Julgamento clínico e autoeficácia de enfermeiros para o manejo da sepse: uso da simulação clínica

Detalhes bibliográficos
Autor(a) principal: Carvalho, Lilian Regina de
Data de Publicação: 2018
Tipo de documento: Tese
Idioma: por
Título da fonte: Repositório Institucional da UFSCAR
Texto Completo: https://repositorio.ufscar.br/handle/ufscar/10994
Resumo: The use of active methodologies has demonstrated efficacy in the teaching and learning process in nursing. Thus, realistic simulation emerges as a strategy that, in addition to allowing real experimentation without the exposure of a patient, allows reflection on the actions developed within the scenario. The aim of the study was to evaluate the efficacy and clinical judgment of nurses for the management of sepsis based on high fidelity clinical simulation. The research was carried out in two stages. In stage I, a methodological study was carried out, with a quantitative approach, consisting of three phases: i) elaboration of the clinical simulation scenario and knowledge test on sepsis; ii) validation of the content by nine judges; and iii) scenario test with nurses . The theoretical framework used was that of meaningful learning. For the construction of the clinical scenario, we chose the Simulation model of the National League for nursing and the content was based on the protocols proposed by the Latin American Sepsis Institute. The analysis of content was given by the Content Validity Index, considering a value> 0.90. In stage II, a quasi-experimental study of the before and after type was performed, consisting of 28 nurses from a teaching hospital. Participants were submitted to three moments of the research: (i) prior to delivery of the study material; (ii) prior to the simulation; and (iii) after the simulation to evaluate clinical judgment, self-efficacy, and knowledge test on sepsis. For the analysis of this step, Spearman correlations and scatter plots were used to compare the relationship of clinical judgment and self-efficacy. The nonparametric Wilcoxon test was used for independent samples and the orthogonal contrasts were applied to compare the times. The results of stage I demonstrated that the instruments were adequate, obtaining general value> 0.90. Nevertheless, some adjustments of the scenario and the test, regarding the clarity of the writing, the functionalities and the pertinence of protocols were changed, according to suggestion of the judges. While in stage II, the mean values at the three times of each outcome were high. The clinical judgment presented a statistically significant difference between the times. The clinical judgment (p = 0.0252) and self-efficacy (p = 0.0269) of the participants in the simulation scenario were statistically higher in relation to the listeners and a strong correlation was found between self-efficacy and clinical judgment (p = 0.001). It is expected that the knowledge test and the clinical simulation scenario on sepsis will be facilitators for teachers and professionals of the permanent / continuing education centers of health institutions in the training of nurses and nursing students. In addition, it is expected that more training with the use of the simulation will be performed with professionals trained for risk-free care, ensuring patient safety.
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spelling Carvalho, Lilian Regina deZem-Mascarenhas, Silvia Helenahttp://lattes.cnpq.br/0185144417072417http://lattes.cnpq.br/8329953593386274cdb58522-b70b-4574-bf9a-ff6971800b462019-02-19T13:39:01Z2019-02-19T13:39:01Z2018-11-23CARVALHO, Lilian Regina de. Julgamento clínico e autoeficácia de enfermeiros para o manejo da sepse: uso da simulação clínica. 2018. Tese (Doutorado em Enfermagem) – Universidade Federal de São Carlos, São Carlos, 2018. Disponível em: https://repositorio.ufscar.br/handle/ufscar/10994.https://repositorio.ufscar.br/handle/ufscar/10994The use of active methodologies has demonstrated efficacy in the teaching and learning process in nursing. Thus, realistic simulation emerges as a strategy that, in addition to allowing real experimentation without the exposure of a patient, allows reflection on the actions developed within the scenario. The aim of the study was to evaluate the efficacy and clinical judgment of nurses for the management of sepsis based on high fidelity clinical simulation. The research was carried out in two stages. In stage I, a methodological study was carried out, with a quantitative approach, consisting of three phases: i) elaboration of the clinical simulation scenario and knowledge test on sepsis; ii) validation of the content by nine judges; and iii) scenario test with nurses . The theoretical framework used was that of meaningful learning. For the construction of the clinical scenario, we chose the Simulation model of the National League for nursing and the content was based on the protocols proposed by the Latin American Sepsis Institute. The analysis of content was given by the Content Validity Index, considering a value> 0.90. In stage II, a quasi-experimental study of the before and after type was performed, consisting of 28 nurses from a teaching hospital. Participants were submitted to three moments of the research: (i) prior to delivery of the study material; (ii) prior to the simulation; and (iii) after the simulation to evaluate clinical judgment, self-efficacy, and knowledge test on sepsis. For the analysis of this step, Spearman correlations and scatter plots were used to compare the relationship of clinical judgment and self-efficacy. The nonparametric Wilcoxon test was used for independent samples and the orthogonal contrasts were applied to compare the times. The results of stage I demonstrated that the instruments were adequate, obtaining general value> 0.90. Nevertheless, some adjustments of the scenario and the test, regarding the clarity of the writing, the functionalities and the pertinence of protocols were changed, according to suggestion of the judges. While in stage II, the mean values at the three times of each outcome were high. The clinical judgment presented a statistically significant difference between the times. The clinical judgment (p = 0.0252) and self-efficacy (p = 0.0269) of the participants in the simulation scenario were statistically higher in relation to the listeners and a strong correlation was found between self-efficacy and clinical judgment (p = 0.001). It is expected that the knowledge test and the clinical simulation scenario on sepsis will be facilitators for teachers and professionals of the permanent / continuing education centers of health institutions in the training of nurses and nursing students. In addition, it is expected that more training with the use of the simulation will be performed with professionals trained for risk-free care, ensuring patient safety.O uso de metodologias ativas tem demonstrado eficácia no processo de ensino e aprendizagem na enfermagem. Sendo assim, a simulação realística surge como uma estratégia que, além de permitir a experimentação real sem a exposição de um paciente, possibilita a reflexão acerca das ações desenvolvidas dentro do cenário. O objetivo da pesquisa foi o de avaliar a resposta da autoeficácia e do julgamento clínico de enfermeiros para o manejo da sepse a partir de simulação clínica de alta fidelidade. O desenvolvimento da pesquisa ocorreu em duas etapas. Na etapa I, foi realizado um estudo metodológico, de abordagem quantitativa, composto por três fases: i) elaboração do cenário de simulação clínica e teste de conhecimento sobre sepse, ii) validação do conteúdo por nove juízes e iii) teste do cenário com enfermeiros. O referencial teórico utilizado foi o da aprendizagem significativa. Para a construção do cenário clínico, optou-se pelo modelo de Simulação da National League for nursing e o conteúdo foi fundamentado nos protocolos proposto pelo Instituto Latino Americano de Sepse. A análise de conteúdo se deu pelo Indíce de Validade de Conteúdo, considerando adequado um valor >0,90. Na etapa II, foi realizado um estudo quase-experimental do tipo antes e depois composto por 28 enfermeiros de um hospital de ensino. Os participantes foram submetidos a três momentos da pesquisa, sendo eles: i) antes da entrega do material para estudo, ii) antes da simulação e iii) após a simulação para avaliar o julgamento clínico, a autoeficácia e o teste de conhecimento sobre sepse. Para a análise dessa etapa, utilizou-se as correlações de Spearman e gráficos de dispersão para comparar a relação do julgamento clínico e a autoeficácia. O teste não paramétrico de Wilcoxon foi utilizado para amostras independentes e os contrastes ortogonais foram aplicados para comparar os tempos. Os resultados da etapa I demostraram que os instrumentos foram adequados, obtendo valor geral >0,90. No entanto, alguns ajustes do cenário e do teste, no