Abisai Martínez-Sánchez,1 Laura Isabel Hernández-Arzola,1 Concepción Jiménez1
1Universidad de la Sierra Sur, Instituto de Investigación sobre la Salud Pública, Miahuatlán de Porfirio Díaz, Oaxaca, México
Correspondence: Abisai Martínez-Sánchez
Received: November 20th 2015
Judged: March 23rd 2016
Accepted: May 25th 2016
Introduction: Clinical simulation is a valuable educational tool in the training of health professionals and involves a transformation of the teaching-learning process.
Objective: to describe the use of clinical simulators with nursing students at Oaxaca´s Universidad de la Sierra Sur.
Methods: From logbooks of the propaedeutic hall a database was built with records: semester course, number of students, session type, procedure and duration. A descriptive analysis was performed Chi square test was used to establish significant difference between variables.
Results: In second semester were performed the largest number of nursing procedures (p ≤ 0.001). The subject with the most sessions supervised by the teacher was Nursing Clinical Basis, while Medical Surgical Nursing I recorded most frequently programmed activities by the students.
Conclusion: There is a difference between some subjects in the frequency of procedures supervised by the teacher and performed by students independently.
Keywords: Higher education; Nursing education; Learning
The creation of intelligent hospitals, with automatized patient registry and telephone consultations, like the use of new materials to supply human organs,1 involves highly trained professionals competitive in specific, relational skills to intervene in a timely and effective manner to maintain health.2
Success in this process means transforming education by incorporating new paradigms and teaching and learning processes, which must have diversified, innovative content structures with emphasis on practices and forward-thinking methods and empowered health personnel who are equipped to use these technological tools daily.3
It’s important to be aware that no ideal, universal teaching method exists. Therefore, assessment depends on the present learning conditions, demands made, and content specifications. This will stimulate students’ cognitive interest development, linking their learning with life.
One strategy in the teaching-learning process is clinical simulation.4 A combination of methods and tools utilizes videos, computer programs, training framework, and full-scale anatomic models of sections of the body. These are very valuable for teaching skills used in hospital practice in a safe environment that permits error, to learn without real repercussions.5 Therefore, the user learns from experience, and develops psychological security and the ability to make quality patient care decisions.6-8 These methods also facilitate comprehensive and participatory understanding of criteria standardization, i.e. it potentiates the acquisition of knowledge.2
The nursing student studies integral individual, family, and community care, incorporating different technological tools which facilitate the teaching-learning process and developing competancies9,10 to resolve problems in health and demands for care.11
The use of simulation speeds up the learning process because it is an integrated, systemic and orderly factor. Logic must be linked to the appropriate course plan and to the requirements of the curriculum.
Oaxaca state is characterized by highly marginalized epidemiological and social environments, and low human development12,13 with insufficient infrastructure and technology access14 and scarce human resources in medical units.15 Highly trained professionals who have experience with the diverse scenarios of professional nursing—its goal of bettering the general population’s quality of life— are indispensable in this context.16,17
In addressing these gaps it is necessary to integrate new technologies in universities to rethink the role of the teacher as the sole idea access and transmission point. The instructor becomes a guide and companion who promotes communication, research, and information processing skills in students through their use of necessary resources.
These skills give rise to critical and reflective thinking as a way to organize and understand teaching-learning.18 During the implementation of the various simulation techniques, compliance with the bioethical principles is guaranteed at all times.
With that stated, this study’s objective was to describe the use of clinical simulations by Universidad de la Sierra Sur de Oaxaca students.
A cross-sectional descriptive study of Universidad de la Sierra Sur students was conducted from March to July 2014. The Universidad de la Sierra Sur has an annual enrollment of more than 800 nursing students.
A propaedeutic room, the replica of hospital facilities, opened there in 2010. This room consists of six areas: hospitalization, labor, delivery room, intermediate care, operating room, and sterilization and equipment center, all with specialized infrastructure and tools. In this controlled environment, the student can practice procedures and nursing techniques in pre-programmed, clinical cases with different levels of impaired patient health.
The propaedeutic room has low-technology simulators, such as synthetic models or mannequins, for basic clinical procedural practice. It also has audiovisual and tactile simulators, integrated training resources, and other completely realistic and high technology interactive patient simulators that students can use to practice multiple pathophysiological scenarios, similar to those found in hospitals.
Electronic records from the logbooks of the propaedeutic room provided the information. An Excel 2010 database corresponding to the two semesters was created. On at least one occasion, the semester-long course used the practice room for the following classes: Foundations of Clinical Nursing, Hardware and Software in Nursing, Nursing in Maternal and Child Health, Medical-Surgical Nursing I, Medical-Surgical Nursing II, and Pathology II. The session may be supervised, set up, run, and directed by the professor. When used independently, the student (or a group of students) replicates the procedure without instructor supervision. Students have their choice of procedure, use time, and frequency. The tenured course professor designates the number of students that practiced a nursing procedure during the session, and the frequency and number of students assigned. Procedures scheduled and their duration (the time taken by students to perform the procedures in the propaedeutic room) are those appropriate to the class material.
