y de la necesidad de fortalecimiento de la educación en salud de las familias para el cuidado, el serio juego fue evaluado como motivador y adecuado para el aprendizaje en salud.

RESUMO Objetivos: desenvolver e avaliar o Serious Game e-Baby Família junto aos pais de bebês prematuros. Métodos: estudo metodológico quanto ao desenvolvimento do serious game, com design participativo na definição do escopo, partindo-se das necessidades de aprendizagem dos pais sobre os cuidados com o bebê prematuro. Abordagem qualitativa na etapa de avaliação junto aos pais, com análise de conteúdo das falas dos oito participantes. Resultados: na avaliação, emergiram as categorias: Aparência realística do cenário virtual e conteúdo do jogo e Implicações da jogabilidade para o uso do e-Baby Família. O jogo foi avaliado satisfatoriamente com relação ao conteúdo, aparência e dinâmica de uso, motivando os participantes ao aprendizado. Considerações Finais: no contexto da prematuridade enquanto problema de saúde pública no Brasil e da necessidade de fortalecimento da educação em saúde das famílias para o cuidado, o serious game foi avaliado como motivador e adequado para a aprendizagem em saúde.

Adaptação cultural da ferramenta de avaliação de comunicação em saúde (HCAT) para a língua portuguesa, Brasil / Cultural adaptation of the health communication assessment tool to portuguese language, Brazil / Adaptación cultural de la herramienta de evaluación de comunicación en salud (HCAT) para la lengua portuguesa, Brasil

Este estudo tem como objetivo descrever o processo de adaptação cultural da ferramenta Health Communication Assessment Tool (HCAT) para o Brasil. A HCAT é uma escala que avalia comportamentos de comunicação em simulação clínica. Trata-se de uma pesquisa metodológica, desenvolvida em instituição de ensino superior por meio das seguintes etapas: tradução da ferramenta para a língua portuguesa; avaliação por um comitê de juízes; retrotradução; e avaliação semântica. Todas as etapas do processo de adaptação cultural foram rigorosamente seguidas, garantindo equivalências semânticas, idiomáticas, culturais e conceituais entre a versão original e a brasileira, além de concordância superior a 70% dos professores de enfermagem das regiões Nordeste, Sudeste e Sul que participaram da última etapa, ou seja, da avaliação semântica. Conclui-se que a versão brasileira do HCAT foi adaptada culturalmente e poderá avaliar a habilidade de comunicação de estudantes de enfermagem em cenário de simulação clínica.

This study aims to describe the process of cultural adaptation of the Health Communication Assessment Tool (HCAT) to Brazil. The HCAT is a scale that evaluates communication behaviors in clinical simulation. We developed a methodological research in an institution of higher education through the following stages: translation of the tool from English into Portuguese; evaluation by a committee of judges; back-translation; and semantic evaluation. All stages of the cultural adaptation process were rigorously developed ensuring semantic, idiomatic, cultural and conceptual equivalence between the original and the Brazilian version, in addition to a concordance of more than 70% of the nursing teachers who were invited to collaborate in evaluation. They are from three Brazilian regions ­ Northeast, Southeast and South ­ and participated in the last stage, namely semantic evaluation. It was concluded that the Brazilian version of the HCAT was culturally adapted and it will be a good tool to assess the communication skills of nursing students in a scenario of clinical simulation.

Este estudio se centra en describir el proceso de la adaptación cultural de la herramienta Health Comunnication Assessment Tool (HCAT) a Brasil. El HCAT es una escala que evalúa la comunicación de los comportamientos en simulación clínica. El estudio constituye una investigación metodológica desarrollada en una institución de educación superior a través de las siguientes etapas: la traducción de la herramienta al portugués; evaluación por un comité de jueces; back-translation; y evaluación semántica. Todas las etapas del proceso de adaptación cultural fueron desarrolladas con el debido rigor garantizando equivalencias semánticas, idiomáticas, culturales y conceptuales entre la versión original y la brasileña, además de concordancia superior al 70% de los profesores de enfermería de las regiones Nordeste, Sudeste y Sur del Brasil que participaron de la última etapa, es decir, la evaluación semántica. Se consideró que la versión brasileña de la HCAT fue adaptada culturalmente y podrá evaluar las habilidades de comunicación de los estudiantes de enfermería en escenario de simulación clínica.

