This study examined the effectiveness of a training program on the ability of registered nurse students to write complete nursing diagnoses. A comparison group was used as a control. There were 47 participants in the training group and 51 participants in the comparison group who received no training. Five hypotheses were used to examine the (1) complete nursing diagnoses, (2) labels, (3) clarifiers, (4) etiologies, and (5) mislabeled medical diagnoses or clinical problems as nursing diagnoses. As a pretest and posttest, participants in both groups viewed a video tape of a nursing situation and were asked to write nursing diagnoses. The training group received nine clock hours of classroom instruction on the nursing process of which three hours were on nursing diagnosis with a focus on the inclusion of label, clarifier, and etiology necessary for a complete nursing diagnosis. In the clinical component of the educational program the training group wrote nursing diagnoses as part of the nursing process. It was assumed that the comparison group did not receive comparable education. The mean difference of proportions between the pretest and posttest was computed for each group on the item tested by the hypotheses and for the difference between the two groups. Three of the five hypotheses tested in the study were accepted. The training group did have a significant increase in the average (mean) difference of proportions in the number of complete nursing diagnoses and etiologies and a significant decrease in the number of mislabeled nursing diagnoses. There was no significant difference in the number of labels and clarifiers. The training group did show a percentage increase in the number of labels and clarifiers written. There was little or no change in the comparison group over the time period of the study.

Although a great deal is known about the etiology of falls in elderly individuals, fall accidents continue to represent a significant burden to elders residing in long-term care facilities. It has been stated that 75% of deaths due to falls in the United States occur in the 13% of the population age 65 and over. The first objective of the study was to identify which fall-predictor variables acknowledged in the research literature are associated with increased fall frequency with the older population. Identifying specific predictor variables related to a high occurrence of falls in long-term care setting can assist in the redesign of tools and programs aimed to recognize fall risk, and prevent fall-related accidents and fatalities in the geriatric population. The second objective of the study was to identify which combination of predictor variables could better predict the frequency of falls. A history of falls variable was the only predictive variable that differed significantly between groups of residents who had sustained subsequent falls and those who had not. Other variables including age, mental status, day number of stay, elimination, visual impairment, confinement, blood pressure drop, gait and balance, and medication were found to not be statistically significant between groups of fallers and non-fallers. In this setting, the current design of the tool had limited accuracy and exhibited an inability to effectively discriminate between resident populations at risk of falling and those not at risk of falling. Consequently, the current fall risk assessment tool is not adequate for assessing fall risk in this clinical setting. / Master of Science

Akutsjukvård är tidskänsliga vårdinsatser som ges till patienter som drabbas av akut sjukdom. Akut sjukdom kan innebära försämring av kronisk sjukdom eller nytillkommen plötslig ohälsa i behov av snabb handläggning. När en patient drabbas av akut sjukdom ökar risken för vätskebalansrubbningar, exempelvis dehydrering och hyperhydrering. Vätskebalansrubbningar kan leda till ökad ohälsa samt ökade samhällskostnader. Sjuksköterskan ansvarar för bedömning och dokumentation av vätskebalans. Detta ska göras med en helhetssyn och består till stor del av tre komponenter; bedömning av kliniskt status, klinisk kemi och dokumentation i vätskebalanslistor. Hantering av den akut sjuka patientens vätskebalans utgör en avgörande del av patientens vård. Då bedömning och dokumentation av vätskebalans syftar till att tidigt upptäcka inadekvat vätskebalans innebär suboptimal hantering en ökad risk för vårdskada hos patienten. Syftet var att belysa sjuksköterskans genomförande av bedömning och dokumentation av vätskebalans hos patienter som vårdas inom akutsjukvård. Metoden litteraturöversikt valdes för att besvara studiens syfte. Endast studier publicerade mellan åren 2007-2017 samt genomförda inom en