UFPI participates in international project on Virtual Simulation Game for Nursing Students on Valvular Diseases
An international research project is developing a virtual simulation game to improve teaching about valve diseases for nursing students. The initiative is a partnership between the Federal University of Piauí (UFPI) and Queen’s University, in Canada, and is funded by the Canadian Alliance of Nurse Educators Using Simulation (CAN-Sim).
Started in 2022, the project is officially titled “Virtual Simulation Game for Nursing Students on Valve Disease” and brings together researchers from Brazil and Canada. Through a partnership with Professor Marian Florence Luctkar-Flude, from Queen’s University, co-president of the Canadian Association for Simulation (CAN-Sim), funding was raised to make the initiative viable. The collaboration also includes the participation of undergraduate and graduate nursing students from UFPI and another member of CAN-Sim, Professor Jane Tyerman, who brings extensive experience in the development of clinical simulations.
In April 2024, the team held about eight meetings to develop the game, and in August of the same year, members of the project traveled to Canada to record the simulation. The work has already resulted in a publication in the journal BMJ Open and an article is in the process of being submitted to the Journal of Clinical Nursing.
The studies have the collaboration of renowned professionals and researchers, including: Professor Elaine Maria Leite Rangel Andrade, Project Coordinator and Associate Professor of the Nursing Department at the Federal University of Piauí (UFPI); Professor Marian Florence Luctkar-Flude, Associate Professor at the School of Nursing at Queen’s University, with over 20 years of experience in nursing education and clinical simulation design. Co-founder, Director and Co-President of CAN-Sim; Professor Jane Tyerman, Associate Professor at the School of Nursing of the Faculty of Health Sciences at the University of Ottawa, with over 25 years of experience in clinical practice and over 15 years in the development of clinical simulations and virtual games, also co-founder, director and co-president of CAN-Sim; Phellype Kayyaã da Luz, PhD student of the Postgraduate Program in Nursing at UFPI; Raylane da Silva Machado, PhD and former student of the Postgraduate Program in Nursing at UFPI, currently an associate researcher at GEPETEINCO; Sabrina de Oliveira Carvalho, Master in Nursing from UFPI, responsible for the dissertation entitled “Virtual Simulation Game for Nursing Students on Valvular Diseases: Part I”; Ana Beatriz Barbosa Paz, Nurse and former student of the Nursing course at UFPI, author of the course completion work on the use of virtual clinical simulation in cardiology teaching.
Defense by Sabrina Carvalho, supervised by Professor Elaine Maria Leite Rangel Andrade, and with the presence of researcher Marian Florence Luctkar-Flude, from Queen’s University
Epidemiological context and clinical relevance
Cardiovascular diseases are the leading cause of death worldwide, having been responsible for 18.6 million deaths in 2019, according to the Global Burden of Disease (GBD). In Brazil, although there was a reduction in the number of deaths between 2000 and 2017, these conditions still remain the leading cause of death, while in Canada they occupy the second position, according to the Public Health Agency of Canada.
Among these diseases, Heart Valve Disease (CVD) stands out for directly affecting the effectiveness of body circulation. The main CVDs – including Rheumatic Heart Disease (RHD), Aortic Stenosis (AS) and Mitral Regurgitation (MR) – were responsible for 27,857 deaths in the United States in 2017, with the aortic valve accounting for 61% of this total.
Professor Elaine Maria Leite Rangel Andrade, coordinator of the project, explains about these diseases: “Valve diseases act directly on the heart valves and, due to the aging of the population, aortic valve disease tends to become an epidemic, especially due to the process of valve calcification over time”.
In Brazil, the etiology of valve diseases still includes cases resulting from rheumatic fever, sometimes referred to as optic valve disease, while in developed countries calcification resulting from aging predominates. In 2019, 2,600 deaths from non-rheumatic CVD were recorded in Canada and 4,800 in Brazil, highlighting population, socioeconomic, political and cultural differences, but also evidencing the presence of the same risk factors, such as smoking, obesity, hypertension, high glucose levels and dietary risks.
The conduct of health professionals in identifying and intervening in CVD is crucial. The Brazilian Guidelines for Valvular Heart Diseases, updated in 2020, include algorithms that contemplate the evaluation, diagnosis and treatment according to the etiology of each case. Adequate training of nursing students is considered vital so that, in the future, they can effectively execute the Nursing Process (NP) and ensure patient safety. However, the lack of teaching strategies that develop Clinical Reasoning (CR) is highlighted as a challenge that can compromise the quality of care.
In 2021, a study with 18 nursing students from a Canadian university indicated that the use of virtual simulation promoted positive emotions that enhanced the in-person experience. Additional studies reinforce that this modality generates better knowledge retention rates and improves CR when compared to simulation exclusively in the real environment. Traditional clinical simulation has already shown effectiveness in training technical and attitudinal skills, but the virtual model emerges as an alternative that allows “individual training and knowledge acquisition through trial and error”, without the costs and limitations associated with the use of laboratories with mannequins, highlights Prof. Elaine.
In the photo, Professor Elaine Maria Leite Rangel Andrade, next to Sabrina Carvalho
Project Expansion: Undergraduate and Graduate Studies
Postgraduate student Sabrina Carvalho, from the Graduate Program in Nursing (PPGENF/UFPI), explained that the idea of using the project as a study object arose during the COVID-19 pandemic. "I was at the end of my undergraduate degree and technology was a turning point for continuing to advance in nursing," she said. When she entered the master's degree with a project on telehealth, compatible with the research line of her advisor, Professor Elaine Maria Rangel Andrade, they decided, after the first meeting, to work with virtual simulation to address heart valve diseases, given their epidemiological and healthcare importance.
The main objective of the project is to develop a virtual simulation game on valve diseases for nursing students. To date, the first three phases have been completed: in Analysis, a scope review and mapping of the use of virtual simulation in cardiology teaching were conducted; in Design, in partnership with researchers from the Canadian Alliance of Nurse Educators using Simulation - CAN-Sim, the means and resources for the game were selected; and in Development, the resources were used to create documents that will support the filming and editing of the game, both in English and Portuguese.
According to Sabrina, the scope review protocol was published in BMJ Open, and the results of the mapping are in the process of being published in another journal. “For the scientific community, the dissemination of this methodology will contribute to new research and the expansion of the portfolio of available software. For society, it is expected that the qualification of nurses will improve the early identification and treatment of valve diseases”, she emphasized.
Ana Paz, a graduate of the Nursing Course, shared that, in a meeting with her advisor, Professor Elaine Maria Rangel Andrade, she was introduced to the project and included in the research group. It was there that she met the postgraduate students Sabrina Carvalho, Phellype Kayyaã and Raylane Machado. "In order to find out what already existed in the literature on the use of virtual simulation for teaching cardiology in nursing, a scoping review had to be produced", explained Ana. From this, the proposal arose that she would be responsible for preparing the protocol.
The main objective of her work was to present the necessary steps to map the scientific literature on the use of virtual simulation in teaching cardiology for nursing, guiding the completion of a scoping review on the subject. Ana clarified that, since it is a scoping review protocol, there is no "result" per se. "What I can say is that, based on it, a comprehensive strategy was constructed that guided the scoping review", she stated.
"In addition to mobility, which is important, we were able to bring resources from abroad here. Professor Marian is interested in coming to Brazil, and we are seeking funding to bring her next year. She will offer a three-day immersion workshop to teach students everything from script writing to filming a virtual simulation," he said.
The idea behind the initiative is to bring this expertise to the campus, especially to the Nursing Department, with the possibility of involving students and nurses from the University Hospital, which will be used as a field for the internships.