From theory to simulation to teach care for burn victims: case report

Oliveira-Kumakura, Ana Railka de Souza; Silva, Juliany Lino Gomes; Gonçalves, Natália

doi:10.1590/2177-9465-EAN-2017-0391

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EXPERIENCE REPORT • Esc. Anna Nery 22 (3) • 2018 • https://doi.org/10.1590/2177-9465-EAN-2017-0391 copy

From theory to simulation to teach care for burn victims: case report

Desde clases teóricas hasta el uso de la simulación para enseñar el cuidado de las víctimas de quemaduras: reporte de un caso

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Aim:

To report the experience of applying different teaching strategies on undergraduate nursing students caring for burn victims.

Method:

Experience report on the topic, "Nursing care for the patient with burns", for undergraduate nursing student education.

Results:

Teaching strategies during this course involved theoretical lecture, discussion of clinical cases, use of a virtual environment, and practice in a simulated environment. The students reported satisfaction with the tools used.

Conclusion:

It is important to incorporate different active teaching strategies, such as clinical simulation practices, e-learning, classes incorporating dialogue, case studies, and others, for undergraduate nursing education on caring for the burn victim.

Keywords:
Students; Nursing; Burns; Teaching; Simulation

Time	Monitor	Expected actions by the nurse (Participant)	Patient voice
0-8 min	HR = 105 bpm BP = 140/80 mmHg RR = 24 breaths per minute Temp = 98.6ºF Sat = 94%	- Presentation - Patient identification - Handwashing - Conduct patient history and assessment (ABCDE) and monitor the patient - Seek out information (burn context, allergy to any medicine ...?) - Physical examination - Search for prescription - Administer pain scale.	"Nurse, I have too much pain!" "My body is burning!" "Help me! Do something for me." "My pain is level 10." "I burned myself at the time of the barbecue, when I used alcohol to start the fire." "I am allergic to dipyrone."
08-12 min	HR = 115 bpm BP = 146/88 mmHg RR = 26 breaths per minute Temp = 98.6ºF Sat = 92%	- Give pain medication - Assess the wound. - Select the treatment	"What have you done for me?" "What will happen to me?" "I washed with water and ran here." "What will you use on my body? It is burning a lot." "I can smell the burn."
12-15 min	HR = 108 bpm BP = 142/84 mmHg RR = 22 breaths per minute Temp = 98.6ºF Sat = 90%	- Calm the patient - Reassess the pain - Explain the reason for the pain to the patient.	"I still feel pain." "What now?" "I am feeling better." "My pain is now a level 4." "Can I go home now?"

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

Objectives	General objective To perform initial care for burn patients Specific objectives A - To investigate the context of the burn B - To prepare and administer the medication prescribed for pain C - To identify the characteristics of the WOUND D - To select the ideal type of coverage E - To perform therapeutic communication
Fidelity	High fidelity simulation with a high degree of emotional involvement. SimMan 3G manikin with: voice, thoracic expansion, labial cyanosis, opportunity for pulmonary, cardiac and abdominal auscultation, verification of blood pressure, among other skills.
Problem solving	Moderate complexity case, with relevant information for intermediate students to perform initial care and provide an adequate response, for example: • To associate burn history with the need to investigate the situation and make ABCDE (Airway maintenance with cervical spine protection; Breathing and ventilation, Circulation with hemorrhage control, Disability/neurologic assessment, Exposure and environmental control). • To associate the pain symptoms with the type of tissue exposure and the patient's anxiety, and make the decision to administer medication for pain control. • To associate the exposure of superficial, second-degree, deep, and third degree burns with the need for treatment with silver sulfadiazine until patient is stabilized for surgery to debride and graft deeper areas.
Cues	• Presence of pain, in which the patient constantly complains and requests assistance; the participant demonstrates initiative to verify the patient's chart to identify the prescription of an analgesic • Presence of closed dressings on the thigh and arm. • Skin hot to the touch, T = 99.86ºF (axillary). • Allergy to dipyrone
Debriefing	Emotional stage: How did you feel about caring for this patient? Descriptive stage: Could you describe the clinical picture of the patient? Evaluation stage: What were the positive actions you performed? Analytical stage: What would you do differently, if you had another opportunity? Concluding stage: What did you learn from this experience for your future clinical practice?