Effectiveness of a Multimodal Intervention With Simulation for Learning Home Health Nursing Care of Patients With Multimorbidity and Heart Failure

Learning will be analyzed through nursing students' performance during the simulations. Two independent observers with experience in tesching simulation will evaluate each simulation (pretest and posttest) through a validated checklist for each simulation scenario. The checklist evaluates the following aspects: (1) assessment of people and observation of the home (4 items), (2) nursing intervention (5 items), and (3) transversal competencies related to greeting, farewell, and communication skills (5 items). Each item will be evaluated by a dichotomous response (Yes/No) and a final overall evaluation (0-10 points). The observers' degree of agreement will be determined by Cohen's kappa.

Empathy toward patients presenting with pluripathologies and heart failure is essential for providing professional care. The general measure of the students' empathy level was measured by the Spanish version of the Jefferson Scale of Empathy, student version (JSE-S), with a Cronbach's alpha coefficient of 0.90. The JSE-S is a 20-item instrument specifically developed to measure empathy in health profession education and patient care for administration to health profession students and practitioners. Items are answered on a 7-point Likert-type scale (1 = Strongly Disagree, 7 = Strongly Agree). Half of the items are positively worded and directly scored, and the other half are negatively worded (reverse scored). The total score are range from 20 to 140, where a higher score indicates greater empathy.

Immediately after the simulation was performed. This will be measured using the Student Satisfaction and Self-Confidence in Learning (SCLS) scale. The scale is based on a five-point Likert scale, ranging from "strongly disagree" to "strongly agree." The scores that can be obtained range from 13 to 65 points and were validated with a Cronbach's alpha of 0.90.

After the individual and group debriefings. The Educational Practices Questionnaire (student version) (EPQ) will be used. It consists of 16 items, assessed on two 5-point scales. Each item assessed quality and importance. The questionnaire is validated with Cronbach's alphas of 0.86 and 0.91 for the scales respectively.

After the individual and group debriefings. For this purpose, the High Fidelity Clinical Simulation satisfaction scale in students (ESSAF) will be used. This scale contains 33 statements answered on a 5-point Likert-type scale, with a minimum score of 1 (strongly disagree) to 5 (strongly agree). The 33 items are grouped into 8 factors or dimensions of student perception of the simulation clinic: "Usefulness", "Characteristics of cases and applications", "Communication", "Perceived performance", "Increased self-confidence", "Relationship between theory and practice", "Facilities and equipment" and "Positive aspects". It is validated with a Cronbach's alpha of 0.857.