Construction and validation of a sepsis simulation scenario: a methodological study

Carvalho, Lilian Regina de; Zem-Mascarenhas, Silvia Helena

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Revista da Escola de Enfermagem da USP

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Sumário

ORIGINAL ARTICLE • Rev. esc. enferm. USP 54 • 2020 • https://doi.org/10.1590/S1980-220X2019021603638 copy

Construction and validation of a sepsis simulation scenario: a methodological study^* * Extracted from the thesis: “Julgamento clínico e autoeficácia de enfermeiros para o manejo da sepse: uso da simulação clínica”, Departamento de Enfermagem, Universidade Federal de São Carlos, 2018.

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Objective

To build, validate and test a high-fidelity clinical simulation scenario for sepsis management.

Method

Methodological study developed in three phases: construction of a simulation scenario using the framework Model of Nursing Training Simulation and protocols established by the Latin-American Sepsis Institute, content validation by nine judges, and scenario testing by two nurses from a hospital institution. Data analysis was carried out through Content Validity Index, with values > 0.90 among the judges being considered satisfactory.

Results

The simulation scenario was observed to be appropriate and obtained an overall value > 0.90. However, some adjustments to the scenario and the test were performed concerning textual clarity, functionality, and the protocol’s pertinence, following the judges’ suggestions.

Conclusion

The validated simulation scenario is expected to be a facilitator instrument for educators and professionals in the permanent/continued education nuclei of teaching and health institutions.

Simulation; Simulation Training; Patient Simulation; Sepsis; Education, Nursing; Models, Educational

Evaluated items	Judges / Agreement
	O		C		A		P		CVI (%)
	Yes	No	Yes	No	Yes	No	Yes	No	CVI (%)
Scenario title	9		7	2	9		9		94%
Previous study material	9		9		9		9		100%
Online material availability	7	2	7	2	8	1	8		83%
Simulation site – laboratory	9		9		9				100%
Kind of simulator – simulated patient	9		8	1	8	1	8		92%
Primary objectives	9		9		9		9		100%
Secondary objectives	8	1	7	2	8	1	8	1	86%
Simulation duration	9	1	9		9		9		100%
Patient history	8	1	8	1	8	1	8	1	89%
Provided clues	8	1	8	1	8	1	8	1	89%
Scenario fidelity – equipment and material	8	1	8	1	8	1	8	1	89%
Scenario fidelity – actors	9		9		9		9		100%
Briefing	7	2	7		7	2	7	2	78%
Actions performed by the nurse based on clinical judgment	9		9		9		9		100%

Judges	Organization	Clarity	Appearance	Pertinence
Judge 1	100%	100%	100%	100%
Judge 2	100%	100%	100%	100%
Judge 3	89%	78%	94%	94%
Judge 4	100%	100%	100%	100%
Judge 5	94%	94%	94%	94%
Judge 6	94%	94%	94%	94%
Judge 7	100%	100%	100%	100%
Judge 8	72%	61%	67%	72%
Judge 9	100%	100%	100%	100%

1. CONTEXT
Scenario title: Nurses’ actions towards sepsis management Public: Nursing students and nurses Pre-simulation knowledge proposal Material to be employed - National and international literature, as well as the theoretical framework by Latin-American Sepsis Institute – ILAS. Discussion board: Social networks Simulation modality: High-fidelity scenic simulation Simulation site: First aid station scenario with three areas: nursing area, medical office and waiting room Necessary material Nursing area: stretcher, gloves, alcohol gel, safety glasses, sphygmomanometer, stethoscope, thermometer, antibiotic, serum support, physiological serum, macro-drip infusion set, two-way infusion set connector, flexible catheter for venous puncture, micropore, cotton, gauze, pen, computer, room identification, glasses for exam and culture collection Medical office: Table, chair, medication prescription, pen, room identification and admission paperwork in the entrance Waiting room: Chairs and area identification Type of simulator Actors: Nursing technique to aid in procedures pertinent to this category, the wife, the patient, and the physician Patient should have: identification wristband, moulage technique for identifying the operative wound with a bandage smeared with yellowish secretion. Simulation proposal: Instructional
2. BACKGROUND Objectives General • Precociously identifying sepsis risk and quick decision making Specific • Demonstrate clinical judgment for the recognition of sepsis through information collection and specific physical exam; • Interpreting results, suspecting sepsis and opening a protocol; • Prioritizing and supervising immediate treatment.
Time Prebriefing – 10 days Briefing– 5 minutes Scenario – 10 minutes Debriefing – 30 minutes
3. DESIGN Information contained in the Admission form: Thirty-five years old patient with a record of controlled type 1 diabetes followed-up by an endocrinologist, taking regular insulin 10 UI after lunch and NPH insulin SC 15 UI in the morning and 10 UI in the evening. Admitted to the first aid station accompanied by wife who reports her husband was hospitalized for two days due to appendix surgery and was discharged three days ago. He has been experiencing abdominal pain and lowered urine volume since yesterday. He woke up today with fever, abdominal pain, accelerated respiration, operative wound secretion, accelerated heart rate and drowsy. VS: BP: 80x50 mmHg (MBP 60 mmHg); RR – 25 irmp; Glycemia – 250 mg/dl; Temperature – 38ºC; HR – 125 bpm. The patient must be classified as yellow and may wait for up to one hour. Clues provided by actors and which are contained in the admission form: Hypotension 80x50 mmHg (MBP 60 mmHg) Tachypnea – 25 irmp Hyperglycemia – 250 mg/dl Fever – 38ºC Oliguria – < 0.5 mL/kg/hour Tachycardia – 125 bpm Mental confusion - Glasgow 14 Medication prescription 1- PS 0.9% 2100ml EV clamp open now 2- Amoxicillin + clavulanic acid 1g solved in PS 100 ml EV now and every 8 hours or in accordance with the institutional protocol 3- Conducting blood exam and cultures Fidelity High-fidelity scenic simulation Patient and wife must be professional actors to involve professionals emotionally during assistance
4. SIMULATION EXPERIENCE Participants’ report on debriefing or validated instruments
5. FACILITATOR AND EDUCATIONAL STRATEGIES Briefing Two nurses will be involved in the simulation scenario. One is responsible for the unit and the other is regarded as a trainee The scenario is presented as follows: thirty-five years old patient accompanied by wife, has been through an at-risk admission and has been waiting for consultation in the waiting room for forty minutes. The physician is in an emergency and may be requested while on the scenario. If conducting exams is necessary, simply mention that the exams were conducted and which ones. If it is necessary to provide medication or measure VS, this may be requested to the nursing technician. You may not request help from outsiders, only from those in the scene. Talk louder so that everyone can hear. Show them the scenario, its equipment, its functionalities, the nursing technician, and the physician. Time for adaptation. Debriefing In this phase, it will be possible to identify one of the steps of clinical judgment, which is “Reflecting”. The following questions may be helpful in this moment: Emotional stage: How do you feel assisting this patient? Descriptive stage: May you describe the clinical condition you have found? Evaluative stage: Which positive actions did you perform? Analytical stage: What would you do if you had another opportunity? Conclusive stage: What have you learned from this experience in your clinical practice?
6. PARTICIPANT Participants must execute a high-complexity action through the identification of the three aspects of clinical judgment “observing, interpreting and answering” Observing: Collecting information from the wife and the admission form Interpreting: Conducting a physical exam specific to the abdomen Verifying VS values in the admission form Associating the signs of tachycardia, mental confusion, reduced diuresis, fever, tachypnea, hyperglycemia and hypotension with SIRS manifestation and organic dysfunction Raising sepsis suspicion Responding Opening sepsis protocol Reporting to the physician Conducting blood exam and cultures collection Requesting antibiotic administration immediately after culture collection
7. OUTCOMES – the outcomes expected for the participant Clinical judgment Facilitator: the facilitator must follow each step of clinical judgment through a checklist composted of: investigating, interpreting and understanding data, prioritizing and planning actions, restarting with reflection on the practice Participant: clinical judgment by the nurse may be evaluated through the instrument Lasater Clinical Judgment Rubric – Brazilian Version.

Universidade de São Paulo, Escola de Enfermagem Av. Dr. Enéas de Carvalho Aguiar, 419 , 05403-000 São Paulo - SP/ Brasil, Tel./Fax: (55 11) 3061-7553, - São Paulo - SP - Brazil
E-mail: reeusp@usp.br

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[1] Corresponding author: Lilian Regina de Carvalho Departamento de Enfermagem, Universidade Federal de São Carlos Rodovia Washington Luís, s/n CEP 13565-905 – São Carlos, SP, Brazil liliancarvalho.sc@gmail.com

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Construction and validation of a sepsis simulation scenario: a methodological study* * Extracted from the thesis: “Julgamento clínico e autoeficácia de enfermeiros para o manejo da sepse: uso da simulação clínica”, Departamento de Enfermagem, Universidade Federal de São Carlos, 2018.

ABSTRACT

Objective

Method

Results

Conclusion

Construction and validation of a sepsis simulation scenario: a methodological study^* * Extracted from the thesis: “Julgamento clínico e autoeficácia de enfermeiros para o manejo da sepse: uso da simulação clínica”, Departamento de Enfermagem, Universidade Federal de São Carlos, 2018.