Simulated scenarios in nursing: an integrative literature review

Amorim, Gustavo Correa de; Bernardinelli, Fabiana Cristina Pires; Nascimento, Juliana da Silva Garcia; Souza, Ingrid Fidelix de; Contim, Divanice; Chavaglia, Suzel Regina Ribeiro

doi:10.1590/0034-7167-2022-0123

Gustavo Correa de Amorim

conception or design of the study/research

analysis and/or interpretation of data

final review with critical and intellectual participation in the manuscript

Universidade Federal do Triângulo Mineiro. Uberaba, Minas Gerais, Brazil

https://orcid.org/0000-0001-9695-7904

Fabiana Cristina Pires Bernardinelli

conception or design of the study/research

analysis and/or interpretation of data

final review with critical and intellectual participation in the manuscript

Universidade Federal do Triângulo Mineiro. Uberaba, Minas Gerais, Brazil

https://orcid.org/0000-0002-8524-1449

Juliana da Silva Garcia Nascimento

conception or design of the study/research

analysis and/or interpretation of data

final review with critical and intellectual participation in the manuscript

Universidade de São Paulo. Ribeirão Preto, São Paulo, Brazil

https://orcid.org/0000-0003-1118-2738

Ingrid Fidelix de Souza

analysis and/or interpretation of data

final review with critical and intellectual participation in the manuscript

Universidade Federal do Triângulo Mineiro. Uberaba, Minas Gerais, Brazil

https://orcid.org/0000-0003-3856-9676

Divanice Contim

final review with critical and intellectual participation in the manuscript

Universidade Federal do Triângulo Mineiro. Uberaba, Minas Gerais, Brazil

https://orcid.org/0000-0001-5213-1465

Suzel Regina Ribeiro Chavaglia Corresponding author: Suzel Regina Ribeiro Chavaglia, E-mail: suzel.ribeiro@yahoo.com.br

conception or design of the study/research

analysis and/or interpretation of data

final review with critical and intellectual participation in the manuscript

Universidade Federal do Triângulo Mineiro. Uberaba, Minas Gerais, Brazil

https://orcid.org/0000-0001-7033-0185

Corresponding author: Suzel Regina Ribeiro Chavaglia, E-mail: suzel.ribeiro@yahoo.com.br

EDITOR IN CHIEF: Dulce Barbosa

ASSOCIATE EDITOR: Luís Carlos Lopes-Júnior

Database	Descriptors	Search strategy
MEDLINE/PubMed^® Scopus	MeSH controlled descriptors: Nurses; “Students, Nursing”; “Simulation Training”, the keyword: Scenario and synonyms “Nurse; “Pupil Nurses”; “Student, Nursing”; “Nurses, Pupil”; “Nurse, Pupil”; “Pupil Nurse”; “Nursing Student”; “Nursing Students”; “Training, Simulation”	(“Nurses” OR “Nurse” AND “Students, Nursing” OR “Pupil Nurses” OR “Student, Nursing” OR “Nurses, Pupil” OR “Nurse, Pupil” OR “Pupil Nurse” OR “Nursing Student” OR “Nursing Students” AND “Simulation Training” OR “Training, Simulation” AND “Scenario” AND “Teaching” AND “Learning”).
LILACS	DeCS present controlled descriptors in Portuguese: “Enfermagem”; “Estudantes de Enfermagem”; “Treinamento por Simulação”; “Ensino”; “Aprendizagem” and the keyword scenario and its versions in English, Spanish and French.	(“Enfermagem” AND “Estudantes de Enfermagem” AND “Treinamento por Simulação” AND “Cenário” AND “Ensino” AND “Aprendizagem”). (“Nursing” AND “Students, Nursing” AND “Simulation Training” AND “Scenario” AND “Teaching” AND “Learning”). (“Enfermería” AND “Estudiantes de Enfermería” AND “Entrenamiento Simulado” AND “Guión” AND “Enseñanza” AND “Aprendizaje”). (“Soins” AND “Élève infirmier” AND “Formation par simulation” AND “Scénario” AND “Enseignement” AND “Apprentissage”).
CINAHL	Controlled descriptors in titles/subjects in English: Nurses; “Students, Nursing”; “Simulation Training”; Teaching; Learning. The keyword scenario was adopted.	(“Nurses” AND “Students, Nursing” AND “Simulations” AND “Scenario” AND “Teaching” AND “Learning”).
Web of Science	MeSH controlled descriptors in English: “Nurses”; “Students, Nursing”; “Simulation Training”; “Teaching”; “Learning” and the keyword scenario.	TS= (Nurses AND Students, Nursing^* AND Simulation Training^* AND Scenario AND Teaching AND Learning).
Embase	MeSH controlled descriptors in English: “Nurses”; “Students, Nursing”; “Simulation Training”; “Teaching”; “Learning” and the keyword scenario.	(((‘nurses’/exp OR nurses OR ‘nurse’/exp OR nurse) AND (‘students, nursing’/exp OR ‘students, nursing’) OR ‘pupil nurses’ OR ‘student, nursing’ OR ‘nurses, pupil’ OR ‘nurse, pupil’ OR ‘pupil nurse’ OR ‘nursing student’/exp OR ‘nursing student’ OR ‘nursing students’/exp OR ‘nursing students’) AND (‘simulation training’/exp OR ‘simulation training’) OR ‘training, simulation’) AND scenario AND (‘teaching’/exp OR teaching) AND (‘learning’/exp OR learning).
ERIC	Thesaurus controlled descriptors in English: “Nurses”; “Students, Nursing”; “Simulation Training”; “Teaching”; “Learning” and the keyword scenario.	(“Nurses” OR “Nurse” AND “Students, Nursing” OR “Pupil Nurses” OR “Student, Nursing” OR “Nurses, Pupil” OR “Nurse, Pupil” OR “Pupil Nurse” OR “Nursing Student” OR “Nursing Students” AND “Simulation Training” OR “Training, Simulation” AND “Scenario” AND “Teaching” AND “Learning”).

