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Virtual Learning Environment for Malignant Hyperthermia Training: A Case Study, Exercises of Nursing

This document reports a study that aimed to develop and assess the performance of a virtual learning environment (VLE) named 'Tele-education in Malignant Hyperthermia' to promote health education for nursing teams in surgery centers. The document reveals the process of creation and assessment of the educational multimedia program as a VLE website for nursing professionals and experts in health informatics. The developed virtual learning environment is shown to be an effective tool to support teaching on malignant hyperthermia for nursing teams.

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  • What are the educational purposes of the first stage of the VLE for the presentation of malignant hyperthermia (MH)?

Typology: Exercises

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| ORIGINAL ARTICLE |
| 180 |
REV. SOBECC, SÃO PAULO. OUT./DEZ. 2017; 22(4): 180-187
DEVELOPMENT AND ASSESSMENT OF A VIRTUAL
LEARNING ENVIRONMENT FOR TRAINING IN
MALIGNANT HYPERTHERMIA
Desenvolvimento e avaliação de ambiente virtual de aprendizagem para capacitação em hipertermia maligna
Desarrollo y evaluación del entorno virtual de aprendizaje para capacitación en la hipertermia maligna
Emanuela Batista Ferreira e Pereira1, Brenna Cavalcanti Maciel Modesto2, Marília Perrelli Valença3,
Walmir Soares da Silva Junior4, Claudinalle Farias Queiroz de Souza5
1Nurse, Central Sterile Supply Department of Hospital da Restauração; Surgery PhD student, Graduation Program in Surgery, Universidade Federal de Pernambuco (FENSG/UPE); assistant professor at Nossa
Senhora das Graças Nursing School, Universidade de Pernambuco (FENSG/UPE) – Recife (PE), Brazil. Email: emanuela.pereira@upe.br
2Nurse, FENSG/UPE – Recife (PE), Brazil.
3Nurse in the Commission of Hospital Infection Control, Pronto-Socorro Cardiológico Universitário de Pernambuco Professor Luiz Tavares (PROCAPE), UPE; Master’s and PhD degree in Health Sciences, School
of Medical Sciences (FCM) at UPE; assistant professor of FENSG/UPE – Recife (PE), Brazil.
4Bachelor’s Degree in Visual Communication; Master’s degree in Technology and Management in Distance Learning; specialist in system analysis; assistant professor of FENSG/UPE, system analyst and
instructional designer of distance learning courses at UPE – Recife (PE), Brazil.
5Nurse; PhD in Surgery, Graduation Program in Surgery, UFPE; adjunct professor at FENSG/UPE – Recife (PE), Brazil.
Rua Marechal Deodoro, 340 – Encruzilhada – Zip Code: 52030-172 – Recife (PE), Brazil.
Received: 29 Apr. 2017 – Approved: 23 Aug. 2017
DOI: 10.5327/Z1414-4425201700040002
ABSTRACT: Objective: To develop and assess the performance of a vir tual learning environment (VLE) called “Tele-education in Malignant Hyperthermia”
to promote health education for surgery nursing teams. Method: This is a technology validation study of methodolog ical development research with
quantitative and qualitative approach. It revealed the process of creation and assessment of an educational multimedia program as a VLE website for
nursing professionals of surgery center s and for experts in health informatics. Results: The experts’ assessment showed great acceptability of the pro-
gram and received a classification of “very good” in most of the assessed items. Conclusion: The developed virtual learning environment is an effective
tool to support teaching on malignant hyperthermia for nursing teams of surgery centers.
Keywords: Malignant hyperthermia. Surgicenters. Perioperative nursing. Health education. Nursing informatics.
RESUMO: Objetivo: Desenvolver e avaliar a execução de um ambiente virtual de aprendizagem (AVA) intitulado “Teleducação em Hipertermia Maligna”, visando
a promover educação em saúde para equipes de enfermagem em centro cirúrgico. Método: Estudo de validação de tecnologia do tipo pesquisa de desenvol-
vimento metodológico com abordagem quanti-qualitativa, revelando o processo de criação e avaliação de um programa multimídia educacional no formato
website como AVA para profissionais de enfermagem em centro cirúrgico e especialistas em informática em saúde. Resultados: A avaliação dos especialistas
mostrou grande aceitabilidade do programa, recebendo classificação de “muito bom” para a maioria dos itens avaliados. Conclusão: O ambiente virtual de
aprendizagem desenvolvido mostrou-se uma ferramenta eficaz para apoiar o ensino sobre hipertermia maligna a equipes de enfermagem em centro cirúrgico.
Palavras-chave: Hipertermia maligna. Centros cirúrgicos. Enfermagem perioperatória. Educação em saúde. Informática em enfermagem.
RESUMEN: Objetivo: Desarrollar y evaluar la ejecución de un entorno virtual de aprendizaje (EVA) llamado “Teleeducación en Hipertermia Maligna”, con el propósito
de promover la educación en salud para equipos de enfermería en centros quirúrgicos. Método: Estudio de validación de la tecnología de la pesquisa del desarrollo
metodológico, con abordaje cuantitativo y cualitativo, que reveló un proceso de creación y evaluación de un programa de multimedia educacional en formato de sitio
electrónico como EVA para profesionales de enfermería en centros quirúrgicos y expertos en informática aplicada a la salud. Resultados: La evaluación de los expertos
mostró una gran aceptabilidad del programa con el recibimiento de la clasificación “muy bueno” para la mayoría de los ítems evaluados. Conclusión: El entorno virtual
de aprendizaje desarrollado se mostró una herramienta eficaz para apoyar la enseñanza de la hipertermia maligna a los equipos de enfer mería en centros quirúrgicos.
Palabras clave: Hipertermia maligna. Centros quirúrgicos. Enfermería perioperatoria. Educación en salud. Informática aplicada a la enfermería.
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| ORIGINAL ARTICLE | | 180 |

