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Mossenson AI, Livingston PL, Tuyishime E, Brown JA. Assessing Healthcare Simulation Facilitation: A Scoping Review of Available Tools, Validity Evidence, and Context Suitability for Faculty Development in Low-Resource Settings. Simul Healthc 2024:01266021-990000000-00121. [PMID: 38595205 DOI: 10.1097/sih.0000000000000796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/11/2024]
Abstract
SUMMARY STATEMENT Assessment tools support simulation facilitation skill development by guiding practice, structuring feedback, and promoting reflective learning among educators. This scoping review followed a systematic process to identify facilitation assessment tools used in postlicensure healthcare simulation. Secondary objectives included mapping of the validity evidence to support their use and a critical appraisal of their suitability for simulation faculty development in low-resource settings. Database searching, gray literature searching, and stakeholder engagement identified 11,568 sources for screening, of which 72 met criteria for full text review. Thirty sources met inclusion; 16 unique tools were identified. Tools exclusively originated from simulation practice in high-resource settings and predominantly focused on debriefing. Many tools have limited validity evidence supporting their use. In particular, the validity evidence supporting the extrapolation and implications of assessment is lacking. No current tool has high context suitability for use in low-resource settings.
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Affiliation(s)
- Adam I Mossenson
- From the SJOG Midland Public and Private Hospitals (A.I.M., J.A.B.), Perth, Australia; Dalhousie University (A.I.M., P.L.L.), Halifax, Canada; Curtin Medical School, Curtin University, Perth, Australia (A.I.M.); University of Rwanda College of Medicine and Health Sciences (E.T.), Kigali, Rwanda; Curtin School of Nursing (J.A.B.), Curtin University, Perth, Australia ; and Western Australian Group for Evidence Informed Healthcare Practice: A JBI Centre of Excellence (J.A.B.), Perth, Australia
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Bettinger K, Mafuta E, Mackay A, Bose C, Myklebust H, Haug I, Ishoso D, Patterson J. Improving Newborn Resuscitation by Making Every Birth a Learning Event. CHILDREN (BASEL, SWITZERLAND) 2021; 8:children8121194. [PMID: 34943390 PMCID: PMC8700033 DOI: 10.3390/children8121194] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Revised: 12/08/2021] [Accepted: 12/13/2021] [Indexed: 06/14/2023]
Abstract
One third of all neonatal deaths are caused by intrapartum-related events, resulting in neonatal respiratory depression (i.e., failure to breathe at birth). Evidence-based resuscitation with stimulation, airway clearance, and positive pressure ventilation reduces mortality from respiratory depression. Improving adherence to evidence-based resuscitation is vital to preventing neonatal deaths caused by respiratory depression. Standard resuscitation training programs, combined with frequent simulation practice, have not reached their life-saving potential due to ongoing gaps in bedside performance. Complex neonatal resuscitations, such as those involving positive pressure ventilation, are relatively uncommon for any given resuscitation provider, making consistent clinical practice an unrealistic solution for improving performance. This review discusses strategies to allow every birth to act as a learning event within the context of both high- and low-resource settings. We review strategies that involve clinical-decision support during newborn resuscitation, including the visual display of a resuscitation algorithm, peer-to-peer support, expert coaching, and automated guidance. We also review strategies that involve post-event reflection after newborn resuscitation, including delivery room checklists, audits, and debriefing. Strategies that make every birth a learning event have the potential to close performance gaps in newborn resuscitation that remain after training and frequent simulation practice, and they should be prioritized for further development and evaluation.
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Affiliation(s)
- Kourtney Bettinger
- Department of Pediatrics, University of Kansas School of Medicine, 3901 Rainbow Blvd, MS 4004, Kansas City, KS 66103, USA
| | - Eric Mafuta
- School of Public Health, University of Kinshasa, Kinshasa 11850, Democratic Republic of the Congo; (E.M.); (D.I.)
| | - Amy Mackay
- Department of Pediatrics, University of North Carolina at Chapel Hill, 101 Manning Drive, CB 7596, Chapel Hill, NC 27599-7596, USA; (A.M.); (C.B.); (J.P.)
| | - Carl Bose
- Department of Pediatrics, University of North Carolina at Chapel Hill, 101 Manning Drive, CB 7596, Chapel Hill, NC 27599-7596, USA; (A.M.); (C.B.); (J.P.)
