Escenario en simulación realística en salud: ¿qué es relevante para su diseño?

Kaneko, Regina Mayumi Utiyama; Lopes, Maria Helena Baena de Moraes

doi:10.1590/S1980-220X2018015703453

Brasil

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THEORETICAL STUDY • Rev. esc. enferm. USP 53 • 2019 • https://doi.org/10.1590/S1980-220X2018015703453 linkcopiar

Escenario en simulación realística en salud: ¿qué es relevante para su diseño?

Autoría SCIMAGO INSTITUTIONS RANKINGS

RESUMEN

Se buscó describir las etapas de confección de escenarios, con énfasis en los aspectos más relevantes, según la literatura y las directrices de la The International Nursing Association and Learning y de la Best Evidence Medical Education, las que se discuten y ejemplifican de acuerdo con nuestra experiencia profesional. Fueron descritas y comentadas las siguientes etapas para el diseño de escenarios: planificación, objetivos, estructura y formato de la simulación, descripción del caso y percepción del realismo, predebriefing, debriefing, evaluación, materiales y recursos y piloto. El diseño del escenario basado en buenas prácticas abarca elementos importantes, y cada etapa está íntimamente interconectada e interdependiente en su proceso de creación.

DESCRIPTORES: Simulación de Paciente; Entrenamiento Simulado; Aprendizaje; Seguridad del Paciente

Professional	Doctor	Nurse	Psychologist
Objective	Report the death of the patient to the relative.	Evaluate the understanding of the relative who received the news of the patient’s death; To reaffirm the communication of the patient’s death.	Provide support to the family who received the news of the patient’s death; To reaffirm the communication of the patient’s death.
Case	Patient Maria de Jesus, hospitalized in the Intensive Care Unit (ICU) 10 days ago with heart failure, presented cardiorespiratory arrest (CRP), followed by death. The daughter, Ana Maria, is at the reception and is waiting to hear about her mother.	Patient Maria de Jesus, hospitalized in the ICU 10 days ago with Heart Failure, presented a CRP followed by death. The ICU doctor reported the death of Maria de Jesus to her daughter Ana Maria. You are the nurse who will deliver the patient’s belongings to the family member, who is waiting for you at the reception.	Patient Maria de Jesus, hospitalized in the ICU 10 days ago with Heart Failure, presented a CRP followed by death. You have been activated by the nursing team for psychological support to the family member at the front desk. At this moment the family member is out of control and is emotionally very upset.
Evolution	The doctor is expected to perform the bad news reporting steps. The daughter (actress) should initially maintain an optimistic reaction regarding her mother’s state.	The nurse is expected to maintain a receptive posture and recognize the daughter’s lack of understanding regarding the death news provided by the doctor and the communication of the bad news. The daughter (actress) should initially be very confused and tell the nurse that she would like to talk to her mother.	The psychologist is expected to give emotional support and recognize the daughter’s lack of understanding regarding the death news provided by the doctor and the communication of the bad news. The daughter (actress) should initially be very anxious and nervous.

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Universidade de São Paulo, Escola de Enfermagem Av. Dr. Enéas de Carvalho Aguiar, 419 , 05403-000 São Paulo - SP/ Brasil, Tel./Fax: (55 11) 3061-7553, - São Paulo - SP - Brazil
E-mail: reeusp@usp.br

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[TFN1] • This example was created and inspired by the care practice and teaching of the authors, including the names of the characters in order to build realism into the scenarios. Any resemblance to real names, people, and real-life facts would have been mere coincidence.

Case: Maria da Silva, 40 years old, obese, executive, went to the emergency room for care. She has an important meeting to present a project of great relevance to her company.
Physical profile: obese, age range 35-40 years old.
Psychological profile: anxious, worried and upset.
Social profile: MBA (Master in Business Administration), works in a multinational institution and has an important meeting to present a project of relevance to the company and to her professional career.
Attitude A: The actress will initially be anxious, worried and upset because she was referred to the emergency room, accompanied by her husband. If the volunteer performs assertive communication (a verbal and non-verbal communication process, speaks truthfully without making judgments or going off topic, aiming to convey information clearly and safely), the actress agrees to be examined and to continue with the treatment.	Attitude B: The actress will initially be anxious, worried and upset because she was referred to the emergency room, accompanied by her husband. If the volunteer does not perform assertive communication (an improper verbal and non-verbal communication process, not speaking truthfully, making judgments, not transmitting information clearly and safely), the actress will maintain her initial status and will not agree to be examined or to do treatment.
Phrases that can be used (examples): “My husband brought me for an appointment, I have nothing, it’s just a little pain in the chest. It went away!”. “Please, can you do the appointment as quickly as possible?”. “I understand, in case of changes in the exams, I will have to stay...”.	Phrases that can be used (examples): “Who are you? I’m here in the emergency room because my husband made me!”. “You can’t keep me here, I have a very important meeting!”. “You have no idea, of course you don’t!”.