Development of clinical competence in nursing in simulation: the perspective of Bloom’s taxonomy

Nascimento, Juliana da Silva Garcia; Siqueira, Tainá Vilhar; Oliveira, Jordana Luiza Gouvêa de; Alves, Mateus Goulart; Regino, Daniela da Silva Garcia; Dalri, Maria Celia Barcellos

doi:10.1590/0034-7167-2020-0135

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Brasil

Revista Brasileira de Enfermagem

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Brasil

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Sumário

REVIEW • Rev. Bras. Enferm. 74 (1) • 2021 • https://doi.org/10.1590/0034-7167-2020-0135 copy

Development of clinical competence in nursing in simulation: the perspective of Bloom’s taxonomy

Desarrollo de la competencia clínica en enfermería por simulación: perspectiva de la taxonomia de Bloom

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Objectives:

to investigate the scientific evidence on the use of Bloom’s taxonomy for developing competence in nursing professionals and students in clinical simulation.

Methods:

integrative review of the National Library of Medicine (NLM), National Institutes of Health (NIH), Cumulative Index to Nursing and Allied Health Literature (CINAHL), Latin American and Caribbean Literature in Health Sciences (LILACS), Web of Science and SCOPUS databases, using the Rayyan application.

Results:

a total of 871 studies were identified; four composed the sample. The development of clinical competence occurred through the coordination of knowledge, skills, and attitudes. To develop the cognitive domain, the objectives of knowledge and comprehension of the Bloom’s taxonomy were mobilized. The psychomotor domain required development of the skills demanded by the proposed clinical care. The affective domain was developed through will and motivation to learn.

Conclusions:

it is possible to develop clinical competence in nursing by adopting Bloom’s taxonomy in each phase of clinical simulation.

Descriptors:
Education, Nursing; Simulation Training; Clinical Competence; Learning; Classification

Database	Descriptors and keywords	Search strategy
PubMed^® and SCOPUS	MeSH "Nursing"; "Simulation Training"; "Clinical Competence"; keywords: "Bloom taxonomy"	(Nursing OR Nursings AND "Simulation Training" OR "Training, Simulation" OR "Interactive Learning" OR "Learning, Interactive" AND "Bloom taxonomy" AND "Clinical Competence" OR "Competency, Clinical" OR "Competence, Clinical" OR "Clinical Competency" OR "Clinical Competencies" OR "Competencies, Clinical" OR "Clinical Skill" OR "Skill, Clinical" OR "Skills, Clinical" OR "Clinical Skills")
CINAHL	"Students, Nursing"; Nurses; Simulations; "Clinical Competence" keywords: "Bloom Taxonomy"	"Students, Nursing" AND Nurses AND Simulations AND "Bloom Taxonomy" AND "Clinical Competence" OR "Nursing Skills"
LILACS	DeCS "Students, Nursing"; Nurses; Simulation; "Clinical Competence" keywords: "Bloom Taxonomy" and its versions in Portuguese and Spanish	"Students, Nursing" AND Nurses AND Simulation AND "Bloom taxonomy" AND "Clinical Competence" "Estudiantes de Enfermería" AND "Enfermeras y Enfermeros" AND Simulación AND "Taxonomía de Bloom" AND "Competencia Clínica" "Estudantes de Enfermagem" AND "Enfermeiras e Enfermeiros" AND Simulação AND "Taxonomia de Bloom" AND "Competência Clínica"
Web of Science	Nursing; "Simulation Training"; "Clinical Competence"; keywords: "Bloom Taxonomy"	TS=(Nursing AND Simulation* Training* AND Bloom* Taxonomy* AND Clinical* Competence*)

Reference and language	Objectives	Method	Results/Conclusion/Level of evidence
Negri et al.⁽¹⁵15 Negri EC, Pereira Jr GA, Cotta Filho CK, Franzon JC, Mazzo A. Construction and validation of simulated scenario for nursing care to colostomy patients. Texto Contexto Enferm. 2019;28:e20180199. doi: 10.1590/1980-265X-TCE-2018-0199 https://doi.org/10.1590/1980-265X-TCE-20... ⁾ Portuguese	To create and validate a high-fidelity clinical simulation scenario on nursing care for patients with a colostomy, using Bloom's taxonomy.	A descriptive study on creating and establishing face and content validity of a high-fidelity clinical simulation scenario for nursing care of colostomy patients. The scenario was constructed based on Bloom's taxonomy and, after it was structured, it was tested by a group of third- and fourth-year nursing students in a clinical simulation laboratory of a public university.	The clinical simulation scenario was properly validated and was able to identify relevant contributions to adjust the simulated activity and to test the debriefing, with the support of a checklist. The results show that Bloom's taxonomy contributes to the success in the development of knowledge, skills, and attitudes in nursing. Level of evidence 6.
Founds et al.⁽¹⁶16 Founds SA, Zewe G, Scheuer LA. Development of high-fidelity simulated clinical experiences for baccalaureate nursing students. J Prof Nurs. 2011;27(1):5-9. doi: 10.1016/j.profnurs.2010.09.002 https://doi.org/10.1016/j.profnurs.2010.... ⁾ English	To develop simulated high-fidelity clinical experiences for nursing students on prepartum obstetric scenarios, using Bloom's taxonomy.	A descriptive study, conducted at the University of Pittsburgh School of Nursing. A group of professors developed a protocol with several scenarios for clinical simulation using Bloom's taxonomy.	Nursing professors developed and evaluated the execution protocol for clinical simulation using Bloom's taxonomy for the development of cognitive, psychomotor, and affective skills of the students, considered elements for the development of clinical competence in nursing. It was concluded that this model can facilitate the process for other people who wish to explore simulation as an educational method in nursing. Level of evidence 6.
Simkins et al.⁽¹⁷17 Simkins IL, Jaroneski LA. Integrated simulation: a teaching strategy to prepare prelicensure nursing students for professional practice-the students' perspective. Teach Learn Nurs. 2016;11: 15-9. doi: 10.1016/j.teln.2015.08.003 https://doi.org/10.1016/j.teln.2015.08.0... ⁾ English	To develop a teaching strategy to prepare nursing students for professional practice, by means of clinical simulation using Bloom's taxonomy.	Quasi-experimental study conducted in an American nursing university with second year undergraduate students. Two groups were formed: the first participated in a simulation scenario with a patient with gastrointestinal bleeding; the second had a scenario with a patient with peritonitis.	Both groups developed clinical competence in the proposed scenarios. The students reached the highest-level objectives contained in Bloom's taxonomy, which proved to be a valuable tool for the teaching and learning process. Furthermore, students were satisfied with the simulation. Level of evidence 3.
Krautscheid⁽¹⁸18 Krautscheid LC. Embedding microethical dilemmas in high-fidelity simulation scenarios: preparing nursing students for ethical practice. J Nurs Educ. 2017;56(1):55-8. doi: 10.3928/01484834-20161219-11 https://doi.org/10.3928/01484834-2016121... ⁾ English	To develop and implement, using Bloom's taxonomy, a high-fidelity simulation to solve ethical dilemmas related to nursing.	A descriptive, quantitative study conducted in a nursing school course at an American university.	The students reported that the educational strategy used increased confidence in ethical decision making and the overcoming of fears. Thus, the simulation assisted by Bloom's taxonomy goes beyond the improvement of the cognitive and psychomotor domains, also improving the affective ability of the students. Level of evidence 6.

Clinical simulation phases
Bloom's taxonomy domains	First phase - Preparation (divided into pre-simulation and prebriefing/briefing)	Second phase - Participation (execution of the simulated scenario)	Third phase - Debriefing (reflection of the experience)
Cognitive domain: actions in a hierarchical order, from minor to major complexity for learning: knowledge, comprehension, application, analysis, synthesis, and evaluation.	Pre-simulation: (1) Knowledge: memorize the contents previously received; (2) Comprehension: print the meaning of the contents; interpret the knowledge acquired on the subject of simulation. Prebriefing/briefing: (1) Knowledge: memorize the contents previously sent; (2) Comprehension: print meaning to the contents, interpret the knowledge acquired⁽¹⁵15 Negri EC, Pereira Jr GA, Cotta Filho CK, Franzon JC, Mazzo A. Construction and validation of simulated scenario for nursing care to colostomy patients. Texto Contexto Enferm. 2019;28:e20180199. doi: 10.1590/1980-265X-TCE-2018-0199 https://doi.org/10.1590/1980-265X-TCE-20... ^-¹⁶16 Founds SA, Zewe G, Scheuer LA. Development of high-fidelity simulated clinical experiences for baccalaureate nursing students. J Prof Nurs. 2011;27(1):5-9. doi: 10.1016/j.profnurs.2010.09.002 https://doi.org/10.1016/j.profnurs.2010.... ⁾.	1) Comprehension: print meaning, interpret knowledge; (2) Application: use the learning in the scenario; (3) Analysis: analyze the elements, facts, events, and postures⁽¹⁵15 Negri EC, Pereira Jr GA, Cotta Filho CK, Franzon JC, Mazzo A. Construction and validation of simulated scenario for nursing care to colostomy patients. Texto Contexto Enferm. 2019;28:e20180199. doi: 10.1590/1980-265X-TCE-2018-0199 https://doi.org/10.1590/1980-265X-TCE-20... ^-¹⁶16 Founds SA, Zewe G, Scheuer LA. Development of high-fidelity simulated clinical experiences for baccalaureate nursing students. J Prof Nurs. 2011;27(1):5-9. doi: 10.1016/j.profnurs.2010.09.002 https://doi.org/10.1016/j.profnurs.2010.... ⁾.	(1) Knowledge: memorizing and retaining of knowledge; (2) Comprehension: printing, meaning, interpreting knowledge; (3) Synthesis: articulating with the adopted theoretical reference; (4) Application: transferring knowledge to real situations; (5) Analysis: analyzing elements, facts, events, and postures; (6) Evaluating: evaluating weak and strong points, what is taken to practice⁽¹⁵15 Negri EC, Pereira Jr GA, Cotta Filho CK, Franzon JC, Mazzo A. Construction and validation of simulated scenario for nursing care to colostomy patients. Texto Contexto Enferm. 2019;28:e20180199. doi: 10.1590/1980-265X-TCE-2018-0199 https://doi.org/10.1590/1980-265X-TCE-20... ⁾.
Psychomotor domain - actions in a hierarchical order, from minor to major complexity for learning: perceiving, obtaining conducted response, automating, obtaining complex response, adapting, and organizing.		(1) Perceiving: recognizing the essential movements related to the proposed simulation; (2) Obtaining conducted response: developing a technical skill; (3) Mechanism: performing the skill automatically; (4) Obtaining complex response: obtaining agility and motor coordination; (5) Adapting: improvising movements (knowing how to act coherently and technically); (6) Organizing: acting spontaneously according to the acquired skill⁽¹⁵15 Negri EC, Pereira Jr GA, Cotta Filho CK, Franzon JC, Mazzo A. Construction and validation of simulated scenario for nursing care to colostomy patients. Texto Contexto Enferm. 2019;28:e20180199. doi: 10.1590/1980-265X-TCE-2018-0199 https://doi.org/10.1590/1980-265X-TCE-20... 16 Founds SA, Zewe G, Scheuer LA. Development of high-fidelity simulated clinical experiences for baccalaureate nursing students. J Prof Nurs. 2011;27(1):5-9. doi: 10.1016/j.profnurs.2010.09.002 https://doi.org/10.1016/j.profnurs.2010.... ^-¹⁷17 Simkins IL, Jaroneski LA. Integrated simulation: a teaching strategy to prepare prelicensure nursing students for professional practice-the students' perspective. Teach Learn Nurs. 2016;11: 15-9. doi: 10.1016/j.teln.2015.08.003 https://doi.org/10.1016/j.teln.2015.08.0... ⁾.
Affective domain - actions in hierarchical order, from minor to major complexity for learning: receptivity, response, valuing, organization, and internalization of values	Pre-simulation: (1) Receptivity: willingness and attention to learning; (2) Response: participate actively and with satisfaction Pre-briefing/briefing: (1) Receptivity: willingness and attention to learning; (2) Response: participating actively and satisfactorily⁽¹⁵15 Negri EC, Pereira Jr GA, Cotta Filho CK, Franzon JC, Mazzo A. Construction and validation of simulated scenario for nursing care to colostomy patients. Texto Contexto Enferm. 2019;28:e20180199. doi: 10.1590/1980-265X-TCE-2018-0199 https://doi.org/10.1590/1980-265X-TCE-20... 16 Founds SA, Zewe G, Scheuer LA. Development of high-fidelity simulated clinical experiences for baccalaureate nursing students. J Prof Nurs. 2011;27(1):5-9. doi: 10.1016/j.profnurs.2010.09.002 https://doi.org/10.1016/j.profnurs.2010.... 17 Simkins IL, Jaroneski LA. Integrated simulation: a teaching strategy to prepare prelicensure nursing students for professional practice-the students' perspective. Teach Learn Nurs. 2016;11: 15-9. doi: 10.1016/j.teln.2015.08.003 https://doi.org/10.1016/j.teln.2015.08.0... ^-¹⁸18 Krautscheid LC. Embedding microethical dilemmas in high-fidelity simulation scenarios: preparing nursing students for ethical practice. J Nurs Educ. 2017;56(1):55-8. doi: 10.3928/01484834-20161219-11 https://doi.org/10.3928/01484834-2016121... ⁾.	Participation: (1) Receptivity: willingness and attention to learning; (2) Response: participating actively and satisfactorily⁽¹⁵15 Negri EC, Pereira Jr GA, Cotta Filho CK, Franzon JC, Mazzo A. Construction and validation of simulated scenario for nursing care to colostomy patients. Texto Contexto Enferm. 2019;28:e20180199. doi: 10.1590/1980-265X-TCE-2018-0199 https://doi.org/10.1590/1980-265X-TCE-20... 16 Founds SA, Zewe G, Scheuer LA. Development of high-fidelity simulated clinical experiences for baccalaureate nursing students. J Prof Nurs. 2011;27(1):5-9. doi: 10.1016/j.profnurs.2010.09.002 https://doi.org/10.1016/j.profnurs.2010.... ^-¹⁷17 Simkins IL, Jaroneski LA. Integrated simulation: a teaching strategy to prepare prelicensure nursing students for professional practice-the students' perspective. Teach Learn Nurs. 2016;11: 15-9. doi: 10.1016/j.teln.2015.08.003 https://doi.org/10.1016/j.teln.2015.08.0... ⁾.	Debriefing: (1) Receptivity: willingness and attention to learning; (2) Responding: participating actively and satisfactorily; (3) Valuing: making a commitment to learning; (4) Organization: valuing each learning; (5) Internalization: transferring learning to practice⁽¹⁵15 Negri EC, Pereira Jr GA, Cotta Filho CK, Franzon JC, Mazzo A. Construction and validation of simulated scenario for nursing care to colostomy patients. Texto Contexto Enferm. 2019;28:e20180199. doi: 10.1590/1980-265X-TCE-2018-0199 https://doi.org/10.1590/1980-265X-TCE-20... 16 Founds SA, Zewe G, Scheuer LA. Development of high-fidelity simulated clinical experiences for baccalaureate nursing students. J Prof Nurs. 2011;27(1):5-9. doi: 10.1016/j.profnurs.2010.09.002 https://doi.org/10.1016/j.profnurs.2010.... 17 Simkins IL, Jaroneski LA. Integrated simulation: a teaching strategy to prepare prelicensure nursing students for professional practice-the students' perspective. Teach Learn Nurs. 2016;11: 15-9. doi: 10.1016/j.teln.2015.08.003 https://doi.org/10.1016/j.teln.2015.08.0... ^-¹⁸18 Krautscheid LC. Embedding microethical dilemmas in high-fidelity simulation scenarios: preparing nursing students for ethical practice. J Nurs Educ. 2017;56(1):55-8. doi: 10.3928/01484834-20161219-11 https://doi.org/10.3928/01484834-2016121... ⁾.

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[1] Corresponding author: Juliana da Silva Garcia Nascimento. E-mail: mestradounesp28@yahoo.com.br