Form for planning and elaborating high fidelity simulation scenarios: A validation study

Every human being has the right to safe, dignified and harm-free care in health institutions. High fidelity simulation has been used in teaching for the training and continuing education of health professionals to promote quality, safe and humanized patient care. Elaborating scenarios is an important phase to provide a simulation-based experience, and is relevant in the teaching-learning process. The objective of this study was to validate the content and applicability of the High Fidelity Simulation Scenario Planning and Development Form and its Operational Manual. The form could be used to development of scenarios to medicine, nursing, physiotherapy and as well as other specialties in the healthcare. This was a methodological validation study of the form and its manual content by experts in simulation and its feasibility, conducted in two phases: Phase 1: eight experts were selected using the “snowball” sampling technique to validate the content measured by the content validity index; Phase 2 (test): the form and its operational manual validated by the experts were made available to 28 participants in order to elaborate scenarios for the feasibility assessment and participation in the focus group. All items in the form and in the operational manual reached a content validity index above 0.80. The total content validity index was 0.98. The evaluation of the usability of the instruments carried out by the participants reached a percentage above 96.43% in all alternatives except for the item “It was easy to use the form to build your scenario” (75%). Eight participants were present in the focus group. Focus group discussions were categorized into completeness, practicality and usefulness according to comments and suggestions. The form and its operational manual proved to be valid instruments.


INTRODUCTION
This operational manual for completing the Realistic Health Simulation Planning and Development Form (ForPEC), version 1.2 of October 2018, aims to serve as a reference source for the construction of health simulation scenarios using ForPEC, version October 1.3, 2018.
It is organized into parts according to the numbering in ForPEC, version 1.3 October 2018 and with a detailed description of each item below.
A technical scenario and a behavioral scenario are included in the annex as examples to facilitate understanding and use of this manual.
12. Record the necessary teaching and learning activities prior to the realization of the scenario, such as reading articles, lectures, e-learning, monitored practice and others. 13. Record the content transfer activities to be developed after the scenario is carried out, such as articles, guidelines, reminders, critical points of the scenario where students/participants had greater difficulty in conducting them and others. These content transfer activities are planned in line with the target audience, the results and indicators selected for the continuity of learning. 14. Determine the performance of the student/participant assessment prior to the realization of the scenario. Describe the strategy to be used for this assessment, such as: multiple choice test, essay questions, procedure validation, OSCE (Objective Structured Clinical Examination) and others. 15. Determine the performance of student/participant assessment after the scenario. Describe the strategy to be used for this assessment, such as: multiple choice test, essay questions, procedure validation, OSCE (Objective Structured Clinical Examination) and others. Note: Content transfer activities, pre and post simulation assessments are not mandatory. Each institution should outline its guidelines.

PART III: LEARNING FROM RESULTS
16. General objective ( All use (economic or otherwise) depends on prior, formal and express authorization from the author, including partial or complete reproduction and use in any form. When using the document, it is mandatory to mention the name of the person who authored the work."

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Operacional Manual: Formulário de Planejamento e Elaboração de Cenário de Simulação Realística em Saúde -ForPEC 18. Describe the relevant critical points of the scenario to guide the scenario elaboration and debriefing. When selecting the CRM (Crew Resource Management), list the main key points of the scenario: leadership, communication, teamwork, situational awareness, decision making and use of all available resources. For the other critical points, specify, for example, the update of some protocol item, "TeamSTEEPS", "ANTS", "Ottawa GRS", etc. 19. Establish the expected results in the scenario, for example, satisfaction of the participants, achievement of the objective proposed in the scenario, etc. 20. Describe the organizational indicator(s) for monitoring, eg urinary infection rate after scenarios related to the topic. 21. After completing the scenario, fill in the positive points and opportunities to improve the scenario, for example, in the training/course, the need to specify, in addition to the fasting time, the type of food eaten at the last meal or to add materials, was identified, equipment and exams.