DEVELOPMENT AND ASSESSMENT OF A VIRTUAL

LEARNING ENVIRONMENT FOR TRAINING IN

MALIGNANT HYPERTHERMIA

Desenvolvimento e avaliação de ambiente virtual de aprendizagem para capacitação em hipertermia maligna

Desarrollo y evaluación del entorno virtual de aprendizaje para capacitación en la hipertermia maligna

Emanuela Batista Ferreira e Pereira^1 , Brenna Cavalcanti Maciel Modesto^2 , Marília Perrelli Valença^3 ,

Walmir Soares da Silva Junior^4 , Claudinalle Farias Queiroz de Souza^5

(^1) Nurse, Central Sterile Supply Department of Hospital da Restauração ; Surgery PhD student, Graduation Program in Surgery, Universidade Federal de Pernambuco (FENSG/UPE); assistant professor at Nossa Senhora das Graças Nursing School, 2 Universidade de Pernambuco (FENSG/UPE) – Recife (PE), Brazil. Email: emanuela.pereira@upe.br 3 Nurse, FENSG/UPE – Recife (PE), Brazil. Nurse in the Commission of Hospital Infection Control, Pronto-Socorro Cardiológico Universitário de Pernambuco Professor Luiz Tavares (PROCAPE), UPE; Master’s and PhD degree in Health Sciences, School of Medical Sciences (FCM) at UPE; assistant professor of FENSG/UPE – Recife (PE), Brazil. 4 Bachelor’s Degree in Visual Communication; Master’s degree in Technology and Management in Distance Learning; specialist in system analysis; assistant professor of FENSG/UPE, system analyst and instructional designer of distance learning courses at UPE – Recife (PE), Brazil. 5 Nurse; PhD in Surgery, Graduation Program in Surgery, UFPE; adjunct professor at FENSG/UPE – Recife (PE), Brazil. Rua Marechal Deodoro, 340 – Encruzilhada – Zip Code: 52030-172 – Recife (PE), Brazil. Received: 29 Apr. 2017 – Approved: 23 Aug. 2017 DOI: 10.5327/Z1414- ABSTRACT: Objective: To develop and assess the performance of a virtual learning environment (VLE) called “Tele-education in Malignant Hyperthermia” to promote health education for surgery nursing teams. Method: This is a technology validation study of methodological development research with quantitative and qualitative approach. It revealed the process of creation and assessment of an educational multimedia program as a VLE website for nursing professionals of surgery centers and for experts in health informatics. Results: The experts’ assessment showed great acceptability of the pro- gram and received a classification of “very good” in most of the assessed items. Conclusion: The developed virtual learning environment is an effective tool to support teaching on malignant hyperthermia for nursing teams of surgery centers. Keywords: Malignant hyperthermia. Surgicenters. Perioperative nursing. Health education. Nursing informatics. RESUMO: Objetivo: Desenvolver e avaliar a execução de um ambiente virtual de aprendizagem (AVA) intitulado “Teleducação em Hipertermia Maligna”, visando a promover educação em saúde para equipes de enfermagem em centro cirúrgico. Método: Estudo de validação de tecnologia do tipo pesquisa de desenvol- vimento metodológico com abordagem quanti-qualitativa, revelando o processo de criação e avaliação de um programa multimídia educacional no formato website como AVA para profissionais de enfermagem em centro cirúrgico e especialistas em informática em saúde. Resultados: A avaliação dos especialistas mostrou grande aceitabilidade do programa, recebendo classificação de “muito bom” para a maioria dos itens avaliados. Conclusão: O ambiente virtual de aprendizagem desenvolvido mostrou-se uma ferramenta eficaz para apoiar o ensino sobre hipertermia maligna a equipes de enfermagem em centro cirúrgico. Palavras-chave: Hipertermia maligna. Centros cirúrgicos. Enfermagem perioperatória. Educação em saúde. Informática em enfermagem. RESUMEN: Objetivo: Desarrollar y evaluar la ejecución de un entorno virtual de aprendizaje (EVA) llamado “Teleeducación en Hipertermia Maligna”, con el propósito de promover la educación en salud para equipos de enfermería en centros quirúrgicos. Método: Estudio de validación de la tecnología de la pesquisa del desarrollo metodológico, con abordaje cuantitativo y cualitativo, que reveló un proceso de creación y evaluación de un programa de multimedia educacional en formato de sitio electrónico como EVA para profesionales de enfermería en centros quirúrgicos y expertos en informática aplicada a la salud. Resultados: La evaluación de los expertos mostró una gran aceptabilidad del programa con el recibimiento de la clasificación “muy bueno” para la mayoría de los ítems evaluados. Conclusión: El entorno virtual de aprendizaje desarrollado se mostró una herramienta eficaz para apoyar la enseñanza de la hipertermia maligna a los equipos de enfermería en centros quirúrgicos. Palabras clave: Hipertermia maligna. Centros quirúrgicos. Enfermería perioperatoria. Educación en salud. Informática aplicada a la enfermería.

