Undergraduate Nursing Students' Attitude and Perception Toward High-Fidelity Simulation-Based Education in a Middle Eastern Country.

Introduction: Rapid use of technologically driven simulation environment in teaching-learning has caused mixed feelings among students. High-fidelity simulation-based education is superior in cultivating the knowledge, skills, caring, learning interest, and collaboration among nursing students. However, the nursing students' attitudes and perceptions toward high-fidelity simulation-based education are unexplored. Objectives: The present study aims to explore the attitude and perception of undergraduate nursing students toward high-fidelity simulation-based education. Methods: Cross-sectional survey research design was adopted. We used self-administered Education Practices Questionnaire (student version) and Attitude Scale toward Simulation-Based Education to collect the data. A total of 109 nursing students were recruited. Results: Nursing student's attitude shows (mean = 68.26); perception on educational practices of high-fidelity simulation-based education demonstrates (M = 39.33 ± 7.87) and the importance of high-fidelity simulation-based education shows (M = 37.73 ± 7.45). However, no significant difference observed between the male and female student's attitude (t = -0.286 [0.78]) and perception (t [107] = 0.960 [0.34]). Similarly, no significant difference was observed among the different levels of students p > .005 on perception and attitude toward high-fidelity simulation-based education. Conclusion: The study proposed to have high-fidelity simulation-based education as an integral part of teaching in clinical training of students at all levels of nursing program.

Procedural simulators for teaching and learning vasectomy techniques: a scoping review.

Background: Procedural simulators can facilitate teaching and improve learning vasectomy surgical techniques. The objectives of this scoping review were to identify available vasectomy simulators (scrotal models), and to assess their characteristics and potential suitability for optimal transfer of surgical skills of most recommended techniques in clinical practice. Methods: We performed searches up to December 2023 using PubMed and Google search engines to identify existing vasectomy simulators. Articles and Web pages reporting vasectomy simulators were also examined using a snowball strategy. In addition, we asked members of the Vasectomy Network, an international Google discussion group, if they knew any other simulators. Two members of the research team performed the initial evaluations of the physical and functional characteristics of retrieved simulators. All team members made consensus on final evaluations. Results: We retrieved 10 relevant scrotal models through PubMed (n=2), Google (n=4), and the Vasectomy Network (n=4). Three were commercially available simulators produced by Gaumard® in the USA and seven were homemade models. All had limited visual and haptic realism of internal and external structures. Most, however, were suitable for simulating some basic skills of the no-scalpel technique to deliver the vas deferens. Fascial interposition could not be simulated with any model. Commercially available models had no advantage over homemade models. Conclusions: Most vasectomy simulators currently available allow learning some basic surgical skills of the procedure but have limitations for optimal learning of the recommended techniques and skill transfer in clinical practice. There appears to be a need to develop and evaluate new simulators with enhance visual and haptic characteristics for teaching and learning vasectomy techniques.

Socioemotional Skills in the Teaching-Learning Process Mediated by Medium- and High-Fidelity Clinical Simulation in Nursing Students: Protocol for a Scoping Review.

BACKGROUND: In nursing education, contact with real scenarios implies the design of favorable experiences to develop prioritization, reasoning, critical thinking, and management skills that support future practice. In the context of the teaching-learning process, simulation emerges as a support strategy, but its use and management require the knowledge and appropriation of teachers. Clinical simulation during education promotes growth in technical skills and aptitudes such as critical thinking, emotional management, organization, delegation, and teamwork. The culmination positively impacts the student, reflecting on their confidence, security, and adaptability to unexpected or unknown situations and risks. OBJECTIVE: The aim of this scoping review is to determine the socioemotional skills described during the teaching-learning process mediated by medium- and high-fidelity clinical simulation in nursing students. METHODS: The main concepts and limits of the research area will be determined according to the 5 phases of a scoping review proposed by Arksey and O'Malley. Research articles and postgraduate theses published between 2010 and 2023 in English and Spanish will be considered. Dissertation-type documents, book chapters, editorials, abstracts, and articles focused on clinical simulation among nursing professionals will be excluded. The articles will be retrieved from databases available at the Universidad Cooperativa de Colombia, along with CINAHL, Scielo, and PubMed. The search strategy will be based on the Population-Concept-Context framework. Article selection will be carried out by 2 independent evaluators who will review titles and abstracts in stage 1 and the full text in stage 2. A database of retrieved articles will be built with the variables of interest. A qualitative thematic analysis will be conducted by 5 independent reviewers to provide an overview of the literature, focusing on identifying similarities and contrasts between studies and contributions related to the aspects of social skills described in nursing students. RESULTS: The investigation has not yet started. The findings aim to focus on variables within the academic environment that, when correlated with the clinical simulation experience, may determine student learning. The working hypothesis is that students who experience greater satisfaction or possess better communication skills also demonstrate superior performance during high-fidelity simulation activities. The most relevant results will be contrasted considering the stated objective and knowledge gaps. Key aspects will also be compared with other reviews addressing related topics such as communication, self-efficacy, and self-confidence. Skills described by other authors that were not considered in the initial literature review will also be mentioned. CONCLUSIONS: Educational institutions are responsible for including learning experiences in controlled environments such as medium- and high-fidelity simulation to ensure the acquisition of technical capabilities and additional socioemotional skills. Recognizing and managing emotions is necessary to provide adequate care for users of health care services and for the increased effectiveness of professionals. TRIAL REGISTRATION: Open Science Framework p4ays; https://osf.io/p4ays. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): PRR1-10.2196/56436.

