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Clinical simulation in nursing education in intensive therapy: an integrative review

Simulación clínica en la educación en enfermería en terapia intensiva: revisión integradora

ABSTRACT

Objective:

to analyze the publications on clinical simulation practices for education in Nursing in Intensive Care.

Method:

an integrative review carried out through LILACS, PubMed, Cochrane Library, CINAHL and SciELO databases, of articles published from 2008 to 2017.

Results:

29 articles were selected, of which 76% discuss the use of simulation in continuing education of nursing professionals, while the others describe their use for student education. There is a higher prevalence of studies with a level of evidence 6 (17), with 28 international publications. There was an increase in scientific production, with 16 articles published in the last three years.

Conclusion:

variables after simulation use, such as confidence, communication skills, efficiency in the identification of clinical worsening of patients, development of technical skills, teamwork and clinical decision-making, presented a significant improvement, demonstrating that this tool is effective in qualifying care for critical patients.

Descriptors:
Nursing; Nursing Education; Patient Simulation; Simulation Training; Critical Care

RESUMEN

Objetivo:

analizar las publicaciones sobre prácticas de simulación clínica para la educación en Enfermería en Terapia Intensiva.

Método:

revisión integradora realizada en la biblioteca LILACS, PubMed, Cochrane Library, CINAHL y SciELO, de artículos publicados de 2008 a 2017.

Resultados:

se seleccionaron 29 artículos. 76% abordaran el uso de la simulación en la educación continuada de profesionales de enfermería, mientras que los demás describen su uso para la educación de estudiantes. Hay una prevalencia más grande de estudios con nivel de evidencia 6 (17), siendo 28 publicaciones a nivel internacional. Se verificó una creciente en la producción científica, siendo 16 artículos publicados en los tres últimos años.

Conclusión:

las variables, después del uso de la simulación, como confianza, habilidad de comunicación, eficiencia en la identificación del empeoramiento clínico de pacientes, desarrollo de competencias técnicas, trabajo en equipo y toma de decisión clínica presentaron un perfeccionamiento significativo, demostrando que esa herramienta es efectiva en la calificación de la asistencia a pacientes críticos.

Descriptores:
Enfermería; Simulación; Simulación de Paciente; Educación en Enfermería; Cuidados Críticos

RESUMO

Objetivo:

analisar as publicações sobre práticas de simulação clínica para a educação em Enfermagem em Terapia Intensiva.

Método:

revisão integrativa realizada através da biblioteca LILACS, PubMed, The Cochrane Library, CINAHL e SciELO, de artigos publicados de 2008 a 2017.

Resultados:

foram selecionados 29 artigos. 76% abordaram o uso da simulação na educação continuada de profissionais de enfermagem, enquanto os outros descrevem seu uso para a educação de estudantes. Há uma maior prevalência de estudos com nível de evidência 6 (17), sendo 28 publicações em âmbito internacional. Verificou-se uma crescente na produção científica, sendo 16 artigos publicados nos três últimos anos.

Conclusão:

as variáveis, após o uso da simulação, como confiança, habilidade de comunicação, eficiência na identificação da piora clínica de pacientes, desenvolvimento de competências técnicas, trabalho em equipe e tomada de decisão clínica, apresentaram um aperfeiçoamento significativo, demonstrando que essa ferramenta é efetiva na qualificação da assistência a pacientes críticos.

Descritores:
Enfermagem; Simulação; Simulação de Paciente; Educação em Enfermagem; Cuidados Críticos

INTRODUCTION

Nursing care, related to safe and effective care, demands interpretation of human responses accurately, selection of appropriate interventions and evaluation of the results achieved(11 Mendonça S, Basto ML, Ramos A. Nurse's strategies of clinical reasoning in critical care: a systematic review of literature. RIASE Online. 2017;2(3):692-709. doi: http://dx.doi.org/10.24902/r.riase.2016.2(3).754
http://dx.doi.org/10.24902/r.riase.2016....
), in other words, the use of clinical reasoning as a fundamental tool for the nurses’ work, which must be developed from undergraduate and, permanently, in Health Education(22 Harmon MM, Thompson C. Clinical reasoning in pre-licensure nursing students. Teach Learn Nurs. 2015;10(2):63-70. doi: https://doi.org/10.1016/j.teln.2014.12.001
https://doi.org/10.1016/j.teln.2014.12.0...
). In this context, the development of clinical reasoning for an accurate practice should be intrinsically related to the use of different teaching strategies in the course of vocational training(33 Carvalho EC, Oliveira-Kumakura ARS, Morais SCRV. Clinical reasoning in nursing: teaching strategies and assessment tools. Rev Bras Enferm. 2017;70(3):662-8. doi: https://doi.org/10.1590/0034-7167-2016-0509
https://doi.org/10.1590/0034-7167-2016-0...
).

In the scope of active teaching methodologies in Health, the clinical simulation is highlighted(44 Aebersold M, Tschannen D, Bathish M. Innovative simulation strategies in education. Nurs Res Practice. 2012;2012:1-7. doi: https://doi.org/10.1155/2012/765212
https://doi.org/10.1155/2012/765212...
). Simulation represents a technology used to recreate real life situations, being a vehicle for generating clinical reasoning(55 Barreto DG, Silva KGN, Moreira SSCR, Silva TS, Magro MCS. [Realistic simulation as a teaching strategy: an integrative review]. Rev Baiana Enferm[Internet]. 2014 [cited 2018 Jan 23];28(2):208-14. Available from: https://portalseer.ufba.br/index.php/enfermagem/article/viewFile/8476/8874 Portuguese.
https://portalseer.ufba.br/index.php/enf...
). This tool has demonstrated effectiveness in the development of critical thinking(66 Negri EC, Mazzo A, Martins JCA, Pereira GA Jr, Almeida RGS, Pedersoli CE. Clinical simulation with dramatization: gains perceived by students and health professionals. Rev Lat Am Enferm. 2017;25:e2916. doi: https://doi.org/10.1590/1518-8345.1807.2916
https://doi.org/10.1590/1518-8345.1807.2...
), development of skills(77 Martins JCA, Mazzo A, Baptista RCN, Coutinho VRD, Godoy S, Mendes IAC, et al. The simulated clinical experience in nursing education: a historical review. Acta Paul Enferm. 2012;25(4):619-25. doi: https://doi.org/10.1590/S0103-21002012000400022
https://doi.org/10.1590/S0103-2100201200...
), decision-making(88 Berragan L. Simulation: an effective pedagogical approach for nursing? Nurse Educ Today. 2011;31(7):660-3. doi: https://doi.org/10.1016/j.nedt.2011.01.019
https://doi.org/10.1016/j.nedt.2011.01.0...
), teamwork and strengthening self-confidence(99 Bensfield LA, Olech MJ, Horsley TL. Simulation for high-stakes evaluation in nursing. Nurse Educ. 2012;37(2):71-4. doi: https://doi.org/10.1097/NNE.0b013e3182461b8c
https://doi.org/10.1097/NNE.0b013e318246...
).

In training of nurses, clinical simulation has been used as an effective and innovative teaching strategy. Through this methodology, nursing students and professionals have learning and training subsidies, having access to an extended relationship between theory and practice in a safe environment(1010 Garbuio CD, Oliveira SRA, Kameo YS, Melo SE, Dalri MCB, Carvalho EC. [Clinical simulation in nursing: experience report on the construction of a scenario]. Rev Enferm UFPE Online. 2016;10(8):3149-55. doi: https://doi.org/10.5205/reuol.9373-82134-1-RV1008201645 Portuguese.
https://doi.org/10.5205/reuol.9373-82134...
). In practice, clinical simulation emerges as a profitable strategy and is capable of increasing teaching-learning technologies, making it possible to carry out important clinical studies within the framework of safe practices, in promotion of ethical attitudes and professional and interdisciplinary responsibility in care for the patient, family and community(1111 Quirós SM, Vargas MAO. Clinical Simulation: a strategy that articulates teaching and research practices in nursing. Texto Contexto Enferm. 2014;23(4):815-6. doi: http://dx.doi.org/10.1590/0104-07072014001200edt
http://dx.doi.org/10.1590/0104-070720140...
).

Intensive Care Unit (ICU) is a highly complex work environment and thus requires professionals with advanced skills to care for critically ill patients(1212 Dieckmann P, Lippert A, Glavia R, Rall M. When things do not go as expected: scenario life savers. Simul Healthc. 2010;5(4):219-25. doi: http://dx.doi.org/10.1097/SIH.0b013e3181e77f74
http://dx.doi.org/10.1097/SIH.0b013e3181...
). Nursing education in intensive care represents a great challenge for students, professors and health professionals. They deal with the complex health situation of the patients in the care setting, and must exercise the articulation of theoretical knowledge with practice, development of capacity for more accurate perception and rapid and informed decision-making(66 Negri EC, Mazzo A, Martins JCA, Pereira GA Jr, Almeida RGS, Pedersoli CE. Clinical simulation with dramatization: gains perceived by students and health professionals. Rev Lat Am Enferm. 2017;25:e2916. doi: https://doi.org/10.1590/1518-8345.1807.2916
https://doi.org/10.1590/1518-8345.1807.2...
). Considering the specificities of this setting, it is the way in which the incorporation of clinical simulation, during the professional training, can increase quality to the care offered by professionals graduating from the undergraduate.

OBJECTIVE

To analyze publications on clinical simulation practices used in Nursing Education in Intensive Care, at national and international level, considering the use and strengthening of this innovative teaching methodology in nursing for the qualification of students and professionals of the field.

METHOD

It is an integrative review of the literature, using a research method used in evidence-based practice, which allows the incorporation of these in clinical practice(1313 Souza MT, Silva MD, Carvalho R. Integrative review: what is it? How to do it? Einstein. 2010;8(1 Pt 1):102-6. doi: http://dx.doi.org/10.1590/S1679-45082010RW1134
http://dx.doi.org/10.1590/S1679-45082010...
). This method has the purpose of gathering and synthesizing research results on a delimited topic or issue, in a systematic and orderly manner, contributing to the deepening of the knowledge of the researched topic(1414 Whittemore R, Knafl K. The integrative review: updated methodology. J Adv Nurs. 2005;52(2):546-53. doi: http://dx.doi.org/10.1111/j.1365-2648.2005.03621.x
http://dx.doi.org/10.1111/j.1365-2648.20...
-1515 Mendes KDS, Silveira RCCP, Galvão CM. [Integrative literature review: a research method to incorporate evidence in health care and nursing]. Texto Contexto Enferm. 2008;17(4):758-64. doi: http://dx.doi.org/10.1590/S0104-07072008000400018 Portuguese.
http://dx.doi.org/10.1590/S0104-07072008...
).

The guiding question of the review, carried out through the PICO strategy(1616 The Joanna Briggs Institute. Reviewers' Manual. Adelaide: JBI [Internet]; 2014 [cited 2018 Jan 21]. Available from: https://wiki.joannabriggs.org/display/MANUAL/Joanna+Briggs+Institute+Reviewer%27s+Manual
https://wiki.joannabriggs.org/display/MA...
) was: how has clinical simulation been used in nursing education directed to Intensive Care? It was considered the strategic PICO, in which the population P, in this study, corresponds to Nursing (professionals and students); I to intervention, considering the clinical simulation in Intensive Care; and CO from context.

In order to answer the research question, a selection of the controlled descriptors related to each of the components of the PICO strategy was carried out, according to the Health Sciences Descriptors (DeCs) and Medical Subject Headings (MeSH). The controlled descriptors and Boolean operators were selected: Nursing students OR Nurse practitioners OR Nursing education OR Professional Education AND Critical care OR Critical care nursing AND Patient Simulation OR Simulation training.

The data were collected through the search of articles indexed in databases and libraries referring to Latin American & Caribbean Literature in Health Sciences (LILACS), National Library of Medicine (PubMed), The Cochrane Library, Scientific Electronic Library Online (SciELO), Cumulative Index to Nursing and Allied Health Literature (CINAHL).

The studies published in national and international journals in full, with indexation in the Portuguese, English and Spanish, publications made between 2008 and 2017, identified by the Boolean descriptors and terms in the title or abstract. Those who did not respond to the question of research and publications focusing on pediatrics were excluded from the study. The flow followed to define the sample of the selected articles is shown in Figure 1.

Figure 1
Sample’s flow

In the data collection, a detailed tool was used containing: title, journal, authors, publication year, objectives, methodology, results and conclusions. After that, the analysis and synthesis of the articles obtained in a descriptive way. For the evaluation of level of evidence of the studies, the Rating System for the Hierarchy of Evidence for Intervention/Treatment Questions scale, provided in Figure 2(1717 Melnyk B, Fineout-Overholt E. Evidence-based practice in nursing and healthcare: a guide to best practice. 2nd. ed. Philadelphia: Lippincott, Williams & Williams; 2011.).

Chart 1
Characterization of articles on clinical simulation in Nursing Education in Intensive Care, published in the period between 2008 and 2017
Chart 2
Characterization of objectives and conclusions of articles on clinical simulation in Nursing Education in Intensive Care, published from 2008 to 2017
Figure 2
Rating System for the Hierarchy of Evidence for Intervention/Treatment Questions Scale

RESULTS

Twenty-nine publications were selected, predominantly English (28), with 11 publications originating in the United States, six in Finland, three in England, two in Canada, two in Norway, two in Australia, one in Spain, one in Spain in Japan and one in Brazil.

Chart 1 shows the profile of the sample studies and Chart 2, the respective objectives and the conclusions of the studies analyzed.

There was a higher prevalence of evidence-based studies 6 (17), followed by level 2 (05), level 3 (04), level 7 (02) and level 1 (01). There is a growing number of scientific production related to the topic, with 16 articles published in the last three years(1818 Crowe S, Ewart L, Derman S. The impact of simulation based education on nursing confidence, knowledge and patient outcomes on general medicine units. Nurse Educ Pract. 2017;29:70-5. doi: http://dx.doi.org/10.1016/j.nepr.2017.11.017
http://dx.doi.org/10.1016/j.nepr.2017.11...

19 Sánchez-Expósito J, Costa CL, Agea JLD, Izquierdo MDC, Rodríguez DJ. Ensuring relational competency in critical care: importance of nursing students' communication skills. Intensive Crit Care Nurs. 2018;44:85-91. doi: http://dx.doi.org/10.1016/j.iccn.2017.08.010
http://dx.doi.org/10.1016/j.iccn.2017.08...

20 Karlsen MW, Gabrielsen AK, Falch AL, Stubberud DG. Intensive care nursing students' perceptions of simulation for learning confirming communication skills: a descriptive qualitative study. Intens Crit Care Nurs. 2017;42:97-104. doi: http://dx.doi.org/10.1016/j.iccn.2017.04.005
http://dx.doi.org/10.1016/j.iccn.2017.04...

21 McRae ME, Chan A, Hulett R, Lee AJ, Coleman B. The effectiveness of and satisfaction with high-fidelity simulation to teach cardiac surgical resuscitation skills to nurses. Intens Crit Care Nurs. 2017;40:64-9. doi: http://dx.doi.org/10.1016/j.iccn.2016.11.001
http://dx.doi.org/10.1016/j.iccn.2016.11...

22 Smith JM, Van Aman MN, Schneiderhahn ME, Edelman R, Ercole PM. Assessment of delirium in intensive care unit patients: educational strategies. J Contin Educ Nurs. 2017;48(5):239-44. doi: http://dx.doi.org/10.3928/00220124-20170418-09
http://dx.doi.org/10.3928/00220124-20170...

23 Jansson MM, Syrjälä HP, Ohtonen PP, Merilainen MH, Kyngäs HA, Ala-Kokko TI. Effects of simulation education on oral care practices: a randomized controlled trial. Nurs Crit Care. 2017;22(3):161-8. doi: http://dx.doi.org/10.1111/nicc.12276
http://dx.doi.org/10.1111/nicc.12276...

24 Jansson MM, Syrjälä HP, Ohtonen PP, Meriläinen MH, Kyngäs HA, Ala-Kokko TI. Longitudinal effects of single-dose simulation education with structured debriefing and verbal feedback on endotracheal suctioning knowledge and skills: a randomized controlled trial. Am J Infect Control. 2017;45(1):83-5. doi: http://dx.doi.org/10.1016/j.ajic.2016.05.032
http://dx.doi.org/10.1016/j.ajic.2016.05...

25 Gordon CJ, Jorm C, Shulruf B, Weller J, Currie J, Lim R, Osomanski A. Development of a self-assessment teamwork tool for use by medical and nursing students. BMC Med Educ. 2016;16(1):218. doi: http://dx.doi.org/10.1186/s12909-016-0743-9
http://dx.doi.org/10.1186/s12909-016-074...

26 Jansson MM, Syrjala HP, Ohtonen PP, Merilainen MH, Kyngas HA, Ala-Kokko TI. Simulation education as a single intervention does not improve hand hygiene practices: a randomized controlled follow-up study. Am J Infect Control. 2016;44(6):625-30. doi: http://dx.doi.org/10.1016/j.ajic.2015.12.030
http://dx.doi.org/10.1016/j.ajic.2015.12...

27 Lavoie P, Cossette S, Pepin J. Testing nursing students' clinical judgment in a patient deterioration simulation scenario: development of a situation awareness instrument. Nurse Educ Today. 2016;38:61-7. doi: http://dx.doi.org/10.1016/j.nedt.2015.12.015
http://dx.doi.org/10.1016/j.nedt.2015.12...

28 Boling B, Pierce MH. The effect of high-fidelity simulation on knowledge and confidence in critical care training: an integrative review. Nurse Educ Pract. 2016;16(1):287-93. doi: http://dx.doi.org/10.1016/j.nepr.2015.10.004
http://dx.doi.org/10.1016/j.nepr.2015.10...

29 Jansson MM, Syrjala HP, Ohtonen PP, Merilainen MH, Kyngas HA, Ala-Kokko TI. Randomized, controlled trial of the effectiveness of simulation education: a 24-month follow-up study in a clinical setting. Am J Infect Control. 2016;44(4):387-93. doi: http://dx.doi.org/10.1016/j.ajic.2015.10.035
http://dx.doi.org/10.1016/j.ajic.2015.10...

30 Tsai AC, Krisciunas GP, Brook C, Gonzalez M, Crimlisk J, Silva J, Grillone GA. Comprehensive emergency airway response team (EART) training and education: impact on team effectiveness, personnel confidence, and protocol knowledge. Ann Otol Rhinol Laryngol. 2016;125(6):457-63. doi: http://dx.doi.org/10.1177/0003489415619178
http://dx.doi.org/10.1177/00034894156191...

31 Alfes CM, Steiner SL, Manacci CF. Critical care transport training: new strides in simulating the austere environment. Air Med J. 2015;34(4):186-7. doi: http://dx.doi.org/10.1016/j.amj.2015.03.006
http://dx.doi.org/10.1016/j.amj.2015.03....

32 Landsperger JS, Williams KJ, Hellervik SM, Chassan CB, Flemmons LN, Davidson SR, et al. Implementation of a medical intensive care unit acute-care nurse practitioner service. Hosp Pract. 2011;39(2):32-9. doi: http://dx.doi.org/10.3810/hp.2011.04.392
http://dx.doi.org/10.3810/hp.2011.04.392...
-3333 Baid H, Hargreaves J. Quality and safety: reflection on the implications for critical care nursing education. Nurs Crit Care. 2015;20(4):174-82. doi: http://dx.doi.org/10.1111/nicc.12182
http://dx.doi.org/10.1111/nicc.12182...
), making up 55% of the searches found in the selected period.

It can be observed in Chart 2 that 34.5% of the studies are referenced to the use of simulation in education on care techniques of nursing activities, such as mechanical ventilation and invasive airway acquisition, cardiopulmonary resuscitation, oral hygiene and airway aspiration, hand hygiene and delirium identification in ICU patients(2121 McRae ME, Chan A, Hulett R, Lee AJ, Coleman B. The effectiveness of and satisfaction with high-fidelity simulation to teach cardiac surgical resuscitation skills to nurses. Intens Crit Care Nurs. 2017;40:64-9. doi: http://dx.doi.org/10.1016/j.iccn.2016.11.001
http://dx.doi.org/10.1016/j.iccn.2016.11...

22 Smith JM, Van Aman MN, Schneiderhahn ME, Edelman R, Ercole PM. Assessment of delirium in intensive care unit patients: educational strategies. J Contin Educ Nurs. 2017;48(5):239-44. doi: http://dx.doi.org/10.3928/00220124-20170418-09
http://dx.doi.org/10.3928/00220124-20170...

23 Jansson MM, Syrjälä HP, Ohtonen PP, Merilainen MH, Kyngäs HA, Ala-Kokko TI. Effects of simulation education on oral care practices: a randomized controlled trial. Nurs Crit Care. 2017;22(3):161-8. doi: http://dx.doi.org/10.1111/nicc.12276
http://dx.doi.org/10.1111/nicc.12276...

24 Jansson MM, Syrjälä HP, Ohtonen PP, Meriläinen MH, Kyngäs HA, Ala-Kokko TI. Longitudinal effects of single-dose simulation education with structured debriefing and verbal feedback on endotracheal suctioning knowledge and skills: a randomized controlled trial. Am J Infect Control. 2017;45(1):83-5. doi: http://dx.doi.org/10.1016/j.ajic.2016.05.032
http://dx.doi.org/10.1016/j.ajic.2016.05...

25 Gordon CJ, Jorm C, Shulruf B, Weller J, Currie J, Lim R, Osomanski A. Development of a self-assessment teamwork tool for use by medical and nursing students. BMC Med Educ. 2016;16(1):218. doi: http://dx.doi.org/10.1186/s12909-016-0743-9
http://dx.doi.org/10.1186/s12909-016-074...
-2626 Jansson MM, Syrjala HP, Ohtonen PP, Merilainen MH, Kyngas HA, Ala-Kokko TI. Simulation education as a single intervention does not improve hand hygiene practices: a randomized controlled follow-up study. Am J Infect Control. 2016;44(6):625-30. doi: http://dx.doi.org/10.1016/j.ajic.2015.12.030
http://dx.doi.org/10.1016/j.ajic.2015.12...
,2929 Jansson MM, Syrjala HP, Ohtonen PP, Merilainen MH, Kyngas HA, Ala-Kokko TI. Randomized, controlled trial of the effectiveness of simulation education: a 24-month follow-up study in a clinical setting. Am J Infect Control. 2016;44(4):387-93. doi: http://dx.doi.org/10.1016/j.ajic.2015.10.035
http://dx.doi.org/10.1016/j.ajic.2015.10...

30 Tsai AC, Krisciunas GP, Brook C, Gonzalez M, Crimlisk J, Silva J, Grillone GA. Comprehensive emergency airway response team (EART) training and education: impact on team effectiveness, personnel confidence, and protocol knowledge. Ann Otol Rhinol Laryngol. 2016;125(6):457-63. doi: http://dx.doi.org/10.1177/0003489415619178
http://dx.doi.org/10.1177/00034894156191...
-3131 Alfes CM, Steiner SL, Manacci CF. Critical care transport training: new strides in simulating the austere environment. Air Med J. 2015;34(4):186-7. doi: http://dx.doi.org/10.1016/j.amj.2015.03.006
http://dx.doi.org/10.1016/j.amj.2015.03....
,3636 Jansson MM, Ala-Kokko TI, Ohtonen PP, Meriläinen MH, Syrjälä HP, Kyngäs HA. Human patient simulation education in the nursing management of patients requiring mechanical ventilation: a randomized, controlled trial. Am J Infect Control. 2014;42(3):271-6. doi: http://dx.doi.org/10.1016/j.ajic.2013.11.023
http://dx.doi.org/10.1016/j.ajic.2013.11...
).

About training, 76% of the articles(1818 Crowe S, Ewart L, Derman S. The impact of simulation based education on nursing confidence, knowledge and patient outcomes on general medicine units. Nurse Educ Pract. 2017;29:70-5. doi: http://dx.doi.org/10.1016/j.nepr.2017.11.017
http://dx.doi.org/10.1016/j.nepr.2017.11...
,2121 McRae ME, Chan A, Hulett R, Lee AJ, Coleman B. The effectiveness of and satisfaction with high-fidelity simulation to teach cardiac surgical resuscitation skills to nurses. Intens Crit Care Nurs. 2017;40:64-9. doi: http://dx.doi.org/10.1016/j.iccn.2016.11.001
http://dx.doi.org/10.1016/j.iccn.2016.11...

22 Smith JM, Van Aman MN, Schneiderhahn ME, Edelman R, Ercole PM. Assessment of delirium in intensive care unit patients: educational strategies. J Contin Educ Nurs. 2017;48(5):239-44. doi: http://dx.doi.org/10.3928/00220124-20170418-09
http://dx.doi.org/10.3928/00220124-20170...

23 Jansson MM, Syrjälä HP, Ohtonen PP, Merilainen MH, Kyngäs HA, Ala-Kokko TI. Effects of simulation education on oral care practices: a randomized controlled trial. Nurs Crit Care. 2017;22(3):161-8. doi: http://dx.doi.org/10.1111/nicc.12276
http://dx.doi.org/10.1111/nicc.12276...

24 Jansson MM, Syrjälä HP, Ohtonen PP, Meriläinen MH, Kyngäs HA, Ala-Kokko TI. Longitudinal effects of single-dose simulation education with structured debriefing and verbal feedback on endotracheal suctioning knowledge and skills: a randomized controlled trial. Am J Infect Control. 2017;45(1):83-5. doi: http://dx.doi.org/10.1016/j.ajic.2016.05.032
http://dx.doi.org/10.1016/j.ajic.2016.05...

25 Gordon CJ, Jorm C, Shulruf B, Weller J, Currie J, Lim R, Osomanski A. Development of a self-assessment teamwork tool for use by medical and nursing students. BMC Med Educ. 2016;16(1):218. doi: http://dx.doi.org/10.1186/s12909-016-0743-9
http://dx.doi.org/10.1186/s12909-016-074...
-2626 Jansson MM, Syrjala HP, Ohtonen PP, Merilainen MH, Kyngas HA, Ala-Kokko TI. Simulation education as a single intervention does not improve hand hygiene practices: a randomized controlled follow-up study. Am J Infect Control. 2016;44(6):625-30. doi: http://dx.doi.org/10.1016/j.ajic.2015.12.030
http://dx.doi.org/10.1016/j.ajic.2015.12...
,2828 Boling B, Pierce MH. The effect of high-fidelity simulation on knowledge and confidence in critical care training: an integrative review. Nurse Educ Pract. 2016;16(1):287-93. doi: http://dx.doi.org/10.1016/j.nepr.2015.10.004
http://dx.doi.org/10.1016/j.nepr.2015.10...

29 Jansson MM, Syrjala HP, Ohtonen PP, Merilainen MH, Kyngas HA, Ala-Kokko TI. Randomized, controlled trial of the effectiveness of simulation education: a 24-month follow-up study in a clinical setting. Am J Infect Control. 2016;44(4):387-93. doi: http://dx.doi.org/10.1016/j.ajic.2015.10.035
http://dx.doi.org/10.1016/j.ajic.2015.10...

30 Tsai AC, Krisciunas GP, Brook C, Gonzalez M, Crimlisk J, Silva J, Grillone GA. Comprehensive emergency airway response team (EART) training and education: impact on team effectiveness, personnel confidence, and protocol knowledge. Ann Otol Rhinol Laryngol. 2016;125(6):457-63. doi: http://dx.doi.org/10.1177/0003489415619178
http://dx.doi.org/10.1177/00034894156191...

31 Alfes CM, Steiner SL, Manacci CF. Critical care transport training: new strides in simulating the austere environment. Air Med J. 2015;34(4):186-7. doi: http://dx.doi.org/10.1016/j.amj.2015.03.006
http://dx.doi.org/10.1016/j.amj.2015.03....

32 Landsperger JS, Williams KJ, Hellervik SM, Chassan CB, Flemmons LN, Davidson SR, et al. Implementation of a medical intensive care unit acute-care nurse practitioner service. Hosp Pract. 2011;39(2):32-9. doi: http://dx.doi.org/10.3810/hp.2011.04.392
http://dx.doi.org/10.3810/hp.2011.04.392...

33 Baid H, Hargreaves J. Quality and safety: reflection on the implications for critical care nursing education. Nurs Crit Care. 2015;20(4):174-82. doi: http://dx.doi.org/10.1111/nicc.12182
http://dx.doi.org/10.1111/nicc.12182...

34 Gundrosen S, Solligard E, Aadahl P. Team competence among nurses in an intensive care unit: the feasibility of in situ simulation and assessing non-technical skills. Intensive Crit Care Nurs. 2014;30(6):312-7. doi: http://dx.doi.org/10.1016/j.iccn.2014.06.007
http://dx.doi.org/10.1016/j.iccn.2014.06...

35 Calhoun AW, Boone MC, Dauer AK, Campbell DR, Montgomery VL. Using simulation to investigate the impact of hours worked on task performance in an intensive care unit. Am J Crit Care. 2014;23(5):387-95. doi: http://dx.doi.org/10.4037/ajcc2014756
http://dx.doi.org/10.4037/ajcc2014756...

36 Jansson MM, Ala-Kokko TI, Ohtonen PP, Meriläinen MH, Syrjälä HP, Kyngäs HA. Human patient simulation education in the nursing management of patients requiring mechanical ventilation: a randomized, controlled trial. Am J Infect Control. 2014;42(3):271-6. doi: http://dx.doi.org/10.1016/j.ajic.2013.11.023
http://dx.doi.org/10.1016/j.ajic.2013.11...

37 Alinier G, Platt A. International overview of high-level simulation education initiatives in relation to critical care. Nurs Crit Care. 2014;19(1):42-9. doi: http://dx.doi.org/10.1111/nicc.12030
http://dx.doi.org/10.1111/nicc.12030...

38 Abe Y, Kawahara C, Yamashina A, Tsuboi R. Repeated scenario simulation to improve competency in critical care: a new approach for nursing education. Am J Crit Care. 2013;22(1):33-40. doi: http://dx.doi.org/10.4037/ajcc2013229
http://dx.doi.org/10.4037/ajcc2013229...
-3939 Jansson M, Kääriäinen M, Kyngäs H. Effectiveness of simulation-based education in critical care nurses' continuing education: a systematic review. Clin Simul Nurs. 2013;9(9):e355-e360. doi: https://doi.org/10.1016/j.ecns.2012.07.003
https://doi.org/10.1016/j.ecns.2012.07.0...
,4343 Shannon SE, Long-Sutehall T, Coombs M. Conversations in end-of-life care: communication tools for critical care practitioners. Nurs Crit Care. 2011;16(3):124-30. doi: http://dx.doi.org/10.1111/j.1478-5153.2011.00456.x
http://dx.doi.org/10.1111/j.1478-5153.20...

44 Cato D, Murray M. Use of simulation training in the intensive care unit. Crit Care Nurs Q [Internet]. 2010;33(1):44-51. doi: http://dx.doi.org/10.1097/CNQ.0b013e3181c8dfd4
http://dx.doi.org/10.1097/CNQ.0b013e3181...

45 Barbosa SFF, Marin HF. Web-based simulation: a tool for teaching critical care nursing. Rev Latino-Am Enfermagem. 2009;17(1):7-13. doi: http://dx.doi.org/10.1590/S0104-11692009000100002
http://dx.doi.org/10.1590/S0104-11692009...
-4646 Bahouth MN, Esposito-Herr MB. Orientation program for hospital-based nurse practitioners. Advanced Critical Care. 2009;20(1):82-90. doi: http://dx.doi.org/10.1097/NCI.0b013e3181945422
http://dx.doi.org/10.1097/NCI.0b013e3181...
) discuss the use of simulation in continuing education of nursing professionals, while the other studies describe the use of simulation for the education of nursing students(1919 Sánchez-Expósito J, Costa CL, Agea JLD, Izquierdo MDC, Rodríguez DJ. Ensuring relational competency in critical care: importance of nursing students' communication skills. Intensive Crit Care Nurs. 2018;44:85-91. doi: http://dx.doi.org/10.1016/j.iccn.2017.08.010
http://dx.doi.org/10.1016/j.iccn.2017.08...
-2020 Karlsen MW, Gabrielsen AK, Falch AL, Stubberud DG. Intensive care nursing students' perceptions of simulation for learning confirming communication skills: a descriptive qualitative study. Intens Crit Care Nurs. 2017;42:97-104. doi: http://dx.doi.org/10.1016/j.iccn.2017.04.005
http://dx.doi.org/10.1016/j.iccn.2017.04...
,2525 Gordon CJ, Jorm C, Shulruf B, Weller J, Currie J, Lim R, Osomanski A. Development of a self-assessment teamwork tool for use by medical and nursing students. BMC Med Educ. 2016;16(1):218. doi: http://dx.doi.org/10.1186/s12909-016-0743-9
http://dx.doi.org/10.1186/s12909-016-074...
,2727 Lavoie P, Cossette S, Pepin J. Testing nursing students' clinical judgment in a patient deterioration simulation scenario: development of a situation awareness instrument. Nurse Educ Today. 2016;38:61-7. doi: http://dx.doi.org/10.1016/j.nedt.2015.12.015
http://dx.doi.org/10.1016/j.nedt.2015.12...
,4040 Mistry V. Critical care training: using twitter as a teaching tool. Br J Nurs. 2011;20(20):1292-6. doi: http://dx.doi.org/10.12968/bjon.2011.20.20.1292
http://dx.doi.org/10.12968/bjon.2011.20....

41 Mould J, White H, Gallagher R. Evaluation of a critical care simulation series for undergraduate nursing students. Contemp Nurse. 2011;38(1-2):180-90. doi: http://dx.doi.org/10.5172/conu.2011.38.1-2.180
http://dx.doi.org/10.5172/conu.2011.38.1...
-4242 Ruth-Sahd LA, Schneider MA, Strouse A. Fostering cultural and interdisciplinary awareness with "low-tech" simulation in a fundamentals nursing course to prepare student nurses for critical care clinical rotations. Dimens Crit Care Nurs. 2011; 30(5):263-8. doi: http://dx.doi.org/10.1097/DCC.0b013e318227717e
http://dx.doi.org/10.1097/DCC.0b013e3182...
).

A study deals with the professional qualification for air transportation of critical patients through simulation(3131 Alfes CM, Steiner SL, Manacci CF. Critical care transport training: new strides in simulating the austere environment. Air Med J. 2015;34(4):186-7. doi: http://dx.doi.org/10.1016/j.amj.2015.03.006
http://dx.doi.org/10.1016/j.amj.2015.03....
) and another study presents simulation setting for evaluating the effectiveness of nursing care and the time spent in each critical care task(3535 Calhoun AW, Boone MC, Dauer AK, Campbell DR, Montgomery VL. Using simulation to investigate the impact of hours worked on task performance in an intensive care unit. Am J Crit Care. 2014;23(5):387-95. doi: http://dx.doi.org/10.4037/ajcc2014756
http://dx.doi.org/10.4037/ajcc2014756...
).

DISCUSSION

The use of clinical simulation for training and qualification in Nursing related to care for critical patients has been of international interest; however, it is little studied in Brazil. This active teaching methodology has been shown to be effective for the qualification of ICU care in several countries(1818 Crowe S, Ewart L, Derman S. The impact of simulation based education on nursing confidence, knowledge and patient outcomes on general medicine units. Nurse Educ Pract. 2017;29:70-5. doi: http://dx.doi.org/10.1016/j.nepr.2017.11.017
http://dx.doi.org/10.1016/j.nepr.2017.11...
,3232 Landsperger JS, Williams KJ, Hellervik SM, Chassan CB, Flemmons LN, Davidson SR, et al. Implementation of a medical intensive care unit acute-care nurse practitioner service. Hosp Pract. 2011;39(2):32-9. doi: http://dx.doi.org/10.3810/hp.2011.04.392
http://dx.doi.org/10.3810/hp.2011.04.392...
-3333 Baid H, Hargreaves J. Quality and safety: reflection on the implications for critical care nursing education. Nurs Crit Care. 2015;20(4):174-82. doi: http://dx.doi.org/10.1111/nicc.12182
http://dx.doi.org/10.1111/nicc.12182...
,3737 Alinier G, Platt A. International overview of high-level simulation education initiatives in relation to critical care. Nurs Crit Care. 2014;19(1):42-9. doi: http://dx.doi.org/10.1111/nicc.12030
http://dx.doi.org/10.1111/nicc.12030...
-3838 Abe Y, Kawahara C, Yamashina A, Tsuboi R. Repeated scenario simulation to improve competency in critical care: a new approach for nursing education. Am J Crit Care. 2013;22(1):33-40. doi: http://dx.doi.org/10.4037/ajcc2013229
http://dx.doi.org/10.4037/ajcc2013229...
,4242 Ruth-Sahd LA, Schneider MA, Strouse A. Fostering cultural and interdisciplinary awareness with "low-tech" simulation in a fundamentals nursing course to prepare student nurses for critical care clinical rotations. Dimens Crit Care Nurs. 2011; 30(5):263-8. doi: http://dx.doi.org/10.1097/DCC.0b013e318227717e
http://dx.doi.org/10.1097/DCC.0b013e3182...
,4444 Cato D, Murray M. Use of simulation training in the intensive care unit. Crit Care Nurs Q [Internet]. 2010;33(1):44-51. doi: http://dx.doi.org/10.1097/CNQ.0b013e3181c8dfd4
http://dx.doi.org/10.1097/CNQ.0b013e3181...
), training professionals and students in technical and non-technical skills, being a considerable tool for the qualification of care. It should be noted that most publications present a setting of exclusive training of professional nurses, not nursing staff. However, the evaluated abilities of the nurses cover the practices of the nursing team in care in Brazil, with this methodology being able to be considered for the improvement not only of the professional nurse, but also of the team in which it is integrated, being applicable to this heterogeneous group.

Among the skills required for nurses working in ICU, effective communication with staff and families has been an educational challenge. A study(1919 Sánchez-Expósito J, Costa CL, Agea JLD, Izquierdo MDC, Rodríguez DJ. Ensuring relational competency in critical care: importance of nursing students' communication skills. Intensive Crit Care Nurs. 2018;44:85-91. doi: http://dx.doi.org/10.1016/j.iccn.2017.08.010
http://dx.doi.org/10.1016/j.iccn.2017.08...
) revealed through simulation setting that the communication skills of nursing students working together with critical patients are deficient, since these patients demonstrate interest in technologies and clinical complexities. On the other hand, when working in isolation, student communication improved after a specific course using the simulation methodology(2020 Karlsen MW, Gabrielsen AK, Falch AL, Stubberud DG. Intensive care nursing students' perceptions of simulation for learning confirming communication skills: a descriptive qualitative study. Intens Crit Care Nurs. 2017;42:97-104. doi: http://dx.doi.org/10.1016/j.iccn.2017.04.005
http://dx.doi.org/10.1016/j.iccn.2017.04...
). For nursing professionals, the training for the mobilization of communication skills was also effective, ensuring nurses the security to communicate adequately in their care routine, reducing harm to patients and increasing the satisfaction of family and staff(4343 Shannon SE, Long-Sutehall T, Coombs M. Conversations in end-of-life care: communication tools for critical care practitioners. Nurs Crit Care. 2011;16(3):124-30. doi: http://dx.doi.org/10.1111/j.1478-5153.2011.00456.x
http://dx.doi.org/10.1111/j.1478-5153.20...
).

Another variable evaluated and improved through ICU simulation was the development of critical thinking for accurate and efficient clinical decision-making. Simulation provides an environment that allows intensive care nurses the opportunity to explore and develop critical thinking in situations of patient worsening in a controlled and safe environment, increasing their knowledge and confidence(1818 Crowe S, Ewart L, Derman S. The impact of simulation based education on nursing confidence, knowledge and patient outcomes on general medicine units. Nurse Educ Pract. 2017;29:70-5. doi: http://dx.doi.org/10.1016/j.nepr.2017.11.017
http://dx.doi.org/10.1016/j.nepr.2017.11...
). In this context, simulation is more effective for learning than the first contact with the real critical situation, because it allows for the error and application of positive and negative feedback, giving nurses experience, security and ease of decision-making in real assistance situations, as well as improving ICU outcomes(2828 Boling B, Pierce MH. The effect of high-fidelity simulation on knowledge and confidence in critical care training: an integrative review. Nurse Educ Pract. 2016;16(1):287-93. doi: http://dx.doi.org/10.1016/j.nepr.2015.10.004
http://dx.doi.org/10.1016/j.nepr.2015.10...
). Thus, simulation becomes an indicated methodology to reach the increase in the quality of care and safety of critical patients(3333 Baid H, Hargreaves J. Quality and safety: reflection on the implications for critical care nursing education. Nurs Crit Care. 2015;20(4):174-82. doi: http://dx.doi.org/10.1111/nicc.12182
http://dx.doi.org/10.1111/nicc.12182...
), in the sense of better preparing the professional to use his skills in the management of critical patients.

On the development of technical skills, such as knowledge, self-confidence and application of the technique itself, can be evaluated and improved through clinical simulation. Studies were performed considering the assistance of nurses in cardiac surgery resuscitation(2121 McRae ME, Chan A, Hulett R, Lee AJ, Coleman B. The effectiveness of and satisfaction with high-fidelity simulation to teach cardiac surgical resuscitation skills to nurses. Intens Crit Care Nurs. 2017;40:64-9. doi: http://dx.doi.org/10.1016/j.iccn.2016.11.001
http://dx.doi.org/10.1016/j.iccn.2016.11...
), application of a tool to assess delirium in ICU(2222 Smith JM, Van Aman MN, Schneiderhahn ME, Edelman R, Ercole PM. Assessment of delirium in intensive care unit patients: educational strategies. J Contin Educ Nurs. 2017;48(5):239-44. doi: http://dx.doi.org/10.3928/00220124-20170418-09
http://dx.doi.org/10.3928/00220124-20170...
), knowledge and application of oral care(2323 Jansson MM, Syrjälä HP, Ohtonen PP, Merilainen MH, Kyngäs HA, Ala-Kokko TI. Effects of simulation education on oral care practices: a randomized controlled trial. Nurs Crit Care. 2017;22(3):161-8. doi: http://dx.doi.org/10.1111/nicc.12276
http://dx.doi.org/10.1111/nicc.12276...
), endotracheal suctioning skills(2424 Jansson MM, Syrjälä HP, Ohtonen PP, Meriläinen MH, Kyngäs HA, Ala-Kokko TI. Longitudinal effects of single-dose simulation education with structured debriefing and verbal feedback on endotracheal suctioning knowledge and skills: a randomized controlled trial. Am J Infect Control. 2017;45(1):83-5. doi: http://dx.doi.org/10.1016/j.ajic.2016.05.032
http://dx.doi.org/10.1016/j.ajic.2016.05...
), hands hygiene(2626 Jansson MM, Syrjala HP, Ohtonen PP, Merilainen MH, Kyngas HA, Ala-Kokko TI. Simulation education as a single intervention does not improve hand hygiene practices: a randomized controlled follow-up study. Am J Infect Control. 2016;44(6):625-30. doi: http://dx.doi.org/10.1016/j.ajic.2015.12.030
http://dx.doi.org/10.1016/j.ajic.2015.12...
), prevention of complications associated with endotracheal intubation and mechanical ventilation(2929 Jansson MM, Syrjala HP, Ohtonen PP, Merilainen MH, Kyngas HA, Ala-Kokko TI. Randomized, controlled trial of the effectiveness of simulation education: a 24-month follow-up study in a clinical setting. Am J Infect Control. 2016;44(4):387-93. doi: http://dx.doi.org/10.1016/j.ajic.2015.10.035
http://dx.doi.org/10.1016/j.ajic.2015.10...
) and assessment of teamwork in emergency response of the airways(3030 Tsai AC, Krisciunas GP, Brook C, Gonzalez M, Crimlisk J, Silva J, Grillone GA. Comprehensive emergency airway response team (EART) training and education: impact on team effectiveness, personnel confidence, and protocol knowledge. Ann Otol Rhinol Laryngol. 2016;125(6):457-63. doi: http://dx.doi.org/10.1177/0003489415619178
http://dx.doi.org/10.1177/00034894156191...
). The simulation tool was observed as effective for the development of such technical skills and improvement of the professional’s self-confidence(2121 McRae ME, Chan A, Hulett R, Lee AJ, Coleman B. The effectiveness of and satisfaction with high-fidelity simulation to teach cardiac surgical resuscitation skills to nurses. Intens Crit Care Nurs. 2017;40:64-9. doi: http://dx.doi.org/10.1016/j.iccn.2016.11.001
http://dx.doi.org/10.1016/j.iccn.2016.11...
-2222 Smith JM, Van Aman MN, Schneiderhahn ME, Edelman R, Ercole PM. Assessment of delirium in intensive care unit patients: educational strategies. J Contin Educ Nurs. 2017;48(5):239-44. doi: http://dx.doi.org/10.3928/00220124-20170418-09
http://dx.doi.org/10.3928/00220124-20170...
,3030 Tsai AC, Krisciunas GP, Brook C, Gonzalez M, Crimlisk J, Silva J, Grillone GA. Comprehensive emergency airway response team (EART) training and education: impact on team effectiveness, personnel confidence, and protocol knowledge. Ann Otol Rhinol Laryngol. 2016;125(6):457-63. doi: http://dx.doi.org/10.1177/0003489415619178
http://dx.doi.org/10.1177/00034894156191...
,3636 Jansson MM, Ala-Kokko TI, Ohtonen PP, Meriläinen MH, Syrjälä HP, Kyngäs HA. Human patient simulation education in the nursing management of patients requiring mechanical ventilation: a randomized, controlled trial. Am J Infect Control. 2014;42(3):271-6. doi: http://dx.doi.org/10.1016/j.ajic.2013.11.023
http://dx.doi.org/10.1016/j.ajic.2013.11...
) as it promotes to the nurses the application of the technique in a safe environment and as close as possible to the real work environment, allowing the feedback to improve the skill to be used in care. However, even though it is effective for the improvement of technical skills, studies have identified the need for repetition of the simulation activity, since when performed in a single dose it was not effective(2323 Jansson MM, Syrjälä HP, Ohtonen PP, Merilainen MH, Kyngäs HA, Ala-Kokko TI. Effects of simulation education on oral care practices: a randomized controlled trial. Nurs Crit Care. 2017;22(3):161-8. doi: http://dx.doi.org/10.1111/nicc.12276
http://dx.doi.org/10.1111/nicc.12276...
-2424 Jansson MM, Syrjälä HP, Ohtonen PP, Meriläinen MH, Kyngäs HA, Ala-Kokko TI. Longitudinal effects of single-dose simulation education with structured debriefing and verbal feedback on endotracheal suctioning knowledge and skills: a randomized controlled trial. Am J Infect Control. 2017;45(1):83-5. doi: http://dx.doi.org/10.1016/j.ajic.2016.05.032
http://dx.doi.org/10.1016/j.ajic.2016.05...
,2626 Jansson MM, Syrjala HP, Ohtonen PP, Merilainen MH, Kyngas HA, Ala-Kokko TI. Simulation education as a single intervention does not improve hand hygiene practices: a randomized controlled follow-up study. Am J Infect Control. 2016;44(6):625-30. doi: http://dx.doi.org/10.1016/j.ajic.2015.12.030
http://dx.doi.org/10.1016/j.ajic.2015.12...
) and, if not sequential, lost its effect on care after six months(2929 Jansson MM, Syrjala HP, Ohtonen PP, Merilainen MH, Kyngas HA, Ala-Kokko TI. Randomized, controlled trial of the effectiveness of simulation education: a 24-month follow-up study in a clinical setting. Am J Infect Control. 2016;44(4):387-93. doi: http://dx.doi.org/10.1016/j.ajic.2015.10.035
http://dx.doi.org/10.1016/j.ajic.2015.10...
).

