La simulación clínica como metodología para la adquisición de habilidades no técnicas, clínicas y competencias en práctica basada en la evidencia en estudiantes de grado en enfermeríaproyecto SimEnf

Résumé

High-fidelity clinical simulation (HFCS) is an innovative methodology that facilitates active student-centered learning and competency-based education in the health sciences. This technique offers a comprehensive learning and training approach in which theoretical knowledge, practical skills, and human factors are integrated. Implementing simulation-based learning provides nursing students with a safe environment to develop technical and non-technical skills and evidence-based practice competencies required for the Bachelor of Science in Nursing degree. These practices contribute to improved outcomes regarding quality and safety in patient care. The general objective of this Doctoral Thesis was to evaluate non-technical skills, technical skills, evidence-based practice (EBP) competence, and communication skills in undergraduate nursing students, as well as to analyze the relationship between these variables after implementing training based on high-fidelity clinical simulation (HFCS). The work plan was carried out over two years through an extensive methodological process developed in two phases. Phase 1 involved the development and validation of the Scale of Non-Technical Skills in Medical and Surgical Hospitalization Units (NTS-Nursing), which consisted of an instrumental study where the operational definition of the construct, item creation, face and content validation by experts and cognitive piloting were carried out. This was followed by a psychometric analysis (item analysis, internal structure analysis, reliability analysis, and external validity evidence) in which 393 nursing students participated. In phase 2, two studies were conducted, a quasi-experimental and an observational study, to evaluate the assessment of evidence-based practice competence before and after implementing SCAF-based training and to evaluate the predictive value of communication skills and EBP competencies in nursing students and their relationship with performance in simulated clinical scenarios, involving a sample of 182 and 180 nursing students, respectively. The results show that the NTS-Nursing Scale has adequate psychometric properties and allows for measuring non-technical skills in simulated clinical scenarios in nursing students across three dimensions: Teamwork, management of nursing interventions, and communication with the patient/family. In addition, a significant improvement in EBP competency was found after clinical simulation-based training. Students showed a statistically significant (p<0,05) increase in their knowledge and skills towards EBP after SCAF intervention. On the other hand, students demonstrated variable competencies in EBP and communication skills. A positive and statistically significant correlation (p<0,001) between these variables and regression models showed significant associations, highlighting the influence of communication skills and EBP competence on nursing students' performance in non-technical skills and nursing interventions in simulated clinical scenarios. The main conclusions of this Doctoral Thesis are linked to three aspects. First, the ability of the NTS-Nursing Scale to accurately measure non-technical skills in medical and surgical inpatient units in undergraduate nursing students. Second, the SCAF is an effective strategy for improving EBP competency in nursing students. Third, communication skills and EBP competence predict performance in simulated scenarios for nursing students.