SIMULAÇÃO CLÍNICA PARA CAPACITAÇÃO DE CUIDADORES DE PACIENTES CRÔNICOS COM RISCO DE LESÃO POR PRESSÃO

Abstract

Clinical Simulation is a pedagogical strategy that has gained strength in health education. Based on the theory of meaningful learning, it allows learners to know the representation of a real event, in order to learn and practice. Regarding the process of dehospitalization, it is believed that the practice of health education through simulation can improve the process of care at home, ensuring quality in care and especially safety to the patient and caregiver. This study aimed to verify the use of clinical simulation as a strategy for training caregivers for the dehospitalization of adult and bedridden patients in chronic health conditions at risk of pressure injury. The research was conducted in two stages. In the first, an integrative literature review was carried out by peers in the electronic databases from January to March 2022. The guiding question was: "How is clinical simulation used and what are its effects on the preparation of caregivers of patients with chronic diseases in the process of dehospitalization?". 3,218 articles were found. After reading titles, abstracts and full text and applying the selection criteria, five articles were included. It was identified that the conversation wheel with low fidelity simulator, procedural skills training, the simulation of high fidelity with simulated patient and the computer controlled dummies were the types of clinical simulation used in the training of the caregiver described in the literature. The review allowed to observe the need to implement simulated training strategies of a practice based on scientific evidence, as well as to identify knowledge gaps on the subject, training of caregivers of adult patients in the process of dehospitalization. It was identified that the caregivers trained through Clinical Simulation had the improvement of technical skills. The studies also allowed us to verify that the simulations were efficient for the training of caregivers' skills. In the second stage, a qualitative research was carried out. The study site was the Maria Aparecida Pedrossian University Hospital, located in Campo Grande/MS. Data were collected between August and November 2022. First, a questionnaire was completed with the necessary information to characterize the profile of patients and their 17 primary caregivers. Then, a training based on simulation was performed with the caregivers, using skills training with low fidelity simulators. Finally, after discharge, individual semi-structured, audio-recorded interviews were conducted with caregivers in their homes, and the data obtained were submitted to content analysis. From this analysis, four categories emerged: 1) Benefits of training with the use of Clinical Simulation; 2) Training as a facilitating strategy in training the caregiver in practice with the patient; 3) Benefits of skills training with Clinical Simulation in the prevention of Pressure Injury; and 4) Simulation as a learning strategy in the training of caregivers using the doll/mannequin in the process of dehospitalization. It was found that the training enabled the improvement of technical skills and the autonomy of caregivers for home care. They reported greater security to carry out actions related to Pressure Injury prevention measures and to meet the challenges of home care. It was also identified that the intervention of the Clinical Simulation, composed of simulated training during the hospitalization period, with the follow-up at home after hospital discharge, was effective in training primary caregivers of chronic patients at risk of pressure injury. Training in the preparation of caregivers is therefore a valuable tool, which facilitates the acquisition of knowledge and skills for home care, through the use of specific resources and strategies in the prevention of pressure injury. The study was approved by the Research Ethics Committee of the Federal University of Mato Grosso do Sul.