Application of the educational method of realistic simulation in the treatment of pressure injuries

Baracho, Valéria da Silva; Chaves, Maria Emília de Abreu; Lucas, Thabata Coaglio

doi:10.1590/1518-8345.3946.3357

Brasil

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Original Article • Rev. Latino-Am. Enfermagem 28 • 2020 • https://doi.org/10.1590/1518-8345.3946.3357 linkcopy

Application of the educational method of realistic simulation in the treatment of pressure injuries^*

Authorship SCIMAGO INSTITUTIONS RANKINGS

Objective: to evaluate the use of realistic simulation as a strategy to promote teaching about pressure injuries.

Method: This is a quasi-experimental study. A modified and translated version of the Pieper Pressure Ulcer knowledge test was applied. Kappa statistical analysis was used to assess the professionals’ knowledge in the realistic simulation using the SPSS software. A p-value <0.05 was considered significant.

Results: Seventy-seven nursing professionals participated in the realistic simulation, the majority (72.7%) being nursing technicians. Regarding the knowledge of primary and secondary coverage techniques, the Kappa index went from 0.56 (p=0.002) in the pre-test to 0.87 (p=0.001) in the post-test. As for the sterile dressing technique, there was a variation from 0.55 (p=0.002) in the pre-test to 0.91 (p=0.001) in the post-test. Regarding the cleaning of pressure injuries, there was a variation from 0.81 (CI: 0.62-0.84) in the pre-test to 0.91 (0.85-0.97) in the post-test. The knowledge about the use of a sterile spatula to distribute the dressing in the wound increased from an agreement index from regular to good.

Conclusion: The introduction of the realistic simulation in the clinical practice has created quality assessment indicators for the prevention and treatment of pressure injuries.

Descriptors: Wounds and Injuries; High Fidelity Simulation Training; Practice Patterns, Nurses’; Knowledge; Prevention & Control; Teaching

Professional category	n (%)
Nurse	10 (13)
Nursing technician	56 (72.7)
Nursing assistant	5 (6.5)
Student	6 (7.8)
Total	77 (100)

Statements from the knowledge test	Pre-test	Kappa Index	Post-test	Kappa Index
	95% CI^* * CI = 95% Confidence interval;	(Standard Deviation)	95% CI^* * CI = 95% Confidence interval;	(Standard Deviation)
	(p-value)^† † p-value <0.05;		(p-value)^† † p-value <0.05;
A scale with times for changing decubitus is required only for patients with PI^‡ ‡ PI = Pressure injury; , not for those at risk. (F)^§ § F = False;	-0.23.-1.00 (p=0.002)	0.90 (0.021)	-0.32.-1.00 (p=0.001)	0.94 (0.032)
The dressing has the following functions: to keep the wound moist, to remove exudate, and to allow gas exchange. (T)^\|\| \|\| T = True;	0.43.-1.00 (p=0.002)	0.87 (0.032)	-0.21.-1.00 (p=0.001)	0.98 (0.0012)
The ideal environment for the healing of PIs^‡ ‡ PI = Pressure injury; is occlusive and dry. (F)^§ § F = False;	0.73.-0.93 (p=0.002)	0.80 (0.018)	0.65.-1.00 (p=0.001)	0.95 (0.009)
The assessment of PI^‡ ‡ PI = Pressure injury; for signs of infection is not always important. (F)^§ § F = False;	0.95.-0.99	0.97 (0.0014)	0.95.-1.00 (p=0.001)	0.99 (0.001)
For cleaning the PIs^‡ ‡ PI = Pressure injury; 0.9% SS^¶ ¶ SS = 0.9% Saline solution is applied in a jet heated to 35-37ºC. (T)^\|\| \|\| T = True;	0.62-0.84 (p=0.002)	0.81 (0.032)	0.85-0.97 (p=0.001)	0.91 (0.002)
The alginate hydrogel is applied to very exudative, sloughing, bleeding, and open wounds. (F)^§ § F = False;	0.34.-1.00 (p=0.002)	0.61 (0.023)	0.62.-0.98 (p=0.001)	0.94 (0.012)
Alginate and collagenase are applied to granulation tissue. (F)^§ § F = False;	0.55.-0.81 (p=0.002)	0.75 (0.032)	0.88.-1.00 (p=0.001)	0.93 (0.031)
After the primary dressing, the use of a secondary one is recommended, as it avoids the risk of moisture or contamination. (T)^\|\| \|\| T = True;	0.55.-0.81 (p=0.002)	0.56 (0.021)	0.81.-0.98 (p=0.001)	0.87 (0.034)
PIs^‡ ‡ PI = Pressure injury; in Stage II can be painful due to the exposure of nerve endings. (T)^\|\| \|\| T = True;	0.41.-0.57 (p=0.002)	0.43 (0.023)	0.62.-0.85 (p=0.001)	0.76 (0.017)
Granulation tissue is formed by the proliferation of vascular endothelial cells and fibroblasts. (T)^\|\| \|\| T = True;	0.47.-0.64 (p=0.002)	0.56 (0.021)	0.89.-0.97 (p=0.001)	0.95 (0.011)
It is recommended to use a non-sterile spatula to distribute the dressing on the wound bed. (F)^§ § F = False;	0.23.-0.45 (p=0.002)	0.30 (0.045)	0.57.-0.89 (p=0.001)	0.76 (0.035)
Personal protective equipment such as apron and mask are not recommended during dressing. (F)^§ § F = False;	0.51.-0.68 (p=0.002)	0.62 (0.031)	0.76.-0.97 (p=0.001)	0.93 (0.032)

Variables	Pre-test 95% CI^* * CI = 95% Confidence interval; (p-value)^† † p-value<0.05	Kappa Index (Standard Deviation)	Post-test 95% CI^* * CI = 95% Confidence interval; (p-value)^† † p-value<0.05	Kappa Index (Standard Deviation)
Epithelial tissue	0.46.-0.61	0.56	0.56.-0.87	0.78
	(p<0.001)		(p=0.001)
Granulation tissue	0.47.-0.71	0.55	0.75.-0.91	0.86
	(p<0.01)		(p<0.001)
Slough	0.11.-0.45	0.21	0.75.-0.91	0.91
	(p=0.002)		(p<0.001)
Necrosis	0.71.-0.92	0.87	0.95.-0.99	0.97
	(p=0.001)		(p=0.001)

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