<b>Problematization methodology’s impact on nursing and medical students’ knowledge about hypodermoclysis: quasi-experimental study</b>

Coutinho, Juliana de Souza Lima; Mendonça, Érica Toledo de; Braga, Luciene Muniz; Salgado, Patrícia de Oliveira; Ercole, Flavia Falci; Toledo, Luana Vieira

doi:10.1590/1518-8345.7006.4131

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Revista Latino-Americana de Enfermagem

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Original Article • Rev. Latino-Am. Enfermagem 32 • 2024 • https://doi.org/10.1590/1518-8345.7006.4131 copy

Problematization methodology’s impact on nursing and medical students’ knowledge about hypodermoclysis: quasi-experimental study ^* * Paper extracted from master’s thesis “Problematização como estratégia de ensino em hipodermóclise para estudantes de Enfermagem e Medicina”, presented to Universidade Federal de Viçosa, Viçosa, MG, Brazil. Supported by FAPEMIG 2021-2022, Grant #4040276542, Brazil.

Authorship SCIMAGO INSTITUTIONS RANKINGS

Objective:

to analyze the problematization methodology impact on the knowledge of nursing and medical students about hypodermoclysis.

Method:

quasi-experimental study conducted with 22 undergraduate nursing and medical students from a public Brazilian higher education institution. The students participated in the educational intervention using the problematization methodology based on the Arch of Maguerez. A previously validated questionnaire was used to determin’ the students’ knowledge level about hypodermoclysis. This instrument was applied before and after the educational intervention. The results were compared by McNemar’s test and Student’s t test for paired samples.

Results:

when comparing the correct answers before and after the intervention, there was a significant increase in 75% of the questions (p<0.05), including theoretical and practical aspects of hypodermoclysis. The mean score on students’ self-assessment of the ability to explain (0.9 versus 5.9 points) and perform hypodermoclysis (1.9 versus 5.0) was significantly higher after applying the problematization methodology (p<0.001).

Conclusion:

the problematization methodology had a positive impact on the students’ knowledge about hypodermoclysis. The number of correct answers after the educational intervention was higher than the initial assessment. The problematization methodology can be incorporated into the teaching-learning process of nursing and medical students for teaching procedures such as hypodermoclysis.

Descriptors:
Nursing Students; Medical Students; Hypodermoclysis; Educational Technology; Knowledge; Teaching

Highlights:

(1) The problematization methodology had a positive impact on students’ knowledge.

(2) The number of correct answers after the educational intervention increased.

(3) Problematization can be incorporated into the teaching of nursing and medicine.

(4) The teaching-learning process through active methodologies should be encouraged.

(5) Problematization has the potential to develop cognitive and attitudinal skills.

Stages (Duration)	Goals	Performed activities
Pre-test (30 minutes)	Assess students’ prior knowledge	- Application of the questionnaire on students’ knowledge about hypodermoclysis.
Reality observation (30 minutes)	Allow students to approach the topic through critical and reflective reading of the clinical case	- Critical and reflective reading of the situation reported in the clinical case of the patient in palliative care; - Clinical, critical and holistic observation of the situation described in the case; - Identification of the problem: need to treat symptoms using an alternative route to the oral and intravenous route.
Key points survey (60 minutes)	Reflect on the problems identified in the case and define the key points for the investigation	- Group discussion about the case; - Identification of the cases’ key points; - Elaboration of a learning question based on the cases’ key points.
Theorization (270 minutes)	Investigate the topic in scientific literature and compare previous knowledge and new information to solve the problem	- Contact with printed and digital scientific literature; - Synthesis of scientific evidence that responds to the problems identified in the clinical case; - Discussion on the topic between students and facilitator.
Solution hypotheses (60 minutes)	Develop suggestions to solve the clinical case problem	- Suggestion of solutions for the situation described in the clinical case.
Application to reality (60 minutes)	Promote the resolution of the problem presented in the clinical case	- Presentation of detailed planning of the solution hypotheses for the case, so that they can be reproduced in practice.
Post-test (30 minutes)	Assess students’ knowledge after the intervention	- Application of the questionnaire on students’ knowledge about hypodermoclysis.

