THE PRACTICE OF REALISTIC SIMULATION IN NURSING EDUCATION 1 MARTINELLO, Daniela Faustino Gonçalves 2 ; NICOLA, Glaucia Dal Omo 3 ; KERBER, Nalú Pereira da Costa 4 ; VAGHETTI, Helena Heidtmann 5 ; MENDES, Daniel Pinho 6 ; TERRA, Alessandra Chaves 7 ; VIDAL, Danielle 8 ; ILHA, Silomar 9 ABSTRACT The objective was to describe the experience of the realistic simulation practical application in a Southern State University. This activity occurred in the discipline of Women's Health Care and the scenario represented a postpartum home visit. During the activity, the selected group performed interview, physical examination and guidelines for the postpartum woman, corresponding to the Protocol of Actions check-list previously prepared. It is concluded that realistic simulation is a viable activity at any University, since, even with lack of enviromental resources and appropriate humans, it was successful. Descriptors: Malingering; Education, Nursing, Diploma Programs ; Teaching Materials 1. INTRODUCTION 1 Research work. Universidade Federal do Rio Grannde (FURG). 2 Oral presenter. Nurse. Master s degree of Nursing from PPGEnf FURG. Rio Grande, RS, Brasi. Email: daneti86@gmail.com. 3 Nurse. Master s degree of Nursing from PPGEnf FURG. Rio Grande, RS, Brasil 4 Doctor. Teaching at Nursing School of the Universidade Federal do Rio Grande (FURG), Rio Grande, RS, Brasil 5 Doctor. Teaching at Nursing School of the Universidade Federal do Rio Grande (FURG), Rio Grande, RS, Brasil 6 Nurse. Master s degree of Nursing from PPGEnf FURG. Rio Grande, RS, Brasil 7 Nurse. Master s degree of Nursing from PPGEnf FURG. Rio Grande, RS, Brasil 8 Nurse. Master s degree of Nursing from PPGEnf FURG. Rio Grande, RS, Brasil 9 Nurse. Master s degree of Nursing from PPGEnf FURG. Rio Grande, RS, Brasil 1
The connection between nursing and simulation is historical, and there are evidences of this connection since the beginning of the 20th century, where mannequins were developed to portray the care process to the human being. In spite of the great inicial distance between simulated and real environment, this teaching system became popular and was globally inserted in the academical curriculum. (1) Researchers and teachers in the health field noted the need to improve these teaching techniques, presenting new theories for their applicability and for conduction to learning through a more reliable and realistic perspective. Thus, the rebuilt and updated simulation had its traditional concept redesigned, being recognized as a set of techniques developed in order to recreate, in a broad and substitutive way, a functional and therapeutic space that allows the apprentice participation. (2) Nurses and other health professionals need to avoid errors of conduct to the most, as humans are the object of their actions. Therefore, the realistic simulation allows the trainee to previously practice his performance, which may lead to failures but, through discussion (debriefing), he can reformulate his conduct successfully. (3) The realistic simulation may contribute to bring more confidence to the future nurses posture, who will make decisions in a strategically planned way for individuals and families benefit. (4) In addition to these aspects, this approach brings great contributions to the teaching-learning process, since student and teacher will be more satisfied, as the firt tests his knowledge in advance, and the second may check his expository-dialogued classes progress and and effectiveness. Realistic simulation applicability is evident in some high technology learning environments, like the Albert Einstein Hospital s Realistic Simulation Center, where simulators, mannequins and actors are inserted in a structure called "virtual hospital". When the students step into this environment, they experience the patient hospitalization moment, having contact with these and all related social environment, in various problem situations. (5) Considering the public university inherent reality and characteristics, it was created a project which envisions the applicability of realistic simulation in this context. It was entitled "The realistic simulation designed as a nursing graduation teaching qualifier and as a retention and failure prevention" and aims to qualify the theoretical and methodological bases of nursing graduation with a focus on the academical students decisions making in practice situations under different health contexts. 2
1.1. Objetive This experience report aims to describe the first practical application experience of the realistic simulation project in a course of the Nursing School curricular estructure, in Rio Grande s Federal University - FURG. 2. METHODOLOGY The human resources used were students of Rio Grande s Federal University (FURG) Graduate in Nursing / Health. To enable them for the activity, there were two workshops taught by a actors teacher and by the responsible teacher for the project, about acting techniques, and deepening the knowledge about the method. The problematized content in the experience emerged of the Nursing Care in Women's Health class, part of the curricular structure of the Nursing Graduation Pedagogical Project in the mentioned university Nursing School. This is taught in fourth grade and covers, inter alia, promotion, prevention and recovery of women's health, from conception to menopause. The material resources were manufactured by Graduate students, which had an arsenal in the university aimed to