Elaboration and validation of a simulation scenario for communicating institutional bond termination in nursing

6 Ifé Odara Alves Monteiro da Silva Enfermeira. Especialista. Escola de Enfermagem de Ribeirão Preto da Universidade de São Paulo. Estudante de Mestrado. Ribeirão Preto, São Paulo, Brasil. ife.odara@usp.br – ORCID iD: https://orcid.org/0000-0002-6164-4470 Objective: to develop a simulation scenario for teaching difficult communication in institutional bond termination for the nursing team and validate it in terms of face and content. Methods: a methodological study that designed and assessed a simulation scenario with 17 experts in the field. Data were collected and processed using the internet clouds system. Results: the simulation scenario elaborated was improved according to the experts’ suggestions by including topics related to the scenario title; educational objectives; description of pre-briefing; design flowchart; termination protocol; the debriefing model; and scenario references. The final version obtained an average of 94.6%. Conclusion: the simulation scenario was fully validated for using and promoting difficult communication teaching in institutional bond termination in the nursing team.

Nurses work in several areas of human care, and they are responsible for their team 1 . They must lead with good interpersonal relationships, empathy and trust, through effective communication 2 .
Communicating bad news is part of care and management of a team, and is one of the most difficult activities for nurses 2 .
The unpreparedness of the leader who sends the message can cause psychological and social damage to the recipient, which are subject to legal sanctions 3 .
As with any team, the nursing team also suffers from conflicts that require the institutional dismissal of employees, a situation that requires training for a legal, ethical and adequate approach 4 . To that end, it is important that there is training from the academic background to ensure good resourcefulness in a difficult communication process for institutional disconnection in the health team 5 .
In the context of education for health professionals, new paradigms appear that seek to break with obsolete teaching practices using pedagogical tools whose student is the protagonist of their learning process 6 . Therefore, the concept of active teaching methodologies emerges.

-Target audiece
Graduating undergraduate nursing students

-Type of simulation
High fidelity and low complexity simulation.

-Educational objective
Experiencing the management of institutional disconnection of a member of the nursing team in a simulated environment.

-General objective of the scenario
Performing institutional bond termination of a employee of the nursing team using SPIKES strategy.

-Specific objectives of the scenario
a) Assigning employees to a private environment; b) Leading the employee to understand the situation; c) Demonstrating empathy with the employee's feelings, but maintain priority in view of institutional rules, current legislation and the seriousness of the situation; d) Conducting and verbalize conduct (institutional bond termination); e) Ensuring that communication was clear and that there was an understanding by the employee.

Chart 1 -Characterization of the validated simulation scenario for teaching difficult communication in institutional bond termination in the nursing team. São Paulo Brazil, 2019
Chart 2 shows the elements of the scenario design, in which the history of the simulation is evidenced, which objectively contextualizes the staging that will be performed; scenario tips that are hints to help participants solve the problem; pre-briefing, which demonstrates the scenario to the participants and formalizes the regulation of expected conduct during the simulation; description of the participants; presentation of the scenario script and flowchart 8 .

-Story
Isadora, 35, has been working for a year as a nursing technician at the pediatric clinic of a Regional Teaching Hospital. Approximately nine months ago, she committed her first administrative incident by posting on a social network about the care provided at the hospital and telling confidential information about the lives of patients. She then received her first warning.

Chart 2 -Design of the validated simulation scenario for teaching difficult communication in institutional bond termination in the nursing team. São Paulo, Brazil, 2019
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-Story
About six months ago, she received her second written warning, as she published a photo with a child inside the hospital. Yesterday, it came to the attention of the nurse responsible for the sector that Isadora was handling the cell phone while preparing and administering the medication, resulting in a formal denunciation by the child's family members and a request by the administration to terminate the institutional bond.

-Scenario's hints
a) Meeting site; b) Warning history; c) Formal denunciation of the child's relatives; d) Institutional bond termination form filled out.

-Pre-briefing
a) This is a simulation, which provides an opportunity to face everyday facts, so they behave in the most realistic way possible; b) The scenario starts after a verbal command "start of scenario" and ends when either participant or the driver says "end of scenario"; c) If you think you should do something, do it, acting as if you are facing a real situation; d) You have at your disposal the history of the employee's warnings, a place reserved for meetings and the completed institutional termination form; e) Everything you assess and observe must be verbalized, in order to understand your reasoning; f) If you need assistance in any conduct, use your cell phone to speak and it will be provided.

-Participants
a) Nurse role -a student; b) Coordinator role -a student; c) "Isadora" role -a properly trained actress.