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Original Article
Descriptive study of the satisfaction of nursing degree students in high-fidelity clinical simulation practices
Estudio descriptivo de la satisfacción de los estudiantes del Grado en Enfermería en las prácticas de simulación clínica de alta fidelidad
Ana Rosa Alconero-Camareroa,
Corresponding author
alconear@unican.es

Corresponding author.
, Carmen María Sarabia Coboa, Silvia González-Gómezb, Isabel Ibáñez-Rementeríac, María Paz Alvarez-Garcíac
a Departamento de Enfermería, Universidad de Cantabria, Grupo de investigación en enfermería IDIVAL, Santander, Cantabria, Spain
b Atención Primaria, Servicio Cántabro de Salud, Grupo de investigación en enfermería IDIVAL, Santander, Cantabria, Spain
c Departamento de Enfermería, Hospital Universitario Marqués de Valdecilla, Santander, Cantabria, Spain
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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall"><elsevierMultimedia ident="tb0005"></elsevierMultimedia></p><span id="sec5005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect5065">Introduction</span><p id="par0030" class="elsevierStylePara elsevierViewall">At present&#44; Spanish universities are undergoing a process of innovation and reform in higher education&#44; which seeks to level out the many different educational procedures&#46; This dynamic and interactive process is focused on the student and attempts to revitalise the teaching function of the staff and the organisation of teaching and learning &#40;education based on competences and new teaching methodologies&#41;&#44; prompting models which provide access to knowledge and also skills and abilities&#46;<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#8211;3</span></a> Nursing and medical faculties are introducing changes to study plans&#44; and to new approaches in programme design and introducing different education strategies&#46;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> One of these strategies is clinical simulation &#40;CS&#41; where a complementary method of learning has been introduced to the other teaching skills and to practice&#46; It is not&#44; however a replacement&#44; since experience in real practice contains aspects which cannot be reproduced with this tool&#46;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">The use of CS as a training tool for healthcare professionals has increased during the last 10 years&#44; with its efficacy being evident in decision making and the acquisition of technical and communication skills&#46;<a class="elsevierStyleCrossRefs" href="#bib0025"><span class="elsevierStyleSup">5&#8211;7</span></a> CS entails the practice of clinical actions in a realistic environment without any risk to the patients and the professionals&#44; facilitating the standardization of teaching contents and contributing to the detection of training shortfalls&#46;<a class="elsevierStyleCrossRefs" href="#bib0025"><span class="elsevierStyleSup">5&#44;7&#8211;9</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">Lapkin et al&#46;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a> classify different types of simulators into 3 categories&#44; according to their technological complexity&#58; low&#44; medium and high&#46; The low fidelity complexity is essential and is acquired for basic psychomotor skills in a simple procedure of physical examination and simulates only one part of the body&#46; In the medium fidelity&#44; there is a combined use of a mannequin connected to pre-established software of less complexity which allows the instructor to manage basic physiological variables aimed at the development of a competence&#46; Lastly&#44; high fidelity complexity integrates many different physiological variables&#44; for the creation of realistic clinical settings with life sized mannequins&#46; The high fidelity simulators include complementary elements that give the simulators personality and allow the user to identify with the same realism as would be found in real life&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">A recent meta-analysis concluded that the CS in undergraduate training is more effective than traditional learning methods&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> Student training prior to the workplace is a major challenge for completing their training&#44; putting theory into practice in real environments&#44; based on learning from personal reflection&#46;<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">8&#44;11</span></a></p><p id="par0050" class="elsevierStylePara elsevierViewall">CS is an active methodology which promotes teamwork and develops the search for knowledge&#46;<a class="elsevierStyleCrossRefs" href="#bib0060"><span class="elsevierStyleSup">12&#44;13</span></a> For this reason&#44; after completing a case participants analyse their interventions and reflect on thought processes&#46; This analysis is called debriefing and should be included as a basic component of all simulation experiences&#46;<a class="elsevierStyleCrossRefs" href="#bib0070"><span class="elsevierStyleSup">14&#8211;16</span></a> Another issue which is no less important is the role of the instructors&#44; who must be sufficiently trained to encourage the transfer of knowledge among the students&#44; guaranteeing a secure and dynamic environment&#46;<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">13</span></a></p><p id="par0055" class="elsevierStylePara elsevierViewall">Nowadays the measurement of student satisfaction is relevant when it is accompanied by actions that promote improvement and