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CONSTRUCTION AND VALIDITY OF A SIMULATED SCENARIO-CHECKLIST FOR THE ASSESSMENT AND IDENTIFICATION OF SHOCKABLE ARRHYTHMIAS: A METHODOLOGICAL STUDY

CONSTRUCCIÓN Y VALIDACIÓN DE UN ESCENARIO-CHECKLIST SIMULADO PARA LA EVALUACIÓN E IDENTIFICACIÓN DE ARRITMIAS DESFIBRILABLES: UN ESTUDIO METODOLÓGICO

ABSTRACT

Objective:

to construct and validate a simulated scenario and checklist for the assessment and identification of shockable arrhythmias by nurses in adults hospitalized in an Intensive Care Unit.

Method:

this is a methodological study for the construction of a simulated scenario and checklist, validated by experts, with the application of a pilot test on 36 nursing students between April and September 2021, at a public university in Minas Gerais. The construction stage took place by surveying evidence in the literature. The validity stage was based on instrument assessment by 13 experts, from all over Brazil, being interpreted by calculating the Content Validity Coefficient by a cut-off point equal to 0.8 or 80.0%. To assess internal consistency, Cronbach’s alpha was calculated. Subsequently, a pilot test and the Student Satisfaction and Self-Confidence in Learning Scale were applied.

Results:

after building the simulated scenario, three rounds were performed to assess the script (21 items) and two for the checklist (six items), reaching an overall Content Validity Coefficient of 0.98 and 0.95, respectively. A Cronbach’s alpha of 0.79 was obtained at the end of assessment. In the pilot test, the scenario was considered adequate, with high scores of satisfaction and self-confidence in learning, confirming its usability.

Conclusion:

the instrument developed by nurses to assess shockable arrhythmias in adult patients admitted to an Intensive Care Unit is valid in terms of content and has good internal consistency.

DESCRIPTORS:
Nursing; Nursing education; Simulation training; Patient simulation; Arrhythmias; cardiac; Intensive care units; Methods

RESUMEN

Objetivo:

construir y validar un escenario simulado y un checklist para la evaluación e identificación de enfermería de arritmias desfibrilables en adultos hospitalizados en una Unidad de Cuidados Intensivos.

Método:

estudio metodológico para la construcción de un escenario simulado y lista de verificación, validado por especialistas, con la aplicación de una prueba piloto en 36 estudiantes de enfermería entre abril y septiembre de 2021 en una universidad pública de Minas Gerais. La etapa de construcción se llevó a cabo mediante el levantamiento de evidencias en la literatura. La etapa de validación ocurrió a partir de la evaluación de los instrumentos por 13 especialistas, de todo el territorio brasileño, siendo interpretados por el cálculo del Coeficiente de Validez de Contenido por punto de corte igual a 0,8 o 80,0%. Para evaluar la consistencia interna se calculó el alfa de Cronbach. Posteriormente, se realizó una prueba piloto y la aplicación de la Escala de Satisfacción y Autoconfianza del Estudiante en el Aprendizaje.

Resultados:

luego de construir el escenario simulado, se realizaron tres rondas para evaluar el guión (21 ítems) y dos para la lista de verificación (seis ítems), alcanzándose un Coeficiente de Validez de Contenido global de 0,98 y 0,95 respectivamente. Se obtuvo un alfa de Cronbach de 0,79 al final de la evaluación. En la prueba piloto, el escenario se consideró adecuado, con puntuaciones altas de satisfacción y confianza en el aprendizaje, lo que confirma su usabilidad.

Conclusión:

el instrumento desarrollado por enfermeros para evaluar arritmias desfibrilables en pacientes adultos internados en una Unidad de Cuidados Intensivos es válido en cuanto al contenido y tiene buena consistencia interna.

DESCRIPTORES:
Enfermería; Educación en enfermería; Entrenamiento de simulación; Simulación de paciente; Arritmia cardíaca; Unidades de cuidados intensivos; Métodos

RESUMO

Objetivo:

construir e validar um cenário simulado e checklist para avaliação e identificação de arritmias chocáveis pela enfermagem em adultos internados em unidade de terapia intensiva.

Método:

estudo metodológico para construção de cenário simulado e checklist, validado por especialistas, com aplicação de teste piloto em 36 estudantes de enfermagem entre abril e setembro de 2021, em uma Universidade Pública de Minas Gerais. A etapa de construção ocorreu por levantamento de evidências na literatura. A etapa de validação se deu a partir da avaliação dos instrumentos por 13 especialistas, provenientes de todo o território brasileiro, sendo interpretados pelo cálculo do Coeficiente de Validade de Conteúdo por ponto de corte igual a 0,8 ou 80,0%. Para avaliar a consistência interna, foi calculado o alpha de Cronbach. Posteriormente, foram realizados o teste piloto e a aplicação da Escala de Satisfação dos estudantes e autoconfiança na aprendizagem.

Resultados:

após a construção do cenário simulado, foram realizadas três rodadas para avaliação do roteiro (21 itens) e duas para o checklist (seis itens), alcançando Coeficiente de Validade de Conteúdo global de 0,98 e 0,95 respectivamente. Um alfa de Cronbach de 0,79 foi obtido ao final da avaliação. No teste piloto, o cenário foi considerado adequado, com elevados escores de satisfação e autoconfiança na aprendizagem, confirmando a sua usabilidade.

Conclusão:

o instrumento desenvolvido para avaliação de arritmias chocáveis em pacientes adultos internados em Unidade de Terapia Intensiva pela enfermagem é válido em seu conteúdo e possui boa consistência interna.

DESCRITORES:
Enfermagem; Educação em enfermagem; Treinamento por simulação; Simulação de pacientes; Arritmias cardíacas; Unidades de terapia intensiva; Métodos

INTRODUCTION

Health education has traditionally been marked by the transmission of theoretical content, often out of context with practical activities. This disengagement reflects on the training of undergraduate students who, not infrequently, have difficulties in clinical reasoning and making appropriate decisions for health care11. Luiz FS, Leite ICG, Mendonça ET, Dutra HS, Coelho ACO, Sousa AMG, et al. Metodologias ativas de ensino e aprendizagem na educação superior em saúde: Revisão integrativa. REAS [Internet]. 2022 [cited 2022 Dec 27];15(6):e10370. Available from: https://doi.org/10.25248/reas.e10370.2022
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-22. Carvalho LR de, Zem-Mascarenhas SH. Construction and validation of a sepsis simulation scenario: a methodological study. Rev Esc Enferm USP [Internet]. 2020 [cited 2023 Apr 30];54:e03638. Available from: https://doi.org/10.1590/S1980-220X2019021603638
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. Allied to this, in recent decades, rapid transformations and innovations in the context of the health system have led to curricular revisions, consistent with social needs and care demands33. Rocha LAC, Gorla BC, Jorge BM, Afonso MG, Santos ECN, Miranda FBG. Validation of simulated scenarios for nursing students: assessment and treatment of Pressure Ulcers. Rev Eletr Enferm [Internet]. 2021 [cited 2023 Apr 29];23:67489. Available from: https://doi.org/10.5216/ree. v23.67489
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.

In this regard, in Brazil, the curricular guidelines for undergraduate nursing courses established the profile of undergraduate students based on essential skills to recognize health problems, understand the population’s epidemiological profile, in order to intervene in the determinants in a critical way and reflective44. Ministério da Educação (Brasil). Conselho Nacional de Educação. Câmara de Educação Superior. Resolução nº 3, CNE/ CES, de 7 de novembro de 2001. Institui diretrizes curriculares nacionais do curso de graduação em enfermagem [Internet]. Diário Oficial da União; 2001 Nov 9 [cited 2022 Dec 27]. 6 p. Available from: http://portal.mec.gov.br/cne/arquivos/pdf/CES03.pdf
http://portal.mec.gov.br/cne/arquivos/pd...
. The competency profile can be built from a participatory education, which fosters knowledge, skills and attitudes about health issues, in the various life cycles, linking theory and practice11. Luiz FS, Leite ICG, Mendonça ET, Dutra HS, Coelho ACO, Sousa AMG, et al. Metodologias ativas de ensino e aprendizagem na educação superior em saúde: Revisão integrativa. REAS [Internet]. 2022 [cited 2022 Dec 27];15(6):e10370. Available from: https://doi.org/10.25248/reas.e10370.2022
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-22. Carvalho LR de, Zem-Mascarenhas SH. Construction and validation of a sepsis simulation scenario: a methodological study. Rev Esc Enferm USP [Internet]. 2020 [cited 2023 Apr 30];54:e03638. Available from: https://doi.org/10.1590/S1980-220X2019021603638
https://doi.org/10.1590/S1980-220X201902...
,44. Ministério da Educação (Brasil). Conselho Nacional de Educação. Câmara de Educação Superior. Resolução nº 3, CNE/ CES, de 7 de novembro de 2001. Institui diretrizes curriculares nacionais do curso de graduação em enfermagem [Internet]. Diário Oficial da União; 2001 Nov 9 [cited 2022 Dec 27]. 6 p. Available from: http://portal.mec.gov.br/cne/arquivos/pdf/CES03.pdf
http://portal.mec.gov.br/cne/arquivos/pd...
. For this, teaching-learning methodologies that intentionally involve students in the construction of knowledge, in order to encourage critical thinking, clinical reasoning and decision making, show good results in nursing education22. Carvalho LR de, Zem-Mascarenhas SH. Construction and validation of a sepsis simulation scenario: a methodological study. Rev Esc Enferm USP [Internet]. 2020 [cited 2023 Apr 30];54:e03638. Available from: https://doi.org/10.1590/S1980-220X2019021603638
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,55. Jung MJ, Roh YS. Mediating effects of cognitive load on the relationship between learning flow and clinical reasoning skills in virtual simulation learning. Clin Simul Nurs [Internet]. 2022 [cited 2022 Dec 27];64:16. Available from: https://doi.org/10.1016/j.ecns.2021.12.004
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-66. Sim JJM, Rusli KDB, Seah B, Levett-Jones T, Lau Y, Liaw SY. Virtual simulation to enhance clinical reasoning in nursing: A systematic review and meta-analysis. Clin Simul Nurs [Internet]. 2022 [cited 2022 Dec 27];69:26. Available from: https://doi.org/10.1016/j.ecns.2022.05.006
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.

In the context of teaching-learning methodologies, clinical simulation is considered a pedagogical strategy that enables students to acquire skills, anticipating clinical practice in a safe environment, without exposing patients77. Santos KB, Püschel VAA, Luiz FS, Leite ICG, Cavalcante RB, Carbogim FC. Simulation training for hospital admission of patients with Covid-19: Assessment of nursing professionals. Texto Contexto Enferm [Internet]. 2021 [cited 2022 Dec 28];30:e20200569. Available from: https://doi.org/10.1590/1980-265X-TCE-2020-0569
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. However, for good results to be achieved, it is recommended that the construction process follow standards of good practices and references that support the content and guide the simulated clinical scenario’s validity to realistic practice88. Associação Brasileira de Educação Médica. Simulação em saúde para ensino e avaliação: conceitos e práticas [Internet]. São Carlos, SP(BR): Cubo Multimídia; 2021 [cited 2023 Feb 27]. Available from: https://doi.org/10.4322/978-65-86819-11-3
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-99. INACSL Standards Committee. INACSL standards of best practice: Simulation Design. Clin Simul Nurs [Internet]. 2016 [cited 2022 Dec 28];12(S):S5-12. Available from: https://doi.org/10.1016/j.ecns.2016.09.005
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.

In this way, it is a diligent and complex process that involves resources such as simulators and/or mannequins/actors that are adapted to specific situations of clinical practice, emulating reality, according to the degree of complexity related to what is intended to be taught/assessed88. Associação Brasileira de Educação Médica. Simulação em saúde para ensino e avaliação: conceitos e práticas [Internet]. São Carlos, SP(BR): Cubo Multimídia; 2021 [cited 2023 Feb 27]. Available from: https://doi.org/10.4322/978-65-86819-11-3
https://doi.org/10.4322/978-65-86819-11-...
. The entire process is mediated by tutors who provide clues for solving a clinical case, based on best practices and scientific evidence77. Santos KB, Püschel VAA, Luiz FS, Leite ICG, Cavalcante RB, Carbogim FC. Simulation training for hospital admission of patients with Covid-19: Assessment of nursing professionals. Texto Contexto Enferm [Internet]. 2021 [cited 2022 Dec 28];30:e20200569. Available from: https://doi.org/10.1590/1980-265X-TCE-2020-0569
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-88. Associação Brasileira de Educação Médica. Simulação em saúde para ensino e avaliação: conceitos e práticas [Internet]. São Carlos, SP(BR): Cubo Multimídia; 2021 [cited 2023 Feb 27]. Available from: https://doi.org/10.4322/978-65-86819-11-3
https://doi.org/10.4322/978-65-86819-11-...
. Studies1010. Jarvill M, Jenkins S, Akman O, Astroth KS, Pohl C, Jacobs PJ. Effect of Simulation on Nursing Students' Medication Administration Competence. Clin Simul Nurs [Internet]. 2018 [cited 2022 Dec 28];14:3. Available from: https://doi.org/10.1016/j.ecns.2017.08.001
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-1111. Costa RRO, Medeiros SM, Martins JCA, Coutinho VRD, Araújo MS. Effectiveness of simulation in teaching immunization in nursing: A randomized clinical trial. Rev Lat Am Enfermagem [Internet]. 2020 [cited 2022 Dec 28];28:e3305. Available from: https://doi.org/10.1590/1518-8345.3147.3305
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that compared the effectiveness of clinical simulation in relation to traditional laboratory practice identified better performance in nursing students who learned through simulation.

A study1212. Guerrero JG, Ali SAA. The acquired critical thinking skills, satisfaction, and self confidence of nursing students and staff nurses through high-fidelity simulation experience. Clin Simul Nurs [Internet]. 2022 [cited 2022 Apr 6];64:24-30. Available from: https://doi.org/10.1016/j.ecns.2021.11.008
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assessed the clinical performance of 36 nursing interns, dividing students into control (practical clinical training) and experimental groups (simultaneous exposure to high-fidelity simulation together with practical clinical training). In the general assessment of competencies, the experimental group performed significantly better than the control group (p < 0.001), leading the authors to conclude that simultaneous exposure to simulation along with practical training promoted a greater level of safety and competency. In this direction, researches1313. Chang CY, Kao CH, Hwang GJ, Lin FH. From experiencing to critical thinking: A contextual game-based learning approach to improving nursing students’ performance in Electrocardiogram training. Educ Tech Res Dev [Internet]. 2020 [cited 2022 Dec 28];68:1225. Available from: https://doi.org/10.1007/s11423-019-09723-x
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-1414. Ko Y, Issenberg SB, Roh YS. Effects of peer learning on nursing students' learning outcomes in electrocardiogram education. Nurse Educ Today [Internet]. 2022 [cited 2022 Dec 28];108:105182. Available from: https://doi.org/10.1016/j.nedt.2021.105182
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have shown that traditional theoretical-practical teaching has been insufficient for nursing students to feel confident and establish appropriate conducts in shockable arrhythmias. These, classified as ventricular fibrillation (VF) or pulseless ventricular tachycardia (PVT), are classified as cardiorespiratory arrest (CRA) and require recognition in order to proceed with immediate electrical defibrillation1515. Panchal AR, Bartos JA, Cabañas JG, Donnino MW, Drennan IR, Hirsch KG, et al. Adult Basic and Advanced Life Support Writing Group. Part 3: Adult Basic and Advanced Life Support: 2020 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation [Internet]. 2020 [cited 2022 Dec 28]142(16 Suppl 2):S366-468. Available from: https://doi.org/10.1161/CIR.0000000000000916
https://doi.org/10.1161/CIR.000000000000...
.

A study carried out in nine Intensive Care Units (ICU) of a university hospital in São Paulo identified an incidence of 3.6% of CRA in the first 24 hours of hospitalization of patients in this environment1616. Pulze G, Alves W, Paiva BC, Ferretti-Rebustini REL. Incidence and factors associated with cardiorespiratory arrest in the first 24 hours of hospitalization in intensive care unit. Rev Soc Cardiol [Internet]. 2019 [cited 2023 Apr 7];29(2): 192-6. Available from: https://doi.org/10.29381/0103-8559/20192902192-6
https://doi.org/10.29381/0103-8559/20192...
. However, information on the incidence of CRA and its forms of presentation are still scarce in the national and international literature1717. Bernoche C, Timerman S, Polastri TF, Giannetti NS, Siqueira AWDS, Piscopo A, et al. Atualização da diretriz de ressuscitação cardiopulmonar e cuidados cardiovasculares de Emergência da Sociedade Brasileira de Cardiologia - 2019. Arq Bras Cardiol [Internet]. 2019 [cited 2022 Dec 28];113(3):449. Available from: https://doi.org/10.5935/abc.20190203
https://doi.org/10.5935/abc.20190203...
. In order to fill part of this lack of data, the American Hearth Association (AHA)1515. Panchal AR, Bartos JA, Cabañas JG, Donnino MW, Drennan IR, Hirsch KG, et al. Adult Basic and Advanced Life Support Writing Group. Part 3: Adult Basic and Advanced Life Support: 2020 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation [Internet]. 2020 [cited 2022 Dec 28]142(16 Suppl 2):S366-468. Available from: https://doi.org/10.1161/CIR.0000000000000916
https://doi.org/10.1161/CIR.000000000000...
reported in its latest update that, in an out-of-hospital environment, approximately 80.0% of CRA are shockable rhythms, whereas, in an in-hospital environment, approximately 20.0% of cases require defibrillation. In this context, the AHA1515. Panchal AR, Bartos JA, Cabañas JG, Donnino MW, Drennan IR, Hirsch KG, et al. Adult Basic and Advanced Life Support Writing Group. Part 3: Adult Basic and Advanced Life Support: 2020 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation [Internet]. 2020 [cited 2022 Dec 28]142(16 Suppl 2):S366-468. Available from: https://doi.org/10.1161/CIR.0000000000000916
https://doi.org/10.1161/CIR.000000000000...
has highlighted simulation-mediated training as an appropriate methodology for students and health professionals to learn how to safely intervene in CRA.

Considering the above, this study is justified, which was conducted by the following guiding question: will the construction and validity of a simulated scenario and checklist allow the identification of shockable arrhythmias by nurses in adults admitted to the ICU?

It is believed that the study may contribute as a training tool for students and professionals, mobilizing specific skills for the assessment and identification of shockable arrhythmias in the ICU. Therefore, the study aims to build and validate a simulated scenario and checklist for the assessment and identification of shockable arrhythmias by nurses in adults admitted to the ICU.

METHOD

This is a methodological study with the construction and content validity of a simulated scenario developed at a public university in the state of Minas Gerais between April 2020 and September 2021. To develop the study, three sequential steps were used: scenario and checklist (based on the literature, models and instruments) construction;1515. Panchal AR, Bartos JA, Cabañas JG, Donnino MW, Drennan IR, Hirsch KG, et al. Adult Basic and Advanced Life Support Writing Group. Part 3: Adult Basic and Advanced Life Support: 2020 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation [Internet]. 2020 [cited 2022 Dec 28]142(16 Suppl 2):S366-468. Available from: https://doi.org/10.1161/CIR.0000000000000916
https://doi.org/10.1161/CIR.000000000000...
,1818. INACSL Standards Committee. INACSL standards of best practice: Simulation Design. Clin Simul Nurs [Internet]. 2016 [cited 2022 Dec 28];12(S):S5-12. Available from: https://doi.org/10.1016/j.ecns.2016.09.005
https://doi.org/10.1016/j.ecns.2016.09.0...
-2222. Pasquali L. Instrumentação psicológica: Fundamentos e práticas. Porto Alegre, RS(BR): Artmed; 2010.,2323. Nascimento J, Nascimento KG, Regino DSG, Alves MG, Oliveira JLG, Dalri MCB. Debriefing: Desenvolvimento e validação de um roteiro para simulação do suporte básico de vida. Cogit Enferm [Internet]. 2021 [cited 2022 Dec 29];26:e79537. Available from: http://dx.doi.org/10.5380/ce.v26i0.79537
http://dx.doi.org/10.5380/ce.v26i0.79537...
scenario and checklist validity by experts and pilot test with nursing students (Figure 1).

Figure 1-
Flowchart of construction stages and validity of the simulated scenario and checklist for nursing assessment and identification of shockable arrhythmias in adults hospitalized in an Intensive Care Unit. Minas Gerais. MG, Brazil, 2021.

The construction stage was based on the main recommendations of the national and international literature on the subject1515. Panchal AR, Bartos JA, Cabañas JG, Donnino MW, Drennan IR, Hirsch KG, et al. Adult Basic and Advanced Life Support Writing Group. Part 3: Adult Basic and Advanced Life Support: 2020 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation [Internet]. 2020 [cited 2022 Dec 28]142(16 Suppl 2):S366-468. Available from: https://doi.org/10.1161/CIR.0000000000000916
https://doi.org/10.1161/CIR.000000000000...
,1818. INACSL Standards Committee. INACSL standards of best practice: Simulation Design. Clin Simul Nurs [Internet]. 2016 [cited 2022 Dec 28];12(S):S5-12. Available from: https://doi.org/10.1016/j.ecns.2016.09.005
https://doi.org/10.1016/j.ecns.2016.09.0...
-2424. Lucas MG, Nalin GV, Sant’Anna ALGG, Oliveira SA, Machado RC. Validation of content of an instrument for evaluation of training in cardiopulmonary resuscitation. REME - Rev Min Enferm [Internet]. 2018 [cited 2022 Dec 29];22:e-1132. Available from: https://doi.org/10.5935/1415-2762.20180061
https://doi.org/10.5935/1415-2762.201800...
. In addition to the theoretical content, the International Nursing Association for Clinical Simulation and Learning (INACSL)1818. INACSL Standards Committee. INACSL standards of best practice: Simulation Design. Clin Simul Nurs [Internet]. 2016 [cited 2022 Dec 28];12(S):S5-12. Available from: https://doi.org/10.1016/j.ecns.2016.09.005
https://doi.org/10.1016/j.ecns.2016.09.0...
and model for clinical simulation recommendations were followed1919. Fabri RP, Mazzo A, Martins JCA, Fonseca AS, Pedersoli CE, Miranda FBG, et al. Development of a theoretical-practical script for clinical simulation. Rev Esc Enferm USP [Internet]. 2017 [cited 2022 Dec 28];51:e03218. Available from: https://doi.org/10.1590/s1980-220x2016265103218
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-2020. Fehring RJ. Methods to validate nursing diagnoses. Heart Lung [Internet]. 1987 [cited 2022 Dec 28];16(6 Pt 1):625-9. Available from: https://core.ac.uk/download/pdf/213076462.pdf
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.

In the content construction and validity stage, experts were initially selected, with non-random convenience sampling, using the adapted Fehring scale1919. Fabri RP, Mazzo A, Martins JCA, Fonseca AS, Pedersoli CE, Miranda FBG, et al. Development of a theoretical-practical script for clinical simulation. Rev Esc Enferm USP [Internet]. 2017 [cited 2022 Dec 28];51:e03218. Available from: https://doi.org/10.1590/s1980-220x2016265103218
https://doi.org/10.1590/s1980-220x201626...
. The scale1919. Fabri RP, Mazzo A, Martins JCA, Fonseca AS, Pedersoli CE, Miranda FBG, et al. Development of a theoretical-practical script for clinical simulation. Rev Esc Enferm USP [Internet]. 2017 [cited 2022 Dec 28];51:e03218. Available from: https://doi.org/10.1590/s1980-220x2016265103218
https://doi.org/10.1590/s1980-220x201626...
totals 24 points and contains as criteria completion of a Lato Sensu graduate degree (five points), completion of a Stricto Sensu graduate degree (four points), experience with simulation (five points), experience with critically ill patients (five points) and production scientific (five points). For analysis, the curricula were assessed, via the Lattes Platform, regarding professional history, training, experience and bibliographical production on the subject of research and/or clinical simulation. The minimum score for the inclusion of experts was five points.

From the initial assessment, 46 experts met the established inclusion criteria1919. Fabri RP, Mazzo A, Martins JCA, Fonseca AS, Pedersoli CE, Miranda FBG, et al. Development of a theoretical-practical script for clinical simulation. Rev Esc Enferm USP [Internet]. 2017 [cited 2022 Dec 28];51:e03218. Available from: https://doi.org/10.1590/s1980-220x2016265103218
https://doi.org/10.1590/s1980-220x201626...
. These were contacted via electronic mail (e-mail) obtained from the curriculum or published scientific article. Exclusion criteria were experts who did not respond to emails after four attempts (28) within a period of 60 days, or those who initially agreed to participate but did not respond to the second round of assessment. In this regard, 28 experts were excluded for not responding to emails and five did not respond to the second round of assessment, the sample consisting of 13 experts from different regions of Brazil: eight from the southeast region, three from the northeast region and two from the south region. It is noteworthy that, for the effectiveness of validity, the literature recommends that the instrument be assessed at least by five to six experts2121. Vieira TW, Sakamoto VTM, Moraes LC, Blatt CR, Caregnato RCA. Validation methods of nursing protocols: An integrative review. Rev Bras Enferm [Internet]. 2020 [cited 2022 Dec 28];73(Suppl 5):e20200050. Available from: https://doi.org/10.1590/0034-7167-2020-0050
https://doi.org/10.1590/0034-7167-2020-0...
.

To facilitate analysis and validity, an electronic form was prepared via Google Forms, with four sections referring respectively to the Informed Consent Form (ICF), sociodemographic questionnaire, scenario script and checklist, based on Pasquali recommendations2222. Pasquali L. Instrumentação psicológica: Fundamentos e práticas. Porto Alegre, RS(BR): Artmed; 2010.. For each scenario and checklist item, content pertinence, relevance and clarity were verified, in addition to the possibility of comments and suggestions from experts. The assessment of experts’ opinions was used the Delphi technique2525. Nasa P, Jain R, Juneja D. Delphi methodology in healthcare research: How to decide its appropriateness. World J Methodol [Internet]. 2021 [cited 2023 Apr 29];11(4):116-29. Available from: https://doi.org/10.5662/wjm.v11.i4.116
https://doi.org/10.5662/wjm.v11.i4.116...
. Thus, they assessed, via an electronic form, the domains as follows: previous scenario components; scenario preparation; script/instructions for students; and final scenario components; skills checklist.

