Validation of a clinical simulation setting in the management of postpartum haemorrhage

Andrade, Priscyla de Oliveira Nascimento; Oliveira, Sheyla Costa de; Morais, Sheila Coelho Ramalho Vasconcelos; Guedes, Tatiane Gomes; Melo, Geyslane Pereira de; Linhares, Francisca Marcia Pereira

doi:10.1590/0034-7167-2018-0065

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Revista Brasileira de Enfermagem

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ORIGINAL ARTICLE • Rev. Bras. Enferm. 72 (3) • May-Jun 2019 • https://doi.org/10.1590/0034-7167-2018-0065 copy

Validation of a clinical simulation setting in the management of postpartum haemorrhage

Validación de escenario de simulación clínica en el manejo de la hemorragia posparto

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Objective:

To construct and validate a clinical simulation setting for postpartum haemorrhage.

Method:

Quantitative research of methodological development, carried out from May to July of 2016 with 22 expert judges and 30 students. Analysis was performed from descriptive statistics, Binomial Test and Content Validity Index (CVI), considering CVI ≥ 80%.

Results:

Setting construction was based on learning objectives, fidelity, evaluation tool, pre-setting activities and debriefing. Agreement, regarding its validity, was satisfactory in the 23 items analyzed. Items evaluated by judges had CVI> 0.90; in the evaluation by students, CVI was > 0.95.

Conclusion:

It was considered validated and suitable for training and use by nursing students. Other studies should be carried out in order to test its effectiveness in the construction of theoretical and practical knowledge of both nursing students and nurses during Permanent Education.

Descriptors:
Validation Studies; Nursing; Obstetrics; Nursing Education; Simulation Training

Expected nursing activities Performed No			Performance
Communication	To introduce yourself to the woman and call for help		( ) Correct ( ) Incorrect	( )
	To check and request time record		( ) Correct ( ) Incorrect	( )
	To ask the patient what she is feeling		( ) Correct ( ) Incorrect	( )
	To explain patient behaviors		( ) Correct ( ) Incorrect	( )
	Comorbidities; Medication Use; Allergies		( ) Correct ( ) Incorrect	( )
To Perform Physical Examination	To carry out the therapeutic approach		( ) Correct ( ) Incorrect	( )
	To perform skin and mucous membrane inspection		( ) Correct ( ) Incorrect	( )
	To perform palpation of the uterine height and tonus		( ) Correct ( ) Incorrect	( )
	To gauge vital signs		( ) Correct ( ) Incorrect	( )
	To check tonus, tissue, path and thrombin		( ) Correct ( ) Incorrect	( )
To Identify Signs and Symptoms of Risk for Hypovolemic Shock	To check A-B-C		( ) Correct ( ) Incorrect	( )
	To attempt to report dry mouth and thirst		( ) Correct ( ) Incorrect	( )
	To attempt to report respiratory distress		( ) Correct ( ) Incorrect	( )
	To identify drowsiness		( ) Correct ( ) Incorrect	( )
	To identify cold, damp, and hypocritical skin		( ) Correct ( ) Incorrect	( )
	To check decreased peripheral tissue perfusion		( ) Correct ( ) Incorrect	( )
	To verify uterine involution		( ) Correct ( ) Incorrect	( )
	To pay attention to HR^* * HR- Heart Rate, : 110 bpm and BP^† † BP - Blood Pressure, : 80 x 50 mm/Hg		( ) Correct ( ) Incorrect	( )
	To pay attention to weak and fast pulse		( ) Correct ( ) Incorrect	( )
	To pay attention to RR ^‡ ‡ RR - Respiratoy Rate, : 24 mov/min and SO²: 90%		( ) Correct ( ) Incorrect	( )
	To pay attention to T^§ § T - Temperature, SS II - Saline Solution, : 35.5 ºC		( ) Correct ( ) Incorrect	( )
	To request venipuncture and collect blood for lab tests		( ) Correct ( ) Incorrect	( )
	To position patient with slightly elevated headboard		( ) Correct ( ) Incorrect	( )
	To install 0.9% SS II in rapid infusion		( ) Correct ( ) Incorrect	( )
	To administer oxygen by nasal catheter at 3L/min		( ) Correct ( ) Incorrect	( )
	Mechanical Conduct	To perform Uterine Massage	( ) Correct ( ) Incorrect	( )
		To perform manual bi compression	( ) Correct ( ) Incorrect	( )
		To empty the bladder	( ) Correct ( ) Incorrect	( )
		To review birth canal	( ) Correct ( ) Incorrect	( )
To Identify Signs and Symptoms of Risk for Hypovolemic Shock	Drugs	Intramuscular oxytocin 10 ^¶ ¶ IU - Internacional Units, IU	( ) Correct ( ) Incorrect	( )
		Intravenous oxytocin 20 ^¶ ¶ IU - Internacional Units, IU in SS	( ) Correct ( ) Incorrect	( )
		To keep intravenous oxytocin	( ) Correct ( ) Incorrect	( )
		To view lacerations	( ) Correct ( ) Incorrect	( )
		To carry out raffia of bleeding lacerations	( ) Correct ( ) Incorrect	( )
Monitoring	To identify VVSS changes ^ VVSS - Vital Signs.		( ) Correct ( ) Incorrect	( )
Monitoring	To perform clinical monitoring		( ) Correct ( ) Incorrect	( )
Nursing Process	Nursing Diagnosis		( ) Correct ( ) Incorrect	( )
	Expected results		( ) Correct ( ) Incorrect	( )
	Prescription and nursing evolution		( ) Correct ( ) Incorrect	( )

