Clinical simulation scenarios for the planning and management of infusion therapy by nurses

Meszaros, Mariana de Jesus; Almeida, Angélica Olivetto de; Silva, Ruana Luiz Ferreira da; Eduardo, Aline Helena Appoloni; Lima, Maria Helena de Melo; Oliveira-Kumakura, Ana Railka de Souza

doi:10.1590/0034-7167-2023-0019

Mariana de Jesus Meszaros Corresponding author: Mariana de Jesus Meszaros, E-mail: meszaros@unicamp.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 Estadual de Campinas. Campinas, São Paulo, Brazil

https://orcid.org/0000-0002-5510-2253

Angélica Olivetto de Almeida

analysis and/or interpretation of data

final review with critical and intellectual participation in the manuscript

Universidade Estadual de Campinas. Campinas, São Paulo, Brazil

https://orcid.org/0000-0001-5158-493X

Ruana Luiz Ferreira da Silva

analysis and/or interpretation of data

final review with critical and intellectual participation in the manuscript

Universidade Estadual de Campinas. Campinas, São Paulo, Brazil

https://orcid.org/0000-0002-3144-5788

Aline Helena Appoloni Eduardo

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 de São Carlos. São Carlos, São Paulo, Brazil

https://orcid.org/0000-0003-1577-3383

Maria Helena de Melo Lima

conception or design of the study/research

analysis and/or interpretation of data

final review with critical and intellectual participation in the manuscript

Universidade Estadual de Campinas. Campinas, São Paulo, Brazil

https://orcid.org/0000-0001-6521-8324

Ana Railka de Souza Oliveira-Kumakura

conception or design of the study/research

analysis and/or interpretation of data

final review with critical and intellectual participation in the manuscript

Universidade Estadual de Campinas. Campinas, São Paulo, Brazil

https://orcid.org/0000-0002-7075-7987

Corresponding author: Mariana de Jesus Meszaros, E-mail: meszaros@unicamp.br

EDITOR IN CHIEF: Antonio José de Almeida Filho

ASSOCIATE EDITOR: Ana Fátima Fernandes

Scenarios	1. Patient assessment and vascular device selection	2. Identification and management of deep vein thrombosis
Objectives	General: Perform patient assessment for vascular device indication and selection Specific: a) Identify and analyze risk factors related to infusion therapy; b) Indicate the most appropriate vascular device according to the patient’s global assessment; c) Discuss with the multidisciplinary team (physician) the choice of this device.	General: Perform patient assessment for identification and management of suspected PICC†-related DVT^* * DVT -Deep venous thrombosis; †PICC - Peripherally Inserted Central Catheter. . Specific: a) Identify the risk factors for DVT; b) Evaluate the patient and identify signs/symptoms of DVT; c) Discuss the necessary conduct for the management of DVT considering the continuity of infusion therapy.
Fidelity	High fidelity simulation.	High fidelity simulation.
Problem solving	High complexity scenario in which nurses will obtain relevant information for clinical reasoning in the planning of infusion therapy and implement actions based on the association between findings in the patient’s clinical history, physical examination and therapeutic proposal.	High complexity scenario in which participants will obtain relevant information for clinical reasoning in the identification and management of DVT and implement actions based on the association between findings in the patient’s clinical history, physical examination and assessment of the vascular device.
Cues	a) Medical Prescription: intermittent and continuous infusions; irritant and vesicant medications; multiple infusions b) Indication of Norepinephrine infusion by the Physician; c) Provide medical records: clinical history and laboratory tests (alteration: leukocytes, lactate and platelets related to the septic condition); d) Left mastectomy; e) Hemodynamic instability.	a) Patient’s report of pain; b) Medical record with records referring to the patient’s infusion therapy during hospitalization (upper arm circumference, risk factors, PICC insertion data such as vessel diameter and number of puncture attempts); c) Medical prescription: prescription of antibiotic therapy (justifying maintenance of infusion therapy); d) Patient’s complaint: that the catheter is not good (directing the evaluation of catheter patency) and difficulty in performing some activities of daily living (for evaluation of the “Zim Zone”); e) Report of previous thrombosis. f) Intensive care unit nurse: questions the factors related to the suspicion of DVT and conduct
Learning outcomes	Cognitive knowledge: identification of the importance of the planning phase of infusion therapy for the quality of health care and patient safety. Skill (non-technical): development of clinical judgment to identify care needs and potential problems in order to develop actions that help solve problems and achieve favorable results for the patient in the context of infusion therapy. Attitude: decision-making for the indication and selection of the appropriate vascular device based on the systematic evaluation of the patient.	Knowledge (cognitive): identification of risk factors and signs/symptoms of DVT related to the PICC. Skill (non-technical): development of clinical judgment, identification of care needs and potential problems in order to develop actions that help solve problems and achieve favorable results for the patient in the management of DVT related to the PICC. Attitude: decision making to manage DVT related to PICC.

