Déborah Hevelly de Sousa Maia¹

Joselane Izaquiel Marinho²

Jaciely Gondim Sidrônio Nicácio³

Jucicleia Maiara da Silva Freitas⁴

Edlene Régis Silva Pimentel⁵

Luana Carla Santana Ribeiro⁶

Lidiane Lima de Andrade⁷

¹Universidade Federal de Campina Grande. Cuité, Paraíba, Brasil. https://orcid.org/0000-0002-0441-3107

²Universidade Federal de Campina Grande. Cuité, Paraíba, Brasil. https://orcid.org/0000-0002-5713-016X.

³Universidade Federal de Campina Grande. Cuité, Paraíba, Brasil. https://orcid.org/0000-0002-2363-9507.

⁴Graduação em Enfermagem-UFCG. Residência em Saúde da Família e Comunidade-FCM/UFPB. https://orcid.org/0000-0001-5322-9624.

⁵Universidade Federal de Campina Grande. Cuité, Paraíba, Brasil. https://orcid.org/0000-0003-0352-5825.

⁶Universidade Federal de Campina Grande, Cuité, Paraíba, Brasil. https://orcid.org/0000-0003-3485-3100.

⁷Universidade Federal de Campina Grande. Cuité, Paraíba, Brasil. https://orcid.org/0000-0003-1015-923.

Autor correspondente

Joselane Izaquiel Marinho

E-mail: marinhojoselane96@gmail.com

Endereço: Rua Pedro Gondim, 307, Bairro Pref. Jaime Pereira, 58175-000, Cuité – PB – Brasil

ABSTRACT

Objective: to map the educational technologies used to support the teaching of semiology and semiotechniques in nursing during the social distancing caused by the COVID-19 pandemic. Method: an integrative literature review was carried out by searching the MEDLINE, CINAHL, Scopus and Library, information Science & Technology Abstract databases, with the guiding question: what are the educational technologies used to support the teaching of semiology and semiotechniques in nursing during the social distancing caused by the COVID-19 pandemic? Results: the sample consisted of seven articles, regarding the type of technology, educational videos were predominant, about the contents covered, it was found wound care, application of ventrogluteal intramuscular injection, indirect blood pressure measurement, bed bath, strategies effective prevention, management, treatment and control of arterial hypertension, critical thinking through the application of the nursing process, patient safety skills. Final considerations: it is concluded that the educational technologies used to support the teaching of Semiology and Semiotechniques during social distancing were: two applications, communication technology using WhatsApp Messenger; a high-fidelity simulation and three educational videos. The use of these technologies enabled the continuity of teaching and the inclusion of the discipline of Semiology and Semiotechniques, being essential for the continuity of the teaching-learning process in times of social distancing, such as the COVID-19 pandemic.

Keywords: Educational Technology; Physical Distancing; Distance Education; Nursing Education; Nursing.

RESUMEN

Objetivo: mapear las tecnologías educativas utilizadas para apoyar la enseñanza de semiología y semiotecnicas en enfermería durante el distanciamiento social provocado por la pandemia de COVID-19. Método: se realizó una revisión bibliográfica integradora de la literatura mediante la búsqueda en las bases de datos MEDLINE, CINAHL, Scopus y Library, Information Science & Technology Abstract, con la pregunta orientadora: ¿qué tecnologías educativas se utilizan para apoyar la enseñanza de semiología y semiotecnicas en enfermería durante el distanciamiento social provocado por la pandemia del COVID-19? Resultados: la muestra estuvo conformada por siete artículos, en cuanto al tipo de tecnología, predominaron los videos educativos, sobre los contenidos abordados, se encontró cuidado de heridas, aplicación de inyección intramuscular ventroglútea, toma indirecta de presión arterial, baño en cama, estrategias efectivas de prevención, manejo, tratamiento y control de la hipertensión arterial, pensamiento crítico mediante la aplicación del proceso de enfermería, habilidades de seguridad del paciente. Consideraciones finales: se concluye que las tecnologías educativas utilizadas para apoyar la enseñanza de Semiología y Semiotecnicas durante la distancia social fueron: dos aplicaciones, tecnología de comunicación mediante WhatsApp Messenger; una simulación de alta fidelidad y tres videos educativos. El uso de estas tecnologías permitió la continuidad de la enseñanza y la inclusión de la asignatura de Semiología y Semiotecnicas, siendo fundamentales para la continuidad del proceso de enseñanza-aprendizaje en tiempos de distancia social, como la pandemia del COVID-19.