Assessment of the Impact of Technical Incidents in Critical Situations Using High-Fidelity Simulation Techniques in Pediatric Intensive Care.

Introduction In certain fields such as anesthesia and critical care, technical incidents are rare events; however, when they occur, they disrupt workflow, optimal patient care, and survival, with human factors often implicated. In pediatric resuscitation, the impact of these incidents on patient care has not yet been thoroughly explored through simulation. Consequently, we investigated how healthcare teams integrate technical incidents in critical situations and whether this interferes with the adequate management of patients. Materials & methods In a single-blind randomized study utilizing high-fidelity simulation, we incorporated a pediatric scenario involving hypoxemia in an intubated and ventilated infant where the endotracheal tube (ETT) was obstructed. A technical incident (disconnected oxygen supply) was either present (TI+) or absent (TI-) in the scenario. We compared reaction times for "removal of the obstructed ETT" between the two groups (TI+ and TI-). Additionally, we recorded and analyzed reaction times for "bag ventilation" and "repair of the technical incident" in the TI+ group. To assess the scenario's credibility, we conducted an analysis comparing the medians of evaluation forms that were anonymously completed by participants at the end of the sessions. Results In total, 10 simulation sessions were conducted, five TI+ and five TI-. The time required for removal of the obstructed ETT in the presence of a technical incident was significantly prolonged compared to controls (Mann-Whitney test, p=0.03). Furthermore, bag ventilation precedes tube removal in the TI+ group, a contrast to the TI- group, which quickly removes the obstructed ETT before stabilizing the patient with bag-mask ventilation. Conclusion Technical incidents in simulated pediatric scenario adversely affect urgent care in ventilated children. Developing and validating a procedural response to these situations through further simulation is imperative.

Training in cardiothoracic surgery: The role for simulation.

Adequate cardiothoracic surgical training is essential for provision of quality care to patients. In recent years, simulation-based training has been advocated as an adjunct to traditional surgical training. Advances in simulation technology has resulted in many low- and highfidelity simulators being employed in cardiothoracic surgical training. Such models allow trainees to practice an array of realistic full-length procedures in a safe and controlled environment, with the window to make mistakes and consider them learning points. There is significant evidence to demonstrate the effectiveness of cardiothoracic surgery simulation in improving surgical skills and operating room performances in addition to building confidence among trainees. However, owing to the high financial cost of arranging it, simulation-based training is not widespread in low- and middle-income countries, including Pakistan. More work is warranted on the cost effectiveness of implementing simulation-based learning, which, in turn, would increase the uptake of simulation to enhance cardiothoracic surgical training in Pakistan.

Evaluating Satisfaction and Self-Confidence among Nursing Students in Clinical Simulation Learning.

BACKGROUND: Clinical simulation is effective in nursing student education, fostering autonomous learning and critical skill development in safe environments. This method is adaptable to dynamic educational approaches and integrates technology. Satisfaction and self-confidence are key elements in its evaluation. The general objective of this research was to describe the levels of satisfaction and self-confidence among undergraduate nursing students regarding the use of clinical simulation in the field of family and community nursing. METHODS: A cross-sectional descriptive study was conducted at the University of Jaén, Spain, during the 2023/2024 academic year. Data on sociodemographic aspects, satisfaction, and self-confidence were collected using a validated instrument. The statistical analysis included central measures, dispersion, and frequencies, with confidence intervals. RESULTS: The study involved 96 students in scenario 1 (family assessment) and 97 in scenario 2 (family intervention), with the majority being women. In scenario 1, the mean satisfaction score was 4.38 out of 5, and self-confidence was scored 4.44 out of 5. Prior preparation time correlated significantly with higher levels of satisfaction and self-confidence. In scenario 2, the mean scores were slightly higher but not statistically significant. CONCLUSIONS: Our study demonstrated high levels of satisfaction and self-confidence among nursing students following clinical simulations. Prior preparation was associated with better outcomes, and the quality of the simulation positively impacted the results.

Randomized Controlled Trial of Telementoring During Resource-Limited Patient Care Simulation Improves Caregiver Performance and Patient Survival.