innovation&#44; helping us to take accurate decisions&#44; improving safety and boosting self-confidence&#46; Several international and national tools have been developed to measure the satisfaction of students in the field of CS&#46;<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">7&#44;17&#8211;20</span></a> In the University of Cantabria Faculty of Nursing&#44; within the &#8220;Actions in special situations&#8221;&#40;ASS&#41; subject CS has been used for some years as a teaching tool for acquiring general and specific competence of the said subject&#46; The interest of the teacher in improving the development of the scenarios&#44; and the correct learning year after year&#44; requires constructive feedback by the student who receives it&#46; After the search for validated tools with which to measure the aspect of student satisfaction and not finding&#44; as far as we know&#44; any validated into Spanish&#44; we decided to create and validate a tool to this end&#58; the High fidelity clinical simulation satisfaction scale in students &#40;ESSAF for its initials in Spanish&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">21</span></a> This is the only scale of these specific characteristics for nursing students&#46; After validation of this questionnaire&#44; the following phase was to conduct a descriptive study with a cohort of different students from those who participated in the validation&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">The aim of this study is to describe the satisfaction of nursing students who do CS&#44; using the ESSAF&#44;<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">21</span></a> a tool created to assess&#44; among other aspects&#44; the management of priorities and the taking of decisions in critical simulated situations in real practice&#46;</p></span><span id="sec7010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect1070">Method</span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Design</span><p id="par0065" class="elsevierStylePara elsevierViewall">This was a descriptive observational study of a retrospective cross section&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Area and subjects</span><p id="par0070" class="elsevierStylePara elsevierViewall">The activity was developed over 2 years&#44; 2016&#8211;2017 and 2017&#8211;2018&#44; with 2nd year undergraduate nursing students of the ASS subject of the University of Cantabria Faculty of Nursing&#46; The activity was considered obligatory for all those who had matriculated in the subject&#44; a total of 269 students&#46; Out of these&#44; sessions with groups of 19 were undertaken&#44; with subgroups of 4&#8211;5 students who attended a scenario with a specific medical diagnosis or procedure&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Description of the activity</span><p id="par0075" class="elsevierStylePara elsevierViewall">The CS was performed in the Hospital Virtual Valdecilla &#40;HVV&#41; &#40;Spain&#41;&#44; a centre specialising in training and CS&#44; the collaborative centre of the Medical Simulation and Harvard-MIT Division of Health Sciences and Technology&#46; The University of Cantabria &#40;Spain&#41; has an agreement with the HVV to carry out CS scenarios with health science students&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">Eight scenarios were designed to recreate patients with acute coronary syndrome type diagnoses&#44; arrhythmias and procedures such as electric cardioversion and hypovolemic shock&#44; represented in the Emergency Services&#46;</p><p id="par0085" class="elsevierStylePara elsevierViewall">The students were previously told of the general requirements needed for good practice &#40;e&#46;g&#46; confidentiality on participant action and on the characteristics of the simulated cases&#41; and that the activity was not aimed at assessment but at fostering learning&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall">When designing the scenarios the following were defined&#58; the personnel required &#40;a nurse acting in the scene&#44; a software technician and an instructor&#44; who in this case was the teacher of the subject&#44; who guided the development of the scenario with an anamnesis script &#91;variables at the start of the examination&#44; additional tests and changes to be made according to the foreseeable action&#93;&#41;&#44; and posterior debriefing session&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Developing the scene</span><p id="par0095" class="elsevierStylePara elsevierViewall">Each CS practice lasted 2&#8239;h&#44; with the duration of each case being 15&#8239;min and the debriefing phase being 25&#8239;min&#46; It was not possible to understand the CS without the debriefing sessions&#46; With this approach personal opinion is shared&#44; accepting the best the participants offer and allowing them to commit errors and discuss them&#44; making them feel appreciated and capable&#46;<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">16</span></a> It also allows the instructors to demonstrate their experience and made constructive criticisms&#46;</p><p id="par0100" class="elsevierStylePara elsevierViewall">The development of each situation was recorded in audio and video&#44; for posterior analysis together with the teacher&#47;instructor and the students&#46; The teacher&#47;instructor outside the simulation room was in continuous communication through microphones and headphones and was able to provide information to the trainer inside the room all the time&#46; The instructor viewed the case&#44; but the student was unable to see the control room&#46;</p><p id="par0105" class="elsevierStylePara elsevierViewall">Once the case had been explained to the whole group of students&#44; 4&#8211;5 students participated in the scenario&#44; attending the patient&#44; whilst the rest of the group stayed in the other room as observers&#44; watching the case on television screens&#46; None of the groups repeated the same case and they all intervened on successive days&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Data collection</span><p id="par0110" class="elsevierStylePara elsevierViewall">Once the activity had finished and after the appropriate debriefing session&#44; all the students completed the ESSAF questionnaire anonymously and voluntarily on paper and signed their consent for the results to be used for academic purposes&#46;</p><p id="par0115" class="elsevierStylePara elsevierViewall">The ESSAF questionnaire was created and validated to this end&#44; with an alpha of 0&#46;857&#46;<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">21</span></a> the paper questionnaire was self-administered and anonymous and included&#58; variables such as age and sex&#44; and whether any simulation had been practised in other subjects&#46; It included 33 closed-end questions with a Likert type response on a scale of 5&#58; 1&#8239;&#61;&#8239;totally disagree&#59; 2&#8239;&#61;&#8239;disagree&#59; 3&#8239;&#61;&#8239;indifferent&#59; 4&#8239;&#61;&#8239;agree and 5&#8239;&#61;&#8239;totally agree&#44; plus 3 open-ended questions &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Data analysis</span><p id="par0120" class="elsevierStylePara elsevierViewall">The data obtained were analysed with the SPSS&#169; &#40;IBM&#41; statistical programme version 22&#46;0 in its Spanish version for Windows&#46; A descriptive analysis was performed according to the variables&#46; For qualitative variables percentages were used with their 95 &#37; confidence interval and for quantitative variables central tendency &#40;mean&#41; and dispersion &#40;standard deviation&#41; measurements were used&#46; After this a correlation analysis was carried out between the variables&#44; using Spearman&#46; A p value of &#60;&#46;05 was considered significant&#46;</p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Ethical considerations</span><p id="par0125" class="elsevierStylePara elsevierViewall">The students were informed verbally and in writing that the educational information was to be handled confidentially and anonymously throughout the study&#46; Also data of a personal nature would not be divulged during the research&#46; The students then presented their written consent to participate in the research&#46; Data processing was performed in such a way as to guarantee personal and study information confidentiality&#44; respecting Spanish legislation in force in compliance with the Data protection General Regulation which was implemented on 25th May 2018&#44; repealing Organic Law 15&#47;1999&#44; of 13th December&#44; governing the protection of individuals in personal data treatment&#46; The study was approved by the ethics committee of the University of Cantabria&#46;</p></span></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Results</span><p id="par0130" class="elsevierStylePara elsevierViewall">A total of 269 questionnaires were collected&#46; The mean age of the participants was 21&#46;68 years and 63&#46;3 &#37; were women&#46; 72&#46;5 &#37; stated they had previous experience in simulation&#44; specifically in the subjects of <span class="elsevierStyleItalic">Clinical nursing&#44; women&#8217;s welfare and Pharmacology&#46;</span> Over 89 &#37; indicated that their skills improved thanks to the simulation practices&#44; particularly in decision-making&#44; the ability to prioritise and the learning of procedures&#46;</p><p id="par0135" class="elsevierStylePara elsevierViewall"><a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a> shows the mean score and standard deviation of the questionnaire items given by the students on a Likert scale&#44; where 5 means &#8220;<span class="elsevierStyleItalic">highly agree</span>&#8221;&#46;</p><p id="par0140" class="elsevierStylePara elsevierViewall">The items with lower scores &#40;but above 3&#41; were &#8220;I lost my calm during some of the cases&#8221; and &#8220;I was familiar with the theoretical part of the cases&#8221;&#46;</p><p id="par0145" class="elsevierStylePara elsevierViewall">The items with the highest scores were &#8220;<span class="elsevierStyleItalic">simulation is beneficial because it connects theory with practice&#8221;</span> and &#8220;<span class="elsevierStyleItalic">the cases recreated real situations&#8221;&#46;</span> It is of note that 87 &#37; of the mean response to all items was above 4&#46;</p><p id="par0150" class="elsevierStylePara elsevierViewall">The Spearman correlation study of the most significant variables showed that &#8220;simulation has improved my ability to provide patient care&#8221; and &#8220;simulation is beneficial because it connects theory with practice&#8221; presented a strong positive correlation &#40;r&#8239;&#61;&#8239;&#46;84&#44; p&#8239;&#60;&#8239;&#46;05&#41;&#46; Statistically significant results were also observed in &#8220;the benefit provided by simulation&#44; since it connects theory with practice&#8221; in the &#8220;practical utility&#8221; &#40;r&#8239;&#61;&#8239;&#46;54&#44; p&#8239;&#61;&#8239;&#46;01&#41;&#46; No significant differences were observed for the remaining variables &#40;p&#8239;&#62;&#8239;&#46;2&#41;&#46;</p></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Discussion</span><p id="par0155" class="elsevierStylePara elsevierViewall">In this study students describe a high level of satisfaction through the ESSAF and confirmed that it was highly useful for learning&#46; These results are similar to others published on satisfaction in CS&#46;<a class="elsevierStyleCrossRefs" href="#bib0030"><span class="elsevierStyleSup">6&#44;19&#44;22&#44;23</span></a></p><p id="par0160" class="elsevierStylePara elsevierViewall">Although these results are self-informed perceptions of satisfaction&#44; this study has shown that simulation may be a viable option to prepare nursing students for clinical practice&#46; The students feel that simulation is based on solid educational practice and it is important for their learning&#46; As suggested by Zapko et al&#46;&#44; when training is well done&#44; it may lead to greater satisfaction and confidence in the students&#46;<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">23</span></a> We agree with Ricketts<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> in that the CS provides unequivocal ambiences for the students&#44; where potentially reproducible errors in a clinical environment are avoidable&#44; achieving the professional competences demanded from learning&#46;</p><p id="par0165" class="elsevierStylePara elsevierViewall">In our case&#44; the experience was also satisfactory for the instructor&#44; identifying several gaps in training and exploring emotional aspects and teamwork issues which are rarely analysed in other enviornments&#46;<a class="elsevierStyleCrossRefs" href="#bib0105"><span class="elsevierStyleSup">21&#44;24</span></a> One of the key elements is the training of the instructor&#44; since he or she designs the scenarios and moderates the debriefing&#46; He or she also points out things which have been well done as well as shortcomings&#44; thus boosting confidence&#46;<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">20</span></a></p><p id="par0170" class="elsevierStylePara elsevierViewall">The students recognised the importance of the debriefing as has been published in many studies&#46;<a class="elsevierStyleCrossRefs" href="#bib0070"><span class="elsevierStyleSup">14&#44;15</span></a> This means that new mental models were created and our actions could be redirected during practice so as to change behaviour&#44; improving foreseeable results&#46; As a result&#44; we think that the CS is viable and satisfactory in undergraduate nursing&#46;</p><p id="par0175" class="elsevierStylePara elsevierViewall">Recently&#44; McGaghie et al&#46;<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">13</span></a> reported that&#44; apart from CS being a highly powerful tool for the evaluation of competences in medical training under the right conditions&#44; it is important for research with mixed approaches &#40;quantitative vs&#46; qualitative&#41; in order to improve education and evaluation of healthcare teams&#46;</p><p id="par0180" class="elsevierStylePara elsevierViewall">In further studies the design of new clinical cases for undergraduates is ongoing where students studying nursing and medicine may combine aspects of clinical practice that require a multidisciplinary focus&#46;</p><p id="par0185" class="elsevierStylePara elsevierViewall">Equally interesting is that CS should be another methodological strategy in the training and learning of all subjects&#44; including practice&#46;</p><p id="par0190" class="elsevierStylePara elsevierViewall">In this study students describe a high level of satisfaction with the CS sessions and state that they find them very useful in the learning process&#46; A striking fact is the correlation between satisfaction with learning and usefulness&#46; One notable complaint in the processes of learning in health sciences is the difficulty the students find in incorporating theory into practice&#46; Different studies have evaluated the reasons for this discontent&#44; and usually emphasize that they do not find what they are learning to be useful&#44; that they do not see how practical application can be applied to theory and they do not work in real situations to improve acquisition of competences&#46;<a class="elsevierStyleCrossRefs" href="#bib0125"><span class="elsevierStyleSup">25&#8211;28</span></a> The tool used to assess satisfaction must be interesting and useful to be in keeping with the literature which advises the measurement of CS usefulness&#46;<a class="elsevierStyleCrossRefs" href="#bib0130"><span class="elsevierStyleSup">26&#44;27</span></a></p><p id="par0195" class="elsevierStylePara elsevierViewall">An analysis or debriefing is highly significant in CS because new mental models can be created and feedback of theoretical and practical learnings&#46;<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">29</span></a> This phase of CS is considered as one of the most enriching because students can learn from their errors and successes&#44; through the instruction of an expert &#40;the instructor&#41; but mainly through interaction with peers&#44; the other students&#46;<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">29</span></a> Maximum return from CS is acquired when all the students try it out personally and receive specific feedback during the debriefing&#46;<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">30</span></a></p><p id="par0200" class="elsevierStylePara elsevierViewall">The ESSAF used in this study is a useful and objective tool for measuring student satisfaction with individual learning&#46; It is operative and simple because it provides a lot of information to the teacher&#44; so that scenarios and procedures may be improved to obtain the final objective - to effectively integrate theory and practice</p></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0120">Financing</span><p id="par0205" class="elsevierStylePara elsevierViewall">This research study did not receive any specific funding from public or commercial sector agents or non profit-making bodies&#46;</p></span><span id="sec0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0125">Conflict of interests</span><p id="par0210" class="elsevierStylePara elsevierViewall">The authors have no conflict of interests to declare&#46;</p></span></span>"