| | - Helge Myklebust
- Laerdal Medical Strategic Research Department, Tanke Svilandsgate 30, N-4002 Stavanger, Norway; (H.M.); (I.H.)
| | - Ingunn Haug
- Laerdal Medical Strategic Research Department, Tanke Svilandsgate 30, N-4002 Stavanger, Norway; (H.M.); (I.H.)
| | - Daniel Ishoso
- School of Public Health, University of Kinshasa, Kinshasa 11850, Democratic Republic of the Congo; (E.M.); (D.I.)
| | - Jackie Patterson
- Department of Pediatrics, University of North Carolina at Chapel Hill, 101 Manning Drive, CB 7596, Chapel Hill, NC 27599-7596, USA; (A.M.); (C.B.); (J.P.)
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Bø B, Madangi BP, Ralaitafika H, Ersdal HL, Tjoflåt I. Nursing students' experiences with simulation-based education as a pedagogic method in low-resource settings: A mixed-method study. J Clin Nurs 2021; 31:1362-1376. [PMID: 34423486 DOI: 10.1111/jocn.15996] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Revised: 07/09/2021] [Accepted: 07/15/2021] [Indexed: 10/20/2022]
Abstract
AIMS AND OBJECTIVES This study introduced simulation-based education in nurse education programs in Tanzania and Madagascar and explored nursing students' experiences with this pedagogic method as a mode of learning. BACKGROUND Simulation-based education has barely been introduced to education programs in resource-constrained settings. The study was conducted in two nurse education programs: one in rural Tanzania and the other in the mid-land of Madagascar. Both institutions offer diploma programs in nursing. Simulation-based education has not been included in the teaching methods used in these nursing programs. DESIGN A descriptive and convergent mixed method design was employed. METHODS Ninety-nine nursing students were included in the study. Simulation sessions followed by data collection took place once in 2017 and twice in 2018. Data were collected by means of several questionnaires and six focus groups. The data were analyzed using descriptive statistics and qualitative content analysis. The Standards for Reporting Qualitative Research (SRQR) was used to report the results. RESULTS The quantitative data revealed that the students rated all the questions related to the simulation design elements, educational practices, and students' satisfaction and self-confidence in learning with scores of above four on a 5-point Likert scale. The qualitative data from the first theme, building competence and confidence, further emphasized and outlined the quantitative results. Additionally, the qualitative data revealed a second theme, improving through encouragement and corrections. The students clearly expressed that they wanted to be aware of their weaknesses to be able to improve; however, the provision of feedback should be carried out in an encouraging way. CONCLUSION The findings indicated that the nursing students were satisfied with simulation as a pedagogic method, as it improved their competence and prepared them for professional practice. Further research is necessary to explore whether the students are able to transfer their knowledge into clinical practice. RELEVANCE TO CLINICAL PRACTICE Simulation as a pedagogic method is valuable for the learning of clinical skills and preparation for clinical practice.
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Affiliation(s)
- Bodil Bø
- Faculty of Health Sciences, University of Stavanger, Stavanger, Norway
| | | | - Hanitra Ralaitafika
- Malagasy Lutheran School of Nursing Education (SEFAM), Antsirabe, Madagascar
| | - Hege Langli Ersdal
- Faculty of Health Sciences, University of Stavanger, Stavanger, Norway.,Critical Care and Anaesthesiology Research Group, Stavanger University Hospital, Stavanger, Norway
| | - Ingrid Tjoflåt
- Faculty of Health Sciences, University of Stavanger, Stavanger, Norway
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Chaulagain DR, Malqvist M, Brunell O, Wrammert J, Basnet O, Kc A. Performance of health workers on neonatal resuscitation care following scaled-up quality improvement interventions in public hospitals of Nepal - a prospective observational study. BMC Health Serv Res 2021; 21:362. [PMID: 33874929 PMCID: PMC8054430 DOI: 10.1186/s12913-021-06366-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Accepted: 01/04/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND High-quality resuscitation among non-crying babies immediately after birth can reduce intrapartum-related deaths and morbidity. Helping Babies Breathe program aims to improve performance on neonatal resuscitation care in resource-limited settings. Quality improvement (QI) interventions can sustain simulated neonatal resuscitation knowledge and skills and clinical performance. This study aimed to evaluate the effect of a scaled-up QI intervention package on the performance of health workers on basic neonatal resuscitation care among non-crying infants in public hospitals in Nepal. METHODS A prospective observational cohort design was applied in four public hospitals of Nepal. Performances of health workers on basic neonatal care were analysed before and after the introduction of the QI interventions. RESULTS Out of the total 32,524 births observed during the study period, 3031 newborn infants were not crying at birth. A lower proportion of non-crying infants were given additional stimulation during the intervention compared to control (aOR 0.18; 95% CI 0.13-0.26). The proportion of clearing the airway increased among non-crying infants after the introduction of QI interventions (aOR 1.23; 95% CI 1.03-1.46). The proportion of non-crying infants who were initiated on BMV was higher during the intervention period (aOR 1.28, 95% CI 1.04-1.57) compared to control. The cumulative median time to initiate ventilation during the intervention was 39.46 s less compared to the baseline. CONCLUSION QI intervention package improved health workers' performance on the initiation of BMV, and clearing the airway. The average time to first ventilation decreased after the implementation of the package. The QI package can be scaled-up in other public hospitals in Nepal and other similar settings.