que tange à clareza da redação, às funcionalidades e à pertinência de protocolos foram alterados, conforme sugestão dos juízes. Enquanto que na etapa II, os valores médios nos três tempos de cada desfecho mostrou-se elevado. O julgamento clínico apresentou diferença estatisticamente significativa entre os tempos. O julgamento clínico (p=0,0252) e a autoeficácia (p=0,0269) dos participantes do cenário de simulação foram estatisticamente maiores em relação aos ouvintes e uma forte correlação foi encontrada entre a autoeficácia e o julgamento clínico (p=<0,001). Espera-se que o teste de conhecimento e o cenário de simulação clínica sobre sepse sejam facilitadores para docentes e profissionais dos núcleos de educação permanente/continuada de instituições de saúde na capacitação de enfermeiros e estudantes de enfermagem. Além disso, espera-se que mais treinamento com o uso da simulação seja realizado com profissionais formados para uma assistência livre de riscos, assegurando a segurança do paciente.Não recebi financiamentoporUniversidade Federal de São CarlosCâmpus São CarlosPrograma de Pós-Graduação em Enfermagem - PPGEnfUFSCarTreinamento por simulaçãoJulgamento clínicoAutoeficáciaEnfermagemSimulaçãoTraining by simulationClinical judgmentSelf-efficacyNursingSimulationCIENCIAS DA SAUDE::ENFERMAGEMJulgamento clínico e autoeficácia de enfermeiros para o manejo da sepse: uso da simulação clínicaClinical judgment and self-efficacy of nurses for the management of sepsis: use of clinical simulationJuicio clínico y autoeficacia de enfermeros para el manejo de la sepsis: uso de la simulación clínicainfo:eu-repo/semantics/publishedVersioninfo:eu-repo/semantics/doctoralThesisOnline600600c4ff86eb-83e6-436a-98cd-317c4bfa2c1binfo:eu-repo/semantics/openAccessreponame:Repositório Institucional da UFSCARinstname:Universidade Federal de São Carlos (UFSCAR)instacron:UFSCARORIGINALJULGAMENTO CLÍNICO E AUTOEFICÁCA NA SIMULAÇÃO PARA ENFERMEIROS.pdfJULGAMENTO CLÍNICO E AUTOEFICÁCA NA SIMULAÇÃO PARA ENFERMEIROS.pdfapplication/pdf3641075https://repositorio.ufscar.br/bitstream/ufscar/10994/1/JULGAMENTO%20CL%c3%8dNICO%20E%20AUTOEFIC%c3%81CA%20NA%20SIMULA%c3%87%c3%83O%20PARA%20ENFERMEIROS.pdf91845de3e5def9d8aded859eda1bf7a7MD51LICENSElicense.txtlicense.txttext/plain; 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dc.title.por.fl_str_mv Julgamento clínico e autoeficácia de enfermeiros para o manejo da sepse: uso da simulação clínica
dc.title.alternative.eng.fl_str_mv Clinical judgment and self-efficacy of nurses for the management of sepsis: use of clinical simulation
dc.title.alternative.spa.fl_str_mv Juicio clínico y autoeficacia de enfermeros para el manejo de la sepsis: uso de la simulación clínica
title Julgamento clínico e autoeficácia de enfermeiros para o manejo da sepse: uso da simulação clínica
spellingShingle Julgamento clínico e autoeficácia de enfermeiros para o manejo da sepse: uso da simulação clínica
Carvalho, Lilian Regina de
Treinamento por simulação
Julgamento clínico
Autoeficácia
Enfermagem
Simulação
Training by simulation
Clinical judgment
Self-efficacy
Nursing
Simulation
CIENCIAS DA SAUDE::ENFERMAGEM
title_short Julgamento clínico e autoeficácia de enfermeiros para o manejo da sepse: uso da simulação clínica
title_full Julgamento clínico e autoeficácia de enfermeiros para o manejo da sepse: uso da simulação clínica
title_fullStr Julgamento clínico e autoeficácia de enfermeiros para o manejo da sepse: uso da simulação clínica
title_full_unstemmed Julgamento clínico e autoeficácia de enfermeiros para o manejo da sepse: uso da simulação clínica
title_sort Julgamento clínico e autoeficácia de enfermeiros para o manejo da sepse: uso da simulação clínica
author Carvalho, Lilian Regina de
author_facet Carvalho, Lilian Regina de
author_role author
dc.contributor.authorlattes.por.fl_str_mv http://lattes.cnpq.br/8329953593386274
dc.contributor.author.fl_str_mv Carvalho, Lilian Regina de
dc.contributor.advisor1.fl_str_mv Zem-Mascarenhas, Silvia Helena
dc.contributor.advisor1Lattes.fl_str_mv http://lattes.cnpq.br/0185144417072417
dc.contributor.authorID.fl_str_mv cdb58522-b70b-4574-bf9a-ff6971800b46
contributor_str_mv Zem-Mascarenhas, Silvia Helena
dc.subject.por.fl_str_mv Treinamento por simulação
Julgamento clínico
Autoeficácia
Enfermagem
Simulação
topic Treinamento por simulação
Julgamento clínico
Autoeficácia
Enfermagem
Simulação
Training by simulation
Clinical judgment
Self-efficacy
Nursing