| 181 | VLE IN MALIGNANT HYPERTHERMIA INTRODUCTION The current high-level connectivity is a gift given by the internet. It may promote information sharing, improvement of didactic maneuvers, and develop- ment of health studies not only in education, but in all areas of knowledge^1. The learning-teaching process does not currently focus only on one physical and traditional environment, it is inter- posed between informatics and technologies. It is not dif- ferent in health. Tele-education, for instance, works as an important resource for the education of health profession- als, not only for practical activities, but also for knowledge transmission and research2,3. Society is changing, and so is nursing. Every day, nursing teams are challenged to present new knowl- edge and competences that respond to such changes. Therefore, the internet, together with tele-education, works as a source of information that enables develop- ing new knowledge, achieving new skills, training pro- fessionals, and facing challenges that are determined by technological advances4,5. The virtual learning environment (VLE) aims to support technology-related activities. It enables adapting and adding different kinds of media with distinct purposes, besides pro- viding teaching-learning news2,5,6. For instance, in surgicenter nursing, several subjects may serve as an object of training according to specific needs or service updating, such as malig- nant hyperthermia (MH), which is a rare dominant autoso- mal genetic disorder of the skeletal muscle that is potentially fatal and related to an uncontrolled release of calcium from the sarcoplasmic reticulum^7. MH is traditionally characterized by an abnormal hypermetabolic reaction to anesthetic inhalator agents of the halogenate group, to depolarizing neuromuscu- lar blocking agents (such as succinylcholine) or, even more rarely, to stress (like extreme physical exercises in warm environments)7-9. In Brazil, the first report on this syndrome was published in 1975 and there are no current data about it, but estimates show an occurrence from 500 to 1,000 MH cases per year only in the state of São Paulo9,10. The number of deaths due to MH is high not only due to the syndrome complexity, but also because of the lack of knowledge by the professionals. The mortality index per MH decreased from 80%, in 1970, to 5% in 2007. The treatment of disease reactions should result in 100% survival, but we need quick and qualified care to achieve it, which can only happen with proper training of the surgical center professionals^10. Based on the relevance and severity of MH, we noticed the need for training teams in surgical centers so that they can provide early diagnosis and deal with MH crisis. Therefore, we considered the following question: can the VLE provide a conceptual and technological contribution to nursing education? OBJECTIVE This study aimed to develop and assess the performance of a virtual learning environment (VLE) named “Tele- education in Malignant Hyperthermia”, with the objec- tive of promoting health education for nursing teams in surgery centers. METHOD This is a technology validation study of methodological development research with quantitative and qualitative approach. This paper reports the elaboration and reveals the result of the assessment process provided by surgical center nursing professionals and health informatics experts about an educational multimedia program in the website format as VLE. The elaboration and development of a VLE comprise a group of activities that include structural organization of essential elements, such as the chance of reviewing and redoing them in undetermined moments^5. We based our methodology on Struchiner^11 concepts, which establish basic principles for developing educational material and articulate the structural development stages in a proposal with different criteria^5. The preceding variables that formed and defined the environment were: establishment of theme; choice of scenario to be composed; educational purposes; video and text formatting; and experts’ assessment after using the VLE. We divided the VLE production in two stages: the first one comprised theme definition and VLE creation; the sec- ond corresponded to environment assessment by a group of experts.

| 183 | VLE IN MALIGNANT HYPERTHERMIA The tab “About the course” [ Sobre o Curso ] shows the course stages and how each one works. In addition, it also provides information such as methodology, study place, population, eligibility criteria, and research purposes. The link “How to Participate” [ Como Participar ] provides a step-by-step on how to first access the entire course and then access the “Course” [ Curso ] link. It has two options: “Evaluator” [ Avaliador ] and “Participant” [ Participante ]. To take the course, the user must choose the option “Participant” [ Participante ] and complete all the steps, as described in Figure 2. With the aim of validating the interactivity, we asked for a feedback from professionals invited to assess the VLE. After taking the activities in the “Participant” [ Participante ] link, they needed to go to the “Evaluator” [ Avaliador ] link, where they would find a questionnaire about the VLE functioning and the provided educational purposes. The assessment page also provides a blank Figure 1. First page of the website that shows the course “Tele-education in Malignant Hyperthermia”. Recife, Pernambuco, Brazil, 2016.

