Construction and validation of a scenario for recognizing sepsis by nursing students: a methodological study

Nogueira, Jane Walkíria da Silva; Magro, Marcia Cristina da Silva

doi:10.1590/0034-7167-2022-0537

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Revista Brasileira de Enfermagem

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ORIGINAL ARTICLE • Rev. Bras. Enferm. 76 (4) • 2023 • https://doi.org/10.1590/0034-7167-2022-0537 copy

Construction and validation of a scenario for recognizing sepsis by nursing students: a methodological study

Construcción y validación de escenario para reconocimiento de sepsis por estudiantes de Enfermería: estudio metodológico

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Objective:

To build and validate a clinical simulation scenario for teaching Nursing students about early recognition of signs and symptoms of sepsis in the context of the emergency unit.

Methods:

Methodological study developed in two phases: construction of a simulated scenario and content validation by expert judges. For data analysis, the Content Validity Index (CVI) was calculated considering agreement equal to or greater than 80%. The minimum acceptable CVI value for scenario validation was 1.0.

Results:

The simulation scenario proved to be appropriate, with a global Content Validity Index equal to 1. Some adjustments related to the clarity of the wording were necessary, as suggested by the judges. Conclusions: A medium-complexity, high-fidelity scenario was successfully constructed and validated for teaching early recognition of sepsis signs and symptoms.

Descriptors:
Validation Study; Sepsis; Simulation Training; Nursing Education; Nursing Students

Evaluated items	Delphi Technique First Assessment (first round)								Delphi Technique Second Assessment (second round)
	Organization		Clarity		Appearance		Relevance		Organization		Clarity		Appearance		Relevance
	CVI^* * CVI - Content Validity Index, Exact Binomial Test.	p	CVI^* * CVI - Content Validity Index, Exact Binomial Test.	p	CVI^* * CVI - Content Validity Index, Exact Binomial Test.	p	CVI^* * CVI - Content Validity Index, Exact Binomial Test.	p	CVI^* * CVI - Content Validity Index, Exact Binomial Test.	p	CVI^* * CVI - Content Validity Index, Exact Binomial Test.	p	CVI^* * CVI - Content Validity Index, Exact Binomial Test.	p	CVI^* * CVI - Content Validity Index, Exact Binomial Test.	p
1. Scenario title	100	1.000	100	1.000	100	1.000	100	1.000	100	1.000	100	1.000	100	1.000	100	1.000
2. Public	100	1.000	100	1.000	100	1.000	100	1.000	100	1.000	100	1.000	100	1.000	100	1.000
3. Prior experience of the learner	100	1.000	100	1.000	100	1.000	100	1.000	100	1.000	100	1.000	100	1.000	100	1.000
4. Learning objectives	90	0.893	100	1.000	100	1.000	100	1.000	100	1.000	100	1.000	100	1.000	89	0.866
5. Simulation time	100	1.000	100	1.000	100	1.000	100	1.000	100	1.000	100	1.000	100	1.000	100	1.000
6. Human Resources	100	1.000	100	1.000	100	1.000	100	1.000	100	1.000	100	1.000	100	1.000	100	1.000
7. Material resources/equipment	100	1.000	100	1.000	100	1.000	100	1.000	100	1.000	100	1.000	100	1.000	100	1.000
8. Documentation	90	0.893	90	0.893	90	0.893	90	0.893	100	1.000	100	1.000	100	1.000	100	1.000
9. Scenario preparation	90	0.893	90	0.893	90	0.893	90	0.893	100	1.000	100	1.000	100	1.000	100	1.000
10. Briefing	100	1.000	100	1.000	100	1.000	100	1.000	100	1.000	100	1.000	100	1.000	100	1.000
11. Scenario development: description of the clinical case	100	1.000	100	1.000	100	1.000	100	1.000	100	1.000	100	1.000	100	1.000	100	1.000
12. Scenario development: information in the medical record	100	1.000	100	1.000	100	1.000	100	1.000	100	1.000	100	1.000	100	1.000	100	1.000
13. Scene schedule	90	0.893	90	0.893	90	0.893	90	0.893	100	1.000	100	1.000	100	1.000	100	1.000
14. Debriefing	100	1.000	100	1.000	100	1.000	100	1.000	100	1.000	100	1.000	100	1.000	100	1.000
S-CVI-AVE^ S-CVI-AVE - Mean Scale Content Validity Index.	97		98		98		98		100		100		100		99
S-CVI-UA^* ***** S-CVI-UA - Percentage of Item with Unanimous Agreement.	71		79		79		79		100		100		100		93

