Respiratory Failure
Conditions
Keywords
teaching, patient simulation, laryngeal masks, baccalaureate nursing education, teaching strategies, simulation
Brief summary
The purpose of this study is to compare if there difference in acquisition of knowledge and skills in airway management to baccalaureate nursing students submitted to different learning strategies: exhibition-dialogued class and practical activity in skill lab with low-fidelity mannequin or simulation class with low-fidelity mannequin.
Detailed description
The airway control is priority in patient resuscitation. The Laryngeal Mask Airway (LMA) can minimize complications, establishing a safe airway. Is fundamental to nurse acquired skills to act in emergency situations; the simulation is a important learning tool for this, because allows a realistic environment and allows to student the possibility of training skills. Hypothesis: There difference in acquisition of knowledge and skills in airway management to baccalaureate nursing students submitted to different learning strategies: classroom lecture-dialogued follow of laboratory activity practice with low-fidelity mannequin or simulation in laboratory with low-fidelity mannequin? The aim of this study is compare the effect of teaching-learning strategies: classroom lecture-dialogued follow of laboratory activity practice with low-fidelity mannequin or simulation in laboratory with low-fidelity mannequin, in the acquisition of knowledge and skills to baccalaureate nursing. This is a randomized controlled trial, the population is all students of baccalaureate nursing of EERP-USP, eighth period, 69 students in total; the sample will be voluntary and composed for students that accept participate of study. The intervention group (IG) will be submitted to simulation class and the control group (CG)to exhibition-dialogued class, and practical activity in skill lab. The study will have 3 steps: 1. The participants will be recruited with letters and posters, randomized to IG or CG and follow submitted to write pre-test. 2. The GI will submitted to simulation in laboratory and de CG classroom lecture-dialogued follow of laboratory activity practice. The focus will be the airway management with emphasis in LMA. 3. All participants will be submitted to write post test and follow to practice test in simulation scenario, with medium-fidelity mannequin, which simulates human physiologic conditions. The scenario will have a appraiser with a checklist which performance scores of skills and interventions observed. The activities will be filmed and recorded. To data analysis will be used the SPSS software: descriptive statistics, chi-square test, t-test of Student.
Interventions
OTHERSimulation class
The students will be submitted a simulation scenario in laboratory with low-fidelity mannequin for 60 minutes, in subgroups of 4-5 students. The simulated condition is a patient in respiratory failure which need of emergency interventions. The approach concepts of anatomic, physiology and clinical interventions using LMA will be discussed during simulation.
OTHERExhibition-dialogued class
The students randomized to CG will be submitted to exhibition-dialogued class with duration of 60 minutes; after this, will go to practical activity in skill lab using the low-fidelity mannequin with duration of 35 minutes. Each subgroup will be composed of 5-6 students for the practice activity which will last 45 minutes.
Sponsors
University of Sao Paulo
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Masking
SINGLE (Outcomes Assessor)
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
Yes
Inclusion criteria
* student must be in the eighth period of course; * must be registered regular in the baccalaureate nursing course.
Exclusion criteria
* absence in any step of study.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Scores in Pre and Post-test, Number of Participants Successfully Completing the Overall Performance Simulated Scenario(OSCE). | Pretest: 40 minutes; Post-test: 40 minutes; OSCE: 10 minutes | Score obtained in pre and post-test written, time to obtain the first effective ventilation (chest expansion through adequate ventilation on the mannequin), number of attempts to insert the LMA in the simulation scenario (OSCE). Pre-test: 20 questions with score of 0.5 points each - minimum score=0 points and maximum score=10 points. Score 5-7 points was considered satisfactory; scores between 7-8 points was considered good performance; above 8 points excellent. Post-test: 20 questions with score of 0.5 points each - minimum score=0 points and maximum score=10 points. Score 5-7 points was considered satisfactory; scores between 7-8 points was considered good performance; above 8 points excellent. OSCE: instrument with total of 10 skills - each skill was subdivided in 4-5 activities (0.2-0.25 points each) - poor performance was score \< 5.0; satisfactory performance 5.0-7.0; good 7.0-8.5 and excellent above 8.5 points. |
| Time to Conclusion of Simulation Scenario (OSCE) | 10 minutes | This result present the total time for execution of simulation scenario (OSCE) by the students. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Time for Acquisition of First Effective Ventilation, Adequate Tidal Volume and Stabilization of Patient. | 10 minutes (600 sec) | Time of achievement to first effective ventilation and tidal volume (adequate chest expansion). Stabilization of mannequin parameters (spO2 e HR). |
| Number of Attempts to Insertion of LMA | 10 minutes (total time of scenario) | Number of attempts for insertion of LMA and obtainment of effective ventilation. |
Countries
Brazil
Participant flow
Recruitment details
The strategy of data collect were Workshop Airway management in emergencies: use of laryngeal mask which dates of realization 21/11/2012 to 24/11/2012. The disclosure of event were e-mail, site of the institution and posters. Students entries were made through electronic.
Pre-assignment details
The activities were described for the students in the arrive to the workshop.
Participants by arm
| Arm | Count |
|---|---|
| Simulation Class The students will be submitted a simulation scenario in laboratory with low-fidelity mannequin for 60 minutes, in subgroups of 4-5 students. The simulated condition is a patient in respiratory failure which need of emergency interventions.
