Creation and validation of a high-fidelity simulation scenario for suicide postvention

Pedrollo, Laysa Fernanda Silva; Silva, Aline Conceição; Zanetti, Ana Carolina Guidorizzi; Vedana, Kelly Graziani Giacchero

doi:10.1590/1518-8345.6034.3699

Acessibilidade / Reportar erro

Brasil

Revista Latino-Americana de Enfermagem

Español English

Brasil

Español English

sumário « anterior atual seguinte »

Sumário

Original Article • Rev. Latino-Am. Enfermagem 30 • 2022 • https://doi.org/10.1590/1518-8345.6034.3699 copy

Creation and validation of a high-fidelity simulation scenario for suicide postvention

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Objective

to create and validate a high-fidelity simulation scenario about the initial support to suicide bereaved people.

Method

a methodological research study to create and validate a simulation scenario about postvention. Its creation was based on scientific recommendations, the validation process was carried out by experts, based on an instrument developed by the authors; the data were statistically analyzed using the Content Validity Index and Gwet concordance coefficient.

Results

the scenario was created to provide initial support to suicide bereaved people in the Primary Health Care context. As learning objectives, welcoming, health care and organization monitoring were proposed according to technical-scientific recommendations. The scenario was validated by 10 specialists in the themes of postvention (5 judges) and high-fidelity simulation (5 judges). The scenario items met the acceptance and reliability criteria (Content Validity Index = 0.80) and satisfactory concordance (Gwet coefficient = 0.640).

Conclusion

the study presented in full a scenario on postvention with innovative potential that can be used free of charge in clinical simulation development during training of different categories of health professionals, to act in support of suicide bereaved people.

Descriptors:
Suicide; Bereavement; Mental Health; High Fidelity Simulation Training; Simulation Training; Patient Simulation

Item	Items		CVI^*
Item	Yes n^†	No n^†
Title	10	-	1.00
Objective	10	-	1.00
Target audience	9	1	0.9
Number of participants	9	1	0.9
Physical and material resources	9	1	0.9
Previous study	9	1	0.9
Duration	10	-	1.00
Pre-briefing (contracts and conduction)	10	-	1.00
Pre-briefing (guidelines)	10	-	1.00
Instructions for the simulated patient	10	-	1.00
OSCE^‡	10	-	1.00
OSCE^‡ 1	10	-	1.00
OSCE^‡ 2	9	1	0.9
OSCE^‡ 3	10	-	1.00
OSCE^‡ 4	10	-	1.00
OSCE^‡ 5	10	-	1.00
OSCE^‡ 6	10	-	1.00
OSCE^‡ 7	10	-	1.00
OSCE^‡ 8	10	-	1.00
OSCE^‡ 9	10	-	1.00
OSCE^‡ 10	10	-	1.00
Debriefing - Descriptive Phase	10	-	1.00
Debriefing - Analytical Phase	10	-	1.00
Debriefing - Application Phase	10	-	1.00
References	10	-	1.00

	n^†	AC1^*	SD^‡	CI^§
General	10	0.640	0.060	0.515-0.764
Postvention	05	0.499	0.073	0.347-0.650
High-fidelity simulation	05	0.743	0.071	0.595-0.890

Escola de Enfermagem de Ribeirão Preto / Universidade de São Paulo Av. Bandeirantes, 3900, 14040-902 Ribeirão Preto SP Brazil, Tel.: +55 (16) 3315-3451 / 3315-4407 - Ribeirão Preto - SP - Brazil
E-mail: rlae@eerp.usp.br

Acompanhe os números deste periódico no seu leitor de RSS

[1] Corresponding author
Laysa Fernanda Silva Pedrollo. E-mail: laysa.pedrollo@usp.br