akutsjukvårdskontext på vuxna patienter inkluderades. Datainsamlingen skedde genom sökning i de elektroniska databaserna PubMed, CINAHL complete, MEDLINE samt SveMed+ med indexeringsord och fritextord baserade på litteraturöversiktens syfte. Därtill genomfördes en manuell sökning. Datainsamlingen resulterade i att 17 originalartiklar inkluderades i litteraturöversikten. Artiklarnas kvalitet granskades mha Sophiahemmet Högskolas bedömningsunderlag för vetenskaplig klassificering samt kvalitet. Artiklarnas resultat analyserades med integrerad analys och presenterades därefter i en integrerad text. Resultatet visade att det fanns brister i sjuksköterskans bedömning och dokumentation av vätskebalans. Det fanns en fördröjning i agerande vid upptäckt av vätskebalansrubbningar och onormala värden i den kliniska kemin. Sjuksköterskan dokumenterade inte patientens vätskebalans i vätskebalanslista eller kroppsvikt på ett tillfredsställande vis. Faktorer som kunde påverka sjuksköterskans bedömning och dokumentation av vätskebalans var kommunikation, kunskap och patientens sjukdomstillstånd. Därtill indikerade resultatet att de mätmetoder som används för att bedöma vätskebalans inte verkar helt ändamålsenliga för äldre patienter, vilket gällande riktlinjer inte tillsynes tar hänsyn till. Vidare forskning behövs för att kartlägga detta vidare. Slutsatsen av litteraturöversiktens resultat indikerar att sjuksköterskans bedömning och dokumentation av vätskebalans idag är bristfällig. Insatser f  f ör att öka sjuksköterskans kunskap kring vätskebalans torde vara av värde för att förbättra detta. Vidare forskning behövs för att utvärdera huruvida de mätmetoder som används för bedömning och dokumentation av vätskebalans är väl lämpade för akutsjukvård. / Acute care is time sensitive care interventions given to patients who are acutely ill. Acute illness may imply deterioration of chronic disease or newly sudden illness that needs urgent treatment. In this state the risk of fluid balance disorders, such as dehydration and hyperhydration, increases. Fluid balance disorders may lead to increased morbidity and social costs. The nurse has a responsibility to assess and document fluid balance. This should be done with a holistic view and largely consists of three components; assessment of clinical status, clinical chemistry and documentation in fluid balance charts. Fluid balance management in the care of the acutely ill is a fundamental part of patient care. The aim of the assessment and documentation of fluid balance is to discover deviations early, and a suboptimal management of fluid balance implies an increases risk of care related injury. The aim was to illuminate the nurse’s implementation of fluid balance assessment and documentation in patients within acute care. The study was executed through a literature review. Only articles published between 2007 and 2017, conducted in acute care settings and of adult patients were included. The data collection was carried out using the electronic databases PubMed, CINAHL complete, MEDLINE and SveMed+ using keywords based on the purpose of the literature review. Both thesaurus and free text words were used as keywords. Thereafter a manual search was performed. The data collection process resulted in 17 original articles that were included in the literature review. The quality of the articles was assessed using the review template compiled by Sophiahemmet University. The results of the articles were analyzed using integrated analysis and presented within an integrated text. The findings revealed shortcomings in the nurse’s assessment and documentation of fluid balance. There was a delay in action after the detection of fluid imbalances and abnormal values ​​in the clinical chemistry. The nurse did not adequately document the patient's bodyweight or fluid balance in the fluid balance chart. Factors such as communication, knowledge, and the patient’s medical condition could affect the nurse’s assessment and documentation of fluid balance. In addition, the findings indicated that the measurement methods used to assess fluid balance do not appear to be entirely suitable for elderly patients. Applicable guidelines do not seem to recognize the diverse needs of these patients. Additional research is needed to explore this further. The conclusions of this literature review indicates that the nursing assessment and documentation of fluid balance is inadequate. Efforts to increase the nurse’s knowledge of fluid balance might be of value to improve this. Further research is needed to evaluate whether the measurement methods used for the assessment and documentation of the fluid balance are well suited for acute care settings.