In health education, the use of clinical simulation with debriefing is recognized as an essential methodology for the training of health professionals, however, reinforcing the findings of the studies included in the review, the need for continuous use of simulation is present. The practice in a simulation setting, followed by debriefing, promotes learning effectively and the improvement of technical skills, leadership and teamwork, and the debriefing is the closing of the simulation activity from discussion on positive points and points to be improved in the care given for the simulated patient(4747 Taras J, Everett T. Rapid cycle deliberate practice in medical education: a systematic review. Cureus. 2017;9(4):e1180. doi: http://dx.doi.org/10.7759/cureus.1180
http://dx.doi.org/10.7759/cureus.1180...
).

Another applicability of the simulation methodology is focused on the reproduction of critical settings, such as mass service(2525 Gordon CJ, Jorm C, Shulruf B, Weller J, Currie J, Lim R, Osomanski A. Development of a self-assessment teamwork tool for use by medical and nursing students. BMC Med Educ. 2016;16(1):218. doi: http://dx.doi.org/10.1186/s12909-016-0743-9
http://dx.doi.org/10.1186/s12909-016-074...
) and air transport of critical patients(3131 Alfes CM, Steiner SL, Manacci CF. Critical care transport training: new strides in simulating the austere environment. Air Med J. 2015;34(4):186-7. doi: http://dx.doi.org/10.1016/j.amj.2015.03.006
http://dx.doi.org/10.1016/j.amj.2015.03....
). These situations require the aggregation of theoretical and practical knowledge, with traditional education insufficient to enable the development of skills for this assistance. The feasibility of reproduction of these events through clinical simulation promotes professional training, and it is also possible to use them to elaborate and validate protocols of these services(2525 Gordon CJ, Jorm C, Shulruf B, Weller J, Currie J, Lim R, Osomanski A. Development of a self-assessment teamwork tool for use by medical and nursing students. BMC Med Educ. 2016;16(1):218. doi: http://dx.doi.org/10.1186/s12909-016-0743-9
http://dx.doi.org/10.1186/s12909-016-074...
).

As for the process of professional evaluation and quality of care, simulation has been used for this purpose. Studies show that it is possible to select professionals for the ICU and to train them through clinical simulation(3232 Landsperger JS, Williams KJ, Hellervik SM, Chassan CB, Flemmons LN, Davidson SR, et al. Implementation of a medical intensive care unit acute-care nurse practitioner service. Hosp Pract. 2011;39(2):32-9. doi: http://dx.doi.org/10.3810/hp.2011.04.392
http://dx.doi.org/10.3810/hp.2011.04.392...
,3434 Gundrosen S, Solligard E, Aadahl P. Team competence among nurses in an intensive care unit: the feasibility of in situ simulation and assessing non-technical skills. Intensive Crit Care Nurs. 2014;30(6):312-7. doi: http://dx.doi.org/10.1016/j.iccn.2014.06.007
http://dx.doi.org/10.1016/j.iccn.2014.06...
), guaranteeing quality to the services of intensive therapy. This tool is considered of great value for the selection and training of ICU professionals, for the provision of qualified and safe health care, and can be inserted in professional training programs of institutions and in the implementation of teams and new professionals in this sector(4646 Bahouth MN, Esposito-Herr MB. Orientation program for hospital-based nurse practitioners. Advanced Critical Care. 2009;20(1):82-90. doi: http://dx.doi.org/10.1097/NCI.0b013e3181945422
http://dx.doi.org/10.1097/NCI.0b013e3181...
). In addition, it has been used to evaluate the accuracy and time spent on specific nursing tasks(3535 Calhoun AW, Boone MC, Dauer AK, Campbell DR, Montgomery VL. Using simulation to investigate the impact of hours worked on task performance in an intensive care unit. Am J Crit Care. 2014;23(5):387-95. doi: http://dx.doi.org/10.4037/ajcc2014756
http://dx.doi.org/10.4037/ajcc2014756...
), allowing managers to assess the professional competence, technologies used, conformation of care environments, as well as the review of the applied nursing process.

Studies have shown that the use of the Internet to subsidize students and nursing professionals has been used in association with the clinical simulation methodology, with the dissemination of simulation videos on the web(4040 Mistry V. Critical care training: using twitter as a teaching tool. Br J Nurs. 2011;20(20):1292-6. doi: http://dx.doi.org/10.12968/bjon.2011.20.20.1292
http://dx.doi.org/10.12968/bjon.2011.20....
,4545 Barbosa SFF, Marin HF. Web-based simulation: a tool for teaching critical care nursing. Rev Latino-Am Enfermagem. 2009;17(1):7-13. doi: http://dx.doi.org/10.1590/S0104-11692009000100002
http://dx.doi.org/10.1590/S0104-11692009...
). The technological limitation of some institutions, remission time or the need for distance training can be supplied, thus, offering to students who will act in Intensive Therapy settings and video simulation practices, in which it becomes possible to carry out the evaluation of the setting and feedbacks of the conducts carried out, providing a discussion in the classroom and the development of critical thinking, being a gateway to other educational perspectives.

Study limitations

It is highlighted as a limitation of the study not to approach the technological and resource limitations for clinical simulation practices, which would still be a reality in Brazil. Even with the presence of randomized clinical trials, it is necessary to further investigate evidence of this issue in the international and, mainly, national territory.

Contributions to the field of Nursing

The contribution of the present study comes from the compilation of researches already done that demonstrate and evidence the use of clinical simulation in nursing education as an effective teaching methodology, considering it a tool for the qualification of care for critical patients.

CONCLUSIONS

The use of clinical simulation directed at critically ill patients has been used both for the continuing education of nursing teams and in undergraduate nursing education. It was considered an efficient tool for the improvement of the student and the nursing professional. There is a need for this methodology to be applied in a continuous, rather than unique way, so that its results. Variables that were analyzed after the use of simulation, such as confidence, communication skills, efficiency in identifying clinical worsening of patients, development of technical skills, teamwork and clinical decision-making, presented a significant improvement, demonstrating that the tool is effective in qualifying care for critical patients.

It is recommended to apply and expand in the national territory, since universities and health institutions have the subsidies to use this tool. Future research is stimulated in Brazil, evidencing the effectiveness of clinical simulation for the qualification of care for critical patients, increasing the national and international repository.

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Publication Dates

  • Publication in this collection
    19 Aug 2019
  • Date of issue
    Jul-Aug 2019

History

  • Received
    10 May 2018
  • Accepted
    18 Sept 2018
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