For the descriptive analysis, we used central tendency and frequency distribution measures. In the inferential study, the Chi-squared test was performed to establish significant difference in the number of repetitions according to semester, course, session type, and procedure; the Mann-Whitney was used for data on the duration and number of students between supervised and independent procedures. Sigma Stat statistical software version 3.1 was used with a significance level of alpha = 0.05.
The duration of independent procedures was higher compared to the activities supervised by teachers (x = 1.5, s = 1.1, x = 1.07 s = 0.2 respectively, T = 119,041; p ≤ 0.001). The average class size per supervised session was 18.6 (s = 11.6), while the average independent session size was 5.5 people (s = 2.4) with a significant difference (T = 133,272; p ≤ 0.001).
Students in their second semester did the highest number of procedures compared to those of other semesters (Chi-squared = 102.55, p < 0.001). As far as courses, Foundations of Clinical Nursing had the highest number of supervised sessions but with the lowest number of independent activities. Medical-Surgical Nursing I was the opposite case; it had the largest number of independent sessions, but with the fewest number of repetitions supervised by the tenured course professor (Chi-squared = 226.47, p ≤ 0.001). Pathology II (Chi-squared = 0.13, p = 0.57) and Medical-Surgical Nursing II (Chi-squared = 0.15, p = 0.71) showed no significant difference in the number of procedures, whether supervised by the professor and or performed independently (Table I).
|Table I. Number of nursing procedures|
|Semester||Course||Type of session|
|Second||Foundations of Clinical Nursing*||84||26.0||8||2.5|
|Hardware and software in nursing*||82||25.4||42||12.9|
|Fourth||Nursing in Maternal and Child Health*||56||17.3||4||1.2|
|Medical-Surgical Nursing I*||49||15.2||215||66.2|
|Sixth||Medical-Surgical Nursing II||49||15.2||55||16.9|
|*There is significant difference between supervised and independent p ≤ 0.05|
The majority of activities took place in Medical-Surgical classes and the lowest amount were in Pathology II (Chi-squared = 31.65, p ≤ 0.001) (Table II).
|Table II. Type of nursing procedure, by course|
|Course||Practice||Type of session|
|Medical-Surgical Nursing||Enteral nutrition*||6||3.8||51||16.2|
|Neonatal intensive care unit||8||4.8|
|Central venous pressure||8||4.8||13||4|
|Aspirating endotracheal and tracheostomy secretions||22||13.2||48||15|
|Installing urinary catheter*||4||2.4||22||6.8|
|Neurologic patient care||5||3|
|Administering blood derivatives||2||0.6|
|Foundations of Clinical Nursing||Patient transport||3||1.8|
|Handling sterile equipment||2||1.2|
|Intravenous infusion (IV)||4||2.4||3||0.9|
|Sterilization and equipment center||11||3.4|
|Hardware and software in nursing||Infusion pumps||9||2.8|
|Monitoring vital signs and electrocardiogram (EKG)||19||11.4||12||3.7|
|Nursing in Maternal and Child Health||Labor*||24||14.5||3||0.9|
|Pathology II||Electrocardiogram (EKG)||1||0.6||23||7.1|
|*There is significant difference between activities with a professor and independent activities p ≤ 0.05|
Considering the epidemiological profile of Mexico, and Oaxaca in particular, higher educational institutions are obligated to include strategies that motivate university students to acquire scientific knowledge to use in disease prevention and detection and in health promotion.19,20
In the opinion of Ruiz et al.,21 university students insist on learning procedures that ease understanding, skill acquisition, and fundamental abilities in rational cognitive processes. Likewise, specialists22-24 point out that using technology to reproduce hospital scenarios should be according to user experience, that is, students should develop basic to complex abilities and skills throughout their professional formation. According to the results of this study, students in their second semester perform the majority of repetitions under the supervision of an instructor. On the other hand, advanced semester students do activities independently to reinforce their grasp on the technique of patient care. The latter could be partially explained because some authors25-27 indicate that clinical simulation stimulates learning on its own, because it generates interest, motivation, and responsibility, and facilitates participation in making clinical decisions.
According to Dieguez,28 simulator use contributes to creating skills for real clinical situations, as well as positively influencing5,26,29 educational aspects such as: teaching standardization, familiarizing students with self-assessment methods, and error as an independent teaching tool.2,30 Therefore, simulation-based training should be incorporated into the nursing curriculum, allowing students to acquire comprehensive skills regarding clinical activity in the hospital environment.4,31
The study results showed, for some courses, there was difference in the frequency of procedures supervised by the professor and those performed independently by the students. According to Mendoza,26 the instructor's experience is a very important element in the use of clinical simulators. Using this technology in the teaching-learning process requires planning, implementation and monitoring of the setup with a specific number of students. In Chin-Wong's view,32 the teacher must invest time to provide feedback on students' knowledge.Finally, it should be emphasized that clinical simulation is only a complementary tool for teaching professional nursing skills, which does not replace the human resource in health training,29,33 because students need constant specialist supervision during procedures. This understood, and with the collected data, we have the opportunity to investigate factors in teaching to create specialized workshops directed at teachers about using simulators to reproduce standardized clinical situations.34 The data also open the opportunity to study the impact on the academic performance of students with the use of this technology.