Simulation
CIENCIAS DA SAUDE::ENFERMAGEM
dc.subject.eng.fl_str_mv Training by simulation
Clinical judgment
Self-efficacy
Nursing
Simulation
dc.subject.cnpq.fl_str_mv CIENCIAS DA SAUDE::ENFERMAGEM
description The use of active methodologies has demonstrated efficacy in the teaching and learning process in nursing. Thus, realistic simulation emerges as a strategy that, in addition to allowing real experimentation without the exposure of a patient, allows reflection on the actions developed within the scenario. The aim of the study was to evaluate the efficacy and clinical judgment of nurses for the management of sepsis based on high fidelity clinical simulation. The research was carried out in two stages. In stage I, a methodological study was carried out, with a quantitative approach, consisting of three phases: i) elaboration of the clinical simulation scenario and knowledge test on sepsis; ii) validation of the content by nine judges; and iii) scenario test with nurses . The theoretical framework used was that of meaningful learning. For the construction of the clinical scenario, we chose the Simulation model of the National League for nursing and the content was based on the protocols proposed by the Latin American Sepsis Institute. The analysis of content was given by the Content Validity Index, considering a value> 0.90. In stage II, a quasi-experimental study of the before and after type was performed, consisting of 28 nurses from a teaching hospital. Participants were submitted to three moments of the research: (i) prior to delivery of the study material; (ii) prior to the simulation; and (iii) after the simulation to evaluate clinical judgment, self-efficacy, and knowledge test on sepsis. For the analysis of this step, Spearman correlations and scatter plots were used to compare the relationship of clinical judgment and self-efficacy. The nonparametric Wilcoxon test was used for independent samples and the orthogonal contrasts were applied to compare the times. The results of stage I demonstrated that the instruments were adequate, obtaining general value> 0.90. Nevertheless, some adjustments of the scenario and the test, regarding the clarity of the writing, the functionalities and the pertinence of protocols were changed, according to suggestion of the judges. While in stage II, the mean values at the three times of each outcome were high. The clinical judgment presented a statistically significant difference between the times. The clinical judgment (p = 0.0252) and self-efficacy (p = 0.0269) of the participants in the simulation scenario were statistically higher in relation to the listeners and a strong correlation was found between self-efficacy and clinical judgment (p = 0.001). It is expected that the knowledge test and the clinical simulation scenario on sepsis will be facilitators for teachers and professionals of the permanent / continuing education centers of health institutions in the training of nurses and nursing students. In addition, it is expected that more training with the use of the simulation will be performed with professionals trained for risk-free care, ensuring patient safety.
publishDate 2018
dc.date.issued.fl_str_mv 2018-11-23
dc.date.accessioned.fl_str_mv 2019-02-19T13:39:01Z
dc.date.available.fl_str_mv 2019-02-19T13:39:01Z
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dc.identifier.citation.fl_str_mv CARVALHO, Lilian Regina de. Julgamento clínico e autoeficácia de enfermeiros para o manejo da sepse: uso da simulação clínica. 2018. Tese (Doutorado em Enfermagem) – Universidade Federal de São Carlos, São Carlos, 2018. Disponível em: https://repositorio.ufscar.br/handle/ufscar/10994.
dc.identifier.uri.fl_str_mv https://repositorio.ufscar.br/handle/ufscar/10994
identifier_str_mv CARVALHO, Lilian Regina de. Julgamento clínico e autoeficácia de enfermeiros para o manejo da sepse: uso da simulação clínica. 2018. Tese (Doutorado em Enfermagem) – Universidade Federal de São Carlos, São Carlos, 2018. Disponível em: https://repositorio.ufscar.br/handle/ufscar/10994.
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dc.publisher.none.fl_str_mv Universidade Federal de São Carlos
Câmpus São Carlos
dc.publisher.program.fl_str_mv Programa de Pós-Graduação em Enfermagem - PPGEnf
dc.publisher.initials.fl_str_mv UFSCar
publisher.none.fl_str_mv Universidade Federal de São Carlos
Câmpus São Carlos
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