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        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Objective</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">To describe the grade of satisfaction of nursing students with clinical simulation in their undergraduate training&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Method</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">A descriptive observational study of a retrospective cross section was conducted in undergraduate students in Nursing during the academic years 2016-17 and 2017-18&#46; The instrument used was a validated&#44; anonymous and self-administered questionnaire &#40;alpha &#46;857&#41; to measure the grade of satisfaction after high-fidelity clinical simulation practices&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Data were collected from a total of 269 students&#44; of which 63&#46;3 &#37; were women and the average age of the sample was 21&#46;68&#8239;&#177;&#8239;13&#46;46 years&#46; The analysis of frequencies shows results of the grade of satisfaction over 89 &#37;&#44; especially in decision-making&#44; the ability to prioritize and learning procedures&#46; Of the answers&#44; 87 &#37; exceeded an average of 4 out of 5&#46; The questions in the questionnaire with answers higher than 4&#46;6 were the realism of the cases &#40;4&#46;71&#41;&#44; the teacher provides constructive feedback after each session &#40;4&#46;65&#41;&#44; the simulation relates theory to practice &#40;4&#46;72&#41;&#44; the analysis &#40;debriefing&#41; at the end of the session helps reflection on the cases &#40;4&#46;65&#41; and practical utility &#40;4&#46;69&#41;&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusions</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Nursing students from the University of Cantabria &#40;Spain&#41; report high satisfaction in high fidelity clinical simulation&#44; confirming its usefulness in the learning process&#46;</p></span>"
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        "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Objetivo</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Describir el grado de satisfacci&#243;n que los estudiantes de enfermer&#237;a tienen con la simulaci&#243;n cl&#237;nica en su formaci&#243;n de grado&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">M&#233;todo</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Se realiz&#243; un estudio observacional descriptivo de corte transversal retrospectivo en estudiantes de grado en Enfermer&#237;a durante los cursos acad&#233;micos 2016-17 y 2017-18&#46; El instrumento utilizado fue un cuestionario validado&#44; an&#243;nimo y autoadministrado &#40;alpha 0&#44;857&#41; para medir el grado de satisfacci&#243;n tras las pr&#225;cticas en simulaci&#243;n cl&#237;nica de alta fidelidad&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Se recogieron un total de 269 estudiantes&#44; de los cuales&#44; el 63&#44;3 &#37; fueron mujeres y la edad media de la muestra fue de 21&#44;68 &#40;&#177;13&#44;46&#41; a&#241;os&#46; El an&#225;lisis de frecuencias muestran resultados del grado de satisfacci&#243;n superiores al 89 &#37;&#44; especialmente en la toma de decisiones&#44; la capacidad de priorizar y el aprendizaje de procedimientos&#46; El 87 &#37; de las respuestas superaban una media de 4 sobre 5&#46; Las preguntas del cuestionario con respuestas superiores al 4&#44;6 fueron el realismo de los casos &#40;4&#44;71&#41;&#44; el profesor hace retroalimentaci&#243;n constructiva despu&#233;s de cada sesi&#243;n &#40;4&#44;65&#41;&#44; la simulaci&#243;n relaciona la teor&#237;a con la practica &#40;4&#44;72&#41;&#44; el an&#225;lisis &#40;debriefing&#41; al final de la sesi&#243;n ayuda a la reflexi&#243;n de los casos &#40;4&#44;65&#41; y utilidad pr&#225;ctica &#40;4&#44;69&#41;&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusiones</span><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Los estudiantes de Enfermer&#237;a de la Universidad de Cantabria &#40;Espa&#241;a&#41; refieren una elevada satisfacci&#243;n con la Simulaci&#243;n Cl&#237;nica de alta fidelidad&#44; confirmando su utilidad en el proceso de aprendizaje&#46;</p></span>"
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        "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as&#58; Alconero-Camarero AR&#44; Sarabia Cobo CM&#44; Gonz&#225;lez-G&#243;mez S&#44; Ib&#225;&#241;ez-Rementer&#237;a I&#44; Alvarez-Garc&#237;a MP&#46; Estudio descriptivo de la satisfacci&#243;n de los estudiantes del Grado en Enfermer&#237;a en las pr&#225;cticas de simulaci&#243;n cl&#237;nica de alta fidelidad&#46; Enferm Clin&#46; 2020&#59;30&#58;404&#8211;410&#46;</p>"
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      0 => array:8 [
        "identificador" => "tbl0005"
        "etiqueta" => "Table 1"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at0005"
            "detalle" => "Table "
            "rol" => "short"
          ]
        ]
