Education With Hybrid Simulation Method in Patients Administering Subcutaneous Biological Drugs
Condition: Self Administration; Biological Therapy; Training
Study type: Interventional

Summary: 
      In recent years, vital drugs such as heparin, insulin, growth hormone, interferons,
      monoclonal antibodies and drugs containing proteins that can be destroyed in the
      gastrointestinal tract have been developed in the form of self-subcutaneous injection in
      order to reduce the negative effects of treatment practices on the lives of patients. After
      the training, the patients can apply the subcutaneous injection on their own without
      assistance. This situation reduces the dependency on the nurse and allows the patient to
      apply the injection on time, without the need to reach the health institutions. In a study,
      it is stated that the inadequacy of injection training causes many patients to develop
      inappropriate injection behavior patterns and to acquire habits regarding these inappropriate
      techniques. It is also stated that the anxiety they experienced before the injection caused
      them to ignore the critical steps towards the injection application. In this study, the
      Subcutaneous Injection Hybrid Model, developed by the researcher, will be used in the
      training of patients who administer biologic drugs subcutaneously. It is thought that these
      patients will improve their injection practice skills and reduce their anxiety about
      injection by repetitive applications by training with the hybrid simulation method.
    

Detailed description: 
      A poor self-injection experience can lead to undesirable treatment outcomes. However,
      increasing morbidity and mortality rates are closely related to non-adherence to treatment.
      Undesirable results due to non-compliance with treatment lead to more visits to emergency
      services, prolongation of inpatient treatments and increased surgical interventions, thus
      increasing the workload and costs of health services. In addition, patients who cannot
      receive repeated and effective training on subcutaneous injection application cause them to
      experience anxiety about subcutaneous drug administration on their own, and often come to
      health units only for subcutaneous injection, due to the limited ability to administer. This
      situation can both negatively affect the daily life activities and self-efficacy perceptions
      of the patients and increase the workload and cost in health services.

      Hybrid Simulation; It is also defined as "patient-centered simulation". In this method;
      Simulated/standardized patient method is used together with auxiliary tools. Wearable
      simulation tools are used in this simulation type. When the literature is examined, it is
      seen that various training methods for self-administration skills are used in patients
      followed in the rheumatology outpatient clinic, but their effectiveness is controversial. In
      addition, no study has been found to evaluate the effectiveness of a hybrid simulation-based
      training on the improvement of application skills and reduction of anxiety regarding
      subcutaneous injection of biologic drugs, for which adherence to treatment is vital. The aim
      of this study is to evaluate the effect of training given by simulation method on patients
      who administer subcutaneous biologic drugs on their application skills and anxiety level. It
      is thought that these patients, who are trained with the hybrid simulation method, will
      decrease their negative experiences of subcutaneous biologic drug administration by
      repetitive applications and incorrect drug administration due to misunderstandings, their
      injection administration skills will improve, and their anxiety about injection will
      decrease.

      Purpose and Design of the Research

      This study was planned in a pre-test-post-test randomized controlled design in order to
      evaluate the effect of the training given by the hybrid simulation method to the patients who
      administered subcutaneous biologic drugs on the application skill and anxiety level.
    

Intervention name(s): Training with hybrid simulation method; Broshure
Intervention type(s): Device; Other
Intervention description(s): Subcutaneous biological drug self-administration training was given by the researcher in two stages, theoretical and practical, face to face. Power point presentation and training brochure were used in theoretical training. The practical training given after the theoretical training was given using the Hybrid simulation method. The Wearable Subcutaneous Injection Hybrid Simulator developed by the researcher was worn by the individuals after being informed about its purpose and function. Afterwards, they were expected to apply the subcutaneous application step by step as explained to them. Each application step they made incorrectly was corrected and repeated with the support of the researcher. The application was considered successful if they completed all application steps correctly from start to finish. The training took approximately 40 minutes. After the practical training, the individuals' questions, if any, were answered and the training was terminated.; Subcutaneous biological drug self-administration training was given theoretically face to face by the researcher using a power point presentation and training brochure. The training lasted approximately 25 minutes and was given in the same room where the experimental group received training. After the training, any questions the individuals had were answered and the training was ended.
Allocation: Randomized
Intervention model: Parallel Assignment
Intervention model description: The research was carried out with a pretest-posttest randomized controlled experimental design to evaluate the effect of the training given by the hybrid simulation method to individuals who self-administer subcutaneous biological drugs on application skills and anxiety levels.
Masking: Single (Participant)
Primary purpose: Supportive Care
Keywords: Self administratation; anxiety; subcutaneous injection; biological therapy; simulation training