Validation of a clinical simulation setting in the management of postpartum haemorrhage

Validation of clinical simulation scenarios for the teaching of soft skills in child-centered care

Consultations with children and their families are complex and require soft skills. However, there is a gap in the medical curriculum concerning these skills, especially as encounter training is often adult-centered. We developed, validated, and applied simulation scenarios that prioritize active participation of children to train soft skills in child-centered care for undergraduate medical students. This is a methodological study to develop three scenarios and a checklist of what is expected. The content was validated by 18 experts. A pre-test was carried out for adjustments. Then, the simulations were applied and evaluated by 18 medical undergraduate students. They included the participation of 6 pediatric simulated patients aged 9-12 years trained by a drama teacher. According to the results, the scenarios and checklist proved to be valid instruments in content terms (ICV-I > 0.8). The scripts were followed by the simulated pediatric patients, but they had difficulty mimicking a hypoactive state. Some were anxious, but everyone enjoyed participating in the feedback. The simulated parents had difficulty participating and giving space to the child's speech. Participants assessed that the simulations performed as they were proposed and, after experimenting them, felt more prepared. The simulations provided an opportunity for students to practice soft skills by interacting with children in a safe environment. Using children as simulated patients is feasible but presents some challenges. Our study has expanded the ways in which children's health content can be taught. We are investigating whether this training leads to better patient outcomes in real clinical settings.

Instructional and didactic support tool for teaching-learning Post-Partum Haemorrhage care in simulated settings: Creation and validation

OBJECTIVE

To describe the creation and validation process of an instructional, didactic and self-applied support tool for teaching-learning Post-Partum Haemorrhage care in simulated settings.

BACKGROUND

Students frequently face difficulties performing the actions in the proper sequence in Post-Partum Haemorrhage simulated cases. Even in a controlled environment, anxiety, nervousness and fear of making mistakes are evident, which render the simulated experience highly stressful. Having a tool with a guideline can help students perform these actions more assertively.

DESIGN

A methodological study to develop a didactic tool.

METHODS

The creation process of the didactic tool, called Instructional Disk for the Management of Post-Partum Haemorrhage, was divided into five phases: Analysis, Design, Development, Implementation and Evaluation. Nine experts specialised in Obstetrics and Midwifery validated the tool by answering a questionnaire with nine items; in turn, 32 undergraduate Midwifery program students carried out the evaluation using a questionnaire on applicability, functionality, clarity, coherence and usability of the tool in Post-Partum Haemorrhage simulated stations. The data were analysed descriptively, considering absolute agreement when the answers to all questions in the five-point Likert scale corresponded to 5 (I totally agree). The Content Validity Index was calculated for the experts' questionnaires.

RESULTS

In the validation stage, the experts agreed or totally agreed with all nine items, reaching a Content Validity Index = 1. In the total scores assigned by the experts, there was a variation between 80.0% and 100% absolute agreement, with a mean of 95.6%. In the students' assessment, the variation was between 87.5% and 100% absolute agreement, with a mean of 97.7%, in the eight items evaluated. The agreement level above 90% among experts and students was considered high.

CONCLUSIONS

The Instructional Disk for the Management of Post-Partum Haemorrhage was validated by experts with extensive experience in Obstetrics and Midwifery care and teaching, ensuring that the content included in the guidelines for the management of Post-Partum Haemorrhage adopted in Brazil is covered. The students positively evaluated this support tool for learning the care to be provided in Post-Partum Haemorrhage cases in the simulated stations.

Validation of telesimulation in the care of late preterm newborns with hypoglycemia for nursing students

OBJECTIVE

To develop and validate a telesimulation scenario for nursing students in the care of late preterm infants with hypoglycemia.

METHODS

A methodological study conducted between August 2021 and May 2022 in a virtual environment involved constructing and validating the scenario with 10 experts, and testing it with 10 students. The content validity index assessed validity, with a threshold of 80% or higher, and suggestions were analyzed using semantic approximation.

