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Lee N, Lee G. Traumatic perinatal events and educational needs of labor and delivery room nurses in Korea: a cross-sectional survey. WOMEN'S HEALTH NURSING (SEOUL, KOREA) 2024; 30:67-78. [PMID: 38650328 PMCID: PMC11073560 DOI: 10.4069/whn.2024.03.10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Revised: 03/10/2024] [Accepted: 03/10/2024] [Indexed: 04/25/2024]
Abstract
PURPOSE The present study investigated experiences of traumatic perinatal events, the provision of related education, and educational needs of nurses working in the labor and delivery room (LDR). METHODS Nurses working in the LDRs of six institutions and two nurse portal sites were invited to participate in the survey, delivered on paper or online. The data were collected from October 1 to November 25, 2022. Data from 129 nurses were analyzed using frequency, the chi-square test, the Fisher exact test, the t-test, and analysis of variance. RESULTS Virtually all participants (98.6%) reported having experienced at least one traumatic perinatal event (dystocia, postpartum hemorrhage, neonatal congenital anomalies, severe maternal or neonatal injury, stillbirth, and maternal or neonatal death) while working in the LDR. The most shocking traumatic perinatal event experienced was the maternal or neonatal death (40.3%), but 24.8% of participants did not recall ever receiving education on the topic. About 63% of participants experienced traumatic perinatal events within a year of working in the LDR. The average score for education needs regarding traumatic perinatal events was 3.67±0.37 out of 4, and participants preferred simulation education as the most effective educational method. CONCLUSION Since most of the participants had experienced various traumatic perinatal events in the early stages of working in the LDR and expressed a high level of need for education on traumatic perinatal events, it is necessary to provide more effective stimulation education programs in the early period of work in the LDR.
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Affiliation(s)
- Nagyeong Lee
- College of Nursing, Ewha Womans University, Seoul, Korea
| | - Gunjeong Lee
- College of Nursing, Ewha Womans University, Seoul, Korea
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Liagkou A, Lazarou E, Tigka M, Pournara G, Lykeridou K, Metallinou D. Knowledge of Critical Issues in the Intrapartum Period: a Cross-sectional Study Among Undergraduate Final Year Midwifery Students. Mater Sociomed 2022; 34:284-290. [PMID: 36936890 PMCID: PMC10019862 DOI: 10.5455/msm.2022.34.284-290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Accepted: 10/04/2022] [Indexed: 12/05/2022] Open
Abstract
Background Dealing with critical issues in the intrapartum period requires comprehensive knowledge and a full understanding of the basic principles and skills involved, as complications during labor and birth occur unexpectedly.. Objective The aim of this study was to evaluate the knowledge of critical issues in the intrapartum period among undergraduate final year midwifery students. Methods This is a descriptive observational cross-sectional study conducted between February-July 2017. Final year undergraduate midwifery students were recruited from one institution and four public hospitals. The research instrument was a questionnaire designed by the research team. Statistical significance was set at p<0.05 and analyses were performed using the IBM SPSS Statistics version 22. Results The final study sample consisted of 100 participants. The 36.0% of the students had started their final year internship, with a mean duration of 4.3 months. Only 2% of the participants had obtained a bachelor degree from another department, 76% had attended general high school, 17% had pre-graduate work experience and 48.0% had attended a seminar on critical issues in the intrapartum period. Participants' final scores ranged from 5% to 90%, with mean value being 49.7% (SD=16.5%). The knowledge score was found to be significantly higher in midwifery students who had started the internship. However, it was not significantly correlated with other educational characteristics. Finally, no significant correlation was observed between knowledge score and age (r= -0.15, p=0.138) or knowledge score and months of internship (r=0.27, p=0.114). Conclusion In the core midwifery curriculum, the design and integration of didactic and clinical courses focusing on emergency management in midwifery practice is considered of paramount importance. However, teachers should provide midwifery students with guidance on independent learning ability and implement effective strategies to enhance students' self-study skills.