Palabras clave: Tecnología Educacional; Distanciamiento Físico; Educación a Distancia; Educación en Enfermería; Enfermería.

RESUMO

Objetivo: mapear as tecnologias educacionais utilizadas para apoiar o ensino de semiologia e semiotécnica em enfermagem durante o distanciamento social ocasionado pela pandemia de COVID-19. Métodos: realizou-se revisão integrativa da literatura por meio de busca nas bases de dados MEDLINE, CINAHL, Scopus e Library, information Science & Technology Abstract, com a questão norteadora: quais as tecnologias educacionais utilizadas para apoiar o ensino de semiologia e semiotécnica em enfermagem durante o distanciamento social ocasionado pela pandemia de COVID-19? Resultados: a amostra foi composta por sete artigos, quanto ao tipo de tecnologia, vídeos educativos foram predominantes, acerca dos conteúdos abordados, encontrou-se cuidado de feridas, aplicação de injeção intramuscular ventroglútea, medida indireta da pressão arterial, banho no leito, estratégias efetivas de prevenção, manejo, tratamento e controle da hipertensão arterial, pensamento crítico por meio da aplicação do processo de enfermagem, habilidades de segurança do paciente. Considerações finais: Conclui-se que as tecnologias educacionais utilizadas para apoiar o ensino de Semiologia e Semiotécnica durante o distanciamento social foram: dois aplicativos, tecnologia de comunicação utilizando WhatsApp Messenger; uma simulação de alta fidelidade e três vídeos educativos. O uso dessas tecnologias possibilitou a continuidade do ensino e a inclusão da disciplina de Semiologia e Semiotécnica, sendo imprescindíveis para continuidade do processo de ensino-aprendizagem em tempos de distanciamento social, como na pandemia da COVID-19.

Palavras-chave: Tecnologia Educacional; Distanciamento Físico; Educação à Distância; Educação em Enfermagem; Enfermagem.

INTRODUCTION

In Brazil, the first Higher Education Institutions (HEI) with undergraduate courses in Nursing began to emerge since the year 1890⁽¹⁾. In 2020, there were registered in the electronic system for monitoring the processes that regulate national education, e-MEC (Ministry of Education, Eletronic-MEC), about 1,180 institutions that offered undergraduate courses in Nursing. Of these, 1,172 in the face-to-face modality, with 181,994 authorized vacancies and eight in the distance learning (DE) modality, with 82,240 vacancies^(2-3).

With the Coronavirus Disease 19 (COVID-19) pandemic, teaching remotely was exceptional, instituting the implementation of non-face-to-face classes mediated through the use of technology⁽⁴⁾. Therefore, the institutions and their managers had to (re)invent themselves and adapt the teaching method.

The teaching in a virtual way was necessary due to the emergency scenario, and one of its challenges is to make the user feel inside the environment, from navigation and interaction with the teacher. It is noteworthy that for the training of nursing professionals it was considered an obstacle, since it was necessary to introduce dynamic methodologies directed to a theoretical and practical reality in a virtual way⁽⁵⁾.

Moreover, this new scenario has shown that nursing is in constant transition, and it is possible to observe that technological tools are important factors for the evolution of practical classes, resources offered through digital platforms can generate learning effectiveness and empower students in decision-making when facing a problem^(6-7).

Undergraduate nursing courses include in their curricula the discipline of semiology and semiotechniques, which is essential for students to build knowledge for the practice of care in environments where nursing professionals are inserted. It is a theoretical-practical discipline, whose students learn the reality through simulated or real activities⁽⁸⁾.

Among the strategies used, laboratory practices with the use of realistic simulation and practices in health services, which allow the visualization, development of skills and experience of the real scenario, stand out. A study demonstrates efforts in teaching semiology and clinical reasoning through methods different from the traditional ones, introducing practical guides, courses in virtual learning environments, educational videos and games, simulations, and virtual learning objects⁽⁹⁾.

There are several studies that relate to new technologies in distance education, thus, with the pandemic of COVID-19 and its restrictions, ideas that could facilitate student learning were put into practice. In this context, the subject of semiology and semiotechniques experienced difficulties in the teaching-learning process, due to its theoretical and practical nature, but it was seen that the use of different educational technologies could help in this learning process.

Therefore, this study aims to map the educational technologies used to support the teaching of semiology and semiotechniques in nursing during the social detachment occasioned by the COVID-19 pandemic.

METHODS

This is an integrative literature review, which is a method to unite knowledge and incorporate the results of significant studies into practice. Its purpose is to present the general concepts and steps for the preparation of an integrative literature review, based on the most recent scientific evidence⁽¹⁰⁾.