Bedömning av patientens vitalparametrar (andningsfrekvens, blodtryck, puls, kroppstemperatur, saturation och medvetandegrad) är sjuksköterskans ansvar inom den akuta vårdkedjan. Tidigare forskning visar att en tidig identifiering av försämrade patienter minskar både mortalitet och morbiditet. För patientens välmående och säkerhet är det av högsta vikt att sjuksköterskor utför evidensbaserade och säkra bedömningar för att upprätthålla patientsäkerheten. Syftet var att utforska faktorer som påverkar sjuksköterskans bedömning av vitalparametrar för att tidigt upptäcka en försämrad patient inom den intrahospitala akuta vårdkedjan.  En litteraturöversikt med systematisk artikelsökning användes som metod. Databassökningar utfördes i PubMed och CINAHL. Sexton originalartiklar som undersökte sjuksköterskors bedömning av patientens vitalparametrar i den akuta vårdkedjan valdes ut från databassökningen samt manuell sökning. Studierna kvalitetsgranskades för att sedan analyseras med hjälp av integrerad analys.  Resultatet visade att sjuksköterskors bedömning av vitalparametrar påverkades av sjuksköterskefaktorer, patientfaktorer samt organisatoriska faktorer. Sjuksköterskefaktorer som sågs påverka var sjuksköterskans förhållningssätt till vitalparametrar, bedömning av frekvens, kunskap och erfarenhet, intuition, helhetsbild samt avsteg från rutiner. Gällande patientfaktorer sågs specifika patientgrupper svårare att bedöma på grund av exempelvis underliggande grundsjukdomar eller ålder. Organisatoriska faktorer som sågs påverka bedömningen var arbetsmiljö, samarbete/kommunikation, kontinuitet i vården samt bedömningsinstrument.   Slutsats som dras är att sjuksköterskans bedömning av vitalparametrar för att tidigt upptäcka en försämrad patient inom den akuta vårdkedjan är ett komplext ämne som påverkas av både sjuksköterske-, patient-, och organisatoriska faktorer. Även då vitalparametrar är ett viktigt redskap för att upptäcka förändring i patientens tillstånd och således främja patientens välmående och säkerhet, använder inte sjuksköterskans alltid dessa verktyg. Denna studie gav inte några säkra förklaringar till varför detta fenomen förekom utan behöver studeras vidare. / Assessing the patient's vital signs (respiratory rate, blood pressure, pulse, body temperature, saturation, and level of consciousness) is a responsibility assigned to the registered nurse within the emergency care chain. Previous research has shown that early identification of deteriorating patients reduces both mortality and morbidity. To enhance patient safety and well-being, it is vital that the registered nurse performs evidence-based and secure assessments of the patient.  The aim of this study was to explore the factors that influence the nurse’s assessments of vital signs to early detect patient deterioration within emergency care.   The research method used was a literature review with a systematic approach, using database searches in PubMed and CINAHL. Sixteen original articles with the main focus of examining registered nurses’ assessments of vital signs within emergency care was chosen from the database searches and manual searches. The quality of the studies was then examined, and an integrated analysis was performed.  The result of the analysis show that assessment of vital signs performed by registered nurses was affected by factors contributed to the nurse, the patient, and the organization as a whole.  When it comes to the factors found contributed to affect the registered nurses, these factors were found to be, approach to vital signs, assessment of frequency, knowledge and experience, intuition, comprehensive picture, and deviations from the established routine. For the factors contributed by the patient, specific patient groups were regarded as more difficult to assess due to underlying diseases or age.  The organisational factors seen affecting the nursing assessment were the work environment, teamwork/communication, continuity in the care and the evaluation tools at hand.  In conclusion, the results show that this is a complex subject that is affected by several factors contributed to the registered nurse, patient, and the organization. Even though vital signs are an important tool to identify changes in a patient’s well-being and safety, the registered nurse does not always utilize this as a tool. This study could not conclude any clear explanation as to why assessing vital signs was not used more often and will require further studies and analysis to determine an answer.