OBJECTIVES: To determine the impact of telementoring on caregiver performance during a high-fidelity medical simulation model (HFMSM) of a critically ill patient in a resource-limited setting. DESIGN: A two-center, randomized, controlled study using a HFMSM of a patient with community-acquired pneumonia complicated by acute respiratory distress syndrome. SETTING: A notional clinic in a remote location staffed by a single clinician and nonmedical assistant. PARTICIPANTS: Clinicians with limited experience managing critically ill patients. INTERVENTIONS: Telemedicine (TM) support. MEASUREMENTS: The primary outcome was clinical performance as measured by accuracy, reliability, and efficiency of care. Secondary outcomes were patient survival, procedural quality, subjective assessment of the HFMSM, and perceived workload. MAIN RESULTS: TM participants (N = 11) performed better than non-TM (NTM, N = 12) in providing expected care (accuracy), delivering care more consistently (reliability), and without consistent differences in efficiency (timeliness of care). Accuracy: TM completed 91% and NTM 42% of expected tasks and procedures. Efficiency: groups did not differ in the mean (± sd) minutes it took to obtain an advanced airway successfully (TM 15.2 ± 10.5 vs. NTM 22.8 ± 8.4, p = 0.10) or decompress a tension pneumothorax with a needle (TM 0.7 ± 0.5 vs. NTM 0.6 ± 0.9, p = 0.65). TM was slower than NTM in completing thoracostomy (22.3 ± 10.2 vs. 12.3 ± 4.8, p = 0.03). Reliability: TM performed 13 of 17 (76%) tasks with more consistent timing than NTM. TM completed 68% and NTM 29% of procedural quality metrics. Eighty-two percent of the TM participants versus 17% of the NTM participants simulated patients survived (p = 0.003). The groups similarly perceived the HFMSM as realistic, managed their patients with personal ownership, and experienced comparable workload and stress. CONCLUSIONS: Remote expertise provided with TM to caregivers in resource-limited settings improves caregiver performance, quality of care, and potentially real patient survival. HFMSM can be used to study interventions in ways not possible with real patients.

Relationship of high-fidelity simulation experience, clinical reasoning, and clinical competence of new nurses: A cross-sectional study.

AIM: This study aimed to determine which high-fidelity simulation (HFS) experiences were associated with clinical reasoning and clinical competence among new nurses. BACKGROUND: HFS has been actively used in nursing education. It is necessary to verify the effects of HFS transfer to the clinical environment. DESIGN: A cross-sectional study reported following STROBE criteria. METHODS: Data were collected on new nurses (n = 224) who experienced HFS in their fourth-year undergraduate courses. The number of HFSs, the inclusion of simulation elements, the importance of elements to learning, clinical reasoning, and clinical competence were measured. Hierarchical regression models examined factors associated with clinical reasoning and clinical competence. RESULTS: Feedback was the most sufficiently included element of the HFS learning, and participants perceived it as the most important. A significant factor associated with clinical competence was clinical reasoning, and HFS design indirectly affected clinical competence through clinical reasoning. CONCLUSIONS: HFS learning is one of the best ways to improve clinical reasoning. Improving students' clinical reasoning should be an important goal of HFS learning in undergraduate courses to prepare students to be clinically competent nurses. IMPLICATIONS FOR NURSING: The ultimate goal of nursing education is to prepare nursing students to be competent nurses. Validating the outcomes of nursing education in the clinical environment setting is an essential task to improve clinical practice. IMPLICATIONS FOR NURSING POLICY: Nurse educators and leaders can increase nurses' clinical competence by emphasizing education to foster nurses' clinical reasoning in nursing education policies.

Interprofessional Paediatric High-Fidelity Simulation Training: A Mixed Methods Study of Experiences and Readiness among Nursing and Medical Students.

BACKGROUND: Training in communication skills between nursing and medical students during interprofessional paediatric emergency simulation training represents a significant aspect of safe patient care. Evidence highlights that poor communication in paediatric emergency scenarios jeopardises patient safety. Through realistic simulations, students practice the communication strategies of crisis resource management (CRM), such as "closed-loop communication", "speaking up", and "team time-out". AIMS: In this study, we aimed to evaluate the impact of interprofessional simulation on enhancing teamwork and communication skills. Additionally, we sought to assess the occurrence of contexts for the three CRM communication strategies during simulations. METHODS: Employing a mixed methods research design, the analysed students completed pre- and post-simulation online questionnaires. To measure attitudes towards interprofessional collaboration, we used the German version of the University of West England Interprofessional Questionnaire (UWE-IP_german), and to measure interprofessional attitudes, we used the Greifswald Questionnaire for the Measurement of Interprofessional Attitudes (Greif Mie), also in German, for both pre- and post-simulation. For qualitative video analysis, we utilised Grounded Theory Methodology (GTM). RESULTS: Following simulation training, we observed a significant improvement (p > 0.001) in the subscale "attitude towards interprofessional learning" of the UWE-IP_german among nursing and medical students. Medical students consistently exhibited a significantly (p < 0.001) more positive attitude towards other professionals in both the pre- and post-simulation assessments. Overall, all the students expressed satisfaction with the interprofessional simulation training. In the qualitative selective coding process, the central phenomenon "participation" could be identified in the coding paradigm. CONCLUSION: This study presents substantial evidence of the learning impact of interprofessional paediatric simulation training on nursing and medical students.

Design and content validation of a checklist about infection-prevention performance of intensive care nurses in simulation-based scenarios.

OBJECTIVE: To design, develop and validate a new tool, called NEUMOBACT, to evaluate critical care nurses' knowledge and skills in ventilator-associated pneumonia (VAP) and catheter-related bacteraemia (CRB) prevention through simulation scenarios involving central venous catheter (CVC), endotracheal suctioning (ETS) and mechanically ventilated patient care (PC) stations. BACKGROUND: Simulation-based training is an excellent way for nurses to learn prevention measures in VAP and CRB. DESIGN: Descriptive metric study to develop NEUMOBACT and analyse its content and face validity that followed the COSMIN Study Design checklist for patient-reported outcome measurement instruments. METHODS: The first version was developed with the content of training modules in use at the time (NEUMOBACT-1). Delphi rounds were used to assess item relevance with experts in VAP and CRB prevention measures, resulting in NEUMOBACT-2. Experts in simulation methods then assessed feasibility, resulting in NEUMOBACT-3. Finally, a pilot test was conducted among 30 intensive care unit (ICU) nurses to assess the applicability of the evaluation tool in clinical practice. RESULTS: Seven national experts in VAP and CRB prevention and seven national simulation experts participated in the analysis to assess the relevance and feasibility of each item, respectively. After two Delphi rounds with infection experts, four Delphi rounds with simulation experts, and pilot testing with 30 ICU nurses, the NEUMOBACT-FINAL tool consisted of 17, 26 and 21 items, respectively, for CVC, ETS and PC. CONCLUSION: NEUMOBACT-FINAL is useful and valid for assessing ICU nurses' knowledge and skills in VAP and CRB prevention, acquired through simulation. RELEVANCE FOR CLINICAL PRACTICE: Our validated and clinically tested tool could facilitate the transfer of ICU nurses' knowledge and skills learning in VAP and CRB prevention to critically ill patients, decreasing infection rates and, therefore, improving patient safety. PATIENT OR PUBLIC CONTRIBUTION: Experts participated in the Delphi rounds and nurses in the pilot test.

Development and Implementation of a Mobile-Integrated Simulation for COVID-19 Nursing Practice: A Randomized Controlled Pretest-Posttest Experimental Design.

This study developed and evaluated the effects of a mobile-integrated simulation training program on infection prevention and nursing practices based on past experiences of coronavirus disease (COVID-19) care. We developed mobile videos for the experimental group and an educational booklet for the control group based on the Analysis, Design, Development, Implementation, and Evaluation (ADDIE) model. The effects of the simulation program with the use of mobile videos on knowledge of COVID-19 management, infection prevention practice confidence, and clinical decision-making anxiety and confidence were analyzed through a randomized controlled pretest-posttest experimental design. Data from 109 participants were analyzed. Five mobile videos were developed with a total duration of 43 min and 13 s. The experimental group showed significantly greater improvement in knowledge of COVID-19 management (p = 0.002) and infection prevention practice confidence (p < 0.001). Using the mobile-integrated COVID-19 nursing practice simulation program, nurses who have no experience with emerging infectious diseases can increase their infection control knowledge and infection prevention practice confidence. In conclusion, the mobile-integrated COVID-19 nursing practice simulation program was effective in increasing infection control knowledge and infection prevention practice confidence in nurses without COVID-19 care experience.

Development and Effectiveness of a Rapid Cycle Deliberate Practice Neonatal Resuscitation Simulation Program: A Quasi-Experimental Study.

The Rapid Cycle Deliberate Practice (RCDP) simulation during neonatal resuscitation program (NRP) training provides in-event feedback for each simulation step, repeats the simulation from the beginning, and undergoes a continuous improvement process. It also offers after-event debriefing that involves follow-up discussion and reflection after completing simulations. These two methods differ in the timing and frequency of feedback application, and there may be differences in the effectiveness of neonatal resuscitation training. A quasi-experimental simulation study with a pre- and post-test design was used; the experimental group received RCDP simulation NRP training, based on the self-determination theory, while the control group received an after-event debriefing, following the NRP scenario. The experimental group displayed significantly improved clinical decision-making skills compared with the control group. When responding to emergencies involving high-risk newborns, we found that RCDP simulation during NRP training and better preparation for neonatal resuscitation among nursing students improved outcomes for newborns.

Long-Term Retention of Advanced Cardiovascular Life Support Knowledge and Confidence in Doctor of Pharmacy Students.

OBJECTIVE: This study aimed to evaluate the impact of American Heart Association (AHA) advanced cardiovascular life support (ACLS) education and training on long-term retention of ACLS knowledge and confidence in Doctor of Pharmacy (PharmD) students. METHODS: This multicenter study included PharmD students who received ACLS training through different means: 1-hour didactic lecture (didactic), 1-hour didactic lecture with 2-hour skills practice (didactic + skills), and comprehensive AHA ACLS certification through an elective course (elective-certification). Students completed a survey before training, immediately after training, and at least 6-12 months after training to assess demographics and ACLS confidence and knowledge. The primary outcome was a passing score, defined as ≥ 84% on the long-term knowledge assessment. Secondary outcomes included overall knowledge score and perceived confidence, assessed using the Dreyfus model. RESULTS: The long-term assessment was completed by 160 students in the didactic group, 66 in the didactic + skills group, and 62 in the elective-certification group. Six (4%), 8 (12%), and 14 (23%) received a passing score on the long-term knowledge assessment in the didactic, didactic + skills, and elective-certification groups, respectively. The median (IQR) scores on the long-term knowledge assessment were 50% (40-60), 60% (50-70), and 65% (40-80) in the 3 groups. On the long-term assessment, confidence was higher in the elective-certification group, demonstrated by more self-ratings of competent, proficient, and expert, and fewer self-ratings of novice and advanced beginner. CONCLUSION: Long-term retention of ACLS knowledge was low in all groups, but was higher in students who received AHA ACLS certification through an ACLS elective course.

Use and Impact of Simulation in Family Caregiver Education: A Systematic Review.

BACKGROUND: Involving family caregivers in a team-based approach has become increasingly important. Simulation-based interventions in nursing have been effective. However, the effect of simulation on family caregiver education is not widely known and is limited. OBJECTIVE: This study aimed to describe the current state of simulation-based interventions in family caregivers of patients with chronic diseases. METHODS: This systematic review was reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. The literature search was conducted in PubMed, CINAHL, PsycINFO, and Cochrane with a medical librarian's help. This review included quantitative, primary, peer-reviewed English-written research articles that reported outcomes for family caregivers. We focused on the data about purpose, design, setting, population, intervention characteristics, and outcomes. Before analyzing the selected studies, we evaluated the risk of bias using the revised Cochrane Risk-Of-Bias tool for randomized trials. RESULTS: Our search yielded 9 articles that met the inclusion criteria. The majority of the 9 articles analyzed were designed in a quasi-experimental design. In addition, most studies focused on certain diseases and used low-fidelity simulators. The simulation content mainly focused on technical simulations to help care for patients. Some simulations had a positive influence on family caregivers' knowledge, attitudes, and skills. CONCLUSIONS: We expect more simulation-based interventions for caregivers, especially those targeting diverse populations, using appropriate modalities and randomized control designs.

A percepção do estudante de medicina sobre a simulação realística em pediatria / The perception of the medical student about realistic simulation in pediatrics

Resumo Introdução: O uso de simulação realística em emergências pediátricas é particularmente valioso, pois permite o treinamento de habilidades técnicas, atitudinais e cognitivas, ajudando a garantir a segurança do paciente. Objetivo: Este estudo tem como objetivo descrever a percepção do aluno sobre o uso da Simulação Realista de Alta Fidelidade nos módulos de emergência pediátrica durante o internato de medicina. Métodos: Estudo observacional, descritivo, com abordagem quantitativa e qualitativa. Um questionário semiestruturado foi aplicado aos estudantes do sexto ano de medicina ao final dos módulos de internato pediátrico, com oito semanas de duração, de agosto a dezembro de 2020. Todos participaram de dois tipos de atividades sobre 14 temas: simulação de alta fidelidade (SRAF) e discussão estruturada de casos clínicos (DCC). Resultados: Dos 33 participantes, 29 responderam ao questionário. A média de idade foi de 24 ± 1,8 anos, sendo 58,6% do sexo feminino. Todos concordaram que a experiência com SRAF contribuiu para um desempenho mais seguro em emergências pediátricas, considerado ótimo por 76% e bom para os demais. A maioria achava que a associação de SRAF e DCC era o método ideal (96%). A análise de conteúdo das respostas sobre a SRAF destacou unidades temáticas em cinco categorias: aprendizagem significativa, contribuição para a formação profissional, habilidades, atitude/comportamento e qualidade da atividade. Conclusões: A reação dos estudantes ao uso da SRAF em emergências pediátricas foi muito positiva, e sua associação com a DCC foi considerada o método de ensino ideal. Conhecer as reações dos alunos ajuda os professores a planejarem suas atividades para melhorar o método de ensino-aprendizagem.

