Análisis del impacto de la respuesta psicofisiológica y las competencias socioemocionales sobre el rendimiento de estudiantes de enfermería en entornos de simulación clínica

Abstract

Introduction: Clinical simulation is a teaching methodology whose integration in curricula is growing, highlighting its application in the field of nursing. It is a technique that recreates environments and situations with the purpose of promoting controlled and progressive learning, based on previously established objectives and competencies. To provide participants with an immersive experience by facing simulation scenarios in a safety context. Facing complex and realistic situations generates demanding demands in terms of knowledge and skills for students and professionals. This challenge leads to activation of the sympathetic nervous system in participants, who experience stress and anxiety situations similar to those encountered in real clinical practice, which can positively or negatively affect their performance. For this reason, it is important to objectively monitor the psychophysiological parameters and socioemotional competencies that influence the quality of performance during clinical simulation practices. The evaluation of parameters such as vital signs, stress, anxiety, cognitive load or situational awareness by incorporating innovative tools will allow to adapt the learning process and optimize the results of clinical practice. Facial thermography, pupillometry and pupillary monitoring are some of the technological tools that allow the evaluation of the state and activation of the participants during the confrontation of clinical simulation scenarios in the field of nursing. For all these reasons, the general objective of this Doctoral Thesis is to evaluate the impact of psychophysiological response and socioemotional competencies on the performance of nursing students in clinical simulation environments. Method: An investigation composed of four quasi-experimental pre-test/post-test studies was designed, in which Bachelor's and Master's nursing students participated in four experiments. In each of them they had to face a clinical case through a clinical simulation scenario. In each experiment, psychophysiological parameters (heart rate, systolic and diastolic blood pressure, respiratory rate, partial oxygen saturation and peripheral temperature) were monitored and validated questionnaires on various socioemotional competencies (stress, anxiety, cognitive workload, motivation and perceived self-efficacy) were administered before and after facing the simulation practices. The first experiment, corresponding to article 1, included facial thermographic imaging before and after clinical simulation. In the second study, corresponding to article 2, the relationship between physiological parameters and socioemotional competencies of the participants was analyzed. In the scenario of article 3, pupillary dynamics were recorded during the simulation training. Finally, in the last experiment, corresponding to article 4, pupillary tracking was recorded in the environment during the entire clinical simulation practice. Results: Four scientific papers were published detailing the results obtained in the four studies. In the first one, statistically significant differences were identified between the psychophysiological response before and after facing the simulation scenarios. Statistically significant correlations were also observed between anxiety and the temperature of the different facial areas (r = 0.579, p < 0.000; r = 0.394, p < 0.006; r = 0.328; p < 0.019; r = 0.284; p < 0.038). Lower performance was observed associated with higher levels of anxiety. In the second study, statistically significant differences were also observed in the pre- and post-test measurement of heart rate (p < 0.0001). In addition, a multiple regression model establishing a relationship between performance, post-test oxygen saturation, heart rate, workload and self-efficacy was obtained (R2 = 0.490; F (3,39) = 8.305; p < 0.0001; d = 1.663). The third paper performed a multiple regression model in which a statistically significant pattern developed between pupil diameter differences and parameters such as heart rate, systolic blood pressure, workload and performance (R2 = 0.280; F (6.41) = 2.660; p < 0.028; d = 2.042). The latter publication shows statistically significant differences in eye-tracking data (revisits, glances, and duration of fixations) as a function of the areas of interest on which participants focused (p = 0.05). The performance outcomes showed a negative and moderate association with gaze the total number of gazes in the second-cycle group (rho = -0,640, p = 0,010). Conclusions: Assessment of psychophysiological parameters and socioemotional competencies offer a promising framework for predicting the quality of simulated clinical practices. Facial thermography allowed assessment of temperature gradients in relation to variability in anxiety levels, pupillary response enhancement showed consistency with SNS activation, and pupillary tracking described participants' visual attention patterns. Therefore, the incorporation of technological tools opens a field of study to be established as complementary devices in the evaluation of performance during participation in clinical simulation scenarios within the learning processes of nursing students and professionals.