Simulazione e Formazione Video per il Riconoscimento della Flebite e il Processo Decisionale Clinico negli Studenti di Infermieristica

Description:

Participants in this arm receive training through standardized patient (SP)-based simulation scenarios designed to reflect clinical signs and symptoms of peripheral intravenous catheter (PIVC)-related phlebitis. Trained standardized patients portray consistent case scenarios, enabling students to perform patient assessment, identify early signs of phlebitis (e.g., erythema, pain, swelling, and warmth), and engage in clinical decision-making. The intervention emphasizes the integration of cognitive, psychomotor, and affective skills, including communication and empathy. Each session is followed by a structured debriefing process using an evidence-based model (e.g., PEARLS) to support reflective learning and clinical reasoning.

This intervention consists of structured, scenario-based training using standardized patients who are trained to consistently portray clinical manifestations of peripheral intravenous catheter (PIVC)-related phlebitis. Participants are required to perform patient assessment, identify clinical signs (e.g., erythema, pain, swelling, warmth), and make appropriate clinical decisions regarding management. The simulation is conducted in a controlled environment and integrates cognitive, psychomotor, and affective learning domains. Each session is followed by a structured debriefing (e.g., PEARLS model) to enhance reflective learning and clinical reasoning.

Participants in this arm receive video-based educational content specifically developed to demonstrate the recognition and management of PIVC-related phlebitis. The videos include standardized clinical scenarios presenting visual and contextual cues such as insertion site changes, patient-reported symptoms, and appropriate nursing interventions. This intervention allows students to repeatedly observe clinical situations, facilitating cognitive rehearsal and reinforcing clinical reasoning processes. The video-based learning approach is structured to promote active engagement, improve knowledge retention, and support flexible, self-paced learning.

This intervention includes structured video-based educational materials developed to demonstrate the recognition and management of PIVC-related phlebitis. The videos present standardized clinical scenarios with visual and auditory cues, including patient symptoms and appropriate nursing interventions. Participants engage with the content in a guided format, allowing for repeated viewing and cognitive rehearsal. The intervention is designed to enhance knowledge acquisition, clinical reasoning, and learner engagement through flexible and accessible learning.

Participants in the control group receive conventional classroom-based theoretical instruction on PIVC-related complications, including phlebitis. The teaching method consists of lectures and/or standard instructional materials without the use of simulation or video-based learning components. This arm represents the standard educational approach for comparison with innovative, learner-centered interventions.

This scale describes how nursing students perceive clinical decision-making based on their own statements (Jenkins, 2001). The original Clinical Decision-Making Scale for Nursing (CDM) consists of 40 items and four subscales. A reliability and validity study of the CDM in nursing in Turkey was conducted by Durmaz and Dicle (2015). The subscales are, respectively: "Exploring options and ideas", "Investigating goals and values", "Evaluating outcomes", and "Exploring information and adopting new information impartially". Each subscale consists of 10 items. Scores range from 40 to 200 for the total scale and from 10 to 50 for each subscale; there is no cutoff point. A high score indicates a high perception of decision-making, while a low score indicates a low perception of decision-making. The scale is evaluated based on each subscale and the total scale score.

The level of knowledge regarding the recognition of peripheral intravenous catheter (PIVC)-related phlebitis, including identification of signs and symptoms such as erythema, swelling, pain, and warmth.

Measurement Tool:

The "Phlebitis Assessment Knowledge Test" was administered to students in both the experimental and control groups before the intervention and after skill performance assessments. The knowledge test consisted of 10 multiple-choice questions prepared by the researcher based on the literature. Expert opinions on the test will be obtained from five faculty members specializing in the Fundamentals of Nursing. The test is scored between 0 and 100. Higher scores indicate a higher level of knowledge in diagnosing and evaluating phlebitis.

The scale, originally developed by Jeffries and Rizzolo (2006) with 13 items, was adapted into Turkish by Unver et al. (2017) with a total of 12 items (Jeffries & Rizzolo, 2006; Unver et al., 2017). This scale measures students' satisfaction and self-confidence in learning in a simulation environment. The scale consists of two sub-sections: "Satisfaction with Current Learning" and "Self-Confidence in Learning". The "Satisfaction with Current Learning" sub-section consists of 5 items, and the "Self-Confidence in Learning" sub-section consists of 7 items. The scale is a five-point Likert type, with response options for items expressing student feelings being: 1) Strongly disagree, 2) Disagree, 3) Undecided, 4) Agree, and 5) Strongly agree; there are no negative items. An increase in the score on the scale indicates increased student satisfaction and self-confidence in learning (Unver et al., 2017).

The scale consists of 5 subscales and 20 items: "Goals and Knowledge", "Support", "Problem Solving", "Feedback/Guided Reflection", and "Accuracy". Developed by Jeffries and Rizzolo (2006), the scale was adapted into Turkish by Unver et al. (2017) (Jeffries & Rizzolo, 2006; Unver et al., 2017). The scale is scored by dividing the total score given to the answers by the number of items. The lowest possible score on the scale is 1, and the highest is 5. The first section measures whether the best simulation design elements were applied in the simulation application. A high total score on the scale indicates that the best simulation design elements were applied in the simulation application. The second section of the scale measures how important the simulation application is to the students. A high total score on the scale indicates that the student attaches high importance to the simulation experience they have had (Unver et al., 2017).