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Affiliation(s)
| | | | - Maria Tigka
- Obstetric Emergency Department, General and Maternity Hospital ‘Helena Venizelou’, Athens, Greece
- Department of Midwifery, University of West Attica, Attica, Greece
| | - Georgia Pournara
- Department of Midwifery, University of West Attica, Attica, Greece
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van den Broek N. Keep it simple - Effective training in obstetrics for low- and middle-income countries. Best Pract Res Clin Obstet Gynaecol 2021; 80:25-38. [PMID: 34872860 DOI: 10.1016/j.bpobgyn.2021.10.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Revised: 10/06/2021] [Accepted: 10/07/2021] [Indexed: 11/30/2022]
Abstract
In low-and middle-income countries, the burden of disease related to pregnancy and childbirth remains high. The health of the mother is intricately linked to that of the baby. Neonatal mortality is most likely to occur in the first week of life accounting for almost half of all deaths among children under 5-year old. Many babies are stillborn each year. It is important that healthcare is accessible, available, and of good quality. This requires a functioning health system with motivated, competent healthcare providers who were able to provide the continuum of care for mothers and babies. Pre- and in-service training is effective if it uses adult learning approaches, includes all members of the maternity team, and is focused on the core content of the care packages that are agreed for each setting. Most programmes that seek to build the capacity of the health system include training as one of the interventions to be implemented.
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Affiliation(s)
- Nynke van den Broek
- Maternal and Newborn Health, Independent Consultant Global Health, 5 Newcroft Road, Liverpool, L25 6EP, United Kingdom.
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Webb SS, Skene ER, Manresa M, Percy EK, Freeman RM, Tincello DG. Evaluation of midwifery pelvic floor education and Training across the UK and Spain. Eur J Obstet Gynecol Reprod Biol 2020; 256:140-144. [PMID: 33227686 DOI: 10.1016/j.ejogrb.2020.10.065] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Revised: 10/23/2020] [Accepted: 10/28/2020] [Indexed: 11/30/2022]
Abstract
OBJECTIVES The aim of this study was to evaluate current education and training of student and registered midwives across the UK and Spain; analysing both pelvic floor teaching and practical experience. STUDY DESIGN A cross-sectional survey was carried out by 711 student and 384 registered midwives across different universities and regions in the UK and Spain. RESULTS The vast majority (91.5 % n = 382) of UK students complete training without ever cutting or repairing an episiotomy. This compares to 39.4 % (n = 85) of registered midwives who did not cut an episiotomy during training. Only 20 % (n = 9) of Spanish and 10 % (n = 45) of UK registered midwives felt confident undertaking these techniques. In Spain just 15 % (n = 6) of students, compared to 54.8 % (n = 80) of registered midwives had received teaching on longer-term pelvic floor complications. CONCLUSION There is a considerable deficit in the current training practices for midwives regarding episiotomies. This lack of practice and confidence may be impacting on the increased rates of perineal tears and pelvic dysfunction in post-partum women. Across registered midwives there are gaps in education regarding longer-term pelvic floor complications. Our study was limited by a smaller sample size from Spain compared to the UK. Our results show practical assessment of skills during training is desirable and could improve both the confidence and competence of midwives upon registration.
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Affiliation(s)
- Sara S Webb
- Birmingham Women's & Children's NHS Foundation Trust, Edgbaston, Birmingham, UK; Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, UK
| | - Esther R Skene
- University of Leicester Medical School, University of Leicester, University Road, Leicester, LE17RH, UK
| | - Margarita Manresa
- Institut Clinic de Ginecologia, Obstetricia i Neonatologia (ICGON), Hospital Clinic of Barcelona, Carrer de Villarroel, 170, 08036, Barcelona, Spain
| | | | - Robert M Freeman
- Department of Women's Health, University Hospitals Plymouth NHS Trust, UK; Plymouth University Peninsula Schools of Medicine and Dentistry, UK
| | - Douglas G Tincello
- Department of Health Sciences, College of Life Sciences, University of Leicester, University Road, Leicester LE17RH, UK.