PART IV: REFERENCES FOR THE PREPARATION OF CONTENT AND SUBMISSION OF THE MATERIAL FOR PRE-OR POST-SIMULATION READING 22. References
22. List all references used to prepare the scenario (articles, guidelines, policies and institutional routines).

PART V: SIMULATION CENTER LOGISTICS
Volunteer information (Student/Participant) 23. Volunteer(s): 24. Number of volunteers for the initial scenario: ( 1 ) All use (economic or otherwise) depends on prior, formal and express authorization from the author, including partial or complete reproduction and use in any form. When using the document, it is mandatory to mention the name of the person who authored the work." All use (economic or otherwise) depends on prior, formal and express authorization from the author, including partial or complete reproduction and use in any form. When using the document, it is mandatory to mention the name of the person who authored the work." All use (economic or otherwise) depends on prior, formal and express authorization from the author, including partial or complete reproduction and use in any form. When using the document, it is mandatory to mention the name of the person who authored the work." All use (economic or otherwise) depends on prior, formal and express authorization from the author, including partial or complete reproduction and use in any form. When using the document, it is mandatory to mention the name of the person who authored the work."

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Operacional All use (economic or otherwise) depends on prior, formal and express authorization from the author, including partial or complete reproduction and use in any form. When using the document, it is mandatory to mention the name of the person who authored the work." All use (economic or otherwise) depends on prior, formal and express authorization from the author, including partial or complete reproduction and use in any form. When using the document, it is mandatory to mention the name of the person who authored the work." All use (economic or otherwise) depends on prior, formal and express authorization from the author, including partial or complete reproduction and use in any form. When using the document, it is mandatory to mention the name of the person who authored the work." All use (economic or otherwise) depends on prior, formal and express authorization from the author, including partial or complete reproduction and use in any form. When using the document, it is mandatory to mention the name of the person who authored the work." Actions and transitions *Add columns if necessary 83. Record the vital and clinical parameters and the expected actions for the transitions and evolution of the patient's next clinical condition, including a time interval when applicable, according to the conduct and decision-making of the student/participant. Record the duration of each evolution, if applicable, and/or the action that will trigger the next phase of the scenario. These parameters must be recorded and described whenever necessary to conduct the scenario. It is important to develop an algorithm of options for both correct and incorrect behaviors. Other parameters can be entered as needed. Add the number of conditions necessary for the evolution of the scenario. All use (economic or otherwise) depends on prior, formal and express authorization from the author, including partial or complete reproduction and use in any form. When using the document, it is mandatory to mention the name of the person who authored the work." All use (economic or otherwise) depends on prior, formal and express authorization from the author, including partial or complete reproduction and use in any form. When using the document, it is mandatory to mention the name of the person who authored the work." All use (economic or otherwise) depends on prior, formal and express authorization from the author, including partial or complete reproduction and use in any form. When using the document, it is mandatory to mention the name of the person who authored the work." All use (economic or otherwise) depends on prior, formal and express authorization from the author, including partial or complete reproduction and use in any form. When using the document, it is mandatory to mention the name of the person who authored the work."

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Operacional All use (economic or otherwise) depends on prior, formal and express authorization from the author, including partial or complete reproduction and use in any form. When using the document, it is mandatory to mention the name of the person who authored the work." All use (economic or otherwise) depends on prior, formal and express authorization from the author, including partial or complete reproduction and use in any form. When using the document, it is mandatory to mention the name of the person who authored the work."

