Uso de la simulación clínica para mejorar el razonamiento diagnóstico en enfermería

Jerônimo, Ingrid Régia Lopes; Campos, Juliana Faria; Peixoto, Mauricio Abreu Pinto; Brandão, Marcos Antônio Gomes

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RESEARCH • Esc. Anna Nery 22 (3) • 2018 • https://doi.org/10.1590/2177-9465-EAN-2017-0442 copiar

Uso de la simulación clínica para mejorar el razonamiento diagnóstico en enfermería

Autoría SCIMAGO INSTITUTIONS RANKINGS

Resumen

Objetivos:

Proponer una metodología de construcción de escenarios y casos simulados para mejorar el razonamiento diagnóstico de enfermería.

Métodos:

Estudio metodológico con bases teóricas y metodológicas de la Teoría del Doble Proceso para construir casos y escenarios de simulación clínica para el razonamiento diagnóstico de enfermería utilizando correctamente los razonamientos analítico y no analítico.

Resultados y discusión:

Fueron presentados y discutidos aspectos del referencial teórico y elementos operativos: estructura de los escenarios, preparación de la simulación, briefing, debriefing y construcción, incorporando contenidos necesarios. La metodología articula contenido compatible con razonamientos analíticos, no analíticos y mediciones de precisión diagnóstica de estudios de validación clínica.

Conclusión:

Se entiende haber demostrado la factibilidad para construir casos simulados necesarios para el doble proceso del razonamiento diagnóstico de enfermería.

Implicaciones:

Contribución al aprendizaje en ambiente más seguro; adoptando base teórica de estudios de razonamiento humano.

Palabras clave:
Simulación; Diagnóstico de Enfermería; Tecnología Educacional; Métodos; Aprendizaje

OPERATIONALIZATION OF PROPOSED METHODOLOGY
General planning	Purpose, action or recommendation
Define the general objective to be achieved in the simulation	Acquisition of skills and competencies for the nursing diagnostic reasoning guided by the dual processing cognitive system.
Select a learning strategy	Clinical case in a simulated scenario is recommended.
Select the simulator fidelity	The following is recommended: low-, medium- and high-fidelity simulators, simulated patients (actors), simulation in virtual environments or role-playing.
Define specific objectives	Expansion of skills, correction of biases/tendencies of judgment, development of level of expertise, among others.
Plan the construction of cases	Actions: select the central diagnosis of the case, the context or specialty, additional content, and content related to the diagnoses and outcome criteria and results. Use: classification of nursing diagnoses, data documentation and organization system, and current literature with consistent evidence.
Define additional aspects of the case at the moment of simulation	Actions: define the care unit involved, the equipment and devices to be used. Foresee preparation of simulator/simulated patient/environment.
Specific planning	Decision or information required
Select the measurements of sensitivity, specificity, false positive and negative rates of the central diagnosis of the case. For risk diagnosis, odds ratio or relative risk should be used.	Actions: select the highest values, including the confidence intervals of the measurements. For sensitivity and specificity, use values greater than 50%, and for false positive and negative rates, values greater than 20%.
Model 4 scenarios for real diagnoses, and 2 to 3 scenarios for risk diagnoses.	Actions: incorporate accurate and non-accurate indicators to the logical case and clinically articulated to the other case content. Try to construct a case that is close to patterns of clinical reality experienced by the apprentices participating in the simulation.
Development of simulated scenario	Decision or information required
Control scenario duration	The scenarios should last up to 15 minutes.
Manage audiovisual resources	Actions: use audiovisual resources for filming, when available. Use the recorded material for subsequent debriefing.
Observe critical actions	The instructor should pay attention to the critical actions of the participant in the scenario, indicate objectives have been achieved and the scenario can be ended.
Debriefing	Decision or information required
Conduct debriefing	Debriefing should always be guided by previously set learning objectives. The participant should express whether the nursing diagnosis was present or absent and which evidence/data allowed him to make such diagnostic decision. A 30-minute period may be required for this activity.

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[1] Corresponding author: Ingrid Régia Lopes Jerônimo. E-mail: ingridregia@gmail.com