Variables	Pre-test n(%)	Post-test n(%)	p-value *
Theoretical aspects of hypodermoclysis
1. What is hypodermoclysis?	20 (90,9)	22 (100)	0,500
2. Indications	1 (4,5)	9 (40,9)	0,021
3. Absolute contraindications	-	6 (27,3)	0,031
4. Relative contraindications	-	6 (27,3)	0,031
Practical aspects of hypodermoclysis
1. Puncture sites	2 (9,1)	15 (68,2)	<0,001
2. Possible complications	2 (9,1)	2 (9,1)	1,000
3. Responsible for the prescription	5 (22,7)	14 (63,6)	0,012
4. Person responsible for the puncture	4 (18,2)	14 (63,6)	0,004
5. Device used for puncture	7 (31,8)	18 (81,8)	0,001
6. Dwell time needled operated device	1 (4,5)	17 (77,3)	<0,001
7. Dwell time non-needle operated device	-	19 (86,4)	<0,001
8. Maximum volume to be infused in 24h	7 (31,8)	13 (59,1)	0,109

Theoretical aspects of hypodermoclysis	Pre-test n(%)	Post-test n(%)	p-value *
1. What is hypodermoclysis?
a) Intramuscular fluids and medications application’s route	1 (4,5)	-	1,000
b) Intravenous fluids and medications application’s route	1 (4,5)	-	1,000
c) Subcutaneous fluids and medications application’s route	20 (90,9)	22 (100)	0,500
2. Indications (admits more than one correct alternative)
a) Inability to be ingested orally	8 (36,4)	21 (95,5)	<0,001
b) Impossibility of venous access	17 (77,3)	21 (95,5)	0,125
c) Presence of cognitive impairment	3 (13,6)	9 (40,9)	0,070
d) Palliative care	17 (77,3)	22 (100)	0,063
e) Patient in anasarca	3 (13,6)	-	0,250
f) Terminally ill patient	15 (68,2)	20 (90,9)	0,125
g) Other (dehydration, older adults)	3 (13,6)	1 (4,5)	0,625
3. Absolute contraindications (admits more than one correct alternative)
a) Patient’s refusal	8 (36,4)	21 (95,5)	0,001
b) Anasarca	13 (59,1)	18 (81,8)	0,180
c) Severe thrombocytopenia	4 (18,2)	19 (86,4)	<0,001
d) Need for rapid volume replenishment	9 (40,9)	17 (77,3)	0,021
e) Lesion at the puncture site	13 (59,1)	6 (27,3)	0,065
f) Areas with impaired lymphatic circulation	16 (72,7)	10 (45,5)	0,070
g) Cachexia	5 (22,7)	5 (22,7)	1,000
4. Relative contraindications (admits more than one correct alternative)
a) Anasarca	6 (27,3)	5 (22,7)	1,000
b) Severe pulmonary congestion risk	4 (18,2)	3 (13,6)	1,000
c) Patients with coagulation disorders	7 (31,8)	2 (9,1)	0,180
d) Ascites	6 (27,3)	17 (77,3)	0,003
e) Cachexia	6 (27,3)	19 (86,4)	0,002
f) Presence of cognitive impairment	5 (22,7)	3 (13,6)	0,688
g) Possibility for the patient to stay at home	3 (13,6)	2 (9,1)	1,000
h) Bone prominences	9 (40,9)	20 (90,9)	0,001
i) Joints proximity	12 (54,5)	20 (90,9)	0,008
j) Areas of infection, inflammation, or skin lesion	15 (68,2)	18 (81,8)	0,375
k) Other	-	-	-