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Operacional Manual: Formulário de Planejamento e Elaboração de Cenário de Simulação Realística em Saúde -ForPEC Evaluation Ethics and professionalism 51. Expected results: Average of the highest evaluation grade in the evaluation after the simulation; Increase in the rate of knowledge acquisition. 52. Indicators: Knowledge acquisition rate Average of the pre-simulation assessment grade Post-simulation evaluation grade average Notifications of incidents related to drain "clamping". 53. Opportunities to improve the scenario: Professional ethics issues were included as discussions arose in relation to the patient regarding the mistakes committed All use (economic or otherwise) depends on prior, formal and express authorization from the author, including partial or complete reproduction and use in any form. When using the document, it is mandatory to mention the name of the person who authored the work." All use (economic or otherwise) depends on prior, formal and express authorization from the author, including partial or complete reproduction and use in any form. When using the document, it is mandatory to mention the name of the person who authored the work." All use (economic or otherwise) depends on prior, formal and express authorization from the author, including partial or complete reproduction and use in any form. When using the document, it is mandatory to mention the name of the person who authored the work." All use (economic or otherwise) depends on prior, formal and express authorization from the author, including partial or complete reproduction and use in any form. When using the document, it is mandatory to mention the name of the person who authored the work." All use (economic or otherwise) depends on prior, formal and express authorization from the author, including partial or complete reproduction and use in any form. When using the document, it is mandatory to mention the name of the person who authored the work." Security of a condominium, with its source of income, helps your daughter, because her son-in-law is unemployed 76. Physical: Simulator 77. Costume: Nightdress 78. Technical:

References
Start scenario with horizontal decubitus Scenario evolution 79. Attitude A (Positive outcome) 81. Attitude B (Negative outcome) If the volunteer(s) provide adequate communication and guidance, the patient will agree to the procedures and thank the staff.
If the volunteer(s) do not communicate properly, omitting information, the patient will be suspicious and insecure. Will maintain a questioning posture 80. Phrases which can be used 82. Phrases which can be used Este manual operacional para o preenchimento do formulário de planejamento e elaboração de cenário, versão 1.2 de outubro de 2018 contém informações privilegiadas e/ou confidenciais de propriedade da SIMSAFETY Treinamento Desenvolvimento & Educação.
All use (economic or otherwise) depends on prior, formal and express authorization from the author, including partial or complete reproduction and use in any form. When using the document, it is mandatory to mention the name of the person who authored the work."

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Operacional Manual: Formulário de Planejamento e Elaboração de Cenário de Simulação Realística em Saúde -ForPEC "I don't know, the shortness of breath started after they changed the bottle, your colleagues from the previous shift" "Something happened, why did my shortness of breath get worse?" "Do you need to notify the doctor?" "Will I have no problems? What can I do to help them" "What do you mean your colleagues don't know anything!" "It has already happened to the patient next door; how can I trust this hospital!" "I want to talk to my doctor now!" 83. Scenario evolution (Vital and clinical parameters) Condition 1 "declamping" the drain 2 Failure to identify the drain "clamping" All use (economic or otherwise) depends on prior, formal and express authorization from the author, including partial or complete reproduction and use in any form. When using the document, it is mandatory to mention the name of the person who authored the work." All use (economic or otherwise) depends on prior, formal and express authorization from the author, including partial or complete reproduction and use in any form. When using the document, it is mandatory to mention the name of the person who authored the work." All use (economic or otherwise) depends on prior, formal and express authorization from the author, including partial or complete reproduction and use in any form. When using the document, it is mandatory to mention the name of the person who authored the work." All use (economic or otherwise) depends on prior, formal and express authorization from the author, including partial or complete reproduction and use in any form. When using the document, it is mandatory to mention the name of the person who authored the work." All use (economic or otherwise) depends on prior, formal and express authorization from the author, including partial or complete reproduction and use in any form. When using the document, it is mandatory to mention the name of the person who authored the work." Clara Santos, 12 years old, was hospitalized in the Intensive Care Unit for 3 days. A patient with ALL (Acute Lymphoblastic Leukemia) presented pulmonary infection, followed by septic shock, was intubated, was on mechanical ventilation and sedated. She had cardiorespiratory arrest and was unsuccessfully resuscitated. Death was found by the on-call doctor and he reported the death to Clara's mother.