Author, year and origin	Objective	Main results
Gouveia et al., 2021(¹⁹19 Gouveia MF, Souza CC, Braga LM, Carvalho DC, Boscarol GT, Borges AB, et al. Construction and validation of simulated scenario for the development of nursing students diagnostic reasoning. Ciênc Nat. 2021;43(3). https://doi.org/10.5902/2179460X43354 https://doi.org/10.5902/2179460X43354... ), Brazil.	Build and validate a scenario for the development of diagnostic reasoning skills in nursing students.	Eight judges validated the scenario content and obtained an agreement rate of 96%. Scenario components: prior knowledge of students; goals; theoretical foundation; theme; date; responsible; scenario complexity; expected interventions; expected results; faithfulness; clinical cases for facilitator to student and actor; vital parameters; reason for hospitalization; medical prescription; materials; characterization of actors; physical space; human resources; scenario time; validity; development; debriefing; and assessment.
Carreiro; Romão; Costa, 2021(²⁰20 Carreiro BO, Romão LGB, Costa RRO. Construção e validação de cenários de simulação de Suporte Básico de Vida na Atenção Básica. Mundo Saúde. 2021;45(1):195-09. https://doi.org/10.15343/0104-7809.202145195209 https://doi.org/10.15343/0104-7809.20214... ), Brazil.	Build and validate two medium-fidelity clinical simulation scenarios in basic life support in the context of primary care.	A scenario of cardiorespiratory arrest in primary care and airway obstruction by a foreign body was validated in content, by seven judges, obtaining a CVI between 85.7% and 100%. Scenario components: participant’s previous experience; goals; scenario duration; human Resources; theme; faithfulness; clinical case; physical exam; conduct; actor characterization; materials; physical space; development; debriefing; and assessment.
Santana et al., 2021(²¹21 Santana ER, Piacezzi LHV, Lopes MCBT, Batista REA, Vancini-Campanharo CR, Góis AFT. Construção e validação de cenário de simulação de transporte intra-hospitalar. Einstein. 2021;19:eAO5868. https://doi.org/10.31744/einstein_journal/2021AO5868 https://doi.org/10.31744/einstein_journa... ), Brazil.	Build and validate the content of a clinical simulation scenario for teaching in-hospital transport of critically ill patients.	The Delphi technique was adopted to assess inter-rater agreement, obtaining 80% agreement through five judges. Scenario components: theme; target Audience; prerequisites; number of students; scenario; time; goals; pre-briefing/briefing; clinical case; high-fidelity scenario and mannequin preparation; materials; necessary actions; debriefing; and references.
Rocha et al., 2021(²²22 Rocha LAC, Gorla BC, Jorge BM, Afonso MG, Santos ECN, Miranda FBG. Validação de cenários simulados para estudantes de enfermagem: avaliação e tratamento de lesão por pressão. Rev Eletr Enferm. 2021;23. https://doi.org/10.5216/ree.v23.67489 https://doi.org/10.5216/ree.v23.67489... ), Brazil.	Validate simulated scenarios for teaching and learning nursing students about pressure injury assessment and treatment.	Two scenarios were validated for content by ten judges: the first on nursing care in the assessment of pressure injuries to hospitalized patients; and the second about nursing care in the treatment of pressure injuries to the bedridden patient at home, resulting in an overall Scale-Level Content Validity Index greater than 0.80. Scenario components: previous knowledge of students; goals; theoretical foundation; responsible; scenario fidelity; documentation; clinical case; material and human; team training; debriefing; and assessment.