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Khan ANS, Karim F, Chowdhury MAK, Zaka N, Manu A, Arifeen SE, Billah SM. Competence of healthcare professionals in diagnosing and managing obstetric complications and conducting neonatal care: a clinical vignette-based assessment in district and subdistrict hospitals in northern Bangladesh. BMJ Open 2019; 9:e028670. [PMID: 31427325 PMCID: PMC6701613 DOI: 10.1136/bmjopen-2018-028670] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2018] [Revised: 06/24/2019] [Accepted: 07/17/2019] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND This study assesses the competency of maternal and neonatal health (MNH) professionals at district-level and subdistrict-level health facilities in northern Bangladesh in managing maternal and newborn complications using clinical vignettes. The study also examines whether the professional's characteristics and provision of MNH services in health facilities influence their competencies. METHODS 134 MNH professionals in 15 government hospitals were interviewed during August and September 2016 using structured questionnaire with clinical vignettes on obstetric complications (antepartum haemorrhage and pre-eclampsia) and neonatal care (low birthweight and immediate newborn care). Summative scores were calculated for each vignette and median scores were compared across different individual-level and health facility-level attributes to examine their association with competency score. Kruskal-Wallis test was performed to identify the significance of association considering a p value<0.05 as statistically significant. RESULTS The competency of MNH professionals was low. About 10% and 24% of the health professionals received 'high' scores (>75% of total) in maternal and neonatal vignettes, respectively. Medical doctors had higher competency than nurses and midwives (score=11 vs 8 out of 19, respectively; p=0.0002) for maternal vignettes, but similar competency for neonatal vignettes (score=30.3 vs 30.9 out of 50, respectively). Professionals working in health facilities with higher use of normal deliveries had better competency than their counterparts. Professionals had higher competency in newborn vignettes (significant) and maternal vignettes (statistically not significant) if they worked in health facilities that provided more specialised newborn care services and emergency obstetric care, respectively, in the last 6 months. CONCLUSIONS Despite the overall low competency of MNH professionals, exposure to a higher number of obstetric cases at the workplace was associated with their competency. Arrangement of periodic skill-based and drill-based in-service training for MNH professionals in high-use neighbouring health facilities could be a feasible intervention to improve their knowledge and skill in obstetric and neonatal care.
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Affiliation(s)
- Abdullah Nurus Salam Khan
- Health Promotion, Education and Behavior, University of South Carolina, Columbia, South Carolina, USA
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research Bangladesh, Dhaka, Bangladesh
| | - Farhana Karim
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research Bangladesh, Dhaka, Bangladesh
| | - Mohiuddin Ahsanul Kabir Chowdhury
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research Bangladesh, Dhaka, Bangladesh
- Epidemiology, University of South Carolina, Columbia, South Carolina, USA
| | - Nabila Zaka
- Health Section, Maternal and Newborn Health, UNICEF USA, New York, New York, USA
| | - Alexander Manu
- Department of Population Health, Liverpool School of Tropical Medicine, Liverpool, Liverpool, UK
| | - Shams El Arifeen
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research Bangladesh, Dhaka, Bangladesh
| | - Sk Masum Billah
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research Bangladesh, Dhaka, Bangladesh
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Zafar Z, Habib H, Kols A, Assad F, Lu ER, Schuster A. Reinvigorating postpartum intrauterine contraceptive device use in Pakistan: an observational assessment of competency-based training of health providers using low-cost simulation models. BMC MEDICAL EDUCATION 2019; 19:261. [PMID: 31307460 PMCID: PMC6631998 DOI: 10.1186/s12909-019-1683-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/09/2018] [Accepted: 06/24/2019] [Indexed: 06/10/2023]
Abstract
BACKGROUND Improved training approaches have the potential to overcome barriers to the use of postpartum intrauterine devices (PPIUDs) in Pakistan, including a shortage of female providers who are able to insert the device. This study assessed the effectiveness and acceptability of a competency-based onsite training approach that employed a newly developed anatomic model (the Mama-U) to train doctors and midwives on postpartum family planning (PPFP) and the insertion of PPIUDs. METHODS An observational, mixed methods study conducted training evaluations and knowledge and skills assessments with 11 trainers and 88 doctors and midwives who participated in eight PPIUD training sessions. Two months later, follow-up interviews and clinical assessments were conducted with 20 providers, and interviews and a focus group discussion were conducted with 85 married women who received a PPIUD from a trained provider. RESULTS The training significantly improved provider knowledge (p < 0.001), and follow-up assessments showed that clinical skills were retained for at least two months post-training. After training, 81.8% of providers were confident in their ability to provide PPIUD services, and midwives and doctors had similar PPIUD insertion skills. However, midwives were more likely than doctors to meet all 10 key requirements during PPIUD counseling sessions (63.9% versus 13.3%, p = 0.004). Providers found the Mama-U model to be a useful tool for client counseling as well as training and skills practice, and clients agreed. Trainers identified the low cost, light weight, and portability of the Mama-U model as advantages over the conventional training model and noted that its abstract shape reduced embarrassment among trainers, providers, and clients. CONCLUSIONS Competency-based training with the Mama-U model can improve the quality of PPIUD counseling and PPIUD insertion services and has the potential to extend PPFP/PPIUD service delivery to midwives working in rural Pakistan. The portable, low-cost Mama-U permits onsite, on-the-job PPIUD insertion training that is tailored to the local setting; it is also well suited for the continuing practice that providers need to maintain their skills. Further research is needed to confirm the usefulness and cost-effectiveness of the Mama-U at scale and in other settings.