RESULTS

Validation confirmed the appropriateness of all 14 scenario items, with an overall index of 97.8% and clarity and relevance indices of 98.5%. During testing, the overall index was 99.7%, with the "resources" item receiving the lowest score. Adjustments were made to objectives, technical terms, resources, and target audience based on feedback.

CONCLUSION

Telesimulation is a widely accepted educational technology for training nursing students, with potential to enhance teaching quality and neonatal care.

Simulation-based training in Leprosy: development and validation of a scenario for community health workers

OBJECTIVES

To build and validate a clinical simulation scenario designed to instruct community health workers (CHWs) in active leprosy case detection.

METHODS

Methodological study involving the development of a simulated clinical scenario and content validation by experts. The Content Validity Index (CVI) was used to determine the level of agreement among the judging commitee, and a descriptive analysis of their recommendations was performed.

RESULTS

A simulated scenario with a simulated participant was developed - a simulation characterized by low complexity, moderate physical/environmental fidelity, moderate to high psychological fidelity, and high conceptual fidelity, lasting 50 minutes and capable of training up to 10 CHWs simultaneously. The scenario was validated by 14 experts, with a CVI exceeding 80% for all components.

CONCLUSIONS

The validated clinical simulation possesses attributes that make it highly reproducible in various national health contexts, thereby contributing to the global "Towards Zero Leprosy" strategy.

Simulation training of caregivers at hospital discharge of patients with chronic diseases: an integrative review

OBJECTIVE

to identify evidence about the use and effects of clinical simulation for preparing caregivers for discharging patients with chronic conditions.

METHODS

an integrative peer review in the Scopus, PubMed, Web of Science, Cumulative Index to Nursing and Allied Health Literature, ScienceDirect and Virtual Health Library databases, from July to September 2022.

RESULTS

3,218 studies were identified, with a final sample consisting of four national and two international articles. Using simulation as an educational technology contributed to caregiver preparation in home care. In most studies, using clinical simulation included using other strategies to complement training: expository dialogued class, conversation circle and audiovisual resources.

FINAL CONSIDERATIONS

simulation proved to be efficient for training caregivers, with the active participation of family members and nurses in health education actions.

Clinical simulation scenarios for the planning and management of infusion therapy by nurses

OBJECTIVE

to build, evaluate and test two clinical simulation scenarios for the planning and management of infusion therapy by nurses.

METHODS

methodological study, with construction of scenarios based on the NLN Jeffries Simulation Theory and the theoretical model Vessel Health Preservation; evaluation of the scenario design by judges, with calculation of the Modified Kappa Coefficient (MKC); testing scenarios with the target audience. Results: scenarios built for: 1. Patient assessment and vascular device selection; and 2. Identification and management of deep vein thrombosis. In the evaluation by judges, testing of validated scenarios in relation to educational practices and simulation design, the items evaluated presented MKC values ≥ 0.74.

CONCLUSION

two evidence-based scenarios related to infusion therapy were constructed, with high levels of agreement among judges regarding their design. In testing with nurses, good results were obtained regarding the design and structuring of educational practice.

Construction and validation of a scenario for recognizing sepsis by nursing students: a methodological study

OBJECTIVE

To build and validate a clinical simulation scenario for teaching Nursing students about early recognition of signs and symptoms of sepsis in the context of the emergency unit.

METHODS

Methodological study developed in two phases: construction of a simulated scenario and content validation by expert judges. For data analysis, the Content Validity Index (CVI) was calculated considering agreement equal to or greater than 80%. The minimum acceptable CVI value for scenario validation was 1.0.

RESULTS

The simulation scenario proved to be appropriate, with a global Content Validity Index equal to 1. Some adjustments related to the clarity of the wording were necessary, as suggested by the judges. Conclusions: A medium-complexity, high-fidelity scenario was successfully constructed and validated for teaching early recognition of sepsis signs and symptoms.

Factors associated with severe maternal outcome in patients admitted to an intensive care unit in northeastern Brazil with postpartum hemorrhage: a retrospective cohort study

BACKGROUND

Postpartum hemorrhage (PPH) is the leading cause of maternal death worldwide, particularly in low- and middle-income countries; however, the majority of these deaths could be avoided with adequate obstetric care. Analyzing severe maternal outcomes (SMO) has been a major approach for evaluating the quality of the obstetric care provided, since the morbid events that lead to maternal death generally occur in sequence. The objective of this study was to analyze the clinical profile, management, maternal outcomes and factors associated with SMO in women who developed PPH and were admitted to an obstetric intensive care unit (ICU) in northeastern Brazil.

METHODS

This retrospective cohort study included a non-probabilistic, consecutive sample of postpartum women with a diagnosis of PPH who were admitted to the obstetric ICU of the Instituto de Medicina Integral Prof. Fernando Figueira (IMIP) between January 2012 and March 2020. Sociodemographic, biological and obstetric characteristics and data regarding childbirth, the management of PPH and outcomes were collected and analyzed. The frequency of maternal near miss (MNM) and death was calculated. Multiple logistic regression analysis was performed to determine the adjusted odd ratios (AOR) and their 95% confidence intervals (95% CI) for a SMO.

RESULTS

Overall, 136 cases of SMO were identified (37.9%), with 125 cases of MNM (34.9%) and 11 cases of maternal death (3.0%). The factors that remained associated with an SMO following multivariate analysis were gestational age ≤ 34 weeks (AOR = 2.01; 95% CI: 1.12-3.64; p < 0.02), multiparity (AOR = 2.20; 95% CI: 1.10-4.68; p = 0.02) and not having delivered in the institute (AOR = 2.22; 955 CI: 1.02-4.81; p = 0.04).

CONCLUSION

Women admitted to the obstetric ICU with a diagnosis of PPH who had had two or more previous deliveries, gestational age ≤ 34 weeks and who had delivered elsewhere were more likely to have a SMO.

Cenários simulados em enfermagem: revisão integrativa de literatura

RESUMO Objetivos: identificar na literatura científica quais os cenários clínicos simulados desenvolvidos e validados para o ensino e aprendizagem em enfermagem. Métodos: revisão integrativa, realizada em sete fontes de informação. Utilizaram-se o programa Rayyan para seleção, a análise de conteúdo para exploração dos achados e a ferramenta de avaliação metodológica do percurso de validação, intitulada Avaliação da Qualidade para Estudos de Validade. Resultados: identificaram-se, inicialmente, 1.179 manuscritos e 14 compuseram a amostra. Definiram-se duas categorias: Perfil dos cenários clínicos simulados produzidos em enfermagem; e Habilidades clínicas desenvolvidas e seus mecanismos de avaliação. Considerações Finais: houve preponderância de cenários de alta fidelidade, construídos no Brasil, nos últimos cinco anos, voltados a estudantes de enfermagem sobre as temáticas da urgência e emergência, cuidado materno e estomaterapia, abordando a avaliação das habilidades cognitivas, psicomotoras e afetivas em enfermagem. A maioria dos estudos obteve boa qualidade metodológica em seu processo de validação de conteúdo.

Simulated scenarios in nursing: an integrative literature review

ABSTRACT Objectives: to identify in scientific literature which simulated clinical scenarios were developed and validated for teaching and learning in nursing. Methods: integrative review, carried out in seven sources of information. The Rayyan program was used for selection, content analysis to explore the findings and the methodological assessment tool of the validity process, entitled Quality Appraisal tool for Validity Studies. Results: initially, 1,179 manuscripts were identified and 14 were part of the sample. Two categories were defined: Profile of simulated clinical scenarios produced in nursing; and Clinical skills developed and their assessment mechanisms. Final Considerations: there was a preponderance of high-fidelity scenarios, built in Brazil in the last five years, aimed at nursing students on the themes of emergency, maternal care and stomatherapy, addressing the assessment of cognitive, psychomotor and affective skills in nursing. Most studies obtained good methodological quality in their content validity process.

Construction and validation of a clinical simulation scenario on umbilical cord stump care

OBJECTIVE

To develop and validate clinical simulation scenario for teaching women in their puerperium and their families about care for the newborn's umbilical cord stump.

METHOD

Methodological study in two stages: 1 - elaboration of the checklist of the procedure for cleaning the umbilical cord and of the clinical case; and 2 - development of the simulated scenario. A Content Validity Index of 0.8 was adopted as the valid range of agreement.

RESULTS

After validation, the case was validated, being approved by 100% of the experts. All items of the simulation scenario obtained agreement scores above 0.91.

CONCLUSION

The validated scenario can be used in different contexts: teaching of Neonate Nursing, training teams, and teaching women in their puerperium and their families, who were the target of the study. Considering the benefits of simulation, we believe the simulation here will contribute to better and safer care.

Construction and validation of clinical scenarios for training informal caregivers of dependent persons

OBJECTIVE

To construct and validate three clinical scenarios for training dependent persons' informal caregivers.

METHODS

Methodological study, conducted between January and August 2021, in a municipality in the northwest of the state of Paraná. It was developed in two stages: construction of scenarios; and content validation by experts (n = 12). To estimate the degree of agreement between the experts, the content validity index was used, and 80% was considered an acceptable rate of agreement.

RESULTS

The simulation scenarios proved appropriate, obtaining an average value of 91.6%. However, some adjustments were made in their organization pertaining clarity in the wording of guidelines, as suggested by the expert validators.

CONCLUSIONS

The construction and validation of the clinical scenarios proved to be adequate and relevant for use in the training of informal caregivers of dependent persons.

Simulation translation differences between craft groups

Background

Many simulation-based clinical education events (SBCEE) aim to prepare healthcare professionals with the knowledge, skills, and features of professionalism needed to deliver quality patient care. However, how these SBCEE learnings are translated into broader workplace practices by learners from different craft groups has not been described.

Objectives

To understand how learners from different craft groups (doctors and nurses) anticipate simulation-based learnings will translate to their workplaces and the process by which translation occurs.

Design

Qualitative descriptive study design using pre- and post-SBCEE questionnaires.

Settings

A large tertiary Australian hospital-based simulation centre that facilitates SBCEE for multi-professional graduate and undergraduate clinicians from 16 hospitals.

Methods

Participants who attended SBCEEs between May and October 2021 completed questionnaires at two touchpoints, on the day of attending a SBCEE and 6 weeks after. Based on a phenomenological approach, the study examined clinicians’ experiences in relation to simulation education, intended simulation learning use in the workplace, and perceived success in subsequently using these learnings to improve clinical outcomes. Qualitative inductive thematic data analysis was used to develop narratives for different learner cohorts.

Results

Three overarching themes were identified regarding simulation participants’ perceptions of the success of translating simulation learnings into the workplace. These were: scenario-workplace mirroring, self-assessment, and successful confidence. Doctor participants found it difficult to map SBCEE learnings to their workplace environments if they did not mirror those used in simulation. Nurses sought peer evaluation to analyse the effectiveness of their workplace translations, whereas doctors relied on self-assessment. Learners from both craft groups highly prized ‘confidence-building’ as a key indicator of improved workplace performance achieved through SBCEE learning.

Conclusion

A diverse range of factors influences healthcare workers’ experiences in translating simulation learnings to their workplace. To equip simulation learners to translate learnings from a SBCEE into their clinical practices, we suggest the following areas of focus: co-development of translation plans with learners during the delivery of an SBCEE including the indicators of success, above table discussions on the generalisability of learnings to different environments and contexts, smart investment in simulation outputs, and cautious championing of confidence-building.

Construção e validação de cenários clínicos para capacitação de cuidadores informais de pessoas dependentes

RESUMO Objetivo: Construir e validar três cenários clínicos para capacitação de cuidadores informais de pessoas dependentes. Métodos: Estudo metodológico, realizado entre janeiro e agosto de 2021, em um município no noroeste do estado do Paraná. Foi desenvolvido em duas etapas: construção dos cenários; e validação do conteúdo por experts (n = 12). Para estimar o grau de concordância entre os juízes, utilizou-se o índice de validade de conteúdo, e considerou-se o valor de 80% como uma taxa aceitável de concordância. Resultados: Os cenários de simulação mostraram-se apropriados, obtendo valor médio de 91,6%. No entanto, foram feitos alguns ajustes em sua organização no que tange à clareza na redação das orientações, conforme sugestão dos juízes. Conclusões: A construção e validação dos cenários clínicos mostraram-se adequadas e relevantes, de modo que eles podem ser utilizados na capacitação de cuidadores informais de pessoas dependentes.

Construção e validação de cenário de simulação clínica sobre o cuidado com o coto umbilical

RESUMO Objetivo: Desenvolver e validar cenário de simulação clínica para ensino de puérperas e familiares sobre cuidados com o coto umbilical do recém-nascido. Método: Estudo metodológico em duas fases: 1 - construção de checklist do procedimento de higienização do coto umbilical, elaboração e validação semântica do caso clínico com 11 experts em simulação e área materno-infantil; 2 - desenvolvimento e validação do cenário junto a 11 experts em simulação e em neonatologia/pediatria. O Índice de Validade de Conteúdo de 0,8 foi adotado como relevante alcance de concordância. Resultados: Após construção do caso, realizou-se validação, aprovada por 100% dos experts. Todos itens do cenário simulado obtiveram escores de concordância superiores a 0,91. Conclusão: O cenário validado pode ser utilizado em diferentes contextos: ensino da Enfermagem Neonatal, capacitação de equipes e, aprendizagem de puérperas e familiares, alvos do estudo. Vistos benefícios da simulação, acredita-se na sua contribuição para melhoria assistencial e cuidado seguro.

Development and validation of inventory tool to evaluate social accountability principles in case scenarios used in problem-based curriculum (Social accountability inventory for PBL)

Social accountability (SA) is an obligation for medical schools in meeting the priority health concerns of the communities they serve. To measure the integration of SA principles into medical curricula, suitable tools are needed. This study developed and validated an inventory to assess SA values within the existing case scenarios used in problem-based learning (PBL) curricula. The Delphi technique was employed to develop and validate the new inventory. The validation used expert opinion and calculated the content validity using content validity indices (CVIs). The initial draft (Draft 0) was formulated with 25 open-ended questions. Following expert evaluation, Draft 1 had 22 closed-ended questions and the mean ratings, according to the experts, were as follows: relevance, 3.33-4.83; importance (3.5-4.8); clarity (3.33-4.83); and simplicity (3:00-4.67). Draft 2 had 19 questions. After a further round of rating and analysis, a final draft was prepared, consisting of 17 items, with CVI scores ≥ 0.8 and 100% overall satisfaction. Using this inventory tool will help health professions schools to translate SA indicators into curricular activities by identifying the gaps in their PBL curricula. Deficiencies can be either in the type of case scenarios used or the triggers embedded in the individual case scenarios, subsequently leading to the development of PBL case scenarios that address real health social needs. A revision and rewriting of the problem case scenarios to incorporate SA will be the next step.

Development, validation and application of clinical simulation scenarios for assessment of stomatherapy specialists

OBJECTIVES

to build and validate three clinical simulation scenarios and report the application with candidates for the specialist's degree in stomatherapy.

METHODS

methodological study, building three scenarios and evaluation checklists; content validation with judges, using content validity index and Modified Kappa Coefficient; pre-test and application.

RESULTS

scenarios built based on nursing care for: 1. insufficiency and venous ulcer; 2. demarcation of intestinal stomia; and 3. Clean intermittent catheterization. In the content validation of the 24 items appreciated, 83%, 80%, and 92% were validated without change. In the pre-test, the objectives and checklists were adjusted. In the application, to standardize the evaluation, actors and evaluators were trained previously, and each candidate passed the three stations.

CONCLUSIONS

scenarios built and with validated content, based on evidence and covering the three areas of stomatherapy. The pre-test allowed for adjustments in the scenarios, and the candidates achieved the expected objectives.