Scenario title	Nurses’ role in the early recognition of signs and symptoms of sepsis
Public	Nursing Students
Prior knowledge of the learner	Skills in caring for patients with suspected sepsis
Learning objectives	Primary: recognize the risk of sepsis and make decisions. Secondary: collect data in order to identify the patient with suspected sepsis; communicate effectively with the patient and their family members in search of signs and symptoms suggestive of sepsis; when suspecting sepsis, open a protocol and call the medical team; perform and prioritize nursing care.
Simulation time	*Briefing:* 5 minutes; *Scenario: 15 minutes; Debriefing*: 30 minutes
Human Resources:	Three monitors to assume the following roles: simulated patient (high-fidelity simulator control room); doctor who will appear when requested by the nurse; patient’s child; two teaching facilitators with experience or training in simulation.
Material resources/equipment	Hospital bed with side rails, bedding, pillow, gas ruler, auxiliary table, two-step ladder, hospital gown, parrot, serum holder, infectious waste, sealed emergency trolley, procedure and sterile gloves, antiseptics, equipment personal protective equipment, gauze, stainless steel tray, saline, glucose and ringer lactate solutions, needles (40×12; 30×7; 13×45 mm), heparinized syringe, syringes (3, 5, 10, 20 mL), equipment of serum and two-way connector, label for serum identification, hypoallergenic microporous tape, tourniquet, flexible catheter for venipuncture (#20, 22), transparent film, sachet of 70% alcohol, antibiotics and analgesics, flasks for blood culture, tubes for blood collection, kit for indwelling urinary catheter, electrodes, multiparametric monitor, stethoscope, sphygmomanometer, pulse oximeter, spectacle-type nasal oxygen catheter, oxygen humidifier, distilled water, discharge patient simulator dummy fidelity.
Documentation	Medical prescription, nursing record, sheet with laboratory results: blood glucose: 90 mg/dL (RV: 65 to 99 mg/dL); leukocytes: 25,100/cell.mm3 (RV: 5,000-10,000 mm3); lactate: 2.5 mmol/L (RV: 0.3-2.4 mmol/L); imaging exam with report (abdominal tomography): moderate-volume ascites and densification of the peritoneal adipose planes (inflammatory process); splenomegaly.
Scenario preparation
Theme: Sepsis with abdominal focus. Scenario fidelity: High fidelity. Characterization of actors/collaborators: Laerdal SimMan^® Traditional high-fidelity patient simulator, featuring hospital-appropriate attire (gown with open back); patient’s son (monitor wearing jeans and a short-sleeved shirt); doctor (monitor wearing jeans, short-sleeved shirt, and white coat). Physical space: The scene takes place in an environment characterized as the box bed of the emergency unit. Scenario complexity: Medium complexity. Expected actions: confirmation of the clinical case for sepsis, opening of the protocol and start of the first hour package. Previous skills: biosafety principles, measurement and analysis of vital signs, physical examination, communication and interaction with the patient, analysis of data provided by the patient, family, exams, medical records.
Scenario development:
Clinical case description	JRS, male, 65 years old, married, with a history of type 2 diabetes mellitus controlled with diet and regular physical activity. He was admitted to the emergency room accompanied by his son and previous history of hospitalization for laparoscopic cholecystectomy with hospital discharge two days ago. One day ago, oliguria and abdominal pain with the use of analgesics (paracetamol) at home. According to the son, today the patient woke up with a fever of 38^oC and worsening abdominal pain, tachypnea and talking about strange things.
Medical record information	Clinical History: Type 2 diabetes mellitus, laparoscopic cholecystectomy. Denies allergies. Medications in use: Paracetamol every 6 hours in the last 24 hours. Anthropometric data ; Body mass: 85kg
Devices attached to the simulator	Hospital gown, identification wristband, orange color risk rating wristband
*Debriefing*	Structured
Assessment	Students’ practical performance

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[1] Corresponding author: Jane Walkiria da Silva Nogueira , E-mail: janewalkiria@gmail.com