All prelicensure baccalaureate nursing students are expected to graduate with baseline knowledge and clinical judgment skills that will allow them to provide safe and competent patient care to individuals across the lifespan. Research has shown that clinical judgment in new graduates is at an all-time low. There is an abundance of research on how to cultivate clinical judgment skills in both the didactic and simulations settings; however, very few studies have been conducted exploring how to assess and build clinical judgment skills in students in the clinical setting. A pilot study, followed by a quasi-experimental study, and a related correlational study, were performed to explore how clinical judgment can be assessed and enhanced in the prelicensure baccalaureate clinical setting. These studies included outcome variables of knowledge and self-confidence. The studies were guided by Kolb’s Experiential Learning Theory as well as Tanner’s Clinical Judgment Model.The pilot study used an adapted form of the focus group method and aimed to determine the best way to apply the structured debriefing method of Debriefing for Meaningful Learning (DML) in the clinical setting. The pilot study included clinical faculty (N = 4) in a baccalaureate nursing program at a small college in Upstate N.Y. The study began with training on DML, followed by an asynchronous pre implementation survey where participants provided answers to interviewer questions via Google forms. Next the study involved 3 weeks of implementing DML with clinical groups in the clinical setting and concluded with a post implementation synchronous focus group that met via Zoom©. The results of the pilot study led to a few adaptations in the DML process including the creation of a faculty script, a student guide, a new concept map, and a change to when students were expected to complete the concept map during their clinical day. The quasi-experimental study took place at the same college and included participants (N = 62) in the course NSG 323 – Concepts II in both the Spring 2023 and Fall 2023 semesters. The intervention was DML and took place during three clinical experiences (one per week) in the first half of the semester. Participants and clinical faculty completed pretest measures in the week prior to beginning their clinical experiences. Pretest clinical judgment was measured during a simulation scenario by the participants’ clinical faculty using the Lasater Clinical Judgment Rubric (LCJR). The LCJR is a 4-point Likert-type scale measuring 11 dimensions of clinical judgment under four subscales of noticing, interpreting, responding, and reflecting. Self- confidence was measured using a revision of the NLN Student Self-Confidence subscale of the NLN Student Satisfaction and Self-Confidence in Learning instrument. The revised scale is an 11-item Likert-type scale. The revision involved changing items that include the word “simulation” to the word “clinical experience.” Knowledge was measured, posttest only, using scores on the second Unit Exam of the course. A mixed 2 x 2 Analysis of Variance (ANOVA) followed by simple main effects t tests were used to analyze the clinical judgment and self- confidence data, and independent samples t tests was used to analyze exam scores. Results for clinical judgment did not reveal a significant interaction between groups and time (F (1, 60) = .21, p = .652). There was a statistically significant main effect found for group on LCJR scores overall (F (1, 60) = 7.65, p = .008). Both pretest and posttest mean scores for the LCJR were lower in the intervention group (M = 22.54 and M = 25.88 respectively) than in the control group (M = 27.75 and M = 30.33 respectively). The results for self-confidence did not reveal any significant interaction between groups and time (F (1, 59) = 1.44, p = .235). The mean scores for the posttest were higher in the intervention group (M = 42.65) than in the control group (M = 40.83). Results also showed that while self-confidence scores from pretest to posttest for the intervention group increased, the scores from pretest to posttest for the control group decreased; however, the differences in groups did not reach statistical significance (F (1, 60) = .45, p = .504). An independent samples t test showed no significant difference in Unit II exam scores, measuring knowledge, between groups (p = .451, d = .20). A correlational study was completed exploring the relationships between clinical judgment, knowledge, and self-confidence using the data obtained in the quasi-experimental study. This study also explored the differences between groups for each correlation, and whether having prior health care experience impacted each outcome variable. Results showed no statistically significant correlation between pretest clinical judgment and pretest self-confidence scores (r = .09, p = .502), nor between posttest clinical judgment and self-confidence scores (r = -.22, p = .085) for the entire sample. However, there was a significant negative relationship between posttest self-confidence and clinical judgment in the control group (r = -.36, p = .034). The differences between groups in the pretest correlations of clinical judgment to self-confidence (zobs = .298, p = .764) and in the posttest correlations of clinical judgment to self-confidence (zobs = -1.61, p = .107) were not significant. There was also no statistically significant relationship revealed between both the pretest (r = -.10, p = .439) and posttest (r = -.18, p = .163) self-confidence scores and knowledge, as measured by Unit II exam scores for the entire sample, as well as within groups. The difference in correlations between groups on both the pretest self-confidence scores and exam scores (zobs = -1.29, p = .197) and posttest self-confidence scores and exam scores (zobs = -.643, p = .522) were not statistically significant. However, both pretest (r = .36, p = .004) and posttest (r = .39, p = .002) clinical judgment scores and posttest- only exam scores were revealed to have a positive statistically significant correlation for the entire sample, as well as in the intervention group only (r = .59, p = .002 and r = .632, p < .001 respectively). The difference in correlations between pretest clinical judgment and knowledge was significant (zobs = -2.29, p = .023). The correlation between posttest clinical judgment scores and exam scores for control group was .084, and .632 for the experimental group. The difference in correlations between posttest and knowledge was ~ .55, also statistically significant (zobs = -2.45, p = .0151). There is a long-held understanding in nursing education that the teaching-learning strategies in the clinical environment need to be evaluated and improved. While not revealed to have a statistically significant effect in this initial study, the use of structured debriefing methods should still be further explored in the clinical setting to determine whether the process can be an acceptable pedagogical approach to improve knowledge and clinical judgment in the clinical setting. The moderate positive statistically significant relationship between clinical judgment and knowledge found in this study aligns with Tanner’s (2006) theory that the development of both knowledge and clinical judgment is a related and cyclical process where both should be emphasized. The inverse relationship found between self-confidence and clinical judgment/knowledge, while not statistically significant in this study, suggests that students will benefit from honest and constructive feedback on their performance to accurately evaluate themselves and their ability to perform in the clinical setting.

