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Abstract(s)
Introdução: Atualmente, uma das metodologias em expansão no ensino de Enfermagem
é a metodologia de ensino inovadora, sendo uma das suas ferramentas de aprendizagem
a simulação de alta-fidelidade. Este tipo de simulação clínica permite consolidar e integrar
conhecimentos teóricos com a prática clínica, e desenvolver competências técnicas e não
técnicas nos estudantes de Enfermagem, tais como a tomada de decisão.
Metodologia: Este trabalho de investigação teve início na forma de uma revisão
sistemática da literatura, cujo objetivo principal foi evidenciar a importância da execução
de um estudo empírico, dada a escassez de resultados no âmbito da tomada de decisão
dos estudantes de Enfermagem portugueses. Num segundo trabalho, através de um estudo
metodológico, cujo objetivo principal foi validar culturalmente os instrumentos de
medida Clinical Decision Making in Nursing Scale©
e Lasater’s Clinical Judgement
Rubric©
, pretendeu-se desenvolve ferramentas de avaliação válidas em português europeu
que permitissem avaliar a tomada de decisão no ensino de Enfermagem em Portugal. Já
no estudo experimental, do tipo pré-teste e pós-teste com amostras randomizadas,
pretendeu-se determinar a efetividade da prática de simulação de alta-fidelidade e da
simulação de média-fidelidade no processo de tomada de decisão dos estudantes de
Enfermagem, após o desenvolvimento de formação sobre suporte básico de vida e após a
realização de ensino clínico; e avaliar o nível de conhecimento sobre suporte básico de
vida e de tomada de decisão dos estudantes de Enfermagem, antes e após o cenário de
simulação clínica e após a realização de ensino clínico. Este estudo teve na sua génese o
desenvolvimento de uma intervenção, nomeadamente a prática de suporte básico de vida
no adulto. Para a execução desta investigação foi selecionada a Escola Superior de
Enfermagem de Coimbra, por apresentar um Centro de Simulação de Práticas Clínicas.
Os grupos de investigação foram divididos de forma randomizada e homogénea, sendo o
grupo experimental o que praticou simulação de alta-fidelidade e grupo de controlo o que
praticou simulação de média-fidelidade.
Resultados: No estudo de validação da Clinical Decision Making in Nursing Scale©
a
análise fatorial confirmatória evidenciou uma boa qualidade de ajustamento da estrutura
fatorial, composta por três fatores (X2
/gl = 2,056; GFI = 0,927; CFI = 0,917; RMSEA =
0,046; RMR = 0,039; SRMR = 0,050). A determinação da fidelidade da escala exigiu que
ela ficasse constituída por 23 itens, com valores de correlação a variar entre 0,184 e 0,610
e um valor global de alfa de Cronbach de 0,851, demonstrando uma boa fiabilidade. No
que concerne à validação da Lasater’s Clinical Judgement Rubric©
, das 64 observações
obtidas das práticas dos estudantes de Enfermagem, destacou-se o valor de correlações
intraclasses nas 4 fases do instrumento – Observar, Interpretar, Responder, Refletir –
superior a 0,792. Constatou-se um alfa de Cronbach global de 0,921 e 0,876, nos
observadores 1 e 2 respetivamente, com um nível de concordância estatisticamente
significativo, apresentado pelo valor de kappa superior a 0,803. No estudo experimental
participaram 51 estudantes de Enfermagem, com uma média de idades de 20,25±3,804
anos, dos quais 92,2% eram do sexo feminino. Os grupos de investigação demonstraram
homogeneidade nas variáveis idade, conhecimentos, tomada de decisão e horas de ensino
clínico. Dentro do grupo que praticou simulação de alta-fidelidade constatou-se a
manutenção do nível de tomada de decisão dos estudantes de Enfermagem, enquanto no
grupo da simulação de média-fidelidade existiu um decréscimo na pontuação ao longo
dos três momentos de avaliação. Surgiram diferenças estatisticamente significativas
perante a Definição do Problema e Desenvolvimento dos Objetivos, fator 1 da tomada de
decisão, no grupo experimental (p < 0,05), e na Procura e Processamento de Dados, fator
2 da mesma variável, no grupo de controlo (p < 0,01), com tamanho do efeito elevado.