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Affiliation(s)
- Dipak Raj Chaulagain
- Department of Women's and Children's Health, Uppsala University, Uppsala Global Health Research on Implementation and Sustainability (UGHRIS), Dag Hammarskjölds väg 14B, 75185, Uppsala, Sweden.
| | - Mats Malqvist
- Department of Women's and Children's Health, Uppsala University, Uppsala Global Health Research on Implementation and Sustainability (UGHRIS), Dag Hammarskjölds väg 14B, 75185, Uppsala, Sweden
| | - Olivia Brunell
- Department of Women's and Children's Health, Uppsala University, Uppsala Global Health Research on Implementation and Sustainability (UGHRIS), Dag Hammarskjölds väg 14B, 75185, Uppsala, Sweden
| | - Johan Wrammert
- Department of Women's and Children's Health, Uppsala University, Uppsala Global Health Research on Implementation and Sustainability (UGHRIS), Dag Hammarskjölds väg 14B, 75185, Uppsala, Sweden
| | | | - Ashish Kc
- Department of Women's and Children's Health, Uppsala University, Uppsala Global Health Research on Implementation and Sustainability (UGHRIS), Dag Hammarskjölds väg 14B, 75185, Uppsala, Sweden.,Society of Public Health Physicians Nepal (SOPHPHYN), Kathmandu, Nepal
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Tadesse M, Hally S, Rent S, Platt PL, Eusterbrock T, Gezahegn W, Kifle T, Kukora S, Pollack LD. Effect of a Low-Dose/High-Frequency Training in Introducing a Nurse-Led Neonatal Advanced Life Support Service in a Referral Hospital in Ethiopia. Front Pediatr 2021; 9:777978. [PMID: 34900877 PMCID: PMC8656416 DOI: 10.3389/fped.2021.777978] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Accepted: 11/02/2021] [Indexed: 11/13/2022] Open
Abstract
Background and Objective: In Ethiopia, birth asphyxia causes ~30% of all neonatal deaths and 11-31% of deaths among neonates delivered in healthcare facilities that have breathing difficulty at birth. This study aimed to examine the impact of low-dose, high-frequency (LDHF) training for introducing a nurse-led neonatal advanced life support (NALS) service in a tertiary care hospital in Ethiopia. Methods: Through a retrospective cohort study, a total of 12,001 neonates born post-implementation of the NALS service (between June 2017 and March 2019) were compared to 2,066 neonates born before its implementation (between June 2016 and September 2016). Based on when the neonates were born, they were divided into six groups (groups A to F). All deliveries occurred in the inpatient Labor and Delivery Unit (LDU) at St. Paul's Hospital Millennium Medical College. The number of neonatal deaths in the LDU, neonatal intensive care unit (NICU) admission rate, and proportion of neonates with normal axillary temperature (36.5-37.5°C) within the first hour of life were evaluated. Data were analyzed using the χ2 test, and p-values < 0.05 were considered statistically significant. Following the implementation of the NALS service, semi-structured interviews with key stakeholders were conducted to evaluate their perception of the service; the interviews were recorded, transcribed, and coded for thematic analysis. Results: There was a decrease in the proportion of neonates who died in the LDU (from 3.5 to 1%) during the immediate post-implementation period, followed by a sustained decrease over the study period (p < 0.001). The change in the NICU admission rate (from 22.8 to 21.2%) was insignificant (p = 0.6) during this initial period. However, this was followed by a significant sustained decrease (7.8% in group E and 9.8% in group F, p < 0.001). The proportion of newborns with normal axillary temperature improved from 46.2% during the initial post-implementation period to 87.8% (p < 0.01); this proportion further increased to 99.8%. The program was perceived positively by NALS team members, NICU care providers, and hospital administrators. Conclusion: In resource-limited settings, LDHF training for neonatal resuscitation improves the neonatal resuscitation skills and management of delivery room attendants.
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Affiliation(s)
- Misrak Tadesse
- Wax & Gold Inc., Amarillo, TX, United States.,Division of Neonatology, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Suzanne Hally
- Wax & Gold Inc., Amarillo, TX, United States.,Division of Neonatology, Department of Pediatrics, Massachusetts General Hospital, Boston, MA, United States.,School of Nursing, Endicott College, Boston, MA, United States
| | - Sharla Rent
- Division of Neonatology, Department of Pediatrics, University of Michigan, Ann Arbor, MI, United States
| | - Phillip L Platt
- Wax & Gold Inc., Amarillo, TX, United States.,Pediatrix Medical Group, Department of Neonatology, Baptist St Anthony's Hospital, Amarillo, TX, United States
| | - Thomas Eusterbrock
- Wax & Gold Inc., Amarillo, TX, United States.,Division of Neonatology, Alta Bates Summit Medical Center, Berkeley, CA, United States
| | | | - Tsinat Kifle
- Saint Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Stephanie Kukora
- Division of Neonatology, Department of Pediatrics, University of Michigan, Ann Arbor, MI, United States
| | - Louis D Pollack
- Wax & Gold Inc., Amarillo, TX, United States.,Division of Neonatology, Alta Bates Summit Medical Center, Berkeley, CA, United States
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Gardner Yelton SE, McCaw JM, Reuland CJ, Steppan DA, Evangelista PPG, Shilkofski NA. Evolution of a Bidirectional Pediatric Critical Care Educational Partnership in a Resource-Limited Setting. Front Pediatr 2021; 9:738975. [PMID: 34722421 PMCID: PMC8555020 DOI: 10.3389/fped.2021.738975] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Accepted: 09/17/2021] [Indexed: 11/13/2022] Open
Abstract
Introduction: Children in resource-limited settings are disproportionately affected by common childhood illnesses, resulting in high rates of mortality. A major barrier to improving child health in such regions is limited pediatric-specific training, particularly in the care of children with critical illness. While global health rotations for trainees from North America and Europe have become commonplace, residency and fellowship programs struggle to ensure that these rotations are mutually beneficial and do not place an undue burden on host countries. We created a bidirectional, multimodal educational program between trainees in Manila, Philippines, and Baltimore, Maryland, United States, to improve the longitudinal educational experience for all participants. Program Components: Based on stakeholder input and a needs assessment, we established a global health training program in which pediatricians from the Philippines traveled to the United States for observerships, and pediatric residents from a tertiary care center in Baltimore traveled to Manila. Additionally, we created and implemented a contextualized simulation-based shock curriculum for pediatric trainees in Manila that can be disseminated locally. This bidirectional program was adapted to include telemedicine and regularly scheduled "virtual rounds" and educational case conferences during the COVID-19 pandemic. Providers from the two institutions have collaborated on educational and clinical research projects, offering opportunities for resource sharing, bidirectional professional development, and institutional improvements. Conclusion: Although creating a mutually beneficial global health partnership requires careful planning and investment over time, establishment of a successful bidirectional educational and professional development program in a limited-resource setting is feasible and benefits learners in both countries.
