Surgical reconstitution of the perineum after delivery: a qualitative study of a pedagogical practice

Sotto-Mayor, Luísa; Santos, Maria Anabela Ferreira dos; Soares, Irene Maria Trindade; Félix, Maria Teresa Santana; Delgado, Maria João; Serra, Isabel Maria Guerra Gordinho de Rogado

doi:10.1590/1413-81232021262.40752020

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ARTICLE • Ciênc. Saúde Colet. 26 (02) • Feb 2021 • https://doi.org/10.1590/1413-81232021262.40752020 copy

Surgical reconstitution of the perineum after delivery: a qualitative study of a pedagogical practice

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

A pedagogical activity with Master’s Degree and Postgraduate students in Maternal Health and Obstetrics Nursing is described, applying principles of simulated practice in perineal suturing after delivery. This procedure causes a lot of insecurity and generates great anxiety in the students, when they start the internship in a delivery room. Objectives: to develop the psychomotor skills in students for perineal surgical reconstruction; increase students’ self-confidence to perform the procedure. Methodology: qualitative, with 2 moments of data collection applied to two courses. Questionnaire with open questions, focus group session and filming. Content analysis of the answers to the questions and verbatim of the focus group. Results: a close relationship was observed between simulation and skills development. Conclusion: the students emphasized the importance of the pedagogical activity in the acquisition of suturing skills, improving their self-confidence and reducing the initial anxiety. The use of the qualitative research allowed identifying the impact of the simulated practice on the development of the students’ skills and to identify aspects to be improved, contributing to the progress of pedagogical practices.

Key words:
Simulation; Suturing techniques; Perineum; Students; Obstetric nursing

Categories	Subcategories	Registration units	Frequency Units
Perceived facilities	Anticipation of reality	It was possible to have a clearer idea of what I have to do	3
	Observation / previous suture training	I had already worked in an area where we were used to seeing sutures	3
	Use of Biological Model (piece of meat bench model)	The piece of meat better simulates the reality that we will have to face	3
	Decrease in anxiety	If we hadn't had these classes, it would have been a greater overload of anxiety	1
	Mobilization of theoretical knowledge	It is always good to recap the basics	1

Categories	Subcategories	Registration units	Frequency Units
Perceived difficulties	Fidelity of the “high-density foam bench” model”	The foam does not simulate so well	2
	Adaptation to the space / location of the site to be sutured (perineum)	To suture an arm, we have all the space (around it), there we are limited to that little space	8
	Handling of the surgical instruments	The biggest difficulty was in handling the irons	3
	Respect for safety principles	My biggest difficulty was placing the needle safely in the needle holder	3
	Recognition of perineal structures	The biggest difficulty was the recognition of the structures (to be sutured)	2
	Performing the technique rigorously	The biggest difficulty: everything has to be aligned, the planes are all correct, otherwise the purpose won’t be the intended one, if everything is not millimetrically aligned.	1
	First practical contact with the technique	I had never had contact (with sutures and suturing instruments)	2

Categories	Subcategories	Registration units	Frequency Units
Acquired skills	Risk perception	I became aware of the risk I take if I don't take certain precautions	6
	Development of self-confidence	I was already thinking: then how do I pick up the scissors, and how do I pick up the tweezers ... and so we run into things and it is not as complex as we thought it would be	4
	Development of manual dexterity	It helps with dexterity with the material and with the irons, where we put them and where we don't, how we approach the skin	4
	Adaptation to technique	It allows adaptation to the limited space we have to work in	4
	Expanding and mobilizing the knowledge about the technique	Knowledge of the different types of stitches and the different types of planes, and how to perform them	3

Categories	Subcategories	Registration units	Frequency Units
Suggestions	Use of the Biological Model since the beginning, which simulates different structures	With a meat model, the experience is more real, and it raises more doubts	6
	Increase the time of this training activity	The time (of this activity) should be longer	11
	Increase the teacher / student ratio	It should be more teachers in this activity	4
	Maintain the same group of students in different sessions	It should last a full day, morning and afternoon, always with the same people	1
	The “piece of meat” is supplied by the School	The equipment that ESEL provided was adequate, but it could also supply the piece of meat	2
	Do not combine other simulation practice activities	It becomes ‘confusing´ to always change activities	1
	Use of a model closer to reality (size of the puerperal woman’s body)	The model (should) be more real, and have legs (to better simulate the available space)	3

Categories	Subcategories	Registration units	Frequency Units
Teaching-learning process	Importance / Added Value	At the clinical teaching site, the nursing teacher also reports a better performance of students who had simulation practice, compared to those who did not.	8
Cognitive domain	Acquisition of theoretical knowledge	It allowed me to acquire basic knowledge about the technique	9
Psychomotor /instrumental domain	Acquisition of skills for clinical practice	Contributed to the acquisition of skills in the reconstitution of the perineum, because when it was time to perform the perineorrhaphy in clinical teaching it was no longer a new thing	5
	Manual / technical dexterity training	I was able to train several stitches and repeat them enough, so that, when in practice, I wouldn’t feel as 'blind' as if I had never trained	9
	Suture material handling	It gave me the possibility to know and learn how to handle all the suture material	5
	Asepsis Training	It allowed me to train to ensure asepsis	2
Affective domain	Decreased anxiety in internship	On the other hand, being able to practice in the classroom allows less clinical anxiety in the context of clinical teaching	1
	Greater confidence for internship practice	It allowed me to increase my confidence during the Internship with a Report	1
	Training in a controlled and safe environment for the student / client	We were able to practice previously on a piece of meat or foam without causing problems for the woman.	3

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[1] Collaborations

L Sotto-Mayor contributed with data collection; MAF Santos contributed with the study design and final review of the manuscript; IMT Soares and IMGGR Serra contributed with data processing and MTS Félix and MJ Delgado contributed with the theoretical basis.