Abstract Introduction: The use of realistic simulation in pediatric emergencies is particularly valuable, as it allows the training of technical, attitudinal, and cognitive skills, helping to ensure patient safety. Objective: This study aims to describe the student's perception of using the High-Fidelity Realistic Simulation in the pediatric emergency modules during the internship. Methods: Observational, descriptive study with a quantitative and qualitative approach. A semi-structured questionnaire was applied to sixth-year medical students at the end of the pediatric internship modules, which lasted eight weeks, from August to December 2020. All of them participated in two types of activities on 14 topics: high-fidelity simulation (HFS) and structured discussion of clinical cases (SDCC). Results: Of the 33 participants, 29 answered the questionnaire. The mean age was 24 ± 1.8 years, and 58.6% were female. All agreed that the experience with HFS contributed to safer performance in pediatric emergencies, considered optimal by 76% and good for the remainder. Most thought the association of HFS and SDCC was the ideal method (96%). The content analysis of the responses on HFS highlighted thematic units in five categories: significant learning, contribution to professional training, skills, attitude/behavior, and quality of the activity. Conclusions: Students' reaction to using HFS in pediatric emergencies was very positive, and its association with SDCC was considered the ideal teaching method. Knowing the students' reactions helps teachers plan their activities to improve the teaching-learning method.

Comparative study between high-fidelity simulation and medium-fidelity simulation in decision-making of nursing students: experimental study / Estudo comparativo entre simulação de alta-fidelidade e simulação de média-fidelidade na tomada de decisão de estudantes de enfermagem: estudo experimental / Estudio comparativo entre simulación de alta fidelidad y simulación de mediana fidelidad en la toma de decisiones de estudiantes de enfermería: estudio experimental

Abstract Objective: to compare the decision-making of Nursing students, before and after theoretical training on basic life support, using the practice of high-fidelity simulation and medium-fidelity simulation. Method: an experimental study was developed, pre- and post-test type, with quantitative, descriptive and inferential analysis, with theoretical training on basic life support and clinical simulation practices, and with evaluation of knowledge and decision-making of Nursing students, at three different moments - before the simulation scenario (T0), after the simulation scenario (T1) and after clinical teaching (T2). Results: 51 students participated in the research, with an average age of 20.25±3.804, of which 92.2% were female. Statistically significant differences (F=6.47; p=0.039) were evident regarding the definition of the problem and development of objectives in decision-making in the experimental group. Conclusion: Nursing students demonstrate an adequate level of knowledge and a good decision-making process, based on the most current instruments produced by scientific evidence, in clinical simulation scenarios in basic life support, and this innovative methodology should be deepened in the Nursing teaching.

Resumo Objetivo: comparar a tomada de decisão dos estudantes de Enfermagem, antes e após a formação teórica sobre suporte básico de vida, com recurso à prática de simulação de alta-fidelidade e simulação de média-fidelidade. Método: desenvolveu-se um estudo experimental, tipo pré e pós-teste, com análise quantitativa, descritiva e inferencial, com realização da formação teórica sobre suporte básico de vida e práticas de simulação clínica, e com avaliação dos conhecimentos e tomada de decisão dos estudantes de Enfermagem, em três momentos distintos - antes do cenário de simulação (T0), após o cenário de simulação (T1) e após a realização de ensino clínico (T2). Resultados: participaram da pesquisa 51 estudantes, com uma média de idade de 20,25±3,804, dos quais 92,2% eram do sexo feminino. Foram evidenciadas diferenças estatisticamente significativas (F=6,47; p=0,039) perante a definição do problema e desenvolvimento dos objetivos na tomada de decisão no grupo experimental. Conclusão: os estudantes de Enfermagem demonstram um nível de conhecimentos adequado e um bom processo de tomada de decisão, com base nos instrumentos mais atuais produzidos pela evidência científica, perante cenários de simulação clínica em suporte básico de vida, devendo esta metodologia inovadora ser aprofundada no ensino de Enfermagem.

Resumen Objetivo: comparar la toma de decisiones de estudiantes de Enfermería, antes y después de la formación teórica sobre soporte vital básico, utilizando la práctica de simulación de alta fidelidad y simulación de mediana fidelidad. Método: se desarrolló un estudio experimental, tipo pretest y postest, con análisis cuantitativo, descriptivo e inferencial, con formación teórica sobre soporte vital básico y prácticas de simulación clínica, y con evaluación del conocimiento y la toma de decisiones de los estudiantes de Enfermería, en tres momentos distintos: antes del escenario de simulación (T0), después del escenario de simulación (T1) y después de la enseñanza clínica (T2). Resultados: participaron de la investigación 51 estudiantes, con edad promedio de 20,25±3,804 años, de los cuales 92,2% eran mujeres. Se evidenciaron diferencias estadísticamente significativas (F=6,47; p=0,039) en cuanto a la definición del problema y desarrollo de los objetivos en la toma de decisiones en el grupo experimental. Conclusión: los estudiantes de Enfermería demuestran un nivel adecuado de conocimientos y un buen proceso de toma de decisiones, basados en los instrumentos más actuales producidos por la evidencia científica, en escenarios de simulación clínica en soporte vital básico, y esta metodología innovadora debe profundizarse en la enseñanza de Enfermería.

Suicide prevention in a virtual environment: a roadmap for simulation-based education / Prevención del suicidio en un entorno virtual: guion para la enseñanza basada en una simulación / Prevenção do suicídio em ambiente virtual: roteiro para ensino baseado em simulação

Objective: to build and validate a simulation-based education roadmap on suicide prevention in the virtual environment. Method: methodological research subdivided into a development and validation stage. The roadmap was built using a previously drafted template based on international guidelines on good clinical simulation practices and scientific literature on suicide prevention in the virtual environment. For validation, the roadmap was validated by experts through self-application of an assessment form with answers based on "adequate, fair, and inadequate", with a field for suggestions. Descriptive statistics and the Content Validity Index (CVI≥0.8) were used. Results: nine experts took part in the study, the majority of whom were nurses (66.7%), female (55.6%), with an average age of 42.22 years. All the items in the roadmap met the acceptance criteria (CVI≥0.8). Conclusion: this study provides a useful roadmap for teaching suicide prevention in the virtual environment.

Objetivo: elaborar y validar un guion de enseñanza basada en la simulación sobre la prevención del suicidio en el entorno virtual. Método: investigación metodológica subdividida en etapa de elaboración y validación. La elaboración se realizó a partir de un template creado previamente y basado en lineamientos internacionales sobre buenas prácticas de simulación clínica y literatura científica sobre prevención del suicidio en el entorno virtual. Para la validación los especialistas validaron el guion mediante la autoaplicación de un formulario de evaluación cuyas respuestas son: "adecuado, regular e inadecuado", con un campo para sugerencias. Se utilizó estadística descriptiva e Índice de Validez de Contenido (IVC≥0,8). Resultados: participaron nueve especialistas, la mayoría enfermeros (66,7%), mujeres (55,6%), con una edad promedio de 42,22 años. Todos los elementos del guion cumplieron con el criterio de aceptación (IVC≥0,8). Conclusión: este estudio proporciona un guion útil para la enseñanza sobre la prevención del suicidio en el entorno virtual.

Objetivo: construir e validar um roteiro de ensino baseado em simulação sobre a prevenção do suicídio no ambiente virtual. Método: pesquisa metodológica subdividida em etapa de construção e validação. A construção foi realizada a partir de um template previamente elaborado e embasado por diretrizes internacionais em boas práticas de simulação clínica e literatura científica sobre a prevenção do suicídio no ambiente virtual. Para a validação, o roteiro foi validado por especialistas por meio de autoaplicação de formulário de avaliação com respostas baseadas em: "adequado, regular e inadequado", com campo para as sugestões. Foi utilizada a estatística descritiva e o Índice de Validade de Conteúdo (IVC≥0,8). Resultados: participaram nove especialistas, sendo a maioria enfermeiras (66,7%), gênero feminino (55,6%), com média de idade de 42,22 anos. Todos os itens do roteiro alcançaram o critério de aceitação (IVC≥0,8). Conclusão: este estudo disponibiliza um roteiro útil para ser empregado no ensino sobre a prevenção do suicídio no ambiente virtual.

Criação e validação de cenário simulado interprofissional para a pronação de pacientes com SDRA / Creation and validation of an interprofessional simulated scenario for the pronation of patients with ARDS

RESUMO Introdução: Este trabalho versa sobre a construção e validação de um cenário simulado com abordagem interprofissional, que permitirá a utilização no ensino e na educação permanente de profissionais da saúde por meio da metodologia ativa de simulação clínica. Objetivo: Este estudo teve como objetivos construir e validar um cenário simulado para a pronação de pacientes críticos com síndrome do desconforto respiratório agudo. Método: Trata-se de um estudo metodológico desenvolvido durante o ano de 2022 em uma universidade pública do Sul do Brasil e realizado em duas etapas: 1. delineamento do caso clínico e construção do cenário, e 2. validação de conteúdo e de aparência por 11 juízes com expertise em simulação clínica e/ou cuidado destinado ao paciente crítico, que atenderam aos critérios de Fehring. Aplicou-se um questionário do tipo Likert para a avaliação de 37 itens estabelecidos a partir do referencial de Fabri et al. Para medir o percentual de concordância entre os juízes, adotou-se o índice de validade de conteúdo (IVC). Resultado: Para a construção do cenário, desenvolveram-se o roteiro e guia de apoio ao facilitador e ao participante, e o roteiro para o ator simulado; um quadro de ações esperadas para cada participante; a relação de materiais e equipamentos necessários para o desenvolvimento; e o checklist de observação do desenvolvimento de competências e habilidades para cada profissão envolvida no cenário (médico, fisioterapeuta, enfermeiro e técnico de enfermagem). Os juízes eram predominantemente enfermeiros (63,6%), seguidos por fisioterapeutas (18,1%), médico (9%) e docente de enfermagem (9%). Os juízes responderam a um questionário que abordou os seguintes temas: "experiência prévia do participante/briefing", "conteúdo/objetivos", "recursos humanos", "preparo do cenário", "desenvolvimento do cenário" e "avaliação". Todos os itens obtiveram IVC superior ao desejável (0,80) e, portanto, foram considerados válidos. Além disso, os juízes realizaram sugestões de melhorias para o cenário, as quais foram acatadas ou rejeitas e discutidas com a literatura disponível. Conclusão: Este estudo permitiu criar e validar um cenário que reflete a prática real, ao mesmo tempo que oportuniza um ambiente seguro para os participantes e responde aos objetivos da aprendizagem interprofissional.