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Affiliation(s)
- Zonobia Zafar
- Jhpiego Pakistan, 1st Floor, 85 – East Kamran Center Jinnah Avenue, Blue Area, Islamabad, Pakistan
| | - Hammad Habib
- Common Unit for Managing the Global Fund, Ministry of National Health Services Regulations and Coordination, NIH, 1st Floor, Chak Shahzad, Islamabad, Pakistan
| | - Adrienne Kols
- Jhpiego, 1615 Thames Street, Baltimore, MD 21231 USA
| | - Fauzia Assad
- Jhpiego Pakistan, 1st Floor, 85 – East Kamran Center Jinnah Avenue, Blue Area, Islamabad, Pakistan
| | | | - Anne Schuster
- Jhpiego, 1615 Thames Street, Baltimore, MD 21231 USA
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Bhutta SZ, Yasmin H. Comparative Effectiveness of Teaching Obstetrics and Gynaecological Procedural Skills on Patients versus Models: A randomized trial. Pak J Med Sci 2018; 34:794-798. [PMID: 30190730 PMCID: PMC6115552 DOI: 10.12669/pjms.344.15521] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Objective: To compare the effectiveness of learning procedural skills on patients versus mannequins and models. Methods: Seventy four interns from two consecutive batches at the Department of Obstetrics and Gynaecolgy Unit-I at Jinnah Postgraduate Medical Center Karachi participated in the study between April and September 2014. Five basic skills; taking a cervical (Pap) smear, intrauterine contraceptive device insertion, manual vacuum aspiration, making/ suturing an episiotomy and active management of the third stage of labour were identified. Interns were randomly allocated to two training groups (Group-1 and 2 of thirty eight and thirty six trainees respectively), with Group-I received training on the five procedural skills on models and mannequins for four weeks while Group-II trained on patients initially. After an evaluation at four weeks the groups crossed over with a final evaluation at eight weeks. The evaluation was through identical objective structured assessment of technical skills on models and mannequins for both groups with standard checklists. Results: There was no significant difference in skills between the two groups at the four weeks assessment. However at the end of training, Group-1 trainees performed significantly better than Group 2 with higher overall tests scores (86.7 ± 2.7 versus 80.4 ± 4.8, p< 0.001). This difference was more marked in skills of intrauterine contraceptive device insertion, making and suturing an episiotomy and active management of third stage of labour. Conclusion: Our findings suggest that simulations using models and mannequins for developing procedural skills can be readily incorporated in training programs with potential benefits for teaching infrequently performed or more difficult procedures. Our data suggest potential benefits of initiation of trainings on simulations and mannequins followed by human subject exposure.
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Affiliation(s)
- Shereen Zulfiqar Bhutta
- Prof. Shereen Zulfiqar Bhutta, Department of Obstetrics and Gynaecology, Jinnah Postgraduate Medical Centre, Karachi, Pakistan
| | - Haleema Yasmin
- Dr. Haleema Yasmin, Department of Obstetrics and Gynaecology, Jinnah Postgraduate Medical Centre, Karachi, Pakistan
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Apanga PA, Awoonor-Williams JK. Maternal Death in Rural Ghana: A Case Study in the Upper East Region of Ghana. Front Public Health 2018; 6:101. [PMID: 29686982 PMCID: PMC5900389 DOI: 10.3389/fpubh.2018.00101] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2017] [Accepted: 03/21/2018] [Indexed: 11/23/2022] Open
Abstract
Maternal mortality remains a challenge in providing quality maternal and other reproductive healthcare services in Ghana. This is a case investigation of a maternal death in rural Ghana that seeks to unravel the circumstances that lead to her death. We conducted three in-depth interviews with healthcare staff as well as a focused group discussion comprising of six relatives of the deceased, including her husband. The investigation revealed that lack of logistics, medical, and laboratory equipment, inadequate knowledge about the benefits of antenatal care services as well as non-adherence of healthcare workers to treatment protocols and standard operating procedures were found as major setbacks to the provision of effective and quality maternal healthcare services in Ghana. It is, therefore, imperative for the Government of Ghana and other Non-Governmental Organizations to invest in strengthening the healthcare delivery system especially in rural Ghana by making available basic logistics, medical, and laboratory equipment, as well as improving upon maternal health education, and consistently organizing capacity building training programs for healthcare workers.