To carry out an integrative review, it is necessary to follow six steps: 1) identification of the theme and selection of the research hypothesis or question for the integrative review; 2) establishment of criteria for inclusion and exclusion of studies/sampling or literature search; 3) definition of the information to be extracted from the selected studies/study categorization; 4) assessment of the studies included in the integrative review; 5) interpretation of results, and 6) presentation of the review/knowledge synthesis⁽¹⁰⁾.

The research question was constructed based on the PICo strategy (P-population: nursing students, descriptors: "Nursing students" OR Students; I-interest: educational technologies, descriptors: "Educational technology" OR "Digital technology" OR "Simulation training"; Co-context: teaching semiology and semiotechnics during social distancing, descriptors: "Nursing education" OR Teaching OR "Education, Nursing"), which resulted in the following guiding question: what are the educational technologies used to support the teaching of semiology and semiotechnics in nursing during social distancing caused by the COVID-19 pandemic?

To operationalize the search, controlled descriptors were selected, after consulting the Health Science Descriptors (DeCS) vocabularies and databases in the area of health sciences and technological sciences, according to Chart 1.

DISCUSSION

Most studies had Brazilian researchers as researchers. Technology-mediated learning has gained emphasis and space to facilitate the teaching process, and Brazil has been standing out with the use of educational technologies in the health field⁽¹⁹⁾.

Thus, after the suspension of classes in some institutions, training began for faculty members to learn how to use platforms for remote teaching⁽⁷⁾. The results obtained in 13 studies, it was observed that the institutions located in the Northeast and Southeast regions were the first to adhere to remote teaching in Brazil⁽²⁰⁾.

As a result of this situation, the Ministry of Education, through Ordinance No. 343 of March 17, 2020, provided for the replacement of classroom classes by digital classes for the duration of the COVID-19 pandemic. This same ordinance emphasizes that it is the responsibility of educational institutions to define the subjects that may be replaced, the availability of tools for students that allow the monitoring of the contents offered, as well as the performance of assessments during the period of authorization⁽⁴⁾.

However, online education goes beyond videoconferences and sharing of videos, materials and power point. It will be effective if it provokes active learning in students, providing the possibility to write, read, question, analyze and solve problems, creating new learning situations⁽²¹⁾. In this perspective, it is essential that institutions have a working knowledge of technological resources before committing to the use of technologies, because the effective use of technology services may be associated with the technological readiness of an organization⁽²²⁾.

To enter this field of the computerization of educational tools, especially in Brazilian nursing education, besides financial investment, there is an urgent need for a body of human resources skilled in the handling of such technologies. Distance education (EaD in Portuguese) in Brazil is often seen as a modality that promotes more autonomy, and the proper planning of activities are able to stimulate students more than traditional lectures, by keeping them connected and strengthening their skills with technologies in this digital society⁽²³⁾.

Among the publications focused on technologies in nursing education, the methodological and descriptive studies stood out, for having more flexible methods and lower costs to be developed. In a descriptive study, it highlights the great importance of the relationship and connectivity of active methodologies to support teachers and scholars in this moment of remote teaching, which impacts everyone and leads them to search for didactic and pedagogical alternatives to maintain the quality in the teaching and learning processes⁽²⁴⁾.

As for the methodological study, the literature also corroborates the prevalent type found in this study. This information refers to support for the nursing process in construction and validation studies, because these are tools that are in a broad process of technological development, in which experts have come to validate these studies⁽²⁵⁾.

Regarding the level of evidence, the level VI^{(14-15-17-18)} was highlighted, however systematic reviews of randomized clinical trials have the best level of scientific evidence, corresponding to two studies^(13,16) of this work. Notably, considering the importance of the clinical issue to define the appropriate study design to answer your research question is necessary, because it subsidizes the clinical practice of health professionals, promoting the integration of clinical experience to the best available evidence, considering the safety of interventions and ethics in all actions⁽²⁶⁾.

With the advent of the pandemic of COVID-19, due to the restrictions of distance, virtual teaching environments with simulation of practices and improvement of techniques for performing nursing procedures were an alternative to replace face-to-face practices, ensuring the safety of students and the continuity of learning⁽²⁷⁾.

In this way, the use of educational technologies in recent years has been approached in the sense of being a more didactic way used as a teaching-learning methodology, benefiting individual users and providing adequate results in terms of learning⁽²⁸⁾.

In addition, they reduce the distance between student and teacher, make access easier and more flexible for different people, and stimulate autonomy and reflection on their own learning, since it involves the student in an articulated process of strategies and resources related to the use of technology⁽²⁹⁾.

However, the insertion of digital technologies in everyday school life is still, at the same time, a factor of closeness and distance, and therefore a great challenge for teachers, since, although many resources of these technologies are accessible to students and teachers, little movement is perceived to integrate them into the pedagogical practices of teaching and learning in everyday school life⁽³⁰⁾.

It is worth mentioning that technological evolution has reached higher education, especially in nursing education, as an efficient support strategy capable of optimizing teaching practice by ensuring the teacher the essential mission of being a facilitator in the learning process and, when differentiated and modern activities are inserted into traditional classes, the use of technology favors the dynamics of the learning process⁽³¹⁾.

For the development of this study, the educational technologies used were according to the content addressed in each article, serving to present in a more accessible and simplified way what matches the text, facilitating teaching and remote learning during the pandemic of COVID-19. These technologies ranged from videos, to low-cost simulators, to digital and communication technologies.

The pandemic period of COVID-19 presented among the main pedagogical strategies used in remote teaching the use of videos, representing 86.1%, followed by dialogical exposure (58.3%), use of slides (50%) and audios (47.2%)⁽³²⁾. This data supports the same results found in this study, with video being the most used type of technology. These methods add positively to the teaching of students, because only the theoretical classes are not sufficient for the retention and absorption of knowledge⁽¹⁷⁾.

In view of this, using new technologies is a methodological teaching modality that enables the understanding during health training in the nursing field, reproducing educational experiences passed on through virtual media, such as videos with simulations of practical procedures, online games, WhatsApp and Telegram groups⁽³³⁾.

Regarding problematization and realistic simulation, it evidences that the application of Problem-Based Learning Simulation (S-PBL in Portuguese) is a method in which nursing students experience the problem-solving process through interactions with a human patient simulator in an environment with clinical characteristics similar to reality⁽³⁴⁾. Moreover, the promotion of critical and reflective teaching has made simulation one of the most used strategies, since it favors increased student participation; integration between disciplines and insertion in diversified scenarios of professional practice⁽³⁵⁾.

It is also noteworthy the importance of emphasizing the dynamic approach of how to perform the blood pressure measurement through videos and simulations, so that the student feels more secure to perform the procedure on a real patient, when necessary. This method is important because it represents not only the force that directs the perfusion by the human body, but also reflects a part of the cardiac work⁽³⁶⁾.

Another subject that deserves to be approached by the students with more caution is the improvement of instructive measures of the bed bath to the restrained patient. This procedure aims to promote individual comfort and maintain skin integrity by promoting physiological circulation and hydration. It is characterized as a complex technique and contributes to a humanized care as needed, in order to ensure that its objectives are achieved without harm to those who receive it⁽³⁷⁾.

Themes that portray the need for students to have a critical look at routine situations are essential for the formation of a professional with holistic vision, able to situate themselves and maintain control in circumstances of risk. Moreover, it is expected that students learn beyond critical thinking, it is necessary to promote practical experiences so that they are able to evidence the decision-making process in the daily life of being and doing Nursing⁽³⁸⁾.

Another topic to be mentioned is the need to include technological activities as a strategy for improvement, in order to provide learning and patient safety. For example, one can cite the use of online applications as an instructional tool for the practice of intramuscular injection, specifically ventrogluteal, which even though it is a safer route, because it has greater thickness of the gluteal muscle ventricles, is free of blood vessels and important nerves in both adults and children and has less thickness of subcutaneous tissue compared to other application sites, it is still unknown by many professionals and poorly used⁽³⁹⁾.

Aware of the importance of Semiology and Semiotechnics in the training of future nurses, it is understood that it is essential to reflect on its teaching in the undergraduate course, so that through analysis, there are permanent changes regarding the training of nurses who will be in professional practice in the coming years. One of these changes is the reduction in the number of students per teacher, because a large class size probably hinders the progress of a problematizing teaching, and dialogue becomes rarer, with negative repercussions on the processes of reflection and humanization. Thus, the importance of interaction and communication among the subjects participating in the educational process is unquestionable⁽⁴⁰⁾.

FINAL CONSIDERATIONS

It was concluded that the educational technologies used to support the teaching of Semiology and Semiotechnics during the social distance were: two applications, communication technology using WhatsApp Messenger, a high-fidelity simulation and three educational videos. In addition, it was observed that the use of technologies enabled the continuity of teaching and the inclusion of the discipline of Semiology and Semiotics, thus, they were essential to the continuity of the teaching-learning process in times of social isolation due to the COVID-19 pandemic.

