Simulación de entrenamiento de cuidadores en el alta hospitalaria de pacientes con enfermedades crónicas: una revisión integradora

Borges, Luciana Aparecida da Cunha; Almeida, Rodrigo Guimarães dos Santos; Barboza, Elton Santo; Arruda, Guilherme Oliveira de

doi:10.1590/0034-7167-2023-0043

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REVIEW • Rev. Bras. Enferm. 76 (6) • 2023 • https://doi.org/10.1590/0034-7167-2023-0043 linkcopiar

Simulación de entrenamiento de cuidadores en el alta hospitalaria de pacientes con enfermedades crónicas: una revisión integradora

Autoría SCIMAGO INSTITUTIONS RANKINGS

Objetivo: identificar evidencia sobre el uso y efectos de la simulación clínica para la preparación de cuidadores en la deshospitalización de pacientes con enfermedades crónicas.

Métodos: revisión integradora por pares en Scopus, PubMed, Web of Science, Cumulative Index to Nursing and Allied Health Literature, ScienceDirect y Virtual Health Library, de julio a septiembre de 2022.

Resultados: se identificaron 3.218 estudios, con una muestra final compuesta por cuatro artículos nacionales y dos internacionales. El uso de la simulación como tecnología educativa contribuyó a la preparación de los cuidadores en el cuidado domiciliario. En la mayoría de los estudios, el uso de la simulación clínica incluyó el uso de otras estrategias para complementar la formación: clase expositiva dialogada, círculo de conversación y recursos audiovisuales.

Consideraciones finales: la simulación demostró ser eficiente para la formación de cuidadores, con la participación activa de familiares y enfermeros en acciones de educación en salud.

Descriptores:
Entrenamiento Simulado; Cuidadores; Alta del Paciente; Enfermedad Crónica; Enfermería

Acronym	Meaning	Terms
P	Population	1# (“Caregivers” OR “Caregiver” OR “Carers” OR “Carer” OR “Care Givers” OR “Care Giver” OR “Spouse Caregivers” OR “Caregiver, Spouse” OR “Caregivers, Spouse” OR “Spouse Caregiver” OR “Family Caregivers” OR “Caregiver, Family” OR “Caregivers, Family” OR “Family Caregiver” OR “Informal Caregivers” OR “Caregiver, Informal” OR “Caregivers, Informal” OR “Informal Caregiver”) 2# (“Chronic Disease” OR “Disease, Chronic” OR “Diseases, Chronic” OR “Chronic Illness” OR “Chronic Illnesses” OR “Illness, Chronic” OR “Illnesses, Chronic” OR “Chronically Ill”)
V	Variable	3# (“Simulation Training” OR “Training, Simulation” OR “Interactive Learning” OR “Learning, Interactive” OR “Simulation-based education” OR “Simulation based education” OR “Simulation” OR “Patient simulations” OR “Patient Simulations” OR “Simulation, Patient” OR “Simulations, Patient”)
O	Outcome	4# (“Transitional Care” OR “Care, Transitional” OR “Cares, Transitional” OR “Transitional Cares” OR “Transition Care” OR “Transition Cares” OR “Home Transition” OR “Home Transitions” OR “Transition, Home” OR “Transitions, Home” OR “Patient Discharge” OR “Discharge, Patient” OR “Discharges, Patient” OR “Patient Discharges” OR “Discharge Planning” OR “Discharge Plannings” OR “Planning, Discharge” OR “Plannings, Discharge” OR “De-hospitalization”) and an uncontrolled descriptor in MeSH

ID	Authors and year of publication	Author training	Article title	Journal name and country of publication	IF	LoE
A1	Silva M, Charlo PB, Zulin A, Santos FGT, Jaques AE, Haddad MCFL, Radovanovic CAT. (2022)(¹³)	Nurses and physician	Construction and validation of clinical scenarios for training informal caregivers of dependent people	Revista Brasileira de Enfermagem - REBEn Brazil	0.705	IV
A2	Silva APM, Pina JC, Rocha PK, Anders JC, Souza AIJ, Okido ACC. (2020)(¹⁴)	Nurses	Training of caregivers of children with special health needs: simulation contributions	Texto & Contexto - Enfermagem Brazil	0.589	VI
A3	Santos AST, Góes FGB, Ledo BC, Silva LF, Bastos MPC, Silva MA. (2020) (¹⁵)	Nurses	Educational technology on home care for low-risk newborns	UERJ Nursing Journal Brazil	None	VI
A4	Stanley TA, Battles M, Bezruczko N, Latty C. (2019)(¹⁶)	Nurses and psychologist	Simulation effectiveness for caregivers of children with tracheostomy	Clinical Simulation in Nursing United States	2.391	IV
A5	Thrasher J, Baker J, Ventre KM, Martin SE, Dawson J, Cox R, Moore HM, Brethouwer S, Sables-Baus S, Baker CD. (2018)(¹⁷)	Physicians	From hospital to home: A quality improvement initiative to implement high-fidelity simulation training for caregivers of children requiring long-term mechanical ventilation	Journal of Pediatric Nursing United States	2.145	IV
A6	Esteves MT, De Domencio EBL, Petito EL, Gutiérrez MGR. (2013)(¹⁸)	Nurses and physical therapist	Educational intervention for self-monitoring of continuous drainage in the postoperative period of mastectomy	Revista Gaúcha de Enfermagem Brazil	0.638	IV