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Lagrew DC, Kane Low L, Brennan R, Corry MP, Edmonds JK, Gilpin BG, Frost J, Pinger W, Reisner DP, Jaffer S. National Partnership for Maternal Safety: Consensus Bundle on Safe Reduction of Primary Cesarean Births-Supporting Intended Vaginal Births. J Obstet Gynecol Neonatal Nurs 2018; 47:214-226. [PMID: 29478788 DOI: 10.1016/j.jogn.2018.01.008] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Cesarean births and associated morbidity and mortality have reached near epidemic proportions. The National Partnership for Maternal Safety under the guidance of the Council on Patient Safety in Women's Health Care responded by developing a patient safety bundle to reduce the number of primary cesarean births. Safety bundles outline critical practices to implement in every maternity unit. This National Partnership for Maternity Safety bundle, as with other bundles, is organized into four domains: Readiness, Recognition and Prevention, Response, and Reporting and Systems Learning. Bundle components may be adapted to individual facilities, but standardization within an institution is advised. Evidence-based resources and recommendations are provided to assist implementation.
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11
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Lagrew DC, Low LK, Brennan R, Corry MP, Edmonds JK, Gilpin BG, Frost J, Pinger W, Reisner DP, Jaffer S. National Partnership for Maternal Safety: Consensus Bundle on Safe Reduction of Primary Cesarean Births- Supporting Intended Vaginal Births. J Midwifery Womens Health 2018; 63:235-244. [PMID: 29471583 DOI: 10.1111/jmwh.12738] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2018] [Accepted: 01/25/2018] [Indexed: 11/27/2022]
Abstract
Cesarean births and associated morbidity and mortality have reached near epidemic proportions. The National Partnership for Maternal Safety under the guidance of the Council on Patient Safety in Women's Health Care responded by developing a patient safety bundle to reduce the number of primary cesarean births. Safety bundles outline critical practices to implement in every maternity unit. This National Partnership for Maternity Safety bundle, as with other bundles, is organized into four domains: Readiness, Recognition and Prevention, Response, and Reporting and Systems Learning. Bundle components may be adapted to individual facilities, but standardization within an institution is advised. Evidence-based resources and recommendations are provided to assist implementation.
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Experience of lecturers with simulation training in midwifery education in Slovakia. Midwifery 2018; 59:1-3. [PMID: 29331775 DOI: 10.1016/j.midw.2018.01.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2017] [Revised: 12/02/2017] [Accepted: 01/03/2018] [Indexed: 11/21/2022]
Abstract
The simulation training in midwifery has a long tradition. It is aimed at acquiring basic and advanced practical skills such as performing a certain number of births, episiotomy and subsequent suture, assisting during breech birth etc. Midwifery education is currently based on the requirements of the Directives of the European Union exactly specifying number of performed practical procedures and approaches (World Health Organisation (WHO) Europe, 2009). The aim of this paper is to draw attention to the experience with the simulation training from the teacher's point of view in the study program Midwifery in Slovakia. The authors describe the locations for training of midwifery skills, training of basic and advanced midwifery skills using simulation, the types of simulators available and used and training approaches. They outline the advantages and disadvantages of using obstetric simulators based on their own experience.
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Interdisciplinary Skills Review Program to Improve Team Responses During Postpartum Hemorrhage. J Obstet Gynecol Neonatal Nurs 2017; 47:254-263. [PMID: 29080398 DOI: 10.1016/j.jogn.2017.09.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/01/2017] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVE To develop an interdisciplinary, interactive, skills review program to improve team responses during a postpartum hemorrhage (PPH). DESIGN Online didactic modules in combination with an interdisciplinary skills program consisting of seven hemorrhage-related stations. SETTING/LOCAL PROBLEM The project was conducted in the Women's Health Department in a quaternary-care Magnet- and Baby Friendly-designated academic medical center in Philadelphia, Pennsylvania. Women cared for at this center have comorbidities that place them at greater risk for PPH. A need was identified to implement a multidisciplinary and comprehensive program to assess hemorrhage risk and appropriately recognize and intervene with all PPHs in this setting. PARTICIPANTS The 276 participants, including registered nurses, obstetric and family medicine attending physicians and residents, advanced practice nurses, and ancillary staff in the hospital's Women's Health Department, completed the initial obstetric hemorrhage program. INTERVENTION/MEASUREMENTS The program included online didactic modules, seven interdisciplinary skills stations led by trained nurses and providers, and an in situ simulation. Successful completion of the online modules was a prerequisite for participation in the skills stations. All participants completed a written program evaluation at the conclusion of the program. RESULTS Results of the postassessment survey indicated that participants rated the program 3.94 of 4.00 for overall effectiveness to improve interdisciplinary team responses to PPH. Comments were overwhelmingly positive, and participants expressed increased confidence and knowledge related to PPH after completion of the program. CONCLUSION An interdisciplinary program that included online didactic modules, interactive skills stations, and simulation improved team confidence and responses to PPH.
