Teaching of pressure injury prevention and treatment using simulation

The impact of moulage on learners' experience in simulation-based education and training: systematic review

BACKGROUND

Moulage is a technique used to simulate injury, disease, aging and other physical characteristics specific to a scenario, often used in health and emergency worker training, predominantly for simulation-based learning activities. Its use in allied health fields is unclear. Previous work has explored moulage as an adjunct for authentic simulations, however there is opportunity for broadening its scope.

AIM

To explore the effects of moulage interventions in simulation-based education and training, for learner experience. A secondary aim was to understand which pedagogical frameworks were embedded in moulage interventions.

METHOD

Four electronic databases (PubMed, CINAHL, EmBase, Proquest Central) were systematically searched to December 2022 for studies utilising moulage in simulation-based education experiences. Outcomes were focused on learner satisfaction, confidence, immersion, engagement, performance, or knowledge. Study quality was assessed using the Mixed Methods Appraisal Tool.

RESULTS

Twenty studies (n = 11,470) were included. Studies were primarily conducted in medicine (n = 9 studies) and nursing (n = 5 studies) and less frequently across other health disciplines. The findings demonstrated greater learner satisfaction, confidence, and immersion when moulage was used against a comparator group. Minimal improvements in knowledge and performance were identified. One study underpinned the intervention with a pedagogical theory.

CONCLUSION

Moulage improves learner experience in simulation-based education or training, but not knowledge or clinical performance. Further research utilising moulage across a broader range of professions is needed. Interventions using moulage should be underpinned by pedagogical theories.

Simulation-based training in Leprosy: development and validation of a scenario for community health workers

OBJECTIVES

To build and validate a clinical simulation scenario designed to instruct community health workers (CHWs) in active leprosy case detection.

METHODS

Methodological study involving the development of a simulated clinical scenario and content validation by experts. The Content Validity Index (CVI) was used to determine the level of agreement among the judging commitee, and a descriptive analysis of their recommendations was performed.

RESULTS

A simulated scenario with a simulated participant was developed - a simulation characterized by low complexity, moderate physical/environmental fidelity, moderate to high psychological fidelity, and high conceptual fidelity, lasting 50 minutes and capable of training up to 10 CHWs simultaneously. The scenario was validated by 14 experts, with a CVI exceeding 80% for all components.

CONCLUSIONS

The validated clinical simulation possesses attributes that make it highly reproducible in various national health contexts, thereby contributing to the global "Towards Zero Leprosy" strategy.

Cognitive abilities and medical students' practice of physical exams: A quasi-experimental study

BACKGROUND

To highlight the importance of clinical simulations and simulated laboratories for student training, especially in physical examination teaching.

OBJECTIVE

To evaluate the gains obtained by medical students in their cognitive and practical performance of physical examinations (abdominal, cardiological, and pulmonary), as well as satisfaction and self-confidence in what they have learned, after concentrated practice developed in a skills and simulation laboratory.

DESIGN AND SETTING

A quantitative and quasi-experimental study in which 48 students were evaluated at the Faculdade de Odontologia de Bauru, São Paulo, Brazil.

METHODS

A quantitative and descriptive study was conducted with regularly enrolled 2nd year medical students over 18 years of age who had content prior to data collection regarding anamnesis and physical examination remotely taught in a Moodle virtual learning environment. For data collection, the participants were subjected to a concentrated period of skill training (abdominal, cardiological, and pulmonary). Every day after the skill training session, they were subjected to a practical evaluation and completed a theoretical test before and after the practical activities. At the end of all activities, they answered the instrument to assess the simulated practices (self-confidence and satisfaction).

RESULTS

Among the 49 students evaluated, positive and significant theoretical and practical gains were identified in all three components (abdominal, cardiological, and pulmonary) (P = 0.000), as well as in the general evaluation (Theoretical 1 and Theoretical 2) (P = 0.000), satisfaction, and self-confidence (P = 0.000).

CONCLUSION

Concentrated laboratory practice resulted in positive improvements in students' physical examination skills.