| 184 | PEREIRA EBF, MODESTO BCM, VALENÇA MP, SILVA JUNIOR WS, SOUZA CFQ space where experts may leave suggestions and com- ments for improvements. In general, the website “Tele-education in Malignant Hyperthermia” was very well accepted by the evaluators, who provided suggestions for improvement and com- ments, which were mostly positive about the performed work. The assessed items were scored according to the scale: very good (VG), good (G), regular (Re), poor (P), and very poor (VP). The first three questions of the assessment were about the way content is transmitted. These questions approach: didactics, clarity and objectivity; amount and quality; consis- tence and pertinence of the presented material. Table 1 presents the distribution of answers obtained in the assessment made by experts on the content. The con- tent was considered “good” by most of the experts (five) in “didactics, clarity, and objectivity”. “Quantity and quality” of the content and “consistence and pertinence” received “very good” in most of the answers (five). Questions four and five of the assessment form discussed about the course objective regarding the established educa- tional purposes and the pertinence of the proposed learning assessment (pre- and post-test). We observed, in Table 2, that most of the evaluations (five) considered the course objective regarding the proposed educational purposes in the VLE as “very good”. Regarding the “learning assessment (pre- and post-test)” and its pertinence to the VLE content, most of the evaluations were positive, consid- ering the item as “very good” (seven). Also regarding the pre- and Figure 2. Structure of the course in the VLE on “Tele-education in Malignant Hyperthermia”. Recife, PE, Brazil, 2016.

Participant’s Area:

TCLE Registration form Pre-test

  • Early knowledge of MH
  • Sociodemographic questions Educational intervention
  • Video 1
  • Video 2
  • Educational purposes: To identify the MH diagnostic types.
  • Video 3
  • Educational purposes: To specify the treatment and relate the current laws on MH.
  • Form to complete the educational intervention in MH and certification achievement. References Post-test
  • Education purposes: history presentation; definition of concept; demonstration of the epidemiological aspects; characterization of the MH physiopathology and genetics. MH: malignant hyperthermia; TCLE: Free Informed Consent. Table 1. Assessment of the VLE program made by experts regarding its content. Recife, PE, 2016. VG G Re P VP Didactics, clarity, and objectivity 4 5 0 0 0 Quantity and quality 5 4 0 0 0 Consistence and pertinence 5 4 0 0 0 VG: very good; G: good; Re: regular; P: poor; VP: very poor. Table 2. Assessment of the virtual learning environment program by experts regarding the educational purposes and questionnaires. Recife, Pernambuco, 2016. VG G Re P VP Educational purposes 5 4 0 0 0 Learning assessment (pre- and post-test) 7 1 1 0 0 VG: very good; G: good; Re: regular; P: poor; VP: very poor.

| 186 | PEREIRA EBF, MODESTO BCM, VALENÇA MP, SILVA JUNIOR WS, SOUZA CFQ REFERENCES

  1. Évora YDM. The possibilities of the internet use in nursing research. Rev Eletrônica Enferm [Internet]. 2004 [cited on 2016 Dec 14];6(3):395-9. Available from: https://www.fen.ufg.br/revista/ revista6_3/pdf/11_Revisao1.pdf
  2. Pereira MCA, Évora YDM, Camargo RAA, Teixeira CRS, Cruz ACA, Clavatta H. Virtual learning environment for managing costs of dressing for pressure ulcers. Rev Eletrônica Enferm [Internet]. 2014 [cited on 2016 Dec 14];16(2):321-9. Available from: http:// web.a.ebscohost.com/abstract?direct=true&profile=ehost&sco- pe=site&authtype=crawler&jrnl=15181944&AN=108383381&h=Cs- nizOeXUy8Iv07lRpYY0jzHCwnr78MsZ3Vr9zJ1RUpTc26dnttTVpYdu- 8fgyp%2bWDSqzGYIUZ66HvMFS29dwA%3d%3d&crl=c&resultNs= AdminWebAuth&resultLocal=ErrCrlNotAuth&crlhashurl=login.aspx%- 3fdirect%3dtrue%26profile%3dehost%26scope%3dsite%26authtype%- 3dcrawler%26jrnl%3d15181944%26AN%3d
  3. Correia ADDMS, Dobashi BF, Gonçalves CCM, Kanomata MN, Monreal VRFD, Nunes EA. Telessaúde Brasil redes e teleodontologia: relato da experiência em Mato Grosso do Sul. J Bras Tele [Internet]. 2013 [cited on 2016 Feb 29];2(2):87-9. Available from: http://www.e- publicacoes.uerj.br/index.php/jbtelessaude/article/view/8137/
  4. Zem-Mascarenhas SH, Cassiani SHB. Desenvolvimento e avaliação de um software educacional para o ensino de enfermagem pediátrica.Rev Latino-am Enferm [Internet]. 2001 [cited on 2016 Dec 14];9(6):13-8. Available from: http://dx.doi.org/10.1590/S0104-
  5. Aguiar RV, Cassiani SHB. Development and evaluation of a virtual learning environment in professional nursing courses. Rev Latino-am Enferm [Internet]. 2007 [cited on 2016 Dec 14];15(6):1086-91. Available from: http://www.scielo.br/scielo. php?script=sci_arttext&pid=S0104-
  6. Almeida MEB. Educação a distância na internet: abordagens e contribuições dos ambientes digitais de aprendizagem. Educ Pesq [Internet]. 2003 [cited on 2016 Dec 14];29(2):327-40. Available from: http://www.scielo.br/pdf/ep/v29n2/a10v29n2.pdf 7. Correia ACC, Silva PCB, Silva BA. Malignant hyperthermia: clinical and molecular aspects. Rev Bras Anestesiol [Internet]. 2012 [cited on 2016 Feb 29];62(6):820-37. Available from: http://www.scielo. br/pdf/rba/v62n6/en_v62n6a07.pdf 8. Amaral JLG, Carvalho RB, Cunha LBP, Batti MAS, Issy AM, Habib AK, et al. Projeto Diretrizes – Hipertermia Maligna [Internet]. Sociedade Brasileira de Anestesiologia. Brasília: SBA; 2009 [cited on 2016 fev 29]. Available from: http://diretrizes.amb.org.br/_BibliotecaAntiga/ hipertemia-maligna.pdf 9. Silva HCA, Almeida CS, Brandão JCM, Silva CAN, Lorenzo MEP, Ferreira CBND, et al. Malignant Hyperthermia in Brazil: Analysis of Hotline in 2009. Rev Bras Anestesiol [Internet]. 2013 [cited on 2016 Feb 29];63(1):13-26. Available from: http://www.scielo.br/ pdf/rba/v63n1/en_v63n1a02.pdf 10. Sousa CS, Bispo DM, da Cunha ALM, de Siqueira ILCP. Educational intervention on malignant hyperthermia with nursing professional of the operating room. Rev Esc Enferm USP [Internet]. 2015 [cited on 2016 Feb 29];49(2):290-5. Available from: http://www.scielo.br/pdf/reeusp/v49n2/0080- 6234-reeusp-49-02-0292.pdf 11. Struchiner M. Hipermídia na educação: princípios básicos para o desenvolvimento de material educativo [Internet]. Rio de Janeiro (RJ): NUTES/UFRJ; 1999 [cited on 2017 Jan 29]. Available from: http://www.scielo.br/scielo. php?script=sci_nlinks&ref=000087&pid=S0104- 0000500007&lng=pt 12. Kollmann-Camaíora A, Alsina E, Domínguez A, del Blanco B, Yepes MJ, Guerrero JL, et al. Protocolo clínico assistencial de manejo de la hipertermia maligna. Rev Esp Anestesiol Reanim [Internet]. 2017 [cited on 2017 Mar 21];64(1):32-40. Available from: http://www. elsevier.es/es-revista-revista-espanola-anestesiologia-reanimacion- 344-articulo-protocolo-clinico-asistencial-manejo-hipertermia- S0034935616300809?referer=buscador the established educational purposes with more founda- tion and fidelity^2. This study limitations include a privileged look on data collection, considering that the experts come from the dis- cussed theme area; in addition, the results obtained in similar studies not always can be generalized by their own nature and by the used method. But as any other research, we do not intend to conclude the subject, we want to open new perspectives for future studies. CONCLUSION According to the evaluation of experts in surgery center and health informatics, the VLE “Tele-education in Malignant Hyperthermia” was an effective tool during the learning pro- cess. It is believed that promoting the VLE as an educational tool might contribute to achieve an integration between teaching, researching and assisting as a strategic resource to train nurses2,17. After the analysis of the assessments made with this program, we could prove a contribution regarding the ini- tial development proposal of an assisted learning program for nursing. The assessments also provided warning for the modification of some of the website aspects and valuable contents for future availability of the VLE. Informatics should be considered as an instrument that can be used for education, providing more flexibility of infor- mation presentation. In nursing, informatics does not only mean the use of computers, it is a medium to improve the teaching practice and profession assistance4,20.