Almeida et al., 2021(²³23 Almeida AO, Dantas SRPE, Paula MAB, Silva JLG, Franck EM, Oliveira-Kumakura ARS. Development, validation and application of clinical simulation scenarios for assessment of stomatherapy specialists. Rev Bras Enferm. 2021;74(1):e20200360. https://doi.org/10.1590/0034-7167-2020-0360 https://doi.org/10.1590/0034-7167-2020-0... ), Brazil	Validate scenarios for application in stomatherapy care.	The study was validated by the CVI of 96% agreement among five judges. The scenarios were structured with general and specific objectives, fidelity, problem solving, clues, assessment checklist, pre-briefing and briefing.
Fonseca et al., 2020(²⁴24 Fonseca LMM, Monteiro JCS, Aredes NDA, Bueno JV, Domingues AN, Coutinho VRD, Baptista RCN. Interdisciplinary simulation scenario in nursing education: Humanized childbirth and birth. Rev Latino-Am Enferm. 2020;28:e3286. https://doi.org/10.1590/1518-8345.3681.3286 https://doi.org/10.1590/1518-8345.3681.3... ), Brazil.	Validate a maternal-infant simulation scenario on humanized childbirth and birth.	A level of agreement above 80% was obtained in all aspects assessed by 31 experts. Scenario components: learning objectives; necessary resources; pre-briefing and debriefing guidelines; simulated situation, participant and role description; and checklist of expected actions.
Carvalho; Zem-Mascarenhas, 2020(²⁵25 Carvalho LR, Zem-Mascarenhas SH. Construção e validação de um cenário de simulação sobre sepse: estudo metodológico. Rev Esc Enferm USP. 2020;54:e03638. https://doi.org/10.1590/S1980-220X2019021603638 https://doi.org/10.1590/S1980-220X201902... ), Brazil.	Build, validate and test a high-fidelity clinical simulation scenario for the management of sepsis.	The scenario obtained an CVI greater than 0.90 by nine judges. Scenario components: title; public; prior knowledge; simulation modality; simulation site; materials; simulator types; simulation proposal; introduction; time, design; simulation experience; pre-briefing; debriefing; participants; and expected results.
Souza et al., 2020(²⁶26 Souza RS, Oliveira PP, Dias AAL, Simão DAS, Pelizari AEB, Figueiredo RM. Prevenção de infecções associadas a cateteres periféricos: construção e validação de cenário clínico. Rev Bras Enferm. 2020;73(5)e20190390. https://doi.org/10.1590/0034-7167-2019-0390 https://doi.org/10.1590/0034-7167-2019-0... ), Brazil.	Validate a scenario for the prevention of bloodstream infections associated with peripheral venous catheters.	The study showed that all the simulated clinical scenario requirements reached agreement among the 12 judges above 80% regarding clarity and relevance. Scenario components: objectives; team and participants; materials, equipment and props; faithfulness; assessment method; pre-briefing; and debriefing.
Andrade et al., 2019(²⁷27 Andrade PON, Oliveira SC, Morais SCRV, Guedes TG, Melo GP, Linhares FMP. Validation of a clinical simulation setting in the management of postpartum haemorrhage. Rev Bras Enferm. 2019;72(3):624-31. https://doi.org/10.1590/0034-7167-2018-0065 https://doi.org/10.1590/0034-7167-2018-0... ), Brazil.	Build and validate a clinical simulation scenario for postpartum hemorrhage.	The items assessed by the 22 judges had a CVI > 0.90, and in the assessment by students, CVI > 0.95. Scenario components: learning objectives; faithfulness; assessment instrument; activities developed before the scenario; and debriefing.
Negri et al., 2019(⁹9 Negri EC, Júnior GAP, Cotta-Filho CK, Franzon JC, Mazzo A. Construction and validation of simulated scenario for nursing care to colostomy patients. Texto Contexto Enferm. 2019;28:e20180199. https://doi.org/10.1590/1980-265X-TCE-2018-0199 https://doi.org/10.1590/1980-265X-TCE-20... ), Brazil.	Build and validate a scenario on nursing care for colostomy patients.	Nine experts obtained an agreement rate of 100%. Scenario components: previous experience; goals, time; prior reading material; human Resources; scenario preparation; scenario planning, materials and documentation; development; debriefing; and assessment.
Gonçalvez-Meska et al., 2019(²⁸28 Gonçalvez-Meska MH, Constantino-Frazon J, Conti-Machado GC, Yukio-Mano L, Mazzo A. Construcción y validación de escenarios simulados con la presencia de olores. Simul Clin [Internet]. 2019 [cited 2022 Jan 16];1(3):134-43. Available from: https://www.medigraphic.com/pdfs/simulacion/rsc-2019/rsc193d.pdf https://www.medigraphic.com/pdfs/simulac... ), Brazil.	Build and validate four simulated clinical scenarios in care involving the presence of unpleasant odors.	Five judges and 15 undergraduate nursing students validated the scenario in terms of content, obtaining 100% agreement. Scenario components: behavioral guidance, resource recognition, pre-briefing; and debriefing. Four scenarios were validated: care of a patient who presents vomiting; another with diaper evacuation; one with an infected pressure ulcer; and one patient with colostomy.
Leon et al., 2018(²⁹29 Leon CGRMP, Silva AK, Ribeiro LM, Costa Brasil G, Guarda LEA, Fonseca LMM. Construção e validação de casos clínicos para utilização no ensino de enfermagem no contexto materno-infantil. Referência. 2018;4(18):51-62. https://doi.org/10.12707/RIV18013 https://doi.org/10.12707/RIV18013... ), Brazil.	Describe the construction of two clinical cases and validate them for use in the realistic maternal-infant simulation.	The scenarios developed were about safe patient care, validated by five judges, with patient decision-making and self-care preparation validated by six judges. Both obtained CVI > 0.80. Scenario components: objectives; duration; participants; simulator, materials, prerequisites for participation; and clinical case.
Eduardo et al., 2016(³⁰30 Eduardo AHA, Mendes AA, Binotto CCS, Tognoli SH, Tucci AMGB. Cenário para simulação de Resíduos de Serviços de Saúde: estudo metodológico. Online Braz J Nurs[Internet]. 2016 [cited 2022 Jan 14];15(4):611-6. Available from: https://docs.bvsalud.org/biblioref/2019/04/967500/objn-2016.pdf https://docs.bvsalud.org/biblioref/2019/... ), Brazil.	Validate a scenario on waste management from health services.	Three judges validated the scenario, which obtained 100% inter-rater agreement. Scenario components: responsible for the scenario; target audience; learning objectives; expected actions; duration; place; participants; simulator; patient characteristics; equipment; materials; prerequisites to participate; and clinical case.
Jung et al., 2015(³¹31 Jung JL, Hyeon-Cheol J, Kyung-Ah K, Ye-Jean K, Myung-Nam L. Development of a simulation scenario and evaluation checklist for patients with asthma in emergency care. Comput, Inform, Nurs. 2015;33(12):546-554. https://doi.org/10.1097/CIN.0000000000000193 https://doi.org/10.1097/CIN.000000000000... ), South Korea.	Develop and validate a scenario to improve patient safety during asthma care.	A total of ten judges validated this clinical scenario, which obtained a Content Validity Coefficient > 0.80. Scenario components: determination of objectives; content development; preparation; application; and assessment.