Australian First-Year Nursing Student Knowledge and Attitudes on Pressure Injury Prevention: A Three-Year Educational Intervention Survey Study

Pressure injury prevention is a significant issue as pressure injuries are difficult to heal, painful, and create clinical complications for patients. The aim of this study was to investigate knowledge and attitudes of first-year nursing students to pressure injury prevention, and to explore whether additional educational interventions augmented learning. A previously validated online survey was administered to three cohorts of first-year nursing students in 2016, 2017 (after additional online education), and 2018 (after further simulation education), and a subsequent comparative analysis was undertaken. Overall, the knowledge of students about pressure injury was low with measures to prevent pressure injury or shear achieving the lowest score (<50%). Students aged over 25 years (p < 0.001) and men (p = 0.14) gained higher attitude scores. There were significant differences for mean knowledge scores between the 2016 and 2018 cohorts (p = 0.04), including age group (p = 0.013) and number of clinical training units undertaken (p = 0.23). The 2016 cohort scored consistently lower in the attitude survey than both other cohorts (p < 0.001). Online resources and simulation experiences marginally improved knowledge and improved attitudes towards prevention of pressure injury. Nursing curricula should include targeted education to ensure student nurses are adequately prepared to prevent pressure injury through understanding of aetiology and risk assessment.

DESENVOLVIMENTO DE SOFTWARE DA PRESSURE ULCER SCALE FOR HEALING (PUSH): ESTUDO DE INOVAÇÃO

Objetivo:Desenvolver software para avaliação e acompanhamento da lesão por pressão utilizando a pressure ulcer scale for healing (Push). Método:Trata-se de pesquisa metodológica de inovação tecnológica e de desenvolvimento de software. Foi desenvolvido um aplicativo para acompanhamento de lesão por pressão utilizando a Push elaborada pela National Pressure Ulcer Advisor Panel, passando pelo processo de validação de conteúdo. Resultado: Como resultado da primeira etapa, produziu-se uma revisão integrativa, em que foram identificados nove artigos entre os anos de 2012 e 2018. Na segunda etapa ocorreu o processo de construção do aplicativo. Este possui 16 telas, entre elas a escala de Push, o acompanhamento por meio de gráficos e a anamnese. Na terceira etapa houve o processo de validação de conteúdo, com escore geral de 0,95, um valor aceitável para validar um instrumento. Conclusão: Observou-se que o softwareé válido e pode servir de amparo à prática clínica do profissional de enfermagem.

SOFTWARE DEVELOPMENT OF THE PRESSURE ULCER SCALE FOR HEALING (PUSH): AN INNOVATION STUDY

Objective: To develop a software for pressure injury assessment and monitoring using the pressure ulcer scale for healing (PUSH). Method: This is a methodological research of technological innovation and software development. An application was developed to monitor pressure injuries using the PUSH created by National Pressure Ulcer Advisory Panel, and it went through the content validation process. Result: This study resulted in the first stage of an integrative review, in which nine articles were identified between the years 2012 and 2018. In the second stage, the process of building the application took place. It has 16 screens, among them PUSH scale, monitoring through graphics, and anamnesis. In the third stage, the content validation process was carried out, and it was obtained an overall content validity index of 0.95, an acceptable value to validate an instrument. Conclusion: It was observed that the software is applicable and serves as support to the clinical practice of the nursing professional.

THE USE OF MOULAGE IN CLINICAL SIMULATION: MULTIPLE CASE STUDIES

Objective: identify how and why to use moulage within clinical simulation practices. Method: it is a multiple, inclusive, descriptive and exploratory case study with a qualitative approach. The cases were selected through an intentional sample. After applying the eligibility criteria, four cases of simulated scenarios that used moulage were included and analyzed. Results: all the cases analyzed were developed in extracurricular simulated clinical activities by facilitators with experience in clinical practices, teaching and simulation. The moulages used different techniques, promoting greater interaction with the learner through the use of stimulants of different sense organs, sharpening clinical reasoning, the development of skills, competences, among others. In the four cases, the moulage was performed on a simulated patient, in simulated scenarios and simulated video. The reasons described for moulage were: to provide realism, fidelity, easy application and low cost. Conclusion: it was possible to identify that the moulage is an adequate resource in clinical simulation and that when built with rigor and method, it influences the fidelity and realism of the simulated scenario.

O USO DA MOULAGE NA SIMULAÇÃO CLÍNICA: ESTUDO DE CASOS MÚLTIPLOS

Objetivo:identificar como e porque utilizar a moulage dentro das práticas de simulação clínica. Método: trata-se de estudo de casos múltiplos, inclusivo, de caráter descritivo e exploratório com abordagem qualitativa. Os casos foram selecionados por meio de uma amostra intencional. Após aplicação dos critérios de elegibilidade, foram incluídos e analisados quatro casos de cenários simulados que utilizaram moulage. Resultados: todos os casos analisados foram desenvolvidos em atividades clínicas simuladas extracurriculares por facilitadores com experiência em práticas clínicas, na docência e na área de simulação. As moulages utilizaram técnicas diferentes, promovendo maior interação com o aprendiz pelo uso de estimulantes de diferentes órgãos do sentido, aguçando o raciocínio clínico, o desenvolvimento de habilidades, competências, entre outros. Nos quatro casos, a moulage foi realizada em paciente simulado, em cenários simulados e vídeo simulado. Os motivos descritos para moulage foram: prover realismo, fidelidade, fácil aplicação e baixo custo. Conclusão: foi possível identificar que a moulage é um recurso adequando em simulação clínica e que quando construída com rigor e método, influencia na fidelidade e no realismo do cenário simulado.

Examining the effect of simulation-based learning on intravenous therapy administration' knowledge, performance, and clinical assessment skills of first-year nursing students

BACKGROUND

Most nurses at some point of, or throughout, their career will be involved in infusion care. Therefore, it is important to provide a realistic learning environment to nursing students regarding how to safely practice intravenous (IV) therapy administration.

OBJECTIVES

The aim of this study was examining the effect of simulation-based learning on IV therapy administration knowledge, performance and clinical assessment skills of first-year nursing students.

METHODS

This study was a randomized controlled quasi-experimental study. A total of 62 students was included in the study. The students were randomly assigned to either hybrid simulation (HS) (n = 31) or low fidelity simulation (LFS) (n = 31) groups. In the HS group, each student performed in the standardized patients using moulage, and the LFS group each student was performed with mannequin using visuals. Each of the students' level of IV therapy administration knowledge, performance and clinical assessment and satisfaction and self-confidence score was evaluated.

RESULTS

After the lecture, demonstration and simulation training, there was a statistically significant difference between groups in terms of knowledge (p < 0.05), IV catheter insertion performance in simulation and clinical (p = 0.00; p = 0.00) and clinical assessment to classify IV therapy complications on real patients (p = 0.00). Also, satisfaction and self-confidence scale scores of the students in the HS were significantly higher than in the LFS group (p = 0.00). However, there was no significant difference in simulation design scale scores between the two groups (p = 0.164).

CONCLUSION

The students in the HS group better transferred they had learned in the teaching environment to clinical practice. Also, the results show that creating an effective environment in simulation had a positive effect on the development of the students' clinical skills.

Development, production and evaluation of 2-dimensional transfer tattoos to simulate skin conditions in health professions education

BACKGROUND

Moulages can greatly extend the possibilities of simulation in teaching and assessment. Since moulages that fit an educator's exact needs are often unavailable commercially, this paper explains how 2-dimensional transfer tattoos can be independently developed, produced, and evaluated.

METHODS

From representative photographs of the specific skin condition an analogue copy of the pathological finding is drawn. Once validated by the medical expert, it can be digitized by scanning and processed using graphics software. The final digital image file is printed onto transfer paper. Once applied and fixed onto the intended wearer, usually a simulated patient, its authenticity can be confirmed, and further transfer tattoos can be produced.

RESULTS

Using this moulage technique we produced 10 different 2-dimensional transfer tattoos to date, including hematoma, Janeway lesions and splinter nails. These moulages are used in clinical skills training, formative and high-stakes summative assessment in undergraduate medical and nursing programs.

CONCLUSIONS

By sharing our development process for 2-dimensional transfer tattoos, health profession educators can produce their own that best fit their local educational needs. Due to their high authenticity and standardization, 2-dimensional transfer tattoos are ideal for use in high-stakes assessment.

“Sem Pressão”: aplicativo com orientações para identificação, estadiamento e prevenção de lesões por pressão

Objetivo: desenvolver aplicativo com orientações sobre identificação, estadiamento e prevenção de lesões por pressão em adultos. Método: o método descritivo utilizado iniciou com a busca de aplicativos na área de lesões por pressão nas plataformas Google© e Apple©. Após, foi desenvolvido o conteúdo, baseado, principalmente, nas recomendações da National Pressure Injury Advisory Panel. Foi criado um protótipo em www.fábricadeaplicativos.com.br e enviado para avaliação de forma e conteúdo. Seis profissionais de saúde preencheram um questionário avaliando o aplicativo e dois deles sugeriram alterações. O aplicativo foi adequado às sugestões e reavaliado por três enfermeiros estomaterapeutas que não sugeriram alterações. Resultados: o aplicativo foi desenvolvido no site “fábrica de aplicativos” e denominado “Sem Pressão”, com sete abas. Conclusão: foi criado o aplicativo com orientações sobre identificação, estadiamento e prevenção de lesões por pressão em adultos, e disponibilizado para download gratuito.

“Sem Pressão”: application with guidelines for identification, staging and prevention of pressure injuries

Objective: develop an application with guidance on the identification, staging and prevention of pressure injuries in adults. Method: the descriptive method used started with the search for applications in the area of pressure injuries on the Google © and Apple © platforms. Afterwards, the content was developed, based mainly on the recommendations of the National Pressure Injury Advisory Panel. A prototype was created at www.fábricadeaplicativos.com.br and sent for evaluation of form and content. Six health professionals completed a questionnaire evaluating the application and two of them suggested changes. The application was adequate to the suggestions and reassessed by three stomatherapist nurses who did not suggest changes. Results: the application was developed on the “application factory” website and named “Sem Pressão” (No Pressure), with seven tabs. Conclusion: the application was created with guidelines on identification, staging and prevention of pressure injuries in adults, and made available for free download.

Is Moulage effective in improving clinical skills of nursing students for the assessment of pressure injury?

BACKGROUND

In wound care simulations, the practice can be performed on 3D-wounds formed by moulage. Moulage helps the student to perceive the etiology, physiology, and healing processes of the wound, and it can also be used to improve the students' wound assessment skills.

OBJECTIVE

The aim of this study is to investigate the effectiveness of moulage in the improvement of pressure injury assessment skills of nursing students.

DESIGN

A quasi-experimental study.

SETTINGS

A nursing faculty at a public university.

PARTICIPANTS

All fourth-year students (n = 73) who take the simulation elective course were invited to participate.

METHODS

Fall semester students (n = 38) constituted the control group and spring semester students (n = 35) formed the intervention group. The coin-flipping method was used to match the education period and student groups. The intervention group simulation was performed using moulage, and the control group simulation was performed using a pressure ulcer visuals. The same simulation scenarios were used for both groups. The data were collected using the Simulation Design Scale, Student Satisfaction and Self-Confidence Scale, and student identification form, knowledge test, performance checklist and feedback form developed by the researchers.

RESULTS

Students' knowledge scores for pressure injury assessment have improved significantly in both the intervention group (pre-test:61.71 ± 9.77 and post-test 70.57 ± 12.53, t = -4.27, p < 0.001) and the control group (pre-test: 66.81 ± 13.47 and post-test 73.06 ± 15.50, t = -2.34, p = 0.02). Laboratory and clinical pressure injury assessment skill scores of the intervention group students were significantly higher than the control group. Besides, the correct staging percentages of the intervention group students are higher than the control group students during the clinical practice (χ2 = 5.05, p = 0.02).

CONCLUSIONS

It can be concluded that the simulation with moulage was effective in improving the skills of nursing students who received training for pressure injury assessment and in transferring what they learned to the clinical setting.

Simulated patient scenario development: A methodological review of validity and reliability reporting

INTRODUCTION

Some healthcare scholars (educators and researchers) develop their own simulated patient scenarios to address specific learning objectives. Clear processes of validity and reliability are needed in the development of simulated scenarios for the purpose of replication and the transfer of findings to other contexts.

METHODS

This paper reports a methodological review of CINAHL to determine how valid and reliable simulated patient scenarios are developed. We reviewed 375 abstracts based on specific inclusion and exclusion criteria to yield 17 qualifying records. Data about the discipline, population, type of simulation, and validity and reliability processes were extracted.

RESULTS

Selected records were from nursing, medicine, and paramedicine. While some studies used high-fidelity simulations, some used low-fidelity or a combination of high- and low-fidelity simulations. Scholars validated scenarios by using personal experience, consulting experts, or requesting participant feedback. They also examined different types of validity (face, content, construct). Most studies did not address how reliability of scenarios was determined. To ensure consistency in scenario delivery, some studies piloted scenarios with participants, or examined performance through video-tapes or virtual patients.

CONCLUSIONS

This review shows that scholars use inconsistent processes to develop valid and reliable simulated patient scenarios, often overlooking evidence-based approaches to determining validity and reliability. Future practices pertaining to scenario development should use systematic processes in determining validity and reliability so simulation exercises can be replicated in other contexts.