Practical aspects of hypodermoclysis	Pre-test n(%)	Post-test n(%)	p-value*
1. Puncture sites (admits more than one correct alternative)
a) Upper third of the lateral aspect of the arm	14 (63,6)	22 (100)	0,008
b) Gluteal region	2(9,1)	2 (9,1)	1,000
c) Scapular region	10 (45,5)	22 (100)	<0,001
d) Anterolateral region of the thigh	15 (68,2)	21 (95,5)	0,031
e) Abdominal region	15 (68,2)	22 (100)	0,016
f) Infraclavicular region	13 (59,1)	18 (81,8)	0,125
g) Arteries	-	1 (4,5)	1,000
2. Possible complications (admits more than one correct alternative)
a) Local swelling	19 (96,4)	22 (100)	0,250
b) Anasarca	4 (18,2)	1 (4,5)	0,375
c) Local pain/discomfort	19 (86,4)	13 (59,1)	0,070
d) Infection	12 (54,5)	16 (72,7)	0,289
e) Pulmonary congestion	3 (13,6)	1 (4,5)	0,625
f) Hematoma	13 (59,1)	21 (95,5)	0,021
g) Infiltration	12 (54,5)	17 (77,3)	0,267
3. Responsible for the prescription
a) Physician	6 (27,3)	14 (63,6)	0,039
b) Physician or Nurse	10 (45,5)	6 (27,3)	0,289
c) Nurse	1 (4,5)	-	1,000
d) Does not need a specific prescription	-	1 (4,5)	1,000
e) Depends on the institutional protocol	5 (22,7)	1 (4,5)	0,219
4. Person responsible for the puncture
a) Physician	-	1 (4,5)	1,000
b) Nurse	4 (18,2)	-	0,125
c) Physician and nurse	8 (36,4)	2 (9,1)	0,109
d) Physician and nurse and nursing technician	4 (18,2)	13 (59,1)	0,022
e) Any health professional, provided they are qualified	4 (18,2)	6 (27,3)	0,625
f) Depends on the institutional protocol	2 (9,1)	1 (4,5)	1,000
5. Device used for puncture
a) Needle catheter (scalp ^® )	4 (18,2)	1 (4,5)	0,375
b) 13x0.45 mm needle	1 (4,5)	-	1,000
c) Non-needle catheter (abocath ^® , jelco ^® )	2 (9,1)	1 (4,5)	1,000
d) Double lumen catheter	1 (4,5)	-	1,000
e) Needled or non-needled catheter	7 (31,8)	18 (81,6)	0,001
f) Catheter needled, non-needled or 13x0.45 mm needle	7 (31,8)	2 (9,1)	0,125
6. Dwell time needled device
a) From 2 to 3 days	4 (18,2)	2 (9,1)	0,688
b) Up to 5 days	1 (4,5)	18 (81,8)	<0,001
c) Up to 7 days	3 (13,6)	1 (4,5)	0,625
d) Up to 11 days	-	1 (4,5)	1,000
e) After the end of each infusion	10 (45,5)	-	0,002
f) Depends on the medication infused	2(9,1)	-	0,500
g) Cannot be used	2 (9,1)	-	0,500
7. Dwell time non-needle operated device
a) From 2 to 3 days	7 (31,8)	1 (4,5)	0,031
b) Up to 5 days	4 (18,2)	1 (4,5)	0,250
c) Up to 7 days	4 (18,2)	2 (9,1)	0,688
d) Up to 11 days	-	19 (86,4)	<0,001
e) After the end of each infusion	3 (13,6)	-	0,250
f) Depends on the medication infused	4 (18,2)	-	0,125
8. Maximum volume to be infused in 24 h
a) Up to 1000 mL	10 (45,5)	1 (4,5)	0,012
b) Up to 1500 mL	8 (36,4)	13 (59,1)	0,180
c) From 1501 to 3000 mL	1 (4,5)	7 (31,8)	0,070
d) Up to 100 mL	3 (13,6)	1 (4,5)	0,625

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[1] Corresponding author: Juliana de Souza Lima Coutinho E-mail: jslcoutinho@gmail.com https://orcid.org/0000-0001-5435-585X