Start of scenario:
You are a nurse who starts your work shift and received the shift with your colleague. Clara's mother is in the room attached to the ICU and you need to deliver Clara's belongings to the mother. 54. History of current illness: for 4 months, weakness, pallor, fever, bone pain and the appearance of bruises on the body. She was diagnosed with ALL and started chemotherapy treatment 3 months ago. The response to treatment is not as satisfactory as the medical team would like, and bone marrow transplantation has been discussed in the last chemo session. 55. Family history: 56. Social history: Clara has a 9-year-old sister Maria. Ana, the mother is an architect and in her current condition, she passed all the work to the company partner. Ana's father is an engineer. The whole family has been taking turns to stay with Clara in the hospital for hospitalizations and chemotherapy sessions. 57. Family background: 58. All use (economic or otherwise) depends on prior, formal and express authorization from the author, including partial or complete reproduction and use in any form. When using the document, it is mandatory to mention the name of the person who authored the work." All use (economic or otherwise) depends on prior, formal and express authorization from the author, including partial or complete reproduction and use in any form. When using the document, it is mandatory to mention the name of the person who authored the work."  ) 81. Attitude B (Negative outcome) If the volunteer demonstrates welcoming and empathetic behavior, explain Clara's condition if presented (name, position and appropriate body posture); build rapport and empathy, welcoming Ana who shows she doesn't understand the situation; assertive communication (congruence between what he says and what he expresses, verbal and non-verbal); obtain and transmit necessary information; listen actively, the actress must accept the reception at the end of the scenario If the volunteer delivers the belongings and is indifferent to Ana's emotional state, she will present a reactive posture, denial and will question some facts as described below… 80. Phrases which can be used 82. Phrases which can be used "Hi! Is Clara better? Did you manage to perform the procedure? I was asked to leave her side for a while." "Her condition is serious, but she has been through so much worse. You know, she is a warrior, a wonderful daughter, always with a smile on her face despite the pain." "This morning, despite the sedation, I held her little hand and talked to her, we remembered the family moments and the funny things she did! She has often made us strong. It should be the other way around, shouldn't it? The nurse said it was okay for me to talk to her and touch her." "The Doctor came here to talk to me and said that her condition is serious, I didn't understand very well, she spoke with many terms that you use. I can go into the ICU now and be by her side!" "It's not possible, her heart was beating normally, I know her condition is serious, but what do you mean, she died! It's not possible! It can't be!" "My husband has just left the ICU, he spent the night with her!" "How can that be?!! When I left her side, it was all right!" "What did you do?!!" "Her condition is serious, but everything was going well, it was just the changing shifts when this happened!!" "I want to talk to the doctor, I don't want to talk to you" "Do you have kids?!!" "Can you imagine my pain??" "Are you sure they did everything they could?!!" "You are not telling the truth!" "I want to enter the ICU now, who is going to stop me, that security guard over there???" "You didn't even look me in the eye, you come here and you tell me this with this indifference!" "How is this possible??" "I can't believe it, it can't be true!" "You guys did something wrong, I'm going to sue this hospital!" Este manual operacional para o preenchimento do formulário de planejamento e elaboração de cenário, versão 1.2 de outubro de 2018 contém informações privilegiadas e/ou confidenciais de propriedade da SIMSAFETY Treinamento Desenvolvimento & Educação.
All use (economic or otherwise) depends on prior, formal and express authorization from the author, including partial or complete reproduction and use in any form. When using the document, it is mandatory to mention the name of the person who authored the work."

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Operacional Manual: Formulário de Planejamento e Elaboração de Cenário de Simulação Realística em Saúde -ForPEC "Please say it's not true!" -crying-"I have another daughter, Maria. She cut her hair and gave it to Clara to make a wig. What am I going to tell her??! "Is it her clothes? -Open the bag and take the drawing -"it's the drawing she made when she was in the room.
-crying and silence -(don't speak) "I'll never be able to hug her again, make plans, there's an emptiness as if a part were ripped off!!" "Even knowing that one day life ends, we are not prepared to lose someone we love so much! -can get out of control and increase the level of anxiety - All use (economic or otherwise) depends on prior, formal and express authorization from the author, including partial or complete reproduction and use in any form. When using the document, it is mandatory to mention the name of the person who authored the work."