Prática deliberada em ciclos rápidos como estratégia de ensino no atendimento inicial ao paciente com dor torácica
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Data
2025-03-31
Autores
Chiesa, Raquel Alves da Costa
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Universidade Federal do Espírito Santo
Resumo
Initial care for patients presenting with chest pain must be precise, assertive, and performed as quickly as possible in order to enable early detection of acute coronary syndromes, promote myocardial reperfusion, and increase patient survival. In this context, the qualification of nursing actions is essential, particularly in high-complexity care settings. To enhance professional practice, this continuing education project proposes the use of Rapid Cycle Deliberate Practice (RCDP) simulation, directed at nurses working in the Critical Care Unit, where the researcher is professionally embedded. RCDP applied to initial patient assessment promotes technical accuracy, reduces errors, and optimizes time management, which is a critical factor in the care of patients with time-dependent conditions. This study is aligned with the nursing care research line focused on the human development process.The aim of this dissertation was to develop a training program for nurses in the initial care of patients with chest pain, based on Rapid Cycle Deliberate Practice simulation.This research consisted of two interdependent studies. The first was a retrospective exploratory study designed to conduct a situational diagnosis regarding compliance with recommended practices and to identify potential areas for improvement in nursing care for patients presenting with chest pain. Data collection was performed through the analysis of physical and electronic medical records of patients who were spontaneously admitted with chest pain to a university hospital between January and June 2024.The second study was methodological in nature and was conducted between June 2024 and March 2025, aiming to develop, validate, and pilot test a Rapid Cycle Deliberate Practice–based simulation training instrument for nurses involved in the initial management of chest pain. This study was carried out in two phases: the first phase focused on the development of the methodological instruments, while the second phase involved the application and evaluation of the developed instruments and the simulated scenario by a pilot team composed of five nurses from the Critical Care Unit, through training using RCDP simulation. The study was approved by the Research Ethics Committee under opinion number 7,315,332 and Certificate of Presentation for Ethical Consideration (CAAE) number 84726724.8.0000.5071. Analysis of the retrospective data revealed a lack of standardization in the initial care of patients with chest pain, despite the existence of an institutional chest pain protocol. Additionally, the mean times for risk classification and electrocardiogram performance (door-to-electrocardiogram time) exceeded the values recommended by current clinical guidelines. In parallel, the training instruments developed—namely the RCDP Application Guide, pre- and post training checklists, and the simulated scenario script—underwent preliminary validation and were tested and refined based on feedback from the pilot nursing team. It is concluded that the developed instruments have the potential to be implemented according to institutional demands and to be adapted for use in other healthcare institutions with similar chest pain care workflows. The proposed product is expected to contribute to the standardization of nursing care, early intervention in chest pain management, and improvement of quality indicators such as door-to electrocardiogram time, risk classification time, and door-to-balloon time, thereby reducing complications and increasing survival among patients with chest pain associated with acute coronary syndromes and other time-dependent conditions.
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Síndrome coronariana aguda , Tempo porta-eletrocardiograma , PDCR