Index	Scenario 1^{^* * Scenario 1 - Patient assessment and vascular device selection; †Scenario 2 - Identification and management of deep vein thrombosis.}	Scenario 2^†
Objectives
Consistency of content with objectives	1.00	1.00
Clear and concise learning objectives	0.81	1.00
Content facilitates critical thinking	1.00	1.00
Problem resolution	1.00	1.00
Expected results	1.00	0.90
Objectives instigate changes in professional behavior and attitude	1.00	1.00
Structure/Presentation
Support provided to the candidate	1.00	1.00
Target Audience	1.00	0.90
Educational Practice	1.00	1.00
Scenario fidelity	0.81	0.90
Clues	0.90	0.90
Debriefing	0.90	0.90
briefing	0.90	1.00
Case summary	1.00	0.90
Script	0.81	0.81
Materials and equipment	0.90	1.00
Check list	1.00	0.90
Scenario title	1.00	0.90
Scientifically correct information	1.00	0.90
Logical sequence of content	1.00	1.00
Information covers content on Infusion Therapy	1.00	1.00
Appropriate script for nurses	1.00	0.90
Language that is easy for the target audience to understand	1.00	1.00
Attractive view of the scenery	1.00	1.00
Data presented in a structured and objective way	1.00	1.00
Relevance
Important content for the quality of care provided	1.00	1.00
Form of presentation contributes to the learning of nurses	1.00	1.00
Contextual details provide clues based on desired outcomes	1.00	1.00
Patient profile provides sufficient data for clinical judgment	1.00	1.00
Scenario allows the transfer of knowledge in relation to the topic	1.00	1.00
Theme portrays key aspects in relation to clinical practice	1.00	1.00
Model allows learning in different contexts	0.90	0.90
Roadmap proposes the construction of knowledge	1.00	1.00
Use by healthcare professionals and/or educators	1.00	1.00
Scenarios can circulate in the scientific community of the area	1.00	1.00
General evaluation indicators
Adequacy of the intervention for the development of clinical judgment on the subject	1.00	1.00
Feasibility of the intervention	1.00	1.00
Adequacy of the intervention with undergraduate students	1.00	1.00
Adequacy of the intervention at the level of specialization	1.00	1.00

Items	Degree of agreement^* * Likert scale: 1-5 - Degree of agreement: 1 - I totally disagree with the statement; 2- I disagree with the statement; 3 - Undecided-neither agree nor disagree with the statement; 4 - I agree with the statement; 5 - I totally agree with the statement; NA - Not applicable when it does not concern the simulated activity. Degree of importance: 1- Not important; 2- A little important; 3- Neutral; 4- Important; 5- Very important; †SD - Standard Deviation	Degree of importance^* * Likert scale: 1-5 - Degree of agreement: 1 - I totally disagree with the statement; 2- I disagree with the statement; 3 - Undecided-neither agree nor disagree with the statement; 4 - I agree with the statement; 5 - I totally agree with the statement; NA - Not applicable when it does not concern the simulated activity. Degree of importance: 1- Not important; 2- A little important; 3- Neutral; 4- Important; 5- Very important; †SD - Standard Deviation
Items	Mean^* * Likert scale: 1-5 - Degree of agreement: 1 - I totally disagree with the statement; 2- I disagree with the statement; 3 - Undecided-neither agree nor disagree with the statement; 4 - I agree with the statement; 5 - I totally agree with the statement; NA - Not applicable when it does not concern the simulated activity. Degree of importance: 1- Not important; 2- A little important; 3- Neutral; 4- Important; 5- Very important; †SD - Standard Deviation (SD^†)	Mean (SD)
Factor 1 - Active learning	4.85 (0.32)	4.50 (0.10)
Factor 2 - Collaboration	5.00 (0.00)	4.63 (0.00)
Factor 3 - Different ways of learning	5.00 (0.00)	4.63 (0.00)
Factor 4 - High Expectations	5.00 (0.00)	4.50 (0.00)
Total score	4.96 (0.08)	4.56 (0.07)

Items	Scenario 1		Scenario 2
Items	Degree of agreement Mean^* * Likert scale: 1-5 - Degree of agreement: 1 - I totally disagree with the statement; 2- I disagree with the statement; 3 - Undecided-neither agree nor disagree with the statement; 4 - I agree with the statement; 5 - I totally agree with the statement; NA - Not applicable when it does not concern the simulated activity. Degree of importance: 1- Not important; 2- A little important; 3- Neutral; 4- Important; 5- Very important; †SD - Standard Deviation (SD^†)	Degree of importance Mean (SD)	Degree of agreement Mean^* * Likert scale: 1-5 - Degree of agreement: 1 - I totally disagree with the statement; 2- I disagree with the statement; 3 - Undecided-neither agree nor disagree with the statement; 4 - I agree with the statement; 5 - I totally agree with the statement; NA - Not applicable when it does not concern the simulated activity. Degree of importance: 1- Not important; 2- A little important; 3- Neutral; 4- Important; 5- Very important; †SD - Standard Deviation (SD)	Degree of importance Mean (SD)
Factor 1 - Objectives and information	4.75 (0.07)	4.80 (0.23)	4.75 (0.09)	4.80 (0.14)
Factor 2 - Support	4.81 (0.07)	4.91 (0.12)	4.81 (0.07)	4.91 (0.12)
Factor 3 - Problem Solving	4.73 (0.06)	4.75 (0.09)	4.80 (0.07)	4.93 (0.17)
Factor 4 - Feedback/Reflection	4.75 (0.00)	4.84 (0.12)	4.88 (0.00)	4.93 (0.17)
Factor 5 - Realism	4.63 (0.00)	4.75 (0.00)	4.75 (0.00)	4.75 (0.00)
Total score	4.73 (0.07)	4.81 (0.07)	4.80 (0.05)	4.86 (0.08)

[1] Corresponding author: Mariana de Jesus Meszaros, E-mail: meszaros@unicamp.br

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Clinical simulation scenarios for the planning and management of infusion therapy by nurses

Escenarios de simulación clínica para la planificación y gestión de la terapia de infusión por enfermeras

ABSTRACT

Objective:

Methods:

Conclusion: