Simulación clínica para la enseñanza de la asistencia al paciente con herida

relato de experiencia sobre dos escenarios de simulación para asistencia de enfermería al paciente con heridas aplicados a estudiantes de enfermería. Se han estructurado simulaciones en el modelo del National League for Nursing / Jeffries Simulation Framework. Se evaluaron los escenarios por el instrumento Simulation Design Scale y los académicos por la experiencia con la simulación.

Resultado:

los escenarios reprodujeron situaciones de atención, con aplicación de role play y moulage, que permitieron evaluar y discutir el tratamiento de la herida. Las reflexiones en el debriefing fueron importantes para el proceso de enseñanza-aprendizaje y asociación entre teoría y práctica, factores que determinaron satisfacción de los alumnos con la actividad.

Conclusión:

el uso de escenarios de simulación clínica en la enseñanza de estudiantes de enfermería favoreció el raciocinio clínico y la toma de decisión en la evaluación y tratamiento de heridas.

Descriptors:
Enseñanza; Educación en Enfermería; Simulación; Heridas y Lesiones; Cicatrización de Heridas

Time	Actions expected from the nurse (participant)	Role Play
0-4 min	Surveying the patient history	Provides relevant data to the clinical history of the patient (several femur fractures, bedridden, hip fracture, pain when manipulated), fasting for surgery, difficulty to mobilize.
04-10 min	Clinical reasoning considering the data collected - risk of developing new pressure injuries. Evaluation of the wound and its characteristics	May provide the dimensions of the wound (12 × 10 × 5 cm) and the presence of detachment of the borders, this can confirm that the wound presents a great amount of serosanguineous exudate (if the students ask) and the lower edge of the wound is macerated.
10-15 min	Interventions to be made (change of decubitus, use of cushions and supports for mobilization) Wound treatment (topical therapy to be used, protection of the edges to avoid maceration, filling the detachment), frequency of bandage change.

Time	Actions expected from the nurse (participant)	Patient (role play)
0-4 min	- Presentation - Handwashing - Performing anamnesis - Physical examination	- Refers to the wound for three years - Mentions pain in the limb - Mentions that the limb is swollen - Mentions that a vascular specialist stated that limb perfusion is normal - Mentions that has been changing the bandage once a day using essential fatty acids - Mentions that the wound is presenting a large amount of strong-smelling secretion - Mentions that is feeling anxiety
04-10 min	- Evaluation of the characteristics of the wound - Clinical reasoning to determine the etiology of the wound	- Mentions that the skin around the wound is increasingly hardened and dry - Expresses concern due to noticing increased redness in the skin around the wound - Mentions that the yellow tissue at the bed of the wound is increasing
10-15 min	- Determining the topical therapy (concluding that the wound is probably infected) - Performing debridement interventions on the wound (conservative debridement) - Guiding the patient to change the bandage twice a day (10% papain for enzymatic debridement) - Guiding the patient to use compression stockings (refer the patient to the medic for the prescription of compression therapy)	- States that is understanding the guidelines - If necessary, will provide clues to assist the student in clinical reasoning

Associação Brasileira de Enfermagem SGA Norte Quadra 603 Conj. "B" - Av. L2 Norte 70830-102 Brasília, DF, Brasil, Tel.: (55 61) 3226-0653, Fax: (55 61) 3225-4473 - Brasília - DF - Brazil
E-mail: reben@abennacional.org.br

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[1] CORRESPONDING AUTHOR: Ana Railka de Souza Oliveira-Kumakura E-mail: arailka@unicamp.br

Objectives	General: To develop clinical reasoning in wound evaluation and apply the appropriate therapy. Specific: - Investigate the characteristics of the patient - Evaluate the wound - Choose the treatment - Guide the nurse responsible for the care
Fidelity	High-fidelity using role play
Problem Solving	High complexity of the case, with relevant information for the students to interpret, give meaning to the data and provide an appropriate response, such as: - Survey the patient's history (what led to the development of this wound) - Evaluation of the characteristics of the wound - Implementation of interventions to prevent new injuries and promote the wound healing process (change of decubitus, elevation of the headboard to 30°) - Implementation of the appropriate topical therapy
Clues	- Long period of immobilization (bedridden at home) - Prolonged fasting for surgery - Pain when being manipulated - Very nervous nurse
Debriefing	Feelings Stage: How did you felt guiding the nurse that would treat this patient? Descriptive Stage: Could you describe the clinical picture of the patient? Evaluation Stage: What good actions did you perform? Analytical Stage: What would you do differently if you had another chance? Conclusive Stage: What did you draw from this learning experience for your future clinical practice?

Objectives	General: To develop clinical reasoning on the evaluation and treatment of a patient with venous ulcer. Specific: - Investigate the patient history - Evaluate the wound - Implement the actions proposed - Guide the patient about wound care in home environment
Fidelity	High-fidelity using Role play
Problem Solving	Moderate complexity of the case, with relevant information for the students to interpret, give meaning to the data and provide an appropriate response, such as: - Identify the etiology of the wound by surveying the patient's history, physical examination and evaluation of the characteristics of the wound; - Define the proper treatment; - Guide the patient about the bandage at home.
Clues	- The presence of an edema in the lower limb which improves after being raised - Presence of pain at the site of the wound - Varicose veins in the limb - Lipodermatosclerosis - Normal limb perfusion (large arterial pulses, capillary filling < 2 s, normal skin coloration) - Anxious patient
Debriefing	Feelings Stage: How did you feel caring for this patient? Descriptive Stage: Could you describe the clinical picture of the patient? Evaluation Stage: What good actions did you perform? Analytical Stage: What would you do differently if you had another chance? Conclusive Stage: What did you draw from this learning experience for your future clinical practice?