The approach concepts of anatomic, physiology and clinical interventions using LMA will be discussed during simulation. | 9 |
| Control The students randomized to CG will be submitted to exhibition-dialogued class with duration of 60 minutes; after this, will go to the and practical activity in skill lab using the low-fidelity mannequin.
Each subgroup will be composed of 4-5 students for the practice activity which will last 35 minutes. | 8 |
| Total | 17 |
Baseline characteristics
| Characteristic | Control | Simulation Class | Total |
|---|---|---|---|
| Age, Categorical <=18 years | 0 Participants | 0 Participants | 0 Participants |
| Age, Categorical >=65 years | 0 Participants | 0 Participants | 0 Participants |
| Age, Categorical Between 18 and 65 years | 8 Participants | 9 Participants | 17 Participants |
| Age, Continuous | 22.6 years STANDARD_DEVIATION 1.69 | 26 years STANDARD_DEVIATION 5.2 | 24.4 years STANDARD_DEVIATION 4.2 |
| Region of Enrollment Brazil | 8 participants | 9 participants | 17 participants |
| Sex: Female, Male Female | 8 Participants | 8 Participants | 16 Participants |
| Sex: Female, Male Male | 0 Participants | 1 Participants | 1 Participants |
Adverse events
| Event type | EG000 affected / at risk | EG001 affected / at risk |
|---|---|---|
| deaths Total, all-cause mortality | — / — | — / — |
| other Total, other adverse events | 0 / 9 | 0 / 8 |
| serious Total, serious adverse events | 0 / 9 | 0 / 8 |
Outcome results
Primary
Scores in Pre and Post-test, Number of Participants Successfully Completing the Overall Performance Simulated Scenario(OSCE).
Score obtained in pre and post-test written, time to obtain the first effective ventilation (chest expansion through adequate ventilation on the mannequin), number of attempts to insert the LMA in the simulation scenario (OSCE). Pre-test: 20 questions with score of 0.5 points each - minimum score=0 points and maximum score=10 points. Score 5-7 points was considered satisfactory; scores between 7-8 points was considered good performance; above 8 points excellent. Post-test: 20 questions with score of 0.5 points each - minimum score=0 points and maximum score=10 points. Score 5-7 points was considered satisfactory; scores between 7-8 points was considered good performance; above 8 points excellent. OSCE: instrument with total of 10 skills - each skill was subdivided in 4-5 activities (0.2-0.25 points each) - poor performance was score \< 5.0; satisfactory performance 5.0-7.0; good 7.0-8.5 and excellent above 8.5 points.
Time frame: Pretest: 40 minutes; Post-test: 40 minutes; OSCE: 10 minutes
Population: The number of participants result of students that signed up in the workshop.
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| Simulation Class | Scores in Pre and Post-test, Number of Participants Successfully Completing the Overall Performance Simulated Scenario(OSCE). | Pre-test | 6.6 units on a scale | Standard Deviation 1 |
| Simulation Class | Scores in Pre and Post-test, Number of Participants Successfully Completing the Overall Performance Simulated Scenario(OSCE). | Postest | 8.6 units on a scale | Standard Deviation 1.1 |
| Simulation Class | Scores in Pre and Post-test, Number of Participants Successfully Completing the Overall Performance Simulated Scenario(OSCE). | OSCE's score | 8.4 units on a scale | Standard Deviation 0.89 |
| Control | Scores in Pre and Post-test, Number of Participants Successfully Completing the Overall Performance Simulated Scenario(OSCE). | Pre-test | 6.5 units on a scale | Standard Deviation 0.5 |
| Control | Scores in Pre and Post-test, Number of Participants Successfully Completing the Overall Performance Simulated Scenario(OSCE). | Postest | 8.4 units on a scale | Standard Deviation 0.8 |
| Control | Scores in Pre and Post-test, Number of Participants Successfully Completing the Overall Performance Simulated Scenario(OSCE). | OSCE's score | 7.8 units on a scale | Standard Deviation 0.52 |
Primary
Time to Conclusion of Simulation Scenario (OSCE)
This result present the total time for execution of simulation scenario (OSCE) by the students.
Time frame: 10 minutes
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Simulation Class | Time to Conclusion of Simulation Scenario (OSCE) | 520.3 seconds | Standard Deviation 157 |
| Control | Time to Conclusion of Simulation Scenario (OSCE) | 479.8 seconds | Standard Deviation 183.3 |
Secondary
Number of Attempts to Insertion of LMA
Number of attempts for insertion of LMA and obtainment of effective ventilation.
Time frame: 10 minutes (total time of scenario)
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Simulation Class | Number of Attempts to Insertion of LMA | 1.56 attempts | Standard Deviation 0.63 |
| Control | Number of Attempts to Insertion of LMA | 1.63 attempts | Standard Deviation 0.74 |
Secondary
Time for Acquisition of First Effective Ventilation, Adequate Tidal Volume and Stabilization of Patient.
Time of achievement to first effective ventilation and tidal volume (adequate chest expansion). Stabilization of mannequin parameters (spO2 e HR).
Time frame: 10 minutes (600 sec)
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Simulation Class | Time for Acquisition of First Effective Ventilation, Adequate Tidal Volume and Stabilization of Patient. | 428.1 seconds | Standard Deviation 143.6 |
| Control | Time for Acquisition of First Effective Ventilation, Adequate Tidal Volume and Stabilization of Patient. | 426.5 seconds | Standard Deviation 172 |