Another point brings reference to the inequality of access to the internet and/or computers by the group of low-income students, becoming even more evident during the pandemic, which resulted in absences of this portion of the student population in classes and, consequently, repercussions in the learning process. Therefore, it is unacceptable that institutions, especially public ones, give inaccessible classes precisely to their lower-income students.

However, it can be considered that the continuity of teaching for the training of future nursing professionals through the expansion of access and technological tools as an educational aid was extremely necessary in the pandemic period in the face of the teaching-learning process.

It is worth pointing out that the development of this work was limited to the scarcity of studies, since it is a recently approached theme, which made it difficult and restricted the search.

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Submission: 22-10-2022

Approval: 19-12-2022

Database	Search Strategy
MEDLINE	(mh:(“nursing students”)) OR (mh:(students)) AND (mh:(“educational technology”)) OR (mh:(“digital technology”)) OR (mh:("Simulation training")) AND (mh:(“nursing education”)) OR (mh:(teaching)) OR (mh:(“education, nursing”)) AND ( fulltext:("1")) AND (year_cluster:[2020 TO 2022])
CINAHL	MH “Nursing students” OR MH students AND MH “Educational technology” OR MH “Digital technology” OR MH "Simulation training" AND MH “Nursing education” OR MH Teaching OR MH "education, nursing" Limitadores - Texto completo; Data de publicação: 20200101-20221231 Tipo de documentos: revistas acadêmicas
SCOPUS	( KEY ( "Nursing students" ) OR KEY ( students ) AND KEY ( "Educational technology" ) OR KEY ( "Digital technology" ) OR KEY ( "Simulation training" ) AND KEY ( "Nursing education" ) OR KEY ( teaching ) OR KEY ( "Education, Nursing" ) ) AND ( LIMIT-TO ( OA , "all" ) ) AND ( LIMIT-TO ( PUBYEAR, 2022 ) OR LIMIT-TO ( PUBYEAR, 2021 ) OR LIMIT-TO ( PUBYEAR, 2020 ) ) AND ( LIMIT-TO ( DOCTYPE, "ar" ) )
Library, information Science & Technology Abstracts	MH “Nursing students” OR MH students AND MH “Educational technology” OR MH “Digital technology” OR MH "Simulation training" AND MH “Nursing education” OR MH Teaching OR MH "education, nursing" Limiters - Full text; Publication date: 20200101-20221231; Document types: Academic journals

Author/Country	Methodological design	Educational technologies used to support the teaching of semiology and semiotechnics in nursing	Content covered	Level of Evidence
Adderley⁽¹²⁾ England	Experts Opinion	Mobile digital technology with digital imaging capable of interfacing with other essential data systems, and the implementation of a cellular form of a digital wound management system.	Use of technology in favor of lower limb wound care and surgical wound care, as a way to promote the health of the individual providing improved quality of care.	VII
Bayram, et al.⁽¹³⁾ Turkey	Randomized experimental study	WhatsApp Messenger.	The use of WhatsApp Messenger as a learning tool for ventrogluteal intramuscular injection application.	II
Bester, et al.⁽¹⁴⁾ South Africa	Descriptive study	Information communication technology (information technology: hardware, software to store, process, and retrieve data; communication technology: electronic systems that enable communication between individuals and groups.	It addresses the use of information communication technologies in nursing education and its importance in training nurses with critical thinking and forward-looking knowledge to make accurate choices in life-threatening situations.	VI
Bowen-Withington, et al.⁽¹⁵⁾ New Zealand	Integrative literature review	High-fidelity simulation using computerized human patient simulation manikins.	Use of computer simulation technology as a strategy to increase nursing students' clinical skills, maximizing learning and providing, above all, patient safety.	VI
Cividanes, et al.⁽¹⁶⁾ Brazil	Quasi-experimental research of the before-and-after type	Video.	Use of an educational video demonstrating the technique of indirect blood pressure measurement with the oscillometric method.	III
Lopes, et al.⁽¹⁷⁾ Brazil	Methodological study	Video.	Elaboration and validation of a video about the bed bath, contributing to the professional formation and the improvement of knowledge and abilities of nursing students.	VI
7-Caetano, et al.⁽¹⁸⁾ Brazil	Methodological and descriptive study	Vídeo.	Construction of a video with creative, interactive, dynamic and attractive content capable of providing effective strategies for prevention, management, treatment and control of hypertension in screening settings.	VI