Aprendizaje y adquisición de competencias en soporte vital básico y avanzado en estudiantes de enfermería a través de la simulación clínica

Abstract

Introduction: Cardiopulmonary resuscitation is a very important maneuver, since its correct and early application in a cardiorespiratory arrest has been shown to save the life of the victim. Nursing staff must be trained in this technique, therefore, adequate learning during their academic training in the nursing degree is essential. Clinical simulation emerges as an innovative methodology that eases the achievement of the necessary skills for the development of their professional career. Aims: This thesis aimed to analyze the learning and acquisition of skills in Basic and Advanced Life Support in nursing students through clinical simulation, with the following specific aims: (1) To compare the use of a mobile application versus telephone assistance in cardiopulmonary resuscitation in simulated clinical. (2) To explore the experiences and perceptions of nursing students after applying Advanced Life Support techniques to a hospitalized patient suffering from cardiac arrest in a simulated clinical. (3) To determine the pauses made in an Advanced Life Support situation in high-fidelity simulation scenarios. Methodology: (1) A cross-sectional, correlational study was carried out. The sample consisted of 128 undergraduate nursing students from the University of Almería (Spain) who were randomly selected into two intervention groups. Data collection was performed using cardiopulmonary resuscitation observation checklist, cardiopulmonary resuscitation parameter checklist and the Assistant RCP® mobile application. Data were analyzed using the SSPS statistical program, considering significant values for p < 0,05. (2) A phenomenological qualitative study was performed in a sample of 54 undergraduate nursing students from the University of Almería (Spain). A total of 6 focus groups were carried out, containing 9 participants each and selected through intentional convenience sampling. An open question script was used for data collection. Data were analyzed using Atlas-ti 8.0 software. (3) Cross-sectional study on a convenience sample of 142 nursing degree students at the University of Almería (Spain). Pauses in an Advanced Life Support situation were assessed using a checklist developed by the researchers. Data were analyzed using the SSPS statistical program, considering significant values for p < 0,05. Results: (1) The group that used the mobile application obtained significantly results than the telephone assistance group for 5 items during the observation of cardiopulmonary resuscitation: recognize whether the area is safe, ask for help, open the airway, check breathing and call to emergencies. No statistically significant differences comparing intervention groups were found regarding the level of cardiopulmonary resuscitation. The group that used the mobile application showed significantly better scores for the item compression fraction than the telephone assistance group. (2) Three main themes and six sub-themes that illustrated the experiences and perceptions of nursing students about performing Advanced Life Support were identified. The main themes were: analyzing performance as part of the training process, facing reality and experience as a key element to integrate Advanced Life Support in the care environment. (3) Nursing students performed the simulation scenario in an average time of 8.32 minutes. Most of the actions fall within the time established by the resuscitation guidelines. However, the pause time between chest compressions was higher than recommended. A strong positive correlation between identification of the arrhythmia and initiation of defibrillation was found. Conclusions: (1) The students who used the mobile application performed better in the actions of recognizing the safety of the area, asking for help, opening the airway, checking breathing and calling emergencies. However, the results indicate that there are no differences in the parameters of cardiopulmonary resuscitation when using a mobile application or guided by telephone assistance. (2) Nursing students identified the training in an emergency situation through simulation as a fundamental part of nursing education. In addition, they consider such experience as a key element to consolidate the Advanced Life Support into the healthcare environment. (3) Nursing students performed the simulation in Advanced Life Support adhering in most of the actions to the times recommended by the resuscitation guidelines. Early identification of shockable rhythms leads to early defibrillation by nursing. Strategies should be implemented to accelerate the identification of arrhythmias in order to minimize the pauses before defibrillation and improve the results of Advanced Life Support.