| 187 | VLE IN MALIGNANT HYPERTHERMIA

  1. Casco C, Hernández CDG, Soto NAG, Cortés NR. Hipertermia maligna: um caso potencialmente mortal. Rev Bolet Científicos [Internet]. 2015 [cited on 2017 Mar 21];4(7). Available from: https://repository.uaeh.edu.mx/revistas/index.php/ICSA/article/ view/858/
  2. Sousa CS, Diniz TRZ, Cunha ALSM. Malignant Hyperthermia: proposing a care protocol for surgical centers. J Nurs UFPE on line [Internet]. 2013 [cited on 2017 Mar 21];7(spe):6714-8. Available from: http://www.revista.ufpe.br/revistaenfermagem/index.php/ revista/article/view/4878/pdf_
  3. Pan T, Ji W, Nie M, Li Y. Clinical treatment of malignant hyperthermia in three cases. Experimental and Therapeutic Medicine [Internet]. 2016 [cited on 2017 Mar 21];12(5):2881-4. Available from: https:// www.spandidos-publications.com/etm/12/5/
  4. Bellucci Júnior JA, Matsuda LM. Construção e validação de instrumento para avaliação do Acolhimento com Classificação de Risco.Rev Bras Enferm [Internet]. 2012 [cited on 2017 Mar 26];65(5):751-7. Available from: http://pesquisa.bvsalud.org/enfermeria/resource/pt/bde-
    1. Rangel EML, Mendes IAC, Cárnio EC, Alves LMM, Crispim JA, Mazzo A, et al. Evaluation by nursing students in virtual learning environments for teaching endocrine physiology. Acta Paul Enferm [Internet]. 2011 [cited on 2016 Dec 14];24(3):327-33. Available from: http://www.scielo.br/pdf/ape/v24n3/en_04.pdf
    2. Vieira MB, Luciano NA. Construção e Reconstrução de um Ambiente de Aprendizagem para Educação à Distância. ABED [Internet]. 2005 [cited on 2016 Dec 14]. Available from: http://www.abed.org.br/site/ pt/midiateca/textos_ead/643/2005/11/construcao_e_reconstrucao_ de_um_ambiente_de_aprendizagem_para_educacao_a_distancia_
    3. Sousa CS, Cunha ALM. Knowledge of nursing professional of a surgical center regarding malignant hyperthermia. RGE [Internet]. 2014 [cited on 2016 Feb 29];35(3):43-8. Available from:http://seer.ufrgs.br/index. php/RevistaGauchadeEnfermagem/article/view/44643/
    4. Tobase L, Guareschi APDF, Frias MAE, Prado C, Peres HHC.Technological resources in nursing education. J Health Inform [Internet]. 2013 [cited on 2017 Jan 30];5(3):77-81. Available from:http://www.jhi-sbis.saude. ws/ojs-jhi/index.php/jhi-sbis/article/view/218/