Character	Script
Nursing Tech.	- The patient has just given birth, is lying down, a little tired. The nurse is called because of the bleeding Expresses tranquility - There is active bleeding, drowsiness, cold, moist and hypocorous skin, decreased peripheral tissue perfusion, uterine involution at the umbilical and hypotonic scar level.
Nurse	It is presented and questioned what the patient is feeling
Patient	- I'm tired, with dark vision. Oh what a dry mouth! I'm thirsty! I'm feeling short of breath! (Patient)
Nursing Tech.	Provide the following information when you notice or are asked to evaluate these standards by students: - Conscious and oriented - HR^ * HR- Heart Rate, : 110 bpm - RR^† † RR - Respiratory Rate, : 24 irpm* - Weak and fast pulse - BP^‡ ‡ BP - Blood Pressure, : 80 x 50 mmHg - T^§ § T - Temperature, PPH II - postpartum haemorrhage. : 35.5ºC - Saturation: 90%
Nurse	Starts PPH protocol
Nursing Tech.	Wait for student's initial behavior. After some procedures give new data. Conscious and oriented - HR: 112 bpm - BP 100 x 60 mmHg After oxytocin administration: How good that uterus contracted after oxytocin, but bleeding remains. (Nursing Technician) Expects a little student's reasoning. If you do not leave for birth canal review: - It is still bleeding! (Nursing Technician)
Nurse	Attempts to identify other causes of PPH II
Nursing Tech.	After oxytocin and lacerations raffia: - Yeah, looks like the bleeding stopped. Still good! (Nursing Technician) - HR: 86 bpm - Full and regular pulse; - RR: 18 irpm; BP: 90x60 mm/Hg; - T: 36 ºC - Saturation: 98%
Patient	Mentions improvement
Setting closed

