Introduction: Currently, one of the expanding methodologies in nursing education is the innovative teaching methodology, with high-fidelity simulation being one of its learning tools. This type of clinical simulation allows consolidating and integrating theoretical knowledge with clinical practice and developing technical and non-technical skills in nursing students, such as decision making.Methodology: This research work began in the form of a systematic literature review,whose main objective was to highlight the importance of carrying out an empirical study,given the scarcity of results in the context of decision-making by Portuguese Nursing students. In a second work, through a methodological study, whose main objective was to culturally validate the measurement instruments Clinical Decision Making in Nursing Scale©and Lasater's Clinical Judgment Rubric©, it was intended to develop evaluation tools valid in European Portuguese that would allow to evaluate the taking decision making in Nursing education in Portugal. In the experimental study, of the pre-test and post-test type with randomized samples, it was intended to determine the effectiveness of the practice of high-fidelity simulation and medium-fidelity simulation in the decision making process of nursing students, after the development of training on basic life support and after clinical teaching; and assess the level of knowledge about basic life support and decision-making of nursing students, before and after the clinical simulation scenario and after clinical teaching. This study had in its genesis the development of an intervention,namely the practice of basic life support in adults. To carry out this investigation, the Escola Superior de Enfermagem de Coimbra was selected for presenting a Clinical Practices Simulation Center. The research groups were divided in a randomized and homogeneous way, being the experimental group that used high-fidelity simulation and the control group that practiced medium-fidelity simulation.Results: In the validation study of the Clinical Decision Making in Nursing Scale©, the confirmatory factor analysis showed a good quality of adjustment of the factor structure,consisting of three factors (X2/gl = 2.056; GFI = 0.927; CFI = 0.917; RMSEA = 0.046;RMR = 0.039; SRMR = 0.050). Determining the fidelity of the scale required that it be XVI made up of 23 items, with correlation values ranging between 0.184 and 0.610 and an overall Cronbach's alpha value of 0.851, demonstrating good reliability. Regarding the validation of the Lasater's Clinical Judgment Rubric©, of the 64 observations obtainedfrom the practices of nursing students, the value of intraclass correlations in the 4 phases of the instrument – Noticing, Interpreting, Responding, Reflecting – above 0.792 washighlighted. An overall Cronbach's alpha of 0.921 and 0.876 was found in observers 1 and 2 respectively, with a statistically significant level of agreement, presented by a kappa value greater than 0.803. 51 Nursing students participated in the experimental study, with a mean age of 20.25±3.804 years, of which 92.2% were female. The research groups showed homogeneity in the variables age, knowledge, decision making and hours of clinical teaching. Within the group that practiced high-fidelity simulation, the level of decision-making of nursing students was maintained, while in the group that practiced high-fidelity simulation, there was a decrease in scores over the three evaluation moments. Statistically significant differences emerged regarding Problem Definition and Goal Development, factor 1 of decision making, in the experimental group (p < 0.05),and in Data Search and Processing, factor 2 of the same variable, in the control group (p< 0.01), with high effect size. There was an arithmetic mean of 74.3 points in the satisfaction of the experimental group and 72 points in the control group (74.27±4.635 and 72.00±7.572 respectively). Overall, the practice of nursing students on basic life support is at a good level, with averages between 41 and 42 points, respectively in the high-fidelity simulation (41.29±3.245) and in the medium-fidelity simulation(41.64±2.341). In longitudinal terms, it was observed that the level of knowledge presents statistically significant differences (p < 0.01) in both investigation groups, between the three evaluation moments, being more expressive in the high-fidelity simulation group (p< 0.001).Conclusions: The Portuguese Version of the Clinical Decision Making in Nursing Scale©and Lasater's Clinical Judgment Rubric©are valid and reliable instruments, demonstrating a high potential for their use in researching and training the decision-making process and clinical judgment in nursing students in Portugal. With this research work, it was possible to validate, by experts in the field of clinical simulation and experts in the field of critical patients, a training program in the scope of basic life support in an in-hospital environment, using medium-fidelity simulation and to high-fidelity simulation. The experimental study showed that nursing students sustain a good level of knowledge in the XVII context of basic life support, although it is necessary to develop strategies in order to maintain this same level of knowledge over time. Decision-making by nursing students showed a good level, however, it will be necessary, in future studies, to create or validate a measurement instrument within the scope of decision-making by hetero assessment.Based on this investigation, a possible path to develop the decision-making process in nursing students was based, using a high-fidelity simulation structurally prepared and supported by prebriefing and debriefing, after carrying out theoretical training on basiclife support, complemented with practice in clinical teaching. This possibility is an alternative to the practice of just clinical teaching, with a good level of satisfaction, a good level of learning perception and a good level of basic life support practice by nursing students.
| Date of Award | 6 Apr 2022 |
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| Original language | Portuguese |
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| Awarding Institution | - Universidade Católica Portuguesa
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| Supervisor | Maria dos Anjos Dixe (Supervisor) |
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