Health s Education activities. However, there was a need to buy some external artifacts, to ensure greater reliability to the real event guided by the simulation. The realistic scenario makes the student performance easier, practicing communication, teamwork and humanistic approach of care. (6) The selection of the theme, characters, story and scenario emerged from three Graduate students group planning, who were responsible for the task along with the professor in charge of the class. Thus, the chosen content was "Puerperal Home Visit" performed by nurses in a similar context to the social environment more prevalent among puerperal women from our region suburb. To complement the puerperal woman physical details, common pathologies were portrayed, such as areola notch and dehiscence in episiotomy. Therefore, the plot should propitiate the interview, the cephalocaudal physical examination, the implementation of policies, procedures and specific nursing techniques, the 3
therapeutic communication, the interpersonal relationship, the health education, etc.. The contact with reality before the practical acting favors the development of these skills, creating security for future performance with the patient. (6) 3. RESULTS One of the Graduate students was in charge of the observation, using a previously conceived Protocol of Actions, which included aspects that should necessarily be tackled by the students. Alongside other notes, this person collected facts to support future discussion. The other two members of the groups acted in the problem-situation using the material resources to portray the puerperal woman in her home and the community agent. Also participants, the class was divided in groups: four acted in the simulation, four observed and took notes, and the rest watched the course and the colleagues performance with a critical look. All the groups showed interest, and it was noticed varied reactions before the staging. The immediate acting group successfully achieved the meeting goal, taking part in the plot in a active and participatory way, bringing up the adaption to the new familiar dinamic, giving to the puerperal woman means to her autonomy, her selfcare and selfconfidence. Lastly, the class was organized, along the responsable professor, in a circle to do the debriefing. This moment propitiated the other students to show their point of views, and also enabled the problematization of the theoretical aspects, the interconnection with reality, the report of the flaws and suggestions for better conducts. It was observed, as well, aspects of the verbal and non-verbal communication and the empathy, which are matters of tough practical visualization, where the actors have referred their feelings before the interaction with the students, suggesting more efficient methods. 4. CONCLUDING REMARKS The realistic simulation first performance was considered positive in the professor perspective, who finds means to problematize future practice activities matters, and also in the student perspective, who finds in this activity an opportunity to practice and test his 4
learning. The project acceptance was evident in both sides, since they manifested interest to do a future activity. Concerning the unprofessional human resources, it was noted that the replacement for nurses actors doesn t jeopardize the simulation success since they are trained. This professionals already experienced various real situations, what can be considered a factor that facilitates a reliable portray, particularly if they take part in the characters development. The phisycal resources needs were supplied with the creativity in the manufacturing of the materials alongside the imagination of all the simulation participants, creating an enviroment with features very close to reality. So, it appears that this activity is practicable in any local reality, and it may help as an instrument in the students lessons, in spite of the structural conditions. Together with the researches development and increase in this area, it is hoped that the realistic simulation activity can be explored in inumerous realities and problemssituations, so the practice may be improved, and, thus, emphasised in the brazilian curricular structure. The simulation makes the academic learning process more dinamic, and also stimulates the student in his decisions towards different practical cenarios, in educative, assitencial and managerial aspects. REFERENCES 1 Vieira RQ; Caverni LMR. Manequim de Simulação Humana no Laboratório de Enfermagem: uma revisão de literatura. [on line]. 2011. Disponível em: http://www.abennacional.org.br/centrodememoria/here/n3vol1artigo7.pdf 2 Gaba D. The future vision of simulation in health care. Quality and Safety in Health Care, v. 13, n.1, p. 2-10, 2004. 3 Jeffries PR.; Mcneilis AM; Wheeler CA. Simulation as a vehicle for enhancing collaborative practice models. Crit Care Nurs Clin N Am.; v.20, p. 471-80, 2008. 4 Busanello J et al. Participação da mulher no processo decisório no ciclo gravídicopuerperal: revisão integrativa do cuidado de enfermagem. Rev. Gaúcha Enferm., v. 32, n. 4, 2011 5
5 Hospital Albert Einstein. Centro de Simulação Realística. 2011. Disponível em http://www.einstein.br/ensino/paginas/centro-de-simulacao-realistica.aspx 6 Fonseca AS et al. Criação e implantação do Centro de Simulação Realística do Centro de Aprimoramento Profissional de Enfermagem: relato de experiência. Revista Nursing, v. 154, p. 156-160, 2011. 6