ID	Objective	Method	Participants	Type of simulation and simulator
A1	Build and validate three clinical scenarios for training informal caregivers of dependent people.	Methodological study, developed in two stages: construction of scenarios; and content validity by experts.	12 experts in active learning technologies and/or care for dependent patients.	Scenario construction (patient hygiene and comfort; bed bath, skin hydration and change of position); simulated patients (actors)
A2	Know the contributions of simulation to training caregivers of children with special health needs in preparation for hospital discharge.	Descriptive-exploratory study with a qualitative approach	15 caregivers of children with special health needs (CHISHN).	Skills training; low, medium and high-fidelity pediatric simulators
A3	Identify doubts of postpartum women and family members about home care for low-risk newborns; analyze the conversation circle, mediated by a realistic low-fidelity simulator, as an educational technology to prepare families in the maternity discharge process.	Qualitative study	19 family members of low-risk newborns in a municipal hospital in Rio das Ostras, Rio de Janeiro.	Realistic low-fidelity simulator; static vinyl mannequin with dimensions similar to a newborn’s body, fitted with a fictitious plastic umbilical stump and a clamp attached to it
A4	Show that simulation improves confidence and competence in caregivers of children with a tracheostomy and to examine the impacts on emergency room visits and mortality.	All participants received standard classroom training. One group also received simulation training.	Caregivers (parents) of children who received a new tracheostomy.	High-fidelity simulation; human simulator
A5	Create a multimodal discharge readiness curriculum incorporating high-fidelity simulation training to prepare family caregivers of children with complex physicians, conditions that require long-term mechanical ventilation.	Methodological study with a qualitative approach	Family caregivers	High-fidelity simulation; simulator; PediaSIM ECS (CAE Healthcare; Montreal, QC Canada). The simulator is a computer-controlled mannequin.
A6	Assess the performance of patients undergoing surgery for breast cancer in self-monitoring of continuous drainage system.	Prospective study of educational intervention	79 women who underwent surgery for breast cancer and had a drain (continuous drainage system).	Classroom and simulation of continuous drainage system management, performance assessment and reinforcement of guidelines; low-fidelity simulator

ID	Main results	Limitations
A1	Simulation scenarios proved to be appropriate, obtaining an average value of 91.6%. However, some adjustments were made to its organization regarding clarity in the wording of guidelines, as suggested by judges.	The study used only three scenarios; therefore, it was limited by the impossibility of including other important themes in the script. Inserting new themes, alluding to bed bath practices for dependent people at home, would make the video significantly longer in duration, which could harm the main objective and cause the target audience to have less assimilation of the theme addressed. Another limiting issue refers to the need for assessment by the target audience to make the material more cohesive and applicable, in order to configure the realism necessary for the video to have a positive impact on educational issues.
A2	Two categories emerged: Simulation experience as a learning strategy; and Implications of training for home care. Simulations allowed the improvement of procedural skills and coping with possible intercurrences at home. Initially, feelings of fear and anxiety were triggered, especially in high-fidelity simulation. However, after training, caregivers felt relieved, self-confident and satisfied with their performance, highlighting the importance of the support provided during simulations. They mentioned greater confidence in carrying out the procedures on the child and in facing the challenges of home care.	They are limited to technology-dependent children, who represent only a subgroup of CHISHN. Only caregivers of children using oxygen therapy, tracheostomy, gastrostomy and nasojejunal tube participated.
A3	The family members’ doubts were about care with hygiene, food, environment, affection, health, sleep and illnesses. Conversation circle with a low-fidelity simulator was considered a positive strategy to mediate learning.	The limitation of this study refers to the single geographical context, requiring further studies in different social realities, in addition to investigations that validate this educational technology in a representative sample of the target audience.
A4	Post-test confidence was significantly higher in the simulation group. The correlation between post-test confidence and competence measures was not statistically significant. Mortality in family homes was nearly five times higher for children whose caregivers did not participate in simulation.	None.
A5	A total of 87 family caregivers completed the curriculum. This simulation-enhanced curriculum was well received by participants. They reported that post-simulation debriefing was the most beneficial component. There was a trend towards a reduction in readmissions within seven days of implementing the revised curriculum.	First, we limited the scope of the project by offering simulation-based curriculum only to families of children requiring long-term mechanical ventilation. The institution’s inventory required the researchers to use a manikin representing a 5-year-old child, whereas patients’ mean age was 11.5 months. The research was conducted in a single center, and it is not known whether the findings are generalizable to other settings.
A6	It is believed that the combination of educational strategies capable of generating the acquisition of new skills, such as simulation and control of self-management of the drainage system at home, provided a favorable result for drain obstruction prevention, noting that 84.8% kept the system patent. It was found that training focused on self-care exercised by patients and the strategy used favorably influenced self-monitoring of continuous drainage system, preventing drain obstruction, a fact evidenced by the percentage of patients who maintained system patency (84.2%).	None.

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