Construção, validação e avaliação da eficácia de um simulador de baixo custo voltado para o ensino de administração de medicamentos em lactentes

Abstract

Nursing education has several limitations, among which practical training in administering medications to infants stands out, due to the scarcity of opportunities to train this skill. Clinical simulation and simulators are, respectively, potential teaching methods and technologies to reduce this gap. The objective was to build, validate and evaluate the effectiveness of a low-cost simulator for the purpose of administering medications to infants, subcutaneously, intravenously and intramuscularly. This is a mixed methods research, using the concomitant triangulation strategy, consisting of three types of study: one methodological, one interventional and one descriptive. Five steps were necessary for the research: planning, building and testing the simulator; simulator validation; validation of the simulation scenario; intervention study; and descriptive study. For the validation stages, the Kappa index, the Content Validity Index and the Factor Validity Index were calculated. In the intervention study, descriptive and inferential statistics were used, through the use of frequencies and the McNemar test. In the descriptive study, interviews were carried out and received lexicographic information processing in the IRaMuTeQ software, for subsequent content analysis. The simulator construction stage involved the creation of a prototype of an infant, produced with materials of low purchasing value, with a final cost of R$ 326.20. The second stage involved the validation of the simulator by nine judges, who analyzed its functionality, appearance and general aspects. The assessment of functionality using the Kappa, CVI and FVI indices was 0.99. Both when evaluating the general aspects of the simulator and its appearance, a Kappa index of 0.96 and a CVI and FVI of 0.98 were obtained. Therefore, excellent agreement between the evaluators was obtained. The third stage involved content validation of the simulation scenario by 31 judges, who evaluated its representativeness, importance and clarity, resulting in a representativeness CVI of 0.83; CVI importance of 0.94; CVI clarity of 0.88; Kappa of 0.81; FVI of 0.89. In the fourth stage, the medication administration skills of 18 undergraduate nursing students were compared before and after offering a course focused on the topic, with improvements in the 73 items evaluated, of which 25 were statistically significant. There was also an increase in the percentage of self-confidence in the three routes of administration. The last stage involved the students' perception regarding the use of the simulator, emerging four thematic categories: potentialities of using the low-cost simulator in the subcutaneous, intravenous and intramuscular administration routes; the realistic experience of using the low-cost simulator; practical application of theoretical knowledge learned; and practical gaps and repercussions on the safety of medication administration. In effect, the simulator constructed is innovative and reproducible, confirming the thesis that it is possible to construct a lowcost simulator aimed at administering medications to infants that presents evidence of validity in appearance and functionality and that promotes the improvement of patient skills students.