After validity by experts, the pilot test stage was carried out with 36 nursing students from the beginning of the fourth year of graduation (eighth semester), who were willing to participate in the activity. It should be noted that students had not yet attended the discipline in which CRA and high-complexity cardiopulmonary resuscitation (CPR) content is taught. The course on screen is completed in five years or ten semesters.

The pilot test of the elaborated simulated scenario was carried out in three days, with classes lasting four hours. On the first day, a dialogued lecture was held, with the provision of theoretical content on shockable arrhythmias in adult patients in the ICU. On the second day, theoretical-practical training was carried out in the simulation laboratory and. On the third day, application of the simulated scenario and assessment through the checklist were carried out.

After full assessment in the simulated scenario, all students were gathered in a room where the debriefing took place, for about 20 minutes, conducted by the first author, who used the notes in the checklist. At that moment, immediately after all students completed the activity, the strengths, weaknesses and improvements for patient care were highlighted. In the end, students responded to the Student Satisfaction and Self-Confidence in Learning Scale (ESEAA)2626. Almeida RGS, Mazzo A, Martins JCA, Baptista RCN, Girão FB, Mendes IAC. Validation to portuguese of the scale of student satisfaction and self-confidence in learning. Rev Lat Am Enfermagem [Internet]. 2015 [cited 2022 Dec 29];23(6):1007. Available from: https://doi.org/10.1590/0104-1169.0472.2643
https://doi.org/10.1590/0104-1169.0472.2...
. This instrument2626. Almeida RGS, Mazzo A, Martins JCA, Baptista RCN, Girão FB, Mendes IAC. Validation to portuguese of the scale of student satisfaction and self-confidence in learning. Rev Lat Am Enfermagem [Internet]. 2015 [cited 2022 Dec 29];23(6):1007. Available from: https://doi.org/10.1590/0104-1169.0472.2643
https://doi.org/10.1590/0104-1169.0472.2...
has 13 items and is subdivided into a satisfaction subscale, with five items, and a self-confidence subscale, with eight items. The ESEAA items are assessed using a five-point Likert-type scale, ranging from “strongly disagree with the statement” to “strongly agree with the statement.”

For data analysis, the information was typed in Microsoft Excel® 2010 and later transferred to Stata® version 15.0. Data analysis was performed with the description of sociodemographic characteristics and experience in clinical simulation reported by experts as well as the score provided by them in each item and domain of the assessed instrument. For this purpose, the absolute and relative frequencies of qualitative variables and measures of central tendency and dispersion for quantitative variables were calculated, calculating the mean and standard deviation.

Regarding the Content Validity Coefficient (CVC), it was calculated to verify the similarity of experts’ agreement in the answers for each item of the instrument and the total item. For that, in relation to possible answers, a four-point Likert-type scale was used: 1 - strongly disagree; 2 - partially disagree; 3 - partially agree; and 4 - totally agree1010. Jarvill M, Jenkins S, Akman O, Astroth KS, Pohl C, Jacobs PJ. Effect of Simulation on Nursing Students' Medication Administration Competence. Clin Simul Nurs [Internet]. 2018 [cited 2022 Dec 28];14:3. Available from: https://doi.org/10.1016/j.ecns.2017.08.001
https://doi.org/10.1016/j.ecns.2017.08.0...
.

The CVC is obtained through the sum of “3” or “4” responses, divided by the total number of responses. It should be noted that each instrument item is only considered valid if it reaches a score greater than or equal to 0.801010. Jarvill M, Jenkins S, Akman O, Astroth KS, Pohl C, Jacobs PJ. Effect of Simulation on Nursing Students' Medication Administration Competence. Clin Simul Nurs [Internet]. 2018 [cited 2022 Dec 28];14:3. Available from: https://doi.org/10.1016/j.ecns.2017.08.001
https://doi.org/10.1016/j.ecns.2017.08.0...
. For the calculation of the assessed CVC, the sum of the individual CVC was performed, divided by the number of items assessed individually. In order to verify whether the instrument developed had satisfactory internal consistency based on the response given by the evaluators, Cronbach’s alpha was calculated for the domains and the respective confidence interval. It was considered as a score for Cronbach’s alpha: α ≤ 0.30 - Very low; 0.30 < α ≤ 0.60 - Low; 0.60 < α ≤ 0.75 - Moderate; 0.75 < α ≤ 0.90 - High; and α > 0.90 - Very high. The ESEAA,2626. Almeida RGS, Mazzo A, Martins JCA, Baptista RCN, Girão FB, Mendes IAC. Validation to portuguese of the scale of student satisfaction and self-confidence in learning. Rev Lat Am Enfermagem [Internet]. 2015 [cited 2022 Dec 29];23(6):1007. Available from: https://doi.org/10.1590/0104-1169.0472.2643
https://doi.org/10.1590/0104-1169.0472.2...
with a minimum score of 1 and a maximum score of 5 for each item, was analyzed by overall scope, calculating mean, standard deviation (SD), median, minimum and maximum.

The research followed the ethical precepts of Resolution 466/2012 of the Brazilian National Health Council, and was only started after approval by the Research Ethics Committee. Data collection only started after the signature of ICF by all experts and students.

RESULTS

Among the 46 experts considered eligible, 13 responded to the form with information on sociodemographic data, scenario script assessment and checklist. All 13 experts participating in the study were nurses, predominantly female (76.92%), with a mean age of 37.69 (SD=6.03) years, mean time of professional experience of 14.15 (SD 6.06) years. With regard to academic degrees, eight experts had a doctoral degree as their highest degree (61.54%), three had a master’s degree (23.08%) and two had specialization in intensive care (15.38%). As for experts’ experience, only one (7.69%) had no experience with clinical simulation.

With regard to content validity of the 21 items in the simulated scenario, three rounds of assessment were carried out in order to adapt the content to all the recommendations made by experts. In the first round, of the 21 items assessed by experts, only one (guidance for students) did not obtain a CVC >0.80. With the second round, a CVC value > 0.87 was obtained for all items, but there were still considerations expressed by experts. These were accepted by the researchers, who adjusted them to proceed with a third round. Therefore, content validity of the simulated scenario was achieved with a CVC above 0.94 in all 21 items and an overall CVC of 0.97 (Table 1).

Table 1 -
Content Validity Coefficient of items and full scenario in the three rounds. Minas Gerais, MG, Brazil, 2021.

As for the checklist content validity, of the eight items, all obtained a CVC >0.80 in the first assessment, however, considering experts’ considerations, two items were removed, as they were not directly related to the scenario’s objective: “verifies monitoring cables” and “communicates the next conducts.” On the other hand, in compliance with the recommendations in the literature, it was suggested to add “assesses central pulse” and “identifies as a shockable rhythm.” The items “identifies as a shockable rhythm” and “communicates to the multidisciplinary team that patient is in cardiorespiratory arrest” were adjusted in their content. Thus, after adjustments, the six-item checklist was reassessed, obtaining a CVC ≥0.88 for all items and an overall CVC of 0.95 (Table 2).

Table 2 -
Content Validity Coefficient of items, dimensions and instrument in the checklist’s first round. Minas Gerais, MG, Brazil, 2021.

Instrument internal consistency in each assessment round as well as their respective confidence intervals were calculated (Table 3).

Table 3 -
Instrument internal consistency in the three rounds. Minas Gerais, MG, Brazil, 2021.

The simulated scenario’s full script in its final version presents its items arranged in: previous scenario components; scenario preparation; script/instructions for students; and final scenario components (Chart 1).

Chart 1 -
Final script of the simulated scenario for identifying shockable arrhythmias in adult ICU patients, Minas Gerais, MG, Brazil, 2021.

About the final version of the checklist for assessing students in the simulated scenario, presented in Chart 2, it is highlighted that the six items that constitute it are assessed as “performed correctly”, “performed partially” and “did not perform”.

Chart 2 -
Final checklist for student assessment in the simulated scenario on shockable arrhythmias in adult ICU patients. Minas Gerais, MG, Brazil, 2021.

After validity with experts, a pilot test was carried out with the target population, to verify whether or not there was a need for adjustments and to ensure that the simulated scenario was in line with the intended objective. In this way, it was possible to verify its suitability for application in teaching and training.

The pilot test of the simulated scenario was applied to 36 nursing students who were invited and who agreed to participate in the research. Most of them were female (80.0%), with a mean age of 24.31 (±2.47), and all were in their fourth year of graduation (beginning of eighth semester). Regarding previous experience with clinical simulation and knowledge of content, 26 (72.0%) reported not having experienced the simulation as well as the content until that moment.

With regard to performance in the simulated scenario, assessed by the six items of the checklist, only four students (11.0%) had an achievement below 70.0%. Regarding the questionnaire, all students considered the theoretical class, the simulated scenario and patients/mannequins suitable for teaching-learning. However, two (33.3%) participants suggested that the estimated scenario time could be longer than stipulated.

ESEAA was also applied. It was obtained as an overall result: mean 4.55 (±0.29), median 4.61(±0.29), minimum 1, maximum 5, p=0.600.

DISCUSSION

In the health area, more specifically in nursing education, proposals for the construction and validity of simulated scenarios have been promoted in order to allow a prior experience of clinical practicethrough scenarios that allow students to mobilize knowledge, in addition to encouraging metacognitive skills such as critical thinking and clinical judgment33. Rocha LAC, Gorla BC, Jorge BM, Afonso MG, Santos ECN, Miranda FBG. Validation of simulated scenarios for nursing students: assessment and treatment of Pressure Ulcers. Rev Eletr Enferm [Internet]. 2021 [cited 2023 Apr 29];23:67489. Available from: https://doi.org/10.5216/ree. v23.67489
https://doi.org/10.5216/ree. v23.67489...
,77. Santos KB, Püschel VAA, Luiz FS, Leite ICG, Cavalcante RB, Carbogim FC. Simulation training for hospital admission of patients with Covid-19: Assessment of nursing professionals. Texto Contexto Enferm [Internet]. 2021 [cited 2022 Dec 28];30:e20200569. Available from: https://doi.org/10.1590/1980-265X-TCE-2020-0569
https://doi.org/10.1590/1980-265X-TCE-20...
,1818. INACSL Standards Committee. INACSL standards of best practice: Simulation Design. Clin Simul Nurs [Internet]. 2016 [cited 2022 Dec 28];12(S):S5-12. Available from: https://doi.org/10.1016/j.ecns.2016.09.005
https://doi.org/10.1016/j.ecns.2016.09.0...
. This will reflect on accurate decision-making in similar care situations22. Carvalho LR de, Zem-Mascarenhas SH. Construction and validation of a sepsis simulation scenario: a methodological study. Rev Esc Enferm USP [Internet]. 2020 [cited 2023 Apr 30];54:e03638. Available from: https://doi.org/10.1590/S1980-220X2019021603638
https://doi.org/10.1590/S1980-220X201902...
,77. Santos KB, Püschel VAA, Luiz FS, Leite ICG, Cavalcante RB, Carbogim FC. Simulation training for hospital admission of patients with Covid-19: Assessment of nursing professionals. Texto Contexto Enferm [Internet]. 2021 [cited 2022 Dec 28];30:e20200569. Available from: https://doi.org/10.1590/1980-265X-TCE-2020-0569
https://doi.org/10.1590/1980-265X-TCE-20...
.

Therefore, the assessment and identification of shockable arrhythmias in the validated clinical scenario have the purpose of mobilizing skills for safe and quick action in real situations of nurses’ professional practice55. Jung MJ, Roh YS. Mediating effects of cognitive load on the relationship between learning flow and clinical reasoning skills in virtual simulation learning. Clin Simul Nurs [Internet]. 2022 [cited 2022 Dec 27];64:16. Available from: https://doi.org/10.1016/j.ecns.2021.12.004
https://doi.org/10.1016/j.ecns.2021.12.0...
,1515. Panchal AR, Bartos JA, Cabañas JG, Donnino MW, Drennan IR, Hirsch KG, et al. Adult Basic and Advanced Life Support Writing Group. Part 3: Adult Basic and Advanced Life Support: 2020 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation [Internet]. 2020 [cited 2022 Dec 28]142(16 Suppl 2):S366-468. Available from: https://doi.org/10.1161/CIR.0000000000000916
https://doi.org/10.1161/CIR.000000000000...
. Studies1515. Panchal AR, Bartos JA, Cabañas JG, Donnino MW, Drennan IR, Hirsch KG, et al. Adult Basic and Advanced Life Support Writing Group. Part 3: Adult Basic and Advanced Life Support: 2020 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation [Internet]. 2020 [cited 2022 Dec 28]142(16 Suppl 2):S366-468. Available from: https://doi.org/10.1161/CIR.0000000000000916
https://doi.org/10.1161/CIR.000000000000...
,1717. Bernoche C, Timerman S, Polastri TF, Giannetti NS, Siqueira AWDS, Piscopo A, et al. Atualização da diretriz de ressuscitação cardiopulmonar e cuidados cardiovasculares de Emergência da Sociedade Brasileira de Cardiologia - 2019. Arq Bras Cardiol [Internet]. 2019 [cited 2022 Dec 28];113(3):449. Available from: https://doi.org/10.5935/abc.20190203
https://doi.org/10.5935/abc.20190203...
,2727. Tsai JC, Ma JW, Liu SC, Lin TC, Hu SY. Cardiac Arrest Survival Postresuscitation In-Hospital (CASPRI) Score Predicts Neurological Favorable Survival in Emergency Department Cardiac Arrest. J Clin Med [Internet]. 2021 [cited 2022 Dec 31];10(21):5131. Available from: https://doi.org/10.3390/jcm10215131
https://doi.org/10.3390/jcm10215131...
point out that the recognition and agile conduct in shockable CRAs are directly related to the positive clinical outcome. Thus, a qualified team is expected in the ICU for the recognition and treatment of cardiac arrest, with attention to potentially reversible causes1515. Panchal AR, Bartos JA, Cabañas JG, Donnino MW, Drennan IR, Hirsch KG, et al. Adult Basic and Advanced Life Support Writing Group. Part 3: Adult Basic and Advanced Life Support: 2020 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation [Internet]. 2020 [cited 2022 Dec 28]142(16 Suppl 2):S366-468. Available from: https://doi.org/10.1161/CIR.0000000000000916
https://doi.org/10.1161/CIR.000000000000...
,2727. Tsai JC, Ma JW, Liu SC, Lin TC, Hu SY. Cardiac Arrest Survival Postresuscitation In-Hospital (CASPRI) Score Predicts Neurological Favorable Survival in Emergency Department Cardiac Arrest. J Clin Med [Internet]. 2021 [cited 2022 Dec 31];10(21):5131. Available from: https://doi.org/10.3390/jcm10215131
https://doi.org/10.3390/jcm10215131...
.

Thus, a study used high-fidelity simulation to train and assess nurses’ skills in identifying VF and conduct. It was identified from this teaching strategy, the improvement of skills and ability to assess the absence of a pulse, recognize VF and the immediate use of a defibrillator2828. Vincelette C, Quiroz-Martinez H, Fortin O, Lavoie S. Timely recognition of ventricular fibrillation and initiation of cardiopulmonary resuscitation by intensive care unit nurses: A high-fidelity simulation observational study. Clin Simul Nurs [Internet]. 2018 [cited 2022 Dec 31];23:1. Available from: https://doi.org/10.1016/j.ecns.2018.07.005
https://doi.org/10.1016/j.ecns.2018.07.0...
.

However, to achieve reliable results in a simulated clinical scenario, the construct needs to be assessed and validated in its content2222. Pasquali L. Instrumentação psicológica: Fundamentos e práticas. Porto Alegre, RS(BR): Artmed; 2010.. In the present study, the simulated scenario and the checklist were assessed by experts, reaching a CVC >0.8 in all items, configuring their validity. It should be noted that finding a CVC ≥ 0.8 reflects the rigor in planning, construction, case/scenario description and construct clues that were ratified by experts in the area, based on judgments and suggestions for improvement1919. Fabri RP, Mazzo A, Martins JCA, Fonseca AS, Pedersoli CE, Miranda FBG, et al. Development of a theoretical-practical script for clinical simulation. Rev Esc Enferm USP [Internet]. 2017 [cited 2022 Dec 28];51:e03218. Available from: https://doi.org/10.1590/s1980-220x2016265103218
https://doi.org/10.1590/s1980-220x201626...
,2222. Pasquali L. Instrumentação psicológica: Fundamentos e práticas. Porto Alegre, RS(BR): Artmed; 2010..

In this regard, the validity of this simulated scenario’s content as well as the checklist that complements it, aims at scientific rigor, with increased confidence in its use in teaching33. Rocha LAC, Gorla BC, Jorge BM, Afonso MG, Santos ECN, Miranda FBG. Validation of simulated scenarios for nursing students: assessment and treatment of Pressure Ulcers. Rev Eletr Enferm [Internet]. 2021 [cited 2023 Apr 29];23:67489. Available from: https://doi.org/10.5216/ree. v23.67489
https://doi.org/10.5216/ree. v23.67489...
. In this way, experts’ suggestions, in each assessment round, were accepted, as long as they are in line with the most recent evidence, in order to create conditions that enable learning, with coherence of resources and safety for patients22. Carvalho LR de, Zem-Mascarenhas SH. Construction and validation of a sepsis simulation scenario: a methodological study. Rev Esc Enferm USP [Internet]. 2020 [cited 2023 Apr 30];54:e03638. Available from: https://doi.org/10.1590/S1980-220X2019021603638
https://doi.org/10.1590/S1980-220X201902...
,88. Associação Brasileira de Educação Médica. Simulação em saúde para ensino e avaliação: conceitos e práticas [Internet]. São Carlos, SP(BR): Cubo Multimídia; 2021 [cited 2023 Feb 27]. Available from: https://doi.org/10.4322/978-65-86819-11-3
https://doi.org/10.4322/978-65-86819-11-...
,1515. Panchal AR, Bartos JA, Cabañas JG, Donnino MW, Drennan IR, Hirsch KG, et al. Adult Basic and Advanced Life Support Writing Group. Part 3: Adult Basic and Advanced Life Support: 2020 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation [Internet]. 2020 [cited 2022 Dec 28]142(16 Suppl 2):S366-468. Available from: https://doi.org/10.1161/CIR.0000000000000916
https://doi.org/10.1161/CIR.000000000000...
. Furthermore, Cronbach’s alpha equal to or greater than 0.7, achieved in the three assessment rounds, demonstrated the internal consistency of the simulated scenario’s content. This result allows indicating the correlation between each scenario item and the construct as a whole2222. Pasquali L. Instrumentação psicológica: Fundamentos e práticas. Porto Alegre, RS(BR): Artmed; 2010..

In order to improve the simulated scenario and meet the real needs of nursing students, a pilot test was carried out which, according to the literature, must be carried out before implementing the clinical simulation itself so that some unforeseen situations are evidenced and adjusted2929. Arrogante O, González-Romero GM, López-Torre EM, Carrión-García L, Polo A. Comparing formative and summative simulation-based assessment in undergraduate nursing students: Nursing competency acquisition and clinical simulation satisfaction. BMC Nurs [Internet]. 2021 [cited 2022 Dec 31];20(1):92. Available from: https://doi.org/10.1186/s12912-021-00614-2
https://doi.org/10.1186/s12912-021-00614...
. In the present study, the pilot test of the clinical scenario attested to its good suitability as a mediator of knowledge and skills, with only an increase in the stipulated time being suggested. It is considered that, for scenario application, depending on the objective, the time can be extended. However, in a real situation, the time between the identification of a shockable arrhythmia and the establishment of the first shock should occur as soon as possible1515. Panchal AR, Bartos JA, Cabañas JG, Donnino MW, Drennan IR, Hirsch KG, et al. Adult Basic and Advanced Life Support Writing Group. Part 3: Adult Basic and Advanced Life Support: 2020 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation [Internet]. 2020 [cited 2022 Dec 28]142(16 Suppl 2):S366-468. Available from: https://doi.org/10.1161/CIR.0000000000000916
https://doi.org/10.1161/CIR.000000000000...
.

It should be noted that, in the context of good practices in clinical simulation, it is recommended to carry out the prebriefing, a moment reserved for objective guidance on the clinical case, mannequins, equipment and the proposed time of the simulated environment1818. INACSL Standards Committee. INACSL standards of best practice: Simulation Design. Clin Simul Nurs [Internet]. 2016 [cited 2022 Dec 28];12(S):S5-12. Available from: https://doi.org/10.1016/j.ecns.2016.09.005
https://doi.org/10.1016/j.ecns.2016.09.0...
. After simulation, a debriefing was carried out, at which time feedback on performance is provided and students are encouraged to report on facilities and difficulties, encouraging critical thinking1818. INACSL Standards Committee. INACSL standards of best practice: Simulation Design. Clin Simul Nurs [Internet]. 2016 [cited 2022 Dec 28];12(S):S5-12. Available from: https://doi.org/10.1016/j.ecns.2016.09.005
https://doi.org/10.1016/j.ecns.2016.09.0...
. In this regard, it was possible to detect that in prebriefing, most academics reported having good expectations with learning; however, they were insecure about not knowing how to act at the right time. In debriefing, most reports were of satisfaction, greater security and the need to deepen the study of the theme.

As for the result of ESEAA, applied at the end of debriefing, students reported being mostly satisfied and self-confident with the learning process. In the same direction, a study3030. Demirtas A, Guvenc G, Aslan Ö, Unver V, Basak T, Kaya C. Effectiveness of simulation-based cardiopulmonary resuscitation training programs on fourth-year nursing students. Australas Emerg Care [Internet]. 2021 [cited 2023 Apr 7];24(1):4-10. Available from: https://doi.org/10.1016/j.auec.2020.08.005
https://doi.org/10.1016/j.auec.2020.08.0...
found high scores of satisfaction and confidence in nursing students after simulation CRA training. The data led the authors to conclude that pre-simulation concern was replaced by post-simulation satisfaction3030. Demirtas A, Guvenc G, Aslan Ö, Unver V, Basak T, Kaya C. Effectiveness of simulation-based cardiopulmonary resuscitation training programs on fourth-year nursing students. Australas Emerg Care [Internet]. 2021 [cited 2023 Apr 7];24(1):4-10. Available from: https://doi.org/10.1016/j.auec.2020.08.005
https://doi.org/10.1016/j.auec.2020.08.0...
.

Therefore, it is believed that satisfaction with the simulation may favor knowledge retention, acquisition of skills and self-confidence to proceed with the assessment and identification of shockable cardiac arrhythmias in ICU patients3030. Demirtas A, Guvenc G, Aslan Ö, Unver V, Basak T, Kaya C. Effectiveness of simulation-based cardiopulmonary resuscitation training programs on fourth-year nursing students. Australas Emerg Care [Internet]. 2021 [cited 2023 Apr 7];24(1):4-10. Available from: https://doi.org/10.1016/j.auec.2020.08.005
https://doi.org/10.1016/j.auec.2020.08.0...
. Allied to this, self-confident nursing students are better able to articulate theoretical and practical knowledge to make decisions and provide safe care to critically ill patients77. Santos KB, Püschel VAA, Luiz FS, Leite ICG, Cavalcante RB, Carbogim FC. Simulation training for hospital admission of patients with Covid-19: Assessment of nursing professionals. Texto Contexto Enferm [Internet]. 2021 [cited 2022 Dec 28];30:e20200569. Available from: https://doi.org/10.1590/1980-265X-TCE-2020-0569
https://doi.org/10.1590/1980-265X-TCE-20...
,2626. Almeida RGS, Mazzo A, Martins JCA, Baptista RCN, Girão FB, Mendes IAC. Validation to portuguese of the scale of student satisfaction and self-confidence in learning. Rev Lat Am Enfermagem [Internet]. 2015 [cited 2022 Dec 29];23(6):1007. Available from: https://doi.org/10.1590/0104-1169.0472.2643
https://doi.org/10.1590/0104-1169.0472.2...
.

Considering the findings, it is inferred that the simulated scenario and respective checklist constructed and validated may help in the development of specific skills and in decision-making based on the assessment and identification of situations involving shockable arrhythmias in the ICU. As a limitation of this research, it is worth mentioning the performance of validity and pilot test only in the context of nursing and in the ICU, in addition to the establishment of convenience sampling for the pilot test, not allowing generalizations.

CONCLUSION

The instrument developed to assess shockable arrhythmias in adult patients hospitalized in the ICU is valid in its content and has good internal consistency. For this, the simulated scenario and the checklist were adjusted according to experts’ suggestions and, in order to improve it to meet the target audience’s needs, a pilot test was carried out. The scenario and the checklist constructed and validated for teaching nursing have, respectively, 21 and six items.

It is noteworthy that the present simulated scenario may contribute to graduation and continuing education in adult intensive care as well as subsidize future studies, in order to increase the quality of care for cardiorespiratory arrests and patient care.

ACKNOWLEDGMENT

Graduate Program in Nursing at the Universidade Federal de Juiz de Fora . Coordination for the Improvement of Higher Education Personnel (CNPq - Coordenação de Aperfeiçoamento de Pessoal de Nível Superior).

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NOTES

  • ORIGIN OF THE ARTICLE

    Extracted from the dissertation - Construção e validação de cenário simulado e checklist para avaliação e identificação de arritmias chocáveis no indivíduo adulto em UTI, presented to the Graduate Program in Nursing, Universidade Federal de Juiz de Fora, in 2022.
  • APPROVAL OF ETHICS COMMITTEE IN RESEARCH

    Approved by the Ethics Committee in Research of the Universidade Federal de Juiz de Fora, Opinion 4.124.379, CAAE (Certificado de Apresentação para Apreciação Ética - Certificate of Presentation for Ethical Consideration) 31337920.9.0000.5147.

Edited by

EDITORS

Associated Editors: Manuela Beatriz Velho, Ana Izabel Jatobá de Souza Editor-in-chief: Elisiane Lorenzini

Publication Dates

  • Publication in this collection
    04 Sept 2023
  • Date of issue
    2023

History

  • Received
    21 Jan 2023
  • Accepted
    13 June 2023
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