Items	Studies
Items	9	19	20	21	22	23	24	25	26	27	28	29	30	31
1. Was the study design reported?	Y	Y	Y	Y	Y	Y	Y	Y	Y	Y	Y	Y	Y	Y
2. Did the study provide an accurate description of the type of validity tested?	Y	Y	Y	Y	Y	Y	Y	Y	NR	Y	Y	Y	Y	Y
3. Was the study setting and time frame of participant recruitment clearly outlined and described?	Y	Y	Y	Y	Y	Y	Y	Y	N	Y	Y	Y	Y	Y
4. Were the criteria for participant selection clearly described?	Y	Y	Y	Y	Y	Y	Y	Y	N	Y	Y	Y	Y	Y
5. Were the participants in the study representative of the sample population from which they were recruited?	Y	Y	Y	Y	Y	Y	Y	Y	NR	Y	Y	Y	Y	Y
6. Did the study clearly describe the outcome measures to be validated?	Y	Y	Y	Y	Y	Y	Y	Y	N	Y	Y	Y	Y	Y
7. Did the study provide a clear description of the procedures for testing validity?	Y	Y	Y	Y	Y	Y	Y	Y	Y	Y	Y	Y	Y	N
8. Was the testing procedure standardized for all participants?	Y	Y	Y	Y	Y	Y	Y	Y	Y	Y	Y	Y	Y	NR
9. Was a priori sample size calculation performed to ensure that the study had sufficient power?	N	N	N	N	N	N	N	N	N	Y	N	N	N	N
10. Did the study describe and justify any attrition that may have occurred?	NR	NR	NR	NR	NR	NR	NR	NR	NR	NR	NR	NR	NR	NR
11. Were the statistical analyses used to test validity appropriate for the study?	Y	Y	Y	Y	Y	Y	Y	Y	Y	Y	Y	Y	Y	NR
12. When multiple comparisons were performed, were appropriate statistical adjustments used to control for the likelihood of a type 1 error?	NA	NA	NA	NA	NA	NA	NA	NA	NA	NA	NA	NA	NA	NA
13. Did the study identify potential confounding variables and if so, were measures taken to adjust for these confounders?	NA	NA	NA	NA	NA	NA	NA	NA	NA	NA	NA	NA	NA	NA
14. Were the primary findings of the study clearly described?	Y	Y	Y	Y	Y	Y	Y	N	Y	Y	Y	N	Y	N
15. Were validity coefficients reported for primary outcomes?	Y	N	N	N	Y	Y	Y	Y	N	Y	Y	Y	Y	N
16. For primary outcomes, did the study report the standard deviation or confidence intervals for normally distributed data? Or, if non-normally distributed data, did the study report the inter-quartile range for the main outcomes?	N	N	N	N	N	N	N	N	Y	Y	N	N	N	N
17. Was the process of selecting expert panel and their qualifications described?	Y	Y	Y	Y	Y	Y	Y	Y	Y	Y	Y	Y	Y	Y
18. Did the study provide a rationale for the selection of the reference standard?	NA	NA	NA	NA	NA	NA	NA	NA	NA	NA	NA	NA	NA	NA
19. When the index test was assessed by more than one rater, were the raters blinded to the findings of the other raters?	NA	NA	NA	NA	NA	NA	NA	NA	NA	NA	NA	NA	NA	NA
20. When the index test was assessed by more than one rater, was the inter-rater reliability between raters established and reported?	NA	NA	NA	NA	NA	NA	NA	NA	NA	NA	NA	NA	NA	NA
21. Was the time interval used between administration of reference standard and the test measure appropriate?	NA	NA	NA	NA	NA	NA	NA	NA	NA	NA	NA	NA	NA	NA
22. Were subjects in different groups homogenous at baseline or if they weren’t homogenous at baseline, were differences between groups accounted for during the analysis?	NA	NA	NA	NA	NA	NA	NA	NA	NA	NA	NA	NA	NA	NA
23. Did the measures used for convergent validity represent a similar construct as the outcome measure of interest?	NA	NA	NA	NA	NA	NA	NA	NA	NA	NA	NA	NA	NA	NA
24. Did the measures used for discriminant validity represent a construct different from the outcome measure of interest?	NA	NA	NA	NA	NA	NA	NA	NA	NA	NA	NA	NA	NA	NA

[1] Corresponding author: Suzel Regina Ribeiro Chavaglia, E-mail: suzel.ribeiro@yahoo.com.br

Brasil

Brasil

Simulated scenarios in nursing: an integrative literature review

Escenarios simulados en enfermería: revisión integrativa de la literatura

ABSTRACT

Objectives:

Methods:

Results:

Final Considerations: