Presença de avaliador em cenário clínico simulado de ritmos chocáveis de PCR: ensaio clínico randomizado

Abstract

Objective: to compare whether the visible or invisible presence of the evaluator influences the knowledge and skills of nursing students in a simulated clinical scenario on cardiorespiratory arrest at shockable rhythms in Advanced Life Support. Method: randomized clinical trial, with undergraduate nursing students, between August 2021 and April 2022. The study was carried out in six stages. In the first stage, the sociodemographic questionnaire and the Advanced Life Support test (pre-test) were applied. In the second stage, the theoretical content on cardiorespiratory arrest was offered. In the third, practical activity took place in a clinical simulation laboratory. The fourth corresponded to the moment of dispersion, for study and preparation for the evaluation. In the fifth stage, the checklist was applied to assess skills regarding the recognition and care of shockable rhythms in cardiorespiratory arrest; the Advanced Life Support test (immediate post-test), the Simulation Design scale and the performance of the Debriefing. After 30 days of step five, the sixth step was performed, with the reapplication of the Advanced Life Support test (late post-test). The analysis was performed using Stata software version 16.0. Qualitative variables were presented as absolute and relative frequency and quantitative variables as mean and dispersion measures. As outcomes of interest, the correct answers in the Advanced Life Support Questionnaire. For the distribution of the variables constituted by the score obtained in the areas of shockable rhythms, the Shapiro-Wilk test was applied. Parametric tests for differences in means were adopted, with Student's t test for dichotomous variables and the one-way ANOVA test for polychotomous variables and the Bonferroni method for differences between categories. In the face of non-normal distributions, only the Mann-Whitney test was adopted. The significance level adopted was 5%. Results: 68 students participated in the study, 35 assigned to the experimental group and 33 to the control group. Most were women and were between 22 and 37 years old. As for the theme and methodology of the course, less than 30% had previous experience. Regarding theoretical knowledge, there was an increase in knowledge in both groups (<0.001). Most of the assessments for both groups were found to exceed 4 out of 5 points on the Simulation Design Scale. Conclusion: There were no significant differences between the two groups, so having or not having a visible evaluator in the simulated scenario interfered with the students' performance.