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Banke-Thomas A, Wilson-Jones M, Madaj B, van den Broek N. Economic evaluation of emergency obstetric care training: a systematic review. BMC Pregnancy Childbirth 2017; 17:403. [PMID: 29202731 PMCID: PMC5716021 DOI: 10.1186/s12884-017-1586-z] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2017] [Accepted: 11/20/2017] [Indexed: 12/20/2022] Open
Abstract
Background Training healthcare providers in Emergency Obstetric Care (EmOC) has been shown to be effective in improving their capacity to provide this critical care package for mothers and babies. However, little is known about the costs and cost-effectiveness of such training. Understanding costs and cost-effectiveness is essential in guaranteeing value-for-money in healthcare spending. This study systematically reviewed the available literature on cost and cost-effectiveness of EmOC trainings. Methods Peer-reviewed and grey literature was searched for relevant papers published after 1990. Studies were included if they described an economic evaluation of EmOC training and the training cost data were available. Two reviewers independently searched, screened, and selected studies that met the inclusion criteria, with disagreements resolved by a third reviewer. Quality of studies was assessed using the Consolidated Health Economic Evaluation Reporting Standards statement. For comparability, all costs in local currency were converted to International dollar (I$) equivalents using purchasing power parity conversion factors. The cost per training per participant was calculated. Narrative synthesis was used to summarise the available evidence on cost effectiveness. Results Fourteen studies (five full and nine partial economic evaluations) met the inclusion criteria. All five and two of the nine partial economic evaluations were of high quality. The majority of studies (13/14) were from low- and middle-income countries. Training equipment, per diems and resource person allowance were the most expensive components. Cost of training per person per day ranged from I$33 to I$90 when accommodation was required and from I$5 to I$21 when training was facility-based. Cost-effectiveness of training was assessed in 5 studies with differing measures of effectiveness (knowledge, skills, procedure cost and lives saved) making comparison difficult. Conclusions Economic evaluations of EmOC training are limited. There is a need to scale-up and standardise processes that capture both cost and effectiveness of training and to agree on suitable economic evaluation models that allow for comparability across settings. Trial registration PROSPERO_CRD42016041911. Electronic supplementary material The online version of this article (10.1186/s12884-017-1586-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Aduragbemi Banke-Thomas
- Centre for Maternal and Newborn Health, Liverpool School of Tropical Medicine, L3 5QA, Liverpool, UK
| | - Megan Wilson-Jones
- Centre for Maternal and Newborn Health, Liverpool School of Tropical Medicine, L3 5QA, Liverpool, UK
| | - Barbara Madaj
- Centre for Maternal and Newborn Health, Liverpool School of Tropical Medicine, L3 5QA, Liverpool, UK
| | - Nynke van den Broek
- Centre for Maternal and Newborn Health, Liverpool School of Tropical Medicine, L3 5QA, Liverpool, UK.
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Allott HA, Smith H, Kana T, Mdegela M, Bar-Zeev S, Ameh C. Possible Reasons for Limited Effectiveness of a Skills and Drills Intervention to Improve Emergency Obstetric and Newborn Care. GLOBAL HEALTH: SCIENCE AND PRACTICE 2017; 5:175-176. [PMID: 28351884 PMCID: PMC5478226 DOI: 10.9745/ghsp-d-17-00055] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/20/2016] [Accepted: 12/20/2016] [Indexed: 11/15/2022]
Affiliation(s)
- Helen A Allott
- Liverpool School of Tropical Medicine, Centre for Maternal and Newborn Health, Liverpool, UK.
| | - Helen Smith
- Liverpool School of Tropical Medicine, Centre for Maternal and Newborn Health, Liverpool, UK
| | - Terry Kana
- Liverpool School of Tropical Medicine, Centre for Maternal and Newborn Health, Liverpool, UK
| | - Mselenge Mdegela
- Liverpool School of Tropical Medicine, Centre for Maternal and Newborn Health, Liverpool, UK
| | - Sarah Bar-Zeev
- Liverpool School of Tropical Medicine, Centre for Maternal and Newborn Health, Liverpool, UK
| | - Charles Ameh
- Liverpool School of Tropical Medicine, Centre for Maternal and Newborn Health, Liverpool, UK
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Varghese B, Krishnamurthy J, Correia B, Panigrahi R, Washington M, Ponnuswamy V, Mony P. Limited Effectiveness of a Skills and Drills Intervention to Improve Emergency Obstetric and Newborn Care in Karnataka, India: A Proof-of-Concept Study. GLOBAL HEALTH, SCIENCE AND PRACTICE 2016; 4:582-593. [PMID: 27993924 PMCID: PMC5199176 DOI: 10.9745/ghsp-d-16-00143] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/07/2016] [Accepted: 09/20/2016] [Indexed: 11/21/2022]
Abstract
OBJECTIVE The majority of the maternal and perinatal deaths are preventable through improved emergency obstetric and newborn care at facilities. However, the quality of such care in India has significant gaps in terms of provider skills and in their preparedness to handle emergencies. We tested the feasibility, acceptability, and effectiveness of a "skills and drills" intervention, implemented between July 2013 and September 2014, to improve emergency obstetric and newborn care in the state of Karnataka, India. METHODS Emergency drills through role play, conducted every 2 months, combined with supportive supervision and a 2-day skills refresher session were delivered across 4 sub-district, secondary-level government facilities by an external team of obstetric and pediatric specialists and nurses. We evaluated the intervention through a quasi-experimental design with 4 intervention and 4 comparison facilities, using delivery case sheet reviews, pre- and post-knowledge tests among providers, objective structured clinical examinations (OSCEs), and qualitative in-depth interviews. Primary outcomes consisted of improved diagnosis and management of selected maternal and newborn complications (postpartum hemorrhage, pregnancy-induced hypertension, and birth asphyxia). Secondary outcomes included knowledge and skill levels of providers and acceptability and feasibility of the intervention. RESULTS Knowledge scores among providers improved significantly in the intervention facilities; in obstetrics, average scores between the pre- and post-test increased from 49% to 57% (P=.006) and in newborn care, scores increased from 48% to 56% (P=.03). Knowledge scores in the comparison facilities were similar but did not improve significantly over time. Skill levels were significantly higher among providers in intervention facilities than comparison facilities (mean objective structured clinical examination scores for obstetric skills: 55% vs. 46%, respectively; for newborn skills: 58% vs. 48%, respectively; P<.001 for both obstetric and newborn), along with their confidence in managing complications. However, this did not result in significant differences in correct diagnosis and management of complications between intervention and comparison facilities. Shortage of trained nurses and doctors along with unavailability of a consistent supply chain was cited by most providers as major health systems barriers affecting provision of care. CONCLUSIONS Improvements in knowledge, skills, and confidence levels of providers as a result of the skills and drills intervention was not sufficient to translate into improved diagnosis and management of maternal and newborn complications. System-level changes including adequate in-service training may also be necessary to improve maternal and newborn outcomes.
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Affiliation(s)
| | | | | | | | | | | | - Prem Mony
- St. Johns Research Institute, Bangalore, India
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Dyer JM, Latendresse G. Identifying and Addressing Problems for Student Progression in Midwifery Clinical Education. J Midwifery Womens Health 2016; 61:28-36. [PMID: 27880865 DOI: 10.1111/jmwh.12507] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2015] [Revised: 05/18/2016] [Accepted: 05/19/2016] [Indexed: 11/26/2022]
Abstract
Identifying challenges to progression for a health care profession student who is not meeting expectations in a busy clinical practice can be challenging yet can lead to assisting the student toward success. Preceptor preparation includes acquiring knowledge about the student's education program, understanding federal regulations designed to protect students, gathering background information about a student, learning to provide feedback, structuring the clinical experience, and completing student evaluations. Students in health care professions may have difficulties with cognitive, affective, or psychomotor learning, and the clinical preceptor can identify problems for student progression within these learning domains. Subsequently, specific solutions that are tailored to the individual student's needs can be developed, implemented, and evaluated. A structured evaluation of the student's performance by the clinical preceptor, in accordance with the education program's parameters, is essential. Through a structured process, preceptors can assist many students to achieve success, in spite of challenges. This article describes how the preceptor can prepare, identify the type(s) of problem(s), and develop learning solutions for students who are experiencing difficulties in clinical settings.
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Mannella P, Palla G, Cuttano A, Boldrini A, Simoncini T. Effect of high-fidelity shoulder dystocia simulation on emergency obstetric skills and crew resource management skills among residents. Int J Gynaecol Obstet 2016; 135:338-342. [PMID: 27622684 DOI: 10.1016/j.ijgo.2016.06.023] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2016] [Revised: 06/22/2016] [Accepted: 08/22/2016] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To determine the effect of a simulation training program for residents in obstetrics and gynecology in terms of technical and nontechnical skills for the management of shoulder dystocia. METHODS A prospective study was performed at a center in Italy in April-May 2015. Thirty-two obstetrics and gynecology residents were divided into two groups. Residents in the control group were immediately exposed to an emergency shoulder dystocia scenario, whereas those in the simulation group completed a 2-hour training session with the simulator before being exposed to the scenario. After 8weeks, the residents were again exposed to the shoulder dystocia scenario and reassessed. Participants were scored on their demonstration of technical and nontechnical skills. RESULTS In the first set of scenarios, the mean score was higher in the simulation group than the control group in terms of both technical skills (P=0.008) and nontechnical skills (P<0.001). This difference was retained after 8weeks. CONCLUSION High-fidelity simulation programs could be used for the training of residents in obstetrics and gynecology to diagnose and manage obstetric emergencies such as shoulder dystocia.
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Affiliation(s)
- Paolo Mannella
- First Division of Obstetrics and Gynecology, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy.
| | - Giulia Palla
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Armando Cuttano
- U.O. Neonatology, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | - Antonio Boldrini
- U.O. Neonatology, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | - Tommaso Simoncini
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
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Jones SA, Sam B, Bull F, James M, Ameh CA, van den Broek NR. Strengthening pre-service training for skilled birth attendance - An evaluation of the maternal and child health aide training programme in Sierra Leone. NURSE EDUCATION TODAY 2016; 41:24-29. [PMID: 27138478 DOI: 10.1016/j.nedt.2016.03.018] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/18/2015] [Revised: 02/26/2016] [Accepted: 03/09/2016] [Indexed: 06/05/2023]
Abstract
BACKGROUND The high maternal mortality rate in Sierra Leone combined with an ongoing shortage of midwives has led to the introduction of new cadres of healthcare workers. Maternal and Child Health Aides are one such cadre and now provide 56% of patient care. The quality of the education training programme for MCHA is therefore of paramount importance if high quality maternal care is to be provided. OBJECTIVE To conduct an evaluation of the MCHAide training programme in Sierra Leone. DESIGN Mapping of programme and focus group discussions (FGDs) with key informants. Analysis of data using a thematic approach and formulation of recommendations for national, district and individual levels. SETTING All 14 MCHAide schools across Sierra Leone. PARTICIPANTS The National Coordinator, Coordinators from 14 MCHAide schools and District Health Sisters from District Health Management Teams. METHODS Focus group discussions were held with tutors facilitated by a group member to encourage a free flowing discussion. Participants were divided into 4 groups, one for each province, with 5-8 participants per group and 50min for the discussion. RESULTS Strengths, weaknesses and opportunities of the MCHAide training programme were identified. Four major themes were identified; the need for autonomy and support within the programme from stakeholders; the effect of poor infrastructure on teaching and student learning; the need to ensure rigorous academic quality including teaching quality, curricula content and the academic ability of the students; and the benefits of community support. CONCLUSIONS It is important that the key personnel be involved in the development and introduction of training programmes for new cadres of staff from the earliest stages of development. On-going programme review and development is essential and those implementing the programme are the best placed to lead and contribute to this. Gathering the experiences and perceptions of key informants helps provide an in-depth examination that can inform recommendations.
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Affiliation(s)
- Susan A Jones
- Centre for Maternal and Newborn Health, Liverpool School of Tropical Medicine, Liverpool L3 5QA, UK.
| | - Betty Sam
- Liverpool School of Tropical Medicine, Sierra Leone Office, c/o Health Poverty Action, 25 Barracks Road, Murray Town, Freetown, Sierra Leone.
| | - Florence Bull
- Liverpool School of Tropical Medicine, Sierra Leone Office, c/o Health Poverty Action, 25 Barracks Road, Murray Town, Freetown, Sierra Leone.
| | - Margaret James
- UNICEF Sierra Leone, UNICEF, P.O. Box 221, Freetown, Sierra Leone.
| | - Charles A Ameh
- Centre for Maternal and Newborn Health, Liverpool School of Tropical Medicine, Liverpool L3 5QA, UK.
| | - Nynke R van den Broek
- Centre for Maternal and Newborn Health, Liverpool School of Tropical Medicine, Liverpool L3 5QA, UK.
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Making It Happen: Training health-care providers in emergency obstetric and newborn care. Best Pract Res Clin Obstet Gynaecol 2015; 29:1077-91. [DOI: 10.1016/j.bpobgyn.2015.03.019] [Citation(s) in RCA: 64] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2015] [Accepted: 03/23/2015] [Indexed: 11/22/2022]
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