Title of the scenario: Initial support for suicide bereaved people (postvention)
General objective: To develop initial support actions to suicide bereaved people during a home visit.
Target audience of the scenario (scenario participants): Undergraduate students from the health area (having attended some academic discipline related to Mental Health/Psychiatry) and health professionals.
Number of people required to develop the scenario: • Two simulation facilitators (in charge of planning, coordinating and developing the simulated activity); • Two participants (target audience), who took part in the simulated activity; • One simulated patient (who will simulate the person treated in the scenario); • Observers (other participants from the target audience who will externally monitor development of the scenario proposed, as observers of the simulation).
Physical and material resources: • Physical: Teaching or educational practice laboratory, that simulates a living room from a house (depending on the regional context) to conduct a home visit. • Materials: Common objects that make up a domestic environment (living room) depending on the regional context, such as chairs, cushions, rocking hammock, radio or television, glasses, books, pens and decorative objects, among others.
Materials for prior study by participants and observers (provided by the scenario coordinators, via email, for the participants and observers to read in advance): • Previous reading of the booklet entitled “Lidando com o Luto por Suicídio” (“Leading with Suicide Bereavement”). Available in: https://inspiracao-leps.com.br/cartilhas-e-e-books/lidando-com-o-luto/ • Audiovisual support material about the theme of postvention: Interview called “September is the suicide prevention month”, conducted by Rádio Universidade de São Paulo (2018) with PhD Professor Kelly Graziani Giacchero Vedana. Available in: https://jornal.usp.br/atualidades/setembro-e-o-mes-de-prevencao-ao-suicidio/
Estimated duration for each of the scenario stages: 1. Pre-briefing (15 minutes); 2. Simulation (20 minutes); 3. Debriefing (40 minutes).
Pre-briefing (diverse information about contracts and conduction of the simulation): 1. Introduce the environment to the scenario participants; 2. Discuss contracts about emotional safety: secrecy, anonymity, respect and importance of participating in the discussion after the simulation. 3. The following is not foreseen for this simulated case: handoff, reading the user’s medical chart and presentation and/or use of drug prescription.
Pre-briefing (basic guidelines for the simulated case - They can be read and no information should be omitted): This simulation will be developed with the participation of a simulated patient. You are health students/professionals and are in a Basic Health Unit. For today’s activity, you were requested by the health team to carry out a home visit to Mrs. Marta, 44, who lost her son Bruno, 22, due to suicide 3 days ago. You have approximately 20 minutes to perform the initial welcoming of Mrs. Marta, as you need to return to the health service for a team meeting that will discuss users’ cases. Consequently, it is necessary to evaluate the user’s initial needs and implement the required immediate actions. You have to concentrate on the initial welcoming and support actions towards the user in this case (which are important for the individualized therapeutic plan). Immediate postvention support has already been carried out with the user immediately after the death due to suicide and there will be a subsequent follow-up of the user by the Health Unit, which does not need to be fully planned during the scenario. The simulation laboratory will not be subjected to the intervention of people outside the activity, and will be completed by the simulation facilitators when at least one person from the health team leaves the user’s home or at the end of the maximum execution time. Question for the participants and observers: Do you have any doubt about the guidelines and preparation presented?
Instructions for the simulated patient (preparation must be done in the days before the simulation): You will be Mrs. Martha, 44, who lost her 22-year-old son due to suicide 3 days ago. During the simulation, you should address some feelings, sensations and difficulties experienced in the period of mourning, presented in the form of clues, such as: Clues that you will necessarily address in the case: • Unbearable pain and sorrow; • Guilt: “I feel guilty for his death”/“I am to blame for his death, I should’ve done something”; • Anger: “He didn’t think about me, he didn’t think that I’d be left alone”; • Shame: “I don’t want to go out of the house any more, people keep saying things about me”; • Denial and questions related to the death; • “I want to disappear, but not to kill myself”; • Difficulty performing daily activities (self-care); • “People close to me don’t mention my son’s name and don’t want to talk about what happened”. Clues that you will address if you have the possibility/opportunity to do so: • Loneliness and isolation; • Lack of listening and attention from other people; • “The wish to sell my house and move”; • Reporting that the son’s birthday would be next month (birthday-related reactions): “I don’t think I can live that day without him!”; • Reporting that she saw some posts by her son some years ago on the Internet about wanting to die, but she thought he was only kidding with friends. Note: It is necessary for the simulated patient to know the “Structured Objective Clinical Examination” (item below) before the staging, in order to program her clues according to what is expected in the scenario.
Objective Structured Clinical Examination (OSCE^). For each item below, evaluate if the action was performed correctly, using the YES, IN PART or NO options.*
Items evaluated	Assessment
OSCE^* 1: Enable conversation and listening spaces for bereaved people to recognize and express their feelings, experiences and needs, at their own pace and time.	( ) Yes ( ) In part ( ) No
OSCE^* 2: Talk about specifics of suicide bereavement that can generate distress (such as guilt, anger, denial, questioning, loneliness, lack of listening, shame, difficulty approaching what happened, birthday reactions and reductionist explanations about suicide).	( ) Yes ( ) In part ( ) No
OSCE^* 3: Encourage bereaved people to express the need for help and the way in which they want to be helped.	( ) Yes ( ) In part ( ) No
OSCE^* 4: Identify if the bereaved have aid and support to experience mourning, such as a support network.	( ) Yes ( ) In part ( ) No
OSCE^* 5: Guide the bereaved person to seek places and people that make them feel safe and protected, strengthening these supportive relationships in order to avoid isolation due to bereavement (such as family, friends, groups, support groups, among others).	( ) Yes ( ) In part ( ) No
OSCE^* 6: Evaluate the presence of suicidal and/or imitative behaviors in the bereaved.	( ) Yes ( ) In part ( ) No
OSCE^* 7: Encouraged the bereaved to perform self-care and daily activities, by maintaining a healthy routine that promotes well-being.	( ) Yes ( ) In part ( ) No
OSCE^* 8: Instruct the bereaved to avoid making shocking or drastic decisions during mourning.	( ) Yes ( ) In part ( ) No
OSCE^* 9: Avoid telling the person what they need to do, what to say or how to feel.	( ) Yes ( ) In part ( ) No
OSCE^* 10: Develop empathetic and judgment-free listening during the entire initial support provided to the bereaved.	( ) Yes ( ) In part ( ) No
Debriefing based on “The Diamond” model (stage developed after the scenario through three consecutive phases)
Descriptive Phase (Evidence perspectives about what happened in the case, without judging the participants’ performance during simulation): • What happened while offering the initial support to Mrs. Martha? (Question directed to the scenario participants and observers).
Analytical Phase (Evidence perspectives about non-technical skills involved in the simulation that were important for the participants): • How did you feel while offering the initial support to Mrs. Martha? Comment. (Question directed to the scenario participants and observers). • How did you offer the initial support to Mrs. Martha? (Question directed to the observers). • How do you assess your performance in the group work while offering the initial support to Mrs. Martha? (Question directed to the scenario participants). • What positive actions were performed while offering the initial support to Mrs. Martha? (Question directed to the scenario participants and observers).
Application Phase (Evidence perspectives about how the participants may apply this knowledge in their clinical practice): • What would you do differently when facing a new experience of initial support to a suicide bereaved person? (Question directed to the scenario participants). • What can you learn from this experience in the simulation about postvention, and apply it to you professional practice? (Question directed to the scenario participants and observers).