Eficácia da simulação clínica no ensino de estudantes de graduação em enfermagem na avaliação e no tratamento de lesões por pressão: um ensaio clínico randomizado

Abstract

Introduction:Realistic simulation is a teaching methodology capable of promoting the development of cognitive, psychomotor, and emotional skills within a safe and controlled environment. It has been widely used in topics related to patient safety, such as pressure injuries, a significant public health issue and a negative indicator of the quality of care. This research is justified by evidence of the insufficient performance of healthcare students and professionals in treating pressure injuries and the scarcity of studies on the use of simulated environments in the educational process on this topic.Objective:to analyze the effectiveness of high- and medium-fidelity clinical simulation in teaching the assessment and treatment of pressure injuries to undergraduate nursing students. Methodology:A randomized clinical trial of the educational intervention type, with parallel groups and double-blind design. It was conducted with 32 nursing students from the Federal University of Juiz de Fora during the elective course Advanced Practices in Nursing. The control group and the experimental group were taught through theoretical classes and clinical simulation, with the control group receiving the intervention with a mannequin and the experimental group with a simulated patient. In addition to characterizing the participants' profiles, instruments were used to assess stress levels, knowledge, critical thinking disposition, skills, satisfaction and self-confidence, simulation design, and debriefing. The data were consolidated in Microsoft Office Excel 2010 and analyzed in R software version 4.3.0 (R CORE TEAM, 2023) to verify the effect of the group, the time, and the group*time interaction on skills development. An integrative review was previously conducted in the MEDLINE, CINAHL, LILACS, and ERIC databases to identify which teaching methodologies have been used in higher education for training health sciences students. Results:no effect was found for self-reported stress by the students; however, there was a statistically significant increase in heart rate, knowledge test scores, and critical thinking disposition from pre-test to post-test in both groups. Regarding the measurement of skills during the scenario application, there was no statistically significant difference between the groups, with the accuracy rate being above 80% for both. Thus, both medium-fidelity and high-fidelity scenario designs enabled the development of technical and cognitive skills. However, it should be noted that the experimental group had higher mean scores in feelings of satisfaction and self-confidence with learning and in the evaluation of the simulation design compared to the control group. In terms of debriefing, overall, positive results were achieved in both groups in the dimensions of psychosocial, cognitive, and affective value. Conclusion:medium and high fidelity clinical simulation methodology were considered effective for teaching pressure injuries among undergraduate nursing students.