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Affiliation(s)
- Sarah E Gardner Yelton
- Department of Anesthesiology and Critical Care Medicine, Charlotte R. Bloomberg Children's Center, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Julia M McCaw
- Department of Anesthesiology and Critical Care Medicine, Charlotte R. Bloomberg Children's Center, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Carolyn J Reuland
- Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Diana A Steppan
- Department of Anesthesiology and Critical Care Medicine, Charlotte R. Bloomberg Children's Center, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Paula Pilar G Evangelista
- Department of Pediatric Critical Care Medicine, Philippine Children's Medical Center, Quezon City, Philippines
| | - Nicole A Shilkofski
- Department of Anesthesiology and Critical Care Medicine, Charlotte R. Bloomberg Children's Center, Johns Hopkins University School of Medicine, Baltimore, MD, United States.,Department of Pediatrics, Charlotte R. Bloomberg Children's Center, Johns Hopkins University School of Medicine, Baltimore, MD, United States
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Drake M, Bishanga DR, Temu A, Njozi M, Thomas E, Mponzi V, Arlington L, Msemo G, Azayo M, Kairuki A, Meda AR, Isangula KG, Nelson BD. Structured on-the-job training to improve retention of newborn resuscitation skills: a national cohort Helping Babies Breathe study in Tanzania. BMC Pediatr 2019; 19:51. [PMID: 30732580 PMCID: PMC6366017 DOI: 10.1186/s12887-019-1419-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2018] [Accepted: 01/29/2019] [Indexed: 12/12/2022] Open
Abstract
Background Newborn resuscitation is a life-saving intervention for birth asphyxia, a leading cause of neonatal mortality. Improving provider newborn resuscitation skills is critical for delivering quality care, but the retention of these skills has been a challenge. Tanzania implemented a national newborn resuscitation using the Helping Babies Breathe (HBB) training program to help address this problem. Our objective was to evaluate the effectiveness of two training approaches to newborn resuscitation skills retention implemented across 16 regions of Tanzania. Methods An initial training approach implemented included verbal instructions for participating providers to replicate the training back at their service delivery site to others who were not trained. After a noted drop in skills, the program developed structured on-the-job training guidance and included this in the training. The approaches were implemented sequentially in 8 regions each with nurses/ midwives, other clinicians and medical attendants who had not received HBB training before. Newborn resuscitation skills were assessed immediately after training and 4–6 weeks after training using a validated objective structured clinical examination, and retention, measured through degree of skills drop, was compared between the two training approaches. Results Eight thousand, three hundred and ninety-one providers were trained and assessed: 3592 underwent the initial training approach and 4799 underwent the modified approach. Immediately post-training, average skills scores were similar between initial and modified training groups: 80.5 and 81.3%, respectively (p-value 0.07). Both groups experienced statistically significant drops in newborn resuscitation skills over time. However, the modified training approach was associated with significantly higher skills scores 4–6 weeks post training: 77.6% among the modified training approach versus 70.7% among the initial training approach (p-value < 0.0001). Medical attendant cadre showed the greatest skills retention. Conclusions A modified training approach consisting of structured OJT, guidance and tools improved newborn resuscitation skills retention among health care providers. The study results give evidence for including on-site training as part of efforts to improve provider performance and strengthen quality of care. Electronic supplementary material The online version of this article (10.1186/s12887-019-1419-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Mary Drake
- Jhpiego, Plot 72, Block 458, New Bagamoyo Road, Victoria, Dar es Salaam, Tanzania. .,University of Groningen, University Medical Centre Groningen, Department of Health Sciences, GlobalHealth, Groningen, the Netherlands.
| | - Dunstan R Bishanga
- Jhpiego, Plot 72, Block 458, New Bagamoyo Road, Victoria, Dar es Salaam, Tanzania.,University of Groningen, University Medical Centre Groningen, Department of Health Sciences, GlobalHealth, Groningen, the Netherlands
| | - Akwila Temu
- Jhpiego, Plot 72, Block 458, New Bagamoyo Road, Victoria, Dar es Salaam, Tanzania
| | - Mustafa Njozi
- Jhpiego, Plot 72, Block 458, New Bagamoyo Road, Victoria, Dar es Salaam, Tanzania
| | - Erica Thomas
- Jhpiego, Plot 72, Block 458, New Bagamoyo Road, Victoria, Dar es Salaam, Tanzania
| | - Victor Mponzi
- Jhpiego, Plot 72, Block 458, New Bagamoyo Road, Victoria, Dar es Salaam, Tanzania
| | - Lauren Arlington
- Division of Global Health, Department of Pediatrics, Massachusetts General Hospital, 125 Nashua Street, 8th Floor, Boston, MA, 02114, USA
| | - Georgina Msemo
- Ministry of Health and Social Welfare, 36/37 Samora Avenue, Dar es Salaam, Tanzania