Items Evaluated	Agreement			p^* * I-CVI- Item-Level Content Validity Índex,	P^† † PPH- postpartum haemorrhage,	I-CVI^‡ ‡ S-CVI - Scale-Level Content Validity Index.
Items Evaluated	Yes	Null	No	p^* * I-CVI- Item-Level Content Validity Índex,	P^† † PPH- postpartum haemorrhage,	I-CVI^‡ ‡ S-CVI - Scale-Level Content Validity Index.
Objetcive
Contents are consistent with the objective of the clinical simulation setting	22	0	0	1.000	1.000	1.00
Learning objectives are clear and concise	22	0	0	1.000	1.000	1.00
Content of the setting facilitates critical thinking	22	0	0	1.000	1.000	1.00
Information presented is scientifically correct	21	0	1	0.972	0.954	0.95
There is a logical sequence of proposed content	21	0	1	0.972	0.954	0.95
Information presented in the setting covers well the content about PPH§	21	0	1	0.972	0.954	0.95
Information/content is important for the quality of care provided	22	0	0	1.000	1.000	1.00
Objective of the setting invites/instigates changes of behavior and attitude of students	21	0	1	0.972	0.954	0.95
Structure and Presentation
Setting script is appropriate for nursing students	22	0	0	1.000	1.000	1.00
Language used is easy to understand by students	22	0	0	1.000	1.000	1.00
Setting has attractive visuals that keep the attention of students	20	1	1	0.863	0.909	0.91
Data are presented in a structured and objective way	22	0	0	1.000	1.000	1.00
Presentation of setting contributes to students' learning	22	0	0	1.000	1.000	1.00
Contains at least four evidence to confirm a highly accurate diagnosis	21	0	1	0.972	0.954	0.95
Contextual details provide clues based on desired results	21	0	1	0.972	0.954	0.95
Patient profile provides sufficient data to perform a clinical trial	22	0	0	1.000	1.000	1.00
Pages or sections appear organized	20	0	2	0.863	0.909	0.91
Relevance
Setting allows the transfer of knowledge in relation to the management of PPH	22	0	0	1.000	1.000	1.00
The theme portrays key aspects that need to be strengthened	22	0	0	1.000	1.000	1.00
The model allows the transfer and generalization of learning to different contexts	20	1	1	0.863	0.909	0.91
Setting script proposes the construction of knowledge	22	0	0	1.000	1.000	1.00
Can be used by health professionals/or educators	22	0	0	1.000	1.000	1.00
Clinical simulation setting in the management of PPH may circulate in the scientific	22	0	0	1.000	1.000	1.00
S-CVI II						0,976

Items Evaluated	Agreement			I-CVI*
Items Evaluated	Yes	Null	No	I-CVI*
Objective
Setting meets the proposed objective	30	0	0	1.00
Help with the quality of PPH learning ^† † PPH- postpartum haemorrhage,	30	0	0	1.00
Setting is suitable for you to use at the moment	30	0	0	1.00
Organization
Title is attractive and indicates the content of the setting	30	0	0	1.00
Size of the title and the content in the topics are suitable	29	0	1	0.97
Topics have logical sequence	30	0	0	1.00
There is consistency between the objectives and content of the	30	0	0	1.00
Writing Style
Writing is clear and objective	30	0	0	1.00
Text is interesting	30	0	0	1.00
Vocabulary is accessible	30	0	0	1.00
There is an association of the theme of each section with the corresponding text	30	0	0	1.00
Writing style corresponds to the level of your knowledge	30	0	0	1.00
Appearance
Pages and section appear organized	30	0	0	1.00
Setting appearance is simple and clear	30	0	0	1.00
Setting content is attractive	30	0	0	1.00
content is expressive and sufficient	30	0	0	1.00
Motivation
Setting is appropriate for undergraduate students profile	29	0	1	0.97
Content is logical and attractive	30	0	0	1.00
Interaction is invited by texts and suggests actions	29	0	1	0.97
Instigates changes in behavior and attitude during care	30	0	0	1.00
Setting proposes new knowledge for students	30	0	0	1.00
S-CVI^‡ ‡ S-CVI - Scale-Level Content Validity Index.				0.976

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[1] Corresponding Author: Priscyla de Oliveira Nascimento Andrade. E-mail: pricila_nas@yahoo.com.br