Verificou-se uma média aritmética de 74,3 pontos na satisfação do grupo experimental e
72 pontos no grupo de controlo (74,27±4,635 e 72,00±7,572 respetivamente).
Globalmente a prática dos estudantes de Enfermagem sobre suporte básico de vida
encontra-se num nível bom, com médias entre os 41 e 42 pontos, respetivamente na
simulação de alta-fidelidade (41,29±3,245) e na simulação de média-fidelidade
(41,64±2,341). Em termos longitudinais, observou-se que o nível de conhecimentos
apresenta diferenças com significado estatístico (p < 0,01) em ambos os grupos de
investigação, entre os três momentos de avaliação, sendo mais expressivas no grupo da
simulação de alta-fidelidade (p < 0,001).
Conclusões: A Versão Portuguesa da Clinical Decision Making in Nursing Scale© e da
Lasater’s Clinical Judgement Rubric©
são instrumentos válidos e fiáveis, demonstrando
um elevado potencial para a sua utilização na investigação e formação do processo de
tomada de decisão e do julgamento clínico nos estudantes de Enfermagem em Portugal.
Com este trabalho de investigação foi possível validar, por peritos na área da simulação
clínica e peritos na área do paciente crítico, um programa de formação no âmbito do
suporte básico de vida em meio intra-hospitalar, com recurso à simulação de médiafidelidade e à simulação de alta-fidelidade. O estudo experimental evidenciou que os
estudantes de Enfermagem sustentam um bom nível de conhecimentos no contexto de
suporte básico de vida, embora seja necessário desenvolver estratégicas com vista à
manutenção desse mesmo nível de conhecimentos ao longo do tempo. A tomada de
decisão pelos estudantes de Enfermagem evidenciou um nível bom, no entanto será
necessário, em estudos futuros, criar ou validar um instrumento de medida no âmbito da
tomada de decisão por heteroavaliação. Fundamentou-se com esta investigação um
caminho possível para desenvolver o processo de tomada de decisão em estudantes de
Enfermagem, com recurso à simulação de alta-fidelidade preparada estruturalmente e
suportada por prebriefing e debriefing, após a realização de formação teórica sobre
suporte básico de vida, complementada com a realização de prática em ensino clínico.
Esta possibilidade é uma alternativa à prática apenas de ensino clínico, com tradução de
um bom nível de satisfação, um bom nível de perceção de aprendizagem e um bom nível
de prática de suporte básico de vida pelos estudantes de Enfermagem.
Introduction: Currently, one of the expanding methodologies in nursing education is the innovative teaching methodology, with high-fidelity simulation being one of its learning tools. This type of clinical simulation allows consolidating and integrating theoretical knowledge with clinical practice and developing technical and non-technical skills in nursing students, such as decision making. Methodology: This research work began in the form of a systematic literature review, whose main objective was to highlight the importance of carrying out an empirical study, given the scarcity of results in the context of decision-making by Portuguese Nursing students. In a second work, through a methodological study, whose main objective was to culturally validate the measurement instruments Clinical Decision Making in Nursing Scale© and Lasater's Clinical Judgment Rubric© , it was intended to develop evaluation tools valid in European Portuguese that would allow to evaluate the taking decisionmaking in Nursing education in Portugal. In the experimental study, of the pre-test and post-test type with randomized samples, it was intended to determine the effectiveness of the practice of high-fidelity simulation and medium-fidelity simulation in the decisionmaking process of nursing students, after the development of training on basic life support and after clinical teaching; and assess the level of knowledge about basic life support and decision-making of nursing students, before and after the clinical simulation scenario and after clinical teaching. This study had in its genesis the development of an intervention, namely the practice of basic life support in adults. To carry out this investigation, the Escola Superior de Enfermagem de Coimbra was selected for presenting a Clinical Practices Simulation Center. The