ABSTRACT Introduction: This work is focused on the construction and validation of a simulated scenario with an interprofessional approach, which will allow the use in the teaching and continuing education of health professionals through the active methodology of clinical simulation. Objective: To build and validate a simulated scenario for the pronation of critically ill patients with Acute Respiratory Distress Syndrome (ARDS). Method: This is a methodological study developed in 2022 at a public university in Curitiba-PR, which occurred in two stages: 1) delineation of the clinical case and construction of the scenario; 2) content and appearance validation by 11 judges with expertise in clinical simulation and/or critical patient care, who met the Fehring's criteria. A Likert-type questionnaire was applied to evaluate 37 items based on the Fabri's reference. To measure the percentage of agreement among the judges, the Content Validity Index (CVI) was adopted. Results: To build the scenario, the script and support guide for the facilitator, the participant, and the script for the simulated actor; a table of expected actions for each participant; the list of materials and equipment needed for the development; and the checklist for observation of the development of competencies and skills for each profession involved in the scenario (physician, physical therapist, nurse, and nursing technician) were developed. The judges were predominantly nurses (63.6%), followed by physical therapists (18.1%), physicians (9%), and nursing lecturers (9%). The judges responded to a questionnaire that addressed "Prior Participant Experience/Briefing", "Content/Objectives"; "Human Resources"; "Scenario Preparation", "Scenario Development", and "Evaluation". All items scored higher than desirable Content Validity Index (0.80) and were considered valid. In addition, the judges suggested improvements to the scenario, which were accepted or rejected and discussed with the available literature. Conclusion: This study made it possible to create and validate a scenario that reflects actual practice while providing a safe environment for participants and meeting the goals of interprofessional learning.

Neurosurgical simulation models developed in Latin America and the Caribbean: a scoping review.

Simulation training is an educational tool that provides technical and cognitive proficiency in a risk-free environment. Several models have recently been presented in Latin America and the Caribbean (LAC). However, many of them were presented in non-indexed literature and not included in international reviews. This scoping review aims to describe the simulation models developed in LAC for neurosurgery training. Specifically, it focuses on assessing the models developed in LAC, the simulated neurosurgical procedures, the model's manufacturing costs, and the translational outcomes. Simulation models developed in LAC were considered, with no language or time restriction. Cadaveric, ex vivo, animal, synthetic, and virtual/augmented reality models were included for cranial and spinal procedures. We conducted a review according to the PRISMA-ScR, including international and regional reports from indexed and non-indexed literature. Two independent reviewers screened articles. Conflicts were resolved by a third reviewer using Covidence software. We collected data regarding the country of origin, recreated procedure, type of model, model validity, and manufacturing costs. Upon screening 917 studies, 69 models were developed in LAC. Most of them were developed in Brazil (49.28%). The most common procedures were related to general neurosurgery (20.29%), spine (17.39%), and ventricular neuroendoscopy and cerebrovascular (15.94% both). Synthetic models were the most frequent ones (38.98%). The manufacturing cost ranged from 4.00 to 2005.00 US Dollars. To our knowledge, this is the first scoping review about simulation models in LAC, setting the basis for future research studies. It depicts an increasing number of simulation models in the region, allowing a wide range of neurosurgical training in a resource-limited setting.

Breaking the Stigma in Mental Health Nursing through High-Fidelity Simulation Training.

The social stigma toward individuals with mental health problems is habitual among nursing students, which can lead to poor quality of health care services for patients with mental illnesses. The purpose of the present study was to learn about nursing students' perceptions of providing care to patients with severe mental disorders before and after participating in a simulated student clinical case. A descriptive qualitative study was conducted through 39 interviews. The difficulties expected by the students and their perceptions about patients were explored before the simulation training. Their perceptions about the use of clinical simulation for learning about the adequate management of these patients were analyzed afterwards. Results: Before the simulation training, the students assessed the case as being complicated, expressed their lack of specific training, and felt fear and insecurity, thus reproducing the stigma towards mental health patients. After this training, they positively valued the usefulness of the clinical simulation for gaining confidence and overcoming the stigma. Discussion: The use of high-fidelity simulation offers nursing students the opportunity to approach patients with mental health conditions, overcoming their fears and normalizing mental disorders. Simulation training allows nursing students to analyze the reasoning of clinical judgment and to detect the influence of previous prejudices about mental illness in their clinical decision. This study was not registered.