Timely management in pre-hospital emergency care enhances the chances of patients' survival or clinical outcomes of an Acute Coronary Syndrome (ACS). In Botswana nurses serve in the frontline of pre-hospital emergency services as the initial recipients of the emergency reports and situations. Knowledge of the patient's characteristics will assist the nurses as well as the family/others to understand the patient's responses during an ACS situation and therefore enable prompt patient assessment and facilitation of early access to appropriate care. Patient and family involvement in care during cardiac emergencies also influences the patient outcomes. This is a non-experimental, quantitative, exploratory and descriptive study, designed to explore and describe the characteristics of patients with the experience of an ACS, and the available resources during the pre-hospital phase of emergency care, with the aim of improving patients' clinical outcomes. The results indicated that optimal care by nurses is essential in the chain of care influencing patients' chances of surviving ACS. / Health Studies / M.A. (Health Studies)

Timely management in pre-hospital emergency care enhances the chances of patients' survival or clinical outcomes of an Acute Coronary Syndrome (ACS). In Botswana nurses serve in the frontline of pre-hospital emergency services as the initial recipients of the emergency reports and situations. Knowledge of the patient's characteristics will assist the nurses as well as the family/others to understand the patient's responses during an ACS situation and therefore enable prompt patient assessment and facilitation of early access to appropriate care. Patient and family involvement in care during cardiac emergencies also influences the patient outcomes. This is a non-experimental, quantitative, exploratory and descriptive study, designed to explore and describe the characteristics of patients with the experience of an ACS, and the available resources during the pre-hospital phase of emergency care, with the aim of improving patients' clinical outcomes. The results indicated that optimal care by nurses is essential in the chain of care influencing patients' chances of surviving ACS. / Health Studies / M.A. (Health Studies)

Thesis (MCur)--Stellenbosch University, 2014. / ENGLISH ABSTRACT: Differences were observed in clinical demonstration and assessment techniques of clinical supervisors involved with the supervision of undergraduate nursing students at an institution of higher education. These differing techniques displayed by the clinical supervisors may have implications for the standard of nursing care provided by the students and the throughput of these students. A qualitative approach with a descriptive design was applied to explore the perceptions and experiences of the undergraduate nursing students’ on clinical supervision. Nine (n=9) students were deliberately selected by means of purposive sampling from each year to participate in focus group interviews. Nine 1st year students, nine 2nd year students, nine 3rd year students and nine 4th year students respectively constituted the groups that were interviewed. Thus the total sample consisted of n=36 nursing students. Consent to conduct the study was obtained from the Health Research Ethical Committee at Stellenbosch University, as well the institution under study. Informed consent was obtained from all the participants. Data collection was completed by two trained fieldworkers who were not affiliated with the institution under study. The interviews were analysed through content analysis. Six themes emerged from the data. These included support, professionalism, realities of supervision, student preferences regarding supervisors, experiences that relate to abusive behaviour and the clinical supervision process. The findings indicated negative and positive experiences on clinical supervision. Recommendations were proposed to enhance clinical supervision and the learning experiences of student nurses. Key words: Clinical supervision, undergraduate nursing, clinical supervisor, clinical practice, differing techniques. / AFRIKAANSE OPSOMMING: Verskille was waargeneem in kliniese demonstrasie- en assesseringstegnieke van kliniese toesighouers wat betrokke is met die supervisie van voorgraadse verpleegstudente by 'n institusie van hoër onderwys. Die verskille in tegnieke gedemonstreer deur die kliniese toesighouers mag implikasies hê vir die standaard van verpleegsorg gelewer deur die studente en die slaagsyfer van hierdie studente. 'n Kwalitatiewe benadering met 'n beskrywende ontwerp was toegepas om die persepsies en ervaringe van die voorgraadse verpleegstudente oor kliniese supervisie te verken. Nege (n = 9) studente vanuit elke jaargroep was bewustelik gekies by wyse van doelgerigte steekproefneming om deel te neem in fokusgroep onderhoude. Nege 1ste jaar studente, nege 2de jaar studente, nege 3de jaar studente en nege 4de jaar studente het onderskeidelik die groepe gevorm waarmee onderhoude gevoer was. Die totale steekproef het uit n=36 verpleegstudente bestaan. Toestemming om die studie te doen was vanaf die Etiese Komitee vir Gesondheidsnavorsing by Stellenbosch Universiteit, asook die instelling ter ondersoek verkry. Ingeligte toestemming is van al die deelnemers verkry. Data insameling was deur twee opgeleide veldwerkers gedoen wat nie geaffilieer is met die instelling ter ondersoek nie. Die onderhoude was deur inhoudsontleding geanaliseer. Ses temas het uit die data ontstaan. Dit sluit in ondersteuning, professionaliteit, realiteite van supervisie, student voorkeure ten opsigte van toesighouers, ervaringe wat verband hou met mishandelende gedrag en die kliniese supervisie-proses. Die bevindinge het negatiewe en positiewe ervaringe oor kliniese supervisie getoon. Aanbevelings is voorgestel om kliniese supervisie en die leerervaring van die studentverpleegsters te verbeter. Sleutelwoorde: Kliniese supervisie, voorgraadse verpleging, kliniese toesighouer, kliniese praktyk, teenstrydige tegnieke.

Health care systems consist of various individuals and organizations that aim to meet the health care needs of people and provide a complete and responsive health care solution. One of the important aspects of a health care delivery system is nursing. The use of technology is a vital aspect for delivering an optimum and complete nursing care to individuals; and also for improving the quality and delivery mechanism of nursing care. The model proposed in this thesis for Nursing Knowledge Management System is a novel knowledge-based decision support system for nurses to capture and manage nursing practice, and further, to monitor nursing care quality, as well as to test aspects of an electronic health record for recording and reporting nursing practice. As a part of a collaborative research of the Christine E. Lynn College of Nursing and the Department of Computer Science, a prototype toolset was developed to capture and manage nursing practice in order to improve the quality of care. This thesis focuses on implementing a web based SOA solution for Automated Classification of Nursing Care Categories, based on the knowledge gained from the prototype for nursing care practice. / by Sughomoy D. Dass. / Thesis (M.S.C.S.)--Florida Atlantic University, 2011. / Includes bibliography. / Electronic reproduction. Boca Raton, Fla., 2011. Mode of access: World Wide Web.

Estudo descritivo, metodológico que teve como objetivo construir e validar os Marcos de Competências e as Entrustable Professional Activities (EPAs) para formação e avaliação de enfermeiros na assistência de pacientes adultos na abordagem das vias aéreas, ventilação e circulação, e avaliar o uso das EPAs em ambientes clínicos simulados. Após aprovação do Comitê de Ética e Pesquisa da Escola de Enfermagem de Ribeirão Preto e da Comissão Ética da Unidade de Investigação em Ciências da Saúde: Enfermagem da Escola superior de Enfermagem de Coimbra. O estudo contou com a participação de experts que atenderam os critérios adaptados de Fehring e se desenvolveu em três sub-estudos: na primeiro realizou-se uma revisão de literatura para avaliar os ganhos percebidos dos enfermeiros com o uso da simulação clínica nas atividades de urgência e emergência. No segundo realizou-se uma oficina em uma Universidade pública localizada em uma cidade no interior do estado São Paulo, composta por sete experts para a construção dos marcos de competências; na segunda fase desse sub-estudo participaram 15 experts para a validação de aparência e conteúdo por meio da Snowball Technique e a Técnica Delphi, a terceira fase ocorreu após a análise de conteúdo das considerações e sugestões realizadas pelos experts ao material a ser validado. Após a organização dos dados e análise, uma nova versão dos marcos de competências foi emitida e, posteriormente, uma segunda rodada de opiniões foi solicitada. Os 15 experts participantes receberam um novo correio eletrônico com os marcos de competências reformulados, participaram dessa fase 13 experts, caracterizando a concordância do material apresentado. Após foi realizado uma análise de conteúdo das sugestões realizadas e calculado o Índice de Validação de Conteúdo (IVC) para aferir a concordância dos juízes quanto à representatividade de cada item. Com a análise de conteúdo das sugestões recebidas dos experts, chegou-se à conclusão que houve um consenso sobre o conteúdo apresentado, resultando nos quadros dos marcos de competências. A concordância dos juízes quanto à representatividade dos itens em relação ao conteúdo dos quadros resultou na análise final em todos os itens com um IVC >= 85%. No terceiro sub-estudo, construiu-se as EPAs para desenvolver e avaliar no ambiente clínico simulado os marcos de competências construídos e validados. Assim, diante dos marcos de competências e baseados no referencial teórico os autores construíram 21 EPAs. A validação das EPAs quanto ao conteúdo, aparência e aplicabilidade em cenários clínicos simulados em situações de urgência, ocorreu através da participação de nove experts. Para validação utilizou-se quatro cenários clínicos simulados no qual cinco EPAs foram validadas. Embora o número de experts participantes em todas as fases do estudo possa ser considerado em fator limitante, acredita-se que os resultados podem contribuir de maneira efetiva, sendo fonte de estímulo para discussões e mudanças positivas no ensino, na formação e capacitação em enfermagem / This is a descriptive methodological study with the aim to construct and validate milestones of competencies and entrustable professional activities (EPAs) for the education and evaluation of nurses in the delivery of care to adult patients in the approach to their airways, ventilation, and circulation, and to assess the EPAs in simulated clinical environments. The research project was approved by the Research Ethics Committee of the Ribeirão Preto College of Nursing at the University of São Paulo and by the Ethics Committee of the Health Sciences Research Unit of the Higher School of Nursing of Coimbra. The study had the participation of experts who complied with the criteria adapted by Fehring and was developed in three sub-studies. A literature review was conducted in the first study to assess the benefits perceived by nurses with the use of clinical simulation in urgency and emergency activities. In the second study a workshop was developed in a public university located in a city in the state of São Paulo, with the participation of seven experts for the construction of milestones of competencies; in the second stage of this sub-study 15 experts participated in the face and content validation through the snowball and the Delphi techniques; and the third stage took place after analysis of content of the considerations and suggestions made by the experts to the material to be validated. After data organization and analysis, a new version of the milestones of competencies was designed and, later, a second round of reviews was requested. The 15 participating experts received a new e-mail with the reformulated milestones of competencies, and 13 of them participated in this stage, characterizing agreement with the material presented. Analysis of content of the suggestions was conducted and the content validity index (CVI) was calculated to measure the agreement of the experts as regards the representativeness of each item. This content analysis showed that there was a consensus among the experts on the content presented, resulting in charts with the milestones of competencies. Experts\' agreement as regards the items\' representativeness in relation to the content in the charts resulted in the final analysis of all items with a CVI >= 85%. In the third sub-study, the EPAs were constructed to develop and assess the validated milestones of competencies in the simulated clinical environment. Thus, the authors constructed 21 EPAs in face of the milestones of competencies and based on the theoretical framework. The validation of the EPAs regarding content, face, and applicability in simulated clinical environments in emergency situations took place with the participation of nine experts. Four simulated clinical settings were used in the validation of five EPAs.. Although the number of experts participating in each study stage may be considered a limitation, the authors believe that the results of this study can contribute effectively to encourage discussions and positive changes in nursing teaching, education, and qualification