E-baby integridade da pele: inovação tecnológica no ensino de enfermagem neonatal baseado em evidências / E-baby skin integrity: evidence-based technology innovation for teaching in neonatal nursing

Objective: To develop and validate the serious game e-Baby: skin integrity along with a panel of experts. Method: Methodological research approaching the following development steps: scope definition, game format and functions, script and communication with software developers, creation of prototype with evaluation and production; and validation by four experts using the tool Heuristic Evaluation for Digital Educational Game. Results: The serious game was built in a 3D technology with multimedia including animation and scientific-based content. The educational technology was validated by the experts in all heuristics, and among the all 36 analyzed items. 18 (50%) presented no errors, and regarding the remaining items with any error, none had more than 25% errors within levels 3 and 4, according to Nielsen's classification. Conclusion and implications for the practice: The validated serious game is a virtual simulation educational technology with potential to contribute with learning in nursing and with evidence-based clinical practice.

Objetivo: Desarrollar y validar el juego e-Baby: integridad de la piel junto a un panel de peritos. Método: La investigación metodológica contemplando las etapas de desarrollo: definición de alcance, formato del juego y sus funcionalidades, descripción del guion y comunicación con desarrolladores, prototipaje con evaluación y producción; y validación junto a cuatro peritos utilizando el instrumento Heuristic Evaluation for Digital Educational Games. Resultados: El serious game fue construido en 3D con multimedia incluyendo animaciones y contenido basado científicamente. Validado en todas las heurísticas, dentro todos los 36 ítems analizados, 18 (50%) fueran considerados sin problemas, siendo que en ninguno de los ítems ocurrió más que 25% de problemas clasificados en los niveles 3 y 4, segundo la clasificación de Nielsen. Conclusión e implicaciones para la práctica: El juego validado es una tecnología educativa del tipo simulación virtual con potencial para contribuir con el aprendizaje em enfermería y la práctica basada en evidencias.

Objetivo: Desenvolver e validar o serious game e-Baby: integridade da pele junto a um painel de experts. Método: Pesquisa metodológica contemplando as etapas de desenvolvimento: definição de escopo, formato do jogo e suas funcionalidades, descrição do roteiro e comunicação com desenvolvedores, prototipagem com avaliação e produção; e validação junto a quatro experts utilizando o instrumento Heuristic Evaluation for Digital Educational Games. Resultados: O Serious game foi construído em 3D, com multimídia, incluindo animações e conteúdo embasado cientificamente. Validado pelos experts em todas as heurísticas, dentre os 36 itens analisados, 18 (50%) foram considerados isentos de problemas, sendo que em nenhum dos itens houve mais que 25% de problemas classificados nos níveis 3 e 4, segundo a classificação de Nielsen. Conclusão e implicações para a prática: O serious game é uma tecnologia educacional do tipo simulação virtual, validado, e com potencial para contribuir com a aprendizagem e a prática baseada em evidências.

Simulação com pacientes padronizados: habilidades de comunicação em saúde do estudante de enfermagem / Simulation with standardized patients: nursing student's communication skills in health

Objetivo: identificar e medir as habilidades de comunicação em saúde do estudante de enfermagem usando simulação com paciente padronizado. Métodos: descritivo, transversal, realizado junto a 16 estudantes do último ano da graduação em enfermagem. A simulação centrou-se na solicitação de autorização do paciente/família para realizar punção venosa. Durante a simulação, todos os alunos foram avaliados por meio da Ferramenta de Avaliação da Comunicação em Saúde. Resultados: dentre os 22 itens da ferramenta, 18 atingiram concordância superior a 50,0%. Dos 16 participantes, 14 (87,5%) foram avaliados como capazes de se comunicar em mais de 50,0% das afirmações. Conclusão: a comunicação do estudante foi satisfatória; há lacunas relacionadas aos aspectos emocionais do paciente e família, manifestando necessidade de reforçar a comunicação no currículo de enfermagem.(AU)