        "tabla" => array:1 [
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">N&#46;&#186;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Mean&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Standard deviation&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46; The facilities and teams were real&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">225&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&#46;48&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#46;551&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#46; The objectives of the cases were clear&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">225&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&#46;26&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#46;631&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#46; The cases recreated real situations&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">226&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&#46;71&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#46;482&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&#46; The time for each simulation case was appropriate&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">226&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&#46;26&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#46;698&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5&#46; The level of difficulty of the cases was appropriate for my knowledge&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">225&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#46;93&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#46;758&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6&#46; I felt comfortable and respected during the sessions&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">224&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&#46;33&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#46;808&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">7&#46; Simulation is useful for evaluating a patient&#8217;s clinical situation&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">225&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#46;589&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">8&#46; With simulation practices you learn not to commit errors&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">223&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&#46;36&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#46;722&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">9&#46; Simulation has helped me to establish priorities of action&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">226&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&#46;57&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#46;54&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">10&#46; Simulation has improved my ability to provide care to my patients&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">225&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&#46;34&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#46;615&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">11&#46; Simulation has made me reflect with respect to my next clinical practices&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">225&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&#46;56&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#46;588&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">12&#46; Simulation improves communication and the ability to work in the team&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">223&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&#46;44&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#46;688&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">13&#46; Simulation has made me feel more concerned&#47;anxious regarding the skills a graduate nurse has to have&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">225&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&#46;14&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#46;847&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">14&#46; Simulation is beneficial because it connects theory with practice&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">226&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&#46;72&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#46;489&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">15&#46; Simulation has allowed us to efficiently plan patient care&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">226&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&#46;05&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#46;688&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">16&#46; I have improved my technical skills&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">225&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#46;96&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#46;809&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">17&#46; I have reinforced my critical reasoning and decision making&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">226&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&#46;17&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#46;652&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">18&#46; Simulation has helped me appreciate the patient&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">225&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&#46;27&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#46;607&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">19&#46; This experience has helped