research groups were divided in a randomized and homogeneous way, being the experimental group that used high-fidelity simulation and the control group that practiced medium-fidelity simulation. Results: In the validation study of the Clinical Decision Making in Nursing Scale© , the confirmatory factor analysis showed a good quality of adjustment of the factor structure, consisting of three factors (X 2 /gl = 2.056; GFI = 0.927; CFI = 0.917; RMSEA = 0.046; RMR = 0.039; SRMR = 0.050). Determining the fidelity of the scale required that it be XVI made up of 23 items, with correlation values ranging between 0.184 and 0.610 and an overall Cronbach's alpha value of 0.851, demonstrating good reliability. Regarding the validation of the Lasater's Clinical Judgment Rubric© , of the 64 observations obtained from the practices of nursing students, the value of intraclass correlations in the 4 phases of the instrument – Noticing, Interpreting, Responding, Reflecting – above 0.792 was highlighted. An overall Cronbach's alpha of 0.921 and 0.876 was found in observers 1 and 2 respectively, with a statistically significant level of agreement, presented by a kappa value greater than 0.803. 51 Nursing students participated in the experimental study, with a mean age of 20.25±3.804 years, of which 92.2% were female. The research groups showed homogeneity in the variables age, knowledge, decision making and hours of clinical teaching. Within the group that practiced high-fidelity simulation, the level of decision-making of nursing students was maintained, while in the group that practiced high-fidelity simulation, there was a decrease in scores over the three evaluation moments. Statistically significant differences emerged regarding Problem Definition and Goal Development, factor 1 of decision making, in the experimental group (p < 0.05), and in Data Search and Processing, factor 2 of the same variable, in the control group (p < 0.01), with high effect size. There was an arithmetic mean of 74.3 points in the satisfaction of the experimental group and 72 points in the control group (74.27±4.635 and 72.00±7.572 respectively). Overall, the practice of nursing students on basic life support is at a good level, with averages between 41 and 42 points, respectively in the high-fidelity simulation (41.29±3.245) and in the medium-fidelity simulation (41.64±2.341). In longitudinal terms, it was observed that the level of knowledge presents statistically significant differences (p < 0.01) in both investigation groups, between the three evaluation moments, being more expressive in the high-fidelity simulation group (p < 0.001). Conclusions: The Portuguese Version of the Clinical Decision Making in Nursing Scale© and Lasater's Clinical Judgment Rubric© are valid and reliable instruments, demonstrating a high potential for their use in researching and training the decision-making process and clinical judgment in nursing students in Portugal. With this research work, it was possible to validate, by experts in the field of clinical simulation and experts in the field of critical patients, a training program in the scope of basic life support in an in-hospital environment, using medium-fidelity simulation and to high-fidelity simulation. The experimental study showed that nursing students sustain a good level of knowledge in the XVII context of basic life support, although it is necessary to develop strategies in order to maintain this same level of knowledge over time. Decision-making by nursing students showed a good level, however, it will be necessary, in future studies, to create or validate a measurement instrument within the scope of decision-making by hetero assessment. Based on this investigation, a possible path to develop the decision-making process in nursing students was based, using a high-fidelity simulation structurally prepared and supported by prebriefing and debriefing, after carrying out theoretical training on basic life support, complemented with practice in clinical teaching. This possibility is an alternative to the practice of just clinical teaching, with a good level of satisfaction, a good level of learning perception and a good level of basic life support practice by nursing students.
Introduction: Currently, one of the expanding methodologies in nursing education is the innovative teaching methodology, with high-fidelity simulation being one of its learning tools. This type of clinical simulation allows consolidating and integrating theoretical knowledge with clinical practice and developing technical and non-technical skills in nursing students, such as decision making. Methodology: This research work began in the form of a systematic literature review, whose main objective was to highlight the importance of carrying out an empirical study, given the scarcity of results in the context of decision-making by Portuguese Nursing students. In a second work, through a methodological study, whose main objective was to culturally validate the measurement instruments Clinical Decision Making in Nursing Scale© and Lasater's Clinical Judgment Rubric© , it was intended to develop evaluation tools valid in European Portuguese that would allow to evaluate the taking decisionmaking in Nursing education in Portugal. In the experimental study, of the pre-test and post-test type with randomized samples, it was intended to determine the effectiveness of the practice of high-fidelity simulation and medium-fidelity simulation in the decisionmaking process of nursing students, after the development of training on basic life support and after clinical teaching; and assess the level of knowledge about basic life support and decision-making of nursing students, before and after the clinical simulation scenario and after clinical teaching. This study had in its genesis the development of an intervention, namely the practice of basic life support in adults. To carry out this investigation, the Escola Superior de Enfermagem de Coimbra was selected for presenting a Clinical Practices Simulation Center. The research groups were divided in a randomized and homogeneous way, being the experimental group that used high-fidelity simulation and the control group that practiced medium-fidelity simulation. Results: In the validation study of the Clinical Decision Making in Nursing Scale© , the confirmatory factor analysis showed a good quality of adjustment of the factor structure, consisting of three factors (X 2 /gl = 2.056; GFI = 0.927; CFI = 0.917; RMSEA = 0.046; RMR = 0.039; SRMR = 0.050). Determining the fidelity of the scale required that it be XVI made up of 23 items, with correlation values ranging between 0.184 and 0.610 and an overall Cronbach's alpha value of 0.851, demonstrating good reliability. Regarding the validation of the Lasater's Clinical Judgment Rubric© , of the 64 observations obtained from the practices of nursing students, the value of intraclass correlations in the 4 phases of the instrument – Noticing, Interpreting, Responding, Reflecting – above 0.792 was highlighted. An overall Cronbach's alpha of 0.921 and 0.876 was found in observers 1 and 2 respectively, with a statistically significant level of agreement, presented by a kappa value greater than 0.803. 51 Nursing students participated in the experimental study, with a mean age of 20.25±3.804 years, of which 92.2% were female. The research groups showed homogeneity in the variables age, knowledge, decision making and hours of clinical teaching. Within the group that practiced high-fidelity simulation, the level of decision-making of nursing students was maintained, while in the group that practiced high-fidelity simulation, there was a decrease in scores over the three evaluation moments. Statistically significant differences emerged regarding Problem Definition and Goal Development, factor 1 of decision making, in the experimental group (p < 0.05), and in Data Search and Processing, factor 2 of the same variable, in the control group (p < 0.01), with high effect size. There was an arithmetic mean of 74.3 points in the satisfaction of the experimental group and 72 points in the control group (74.27±4.635 and 72.00±7.572 respectively). Overall, the practice of nursing students on basic life support is at a good level, with averages between 41 and 42 points, respectively in the high-fidelity simulation (41.29±3.245) and in the medium-fidelity simulation (41.64±2.341). In longitudinal terms, it was observed that the level of knowledge presents statistically significant differences (p < 0.01) in both investigation groups, between the three evaluation moments, being more expressive in the high-fidelity simulation group (p < 0.001). Conclusions: The Portuguese Version of the Clinical Decision Making in Nursing Scale© and Lasater's Clinical Judgment Rubric© are valid and reliable instruments, demonstrating a high potential for their use in researching and training the decision-making process and clinical judgment in nursing students in Portugal. With this research work, it was possible to validate, by experts in the field of clinical simulation and experts in the field of critical patients, a training program in the scope of basic life support in an in-hospital environment, using medium-fidelity simulation and to high-fidelity simulation. The experimental study showed that nursing students sustain a good level of knowledge in the XVII context of basic life support, although it is necessary to develop strategies in order to maintain this same level of knowledge over time. Decision-making by nursing students showed a good level, however, it will be necessary, in future studies, to create or validate a measurement instrument within the scope of decision-making by hetero assessment. Based on this investigation, a possible path to develop the decision-making process in nursing students was based, using a high-fidelity simulation structurally prepared and supported by prebriefing and debriefing, after carrying out theoretical training on basic life support, complemented with practice in clinical teaching. This possibility is an alternative to the practice of just clinical teaching, with a good level of satisfaction, a good level of learning perception and a good level of basic life support practice by nursing students.
Description
Keywords
Educação em enfermagem Estudantes de enfermagem Estudo de validação Julgamento clínico Pensamento crítico Psicometria Raciocínio clínico Simulação de alta-fidelidade Tomada de decisão clínica Tomada de decisão Tradução Clinical decision-making Clinical judgment Clinical reasoning Critical thinking Decision making Education Nursing High fidelity simulation training Psychometrics Students Nursing Translations Validation study