| | - Mary Azayo
- Ministry of Health and Social Welfare, 36/37 Samora Avenue, Dar es Salaam, Tanzania
| | - Allan Kairuki
- Division of Global Health, Department of Pediatrics, Massachusetts General Hospital, 125 Nashua Street, 8th Floor, Boston, MA, 02114, USA
| | - Amunga R Meda
- Division of Global Health, Department of Pediatrics, Massachusetts General Hospital, 125 Nashua Street, 8th Floor, Boston, MA, 02114, USA
| | - Kahabi G Isangula
- Division of Global Health, Department of Pediatrics, Massachusetts General Hospital, 125 Nashua Street, 8th Floor, Boston, MA, 02114, USA
| | - Brett D Nelson
- Division of Global Health, Department of Pediatrics, Massachusetts General Hospital, 125 Nashua Street, 8th Floor, Boston, MA, 02114, USA.,Harvard Medical School, 25 Shattuck Street, Boston, MA, 02115, USA
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Kamath-Rayne BD, Thukral A, Visick MK, Schoen E, Amick E, Deorari A, Cain CJ, Keenan WJ, Singhal N, Little GA, Niermeyer S. Helping Babies Breathe, Second Edition: A Model for Strengthening Educational Programs to Increase Global Newborn Survival. GLOBAL HEALTH: SCIENCE AND PRACTICE 2018; 6:538-551. [PMID: 30287531 PMCID: PMC6172134 DOI: 10.9745/ghsp-d-18-00147] [Citation(s) in RCA: 60] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/20/2018] [Accepted: 08/27/2018] [Indexed: 12/03/2022]
Abstract
The revised neonatal resuscitation curriculum updates not only the science of resuscitation but also the educational and implementation approaches needed to further enhance neonatal survival, including promoting ongoing practice to retain skills and linkages with quality improvement initiatives. Background: Helping Babies Breathe (HBB), a skills-based program in neonatal resuscitation for birth attendants in resource-limited settings, has been implemented in over 80 countries since 2010. Implementation studies of HBB incorporating low-dose high-frequency practice and quality improvement show substantial reductions in fresh stillbirth and first-day neonatal mortality. Revision of the program aimed to further augment provider and facilitator skills and address gaps in implementation with the goal of improving neonatal survival. Methods: The Utstein Formula for Survival—Medical Science X Educational Efficiency X Local Implementation = Survival—provided a framework for the revisions. The 2015 Neonatal Resuscitation Consensus on Science and Treatment Recommendations by the International Liaison Committee on Resuscitation informed scientific updates, which were harmonized with the 2012 World Health Organization Basic Newborn Resuscitation Guidelines. Published literature and program reports, consensus guidelines on reprocessing equipment, systematic collection of suggestions from frontline users, and responses to a semistructured online questionnaire informed educational/implementation revisions. Links to maternal care were added. Draft materials underwent Delphi review and field testing in India and Sierra Leone. An Utstein-style meeting of stakeholders identified key actions for successful implementation. Results: Scientific revisions included expectant management of infants with meconium-stained amniotic fluid, limitation of suctioning, and initiating and continuing effective ventilation until spontaneous respirations. Frontline users (N=102) suggested augmented simulation methods to build confidence and competence and additional guidance for facilitators on implementation. Users identified a need for sufficient practice during the workshop, systematized ongoing practice, and enough simulators for participants. Field trials refined approaches to self-reflection, feedback and debriefing, and quality improvement. Utstein meeting stakeholders validated the importance of quality improvement and use of data to improve outcomes. Conclusions: The second edition of HBB provides a newer paradigm of learning for providers that incorporates workshop practice, self-reflection, and feedback and debriefing to reinforce learning as well as the promotion of mentorship and development of facilitators, systems for low-dose high-frequency practice in facilities, and quality improvement related to neonatal resuscitation.
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Affiliation(s)
- Beena D Kamath-Rayne
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA, and Perinatal Institute and Global Child Health, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
| | - Anu Thukral
- Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India
| | | | - Eileen Schoen
- Division of Life Support, American Academy of Pediatrics, Itasca, IL, USA
| | - Erick Amick
- Division of Life Support, American Academy of Pediatrics, Itasca, IL, USA
| | - Ashok Deorari
- Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India
| | - Carrie Jo Cain
- World Hope International, Alexandria, VA, USA and Freetown, Sierra Leone
| | - William J Keenan
- Division of Neonatology, Saint Louis University, St. Louis, MO, USA
| | - Nalini Singhal
- Division of Neonatology, University of Calgary, Alberta, Canada
| | - George A Little
- Division of Neonatology, Geisel School of Medicine at Dartmouth, Hanover, NH, USA
| | - Susan Niermeyer
- Section of Neonatology, University of Colorado School of Medicine, Aurora, CