EMERGÊNCIA PEDIÁTRICA COM A PRESENÇA DA FAMÍLIA NO ATENDIMENTO PRÉ-HOSPITALAR MÓVEL: CONSTRUÇÃO E VALIDAÇÃO DE CENÁRIO DE SIMULAÇÃO

Abstract

ABSTRACT The presence of the family in pediatric hospital care is considered a beneficial practice, promoting greater humanization and safety in care. However, in emergency procedures, it remains a topic of debate, even when validated by international guidelines. In the context of mobile pre-hospital care, the inclusion of the family still faces barriers, often being seen as a source of information. Nonetheless, technical assistance focused on the victim prevails, and their presence during procedures depends on the professionals' stance. The absence of clear protocols and specific training represents challenges to implementing the philosophy of Patient and Family-Centered Care, an approach considered ideal for assistance, aiming to promote the health and well-being of individuals and families, involving the family in planning, delivering, and evaluating care. To make this practice feasible, it is necessary to promote the active presence of the family during care, establish directed protocols, and designate trained professionals to ensure effective communication with family members. Continuous education, based on meaningful learning and innovative pedagogical strategies such as clinical simulation, stands out as a tool for team training, strengthening the implementation of this care philosophy. In this context, the nurse plays the role of educator and team liaison. To address this gap, this study is aimed at designing and implementing an educational intervention for nursing professionals in the mobile pre-hospital context, with an emphasis on family-centered pediatric emergency care. A methodological study was carried out in four stages: 1) Scoping Review, anchored in the JBI framework, guided by the question: How has the process of family interaction been in clinical simulation training for first responders in the pediatric emergency context? Searches were conducted from January to March 2024, without language or year limitations. 2) Simulation Scenario Design, based on the main national and international literature recommendations on the topic and the construct's structural framework following the guidelines of the International Nursing Association for Clinical Simulation and Learning and on the theoretical model for clinical simulation. 3) Scenario Validation by Experts, with validation of the scenario in form and content carried out by 12 expert nurses in the field from various regions of Brazil, selected according to Jasper's criteria. For agreement analysis, the Content Validity Coefficient with an acceptance criterion above 0.80, the Content Validity Index, and the Agreement Index, both with a minimum cut-off point of 0.90, were used. Additional suggestions were incorporated to improve the instrument. 4) Pilot Test and Scenario Structure Validation by the Target Audience based on the Simulation Design Scale. The study was conducted between June and October 2024 in Mato Grosso do Sul, Brazil. The scoping review results indicated that 60% of the analyzed publications were from the United States, with all studies conducted in hospitals; only 10% included other settings, with no exclusive focus on pre-hospital care. Clinical simulations focused on multiprofessional training with doctors, nurses, and physical therapists (60%), while 30% exclusively addressed nurse training. Simulated scenarios stood out for emphasizing pediatric resuscitation with family presence (40%). Evidence shows that simulations effectively overcome barriers to family inclusion, promoting confidence and technical and communication skills in controlled environments. However, professional interaction with the family remains secondary in pediatric emergency training, indicating a need for greater attention. In the scenario validation process, two Delphi rounds confirmed the instrument's validity and agreement, with a Content Validity Coefficient

of 0.90, a Content Validity Index of 0.98, and an Agreement Index of 90.6%, demonstrating methodological robustness and practical relevance. Contributions from experts were incorporated, ensuring alignment with the context of application. The target audience's evaluation highlighted high reliability and acceptance, with a Cronbach's Alpha of 0.90 and Agreement Index above 91%. These results reinforce the effectiveness of simulation in training for pediatric emergencies in the pre-hospital context, promoting technical development and integration of patient- and family-centered practices, aligned with humanized care. This study expands knowledge about pediatric emergency care, proposing pathways to explore the pre- hospital context and the inclusion of family members during care. It reinforces clinical simulation as a skilled tool for training, positively impacting professional confidence and communication. The validation of the developed instrument represents a significant advance, promoting skills aligned with patient- and family-centered care. The results highlight the need to expand simulation to the pre-hospital context, contributing to the humanization and quality of pediatric emergency care.

Keywords: Emergency Responders, Emergency Medical Services,Family Nursing, Child, Simulation Training, Education Nursing Continuing