me to prioritise care&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">226&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&#46;31&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#46;649&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">20&#46; Simulation fosters self confidence&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">225&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&#46;13&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#46;848&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">21&#46; I have improved communication with the team&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">226&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&#46;14&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#46;756&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">22&#46; I have improved communication with the family&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">226&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&#46;04&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#46;774&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">23&#46; I have improved communication with the patient&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">226&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#46;68&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">24&#46; This type of practice has increased my security&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">226&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#46;94&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#46;902&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">25&#46; I lost my calm during some of the cases&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">225&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#46;48&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;161&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">26&#46; The interaction with simulation has improved my clinical competence&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">226&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&#46;17&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#46;652&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">27&#46; The teacher made constructive feedback for each simulation session&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">225&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&#46;65&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#46;555&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">28&#46; The debriefing at the end of the session has helped me reflect on the cases&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">226&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&#46;65&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#46;594&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">29&#46;The debriefing at the end of the session has helped me correct errors&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">226&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&#46;55&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#46;646&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">30&#46; I was familiar with the theoretical part of the cases&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">225&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#46;64&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#46;784&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">31&#46; I have learned from the errors I committed during simulation&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">225&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&#46;49&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#46;606&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">32&#46; Practical usefulness&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">225&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&#46;69&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#46;519&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">33&#46;General satisfaction of the sessions&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">226&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&#46;55&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#46;565&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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          "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">What is known&#63;</span><p id="par0015" class="elsevierStylePara elsevierViewall">The use of clinical simulation &#40;CS&#41; as a training tool for healthcare professionals and for students has increased over the last 10 years&#44; with its efficacy in decision-making&#44; the acquisition of technical skills and communication has been proven&#46; CS means that clinical procedures can be put into practice in a realistic environment without any risk to patients&#44; facilitating standardisation of teaching contents and contributing to the detection of training shortfalls&#46; Students acquire skills and approaches in safe environments with consistent feedback by instructors&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">What does this paper contribute&#63;</span><p id="par6015" class="elsevierStylePara elsevierViewall">After simulation&#44; we applied a satisfaction questionnaire to probe on competences&#44; clinical safety&#44; prioritising of interventions and improvement of teamwork&#46; The nursing students stated that their satisfaction with the high-fidelity CS was high&#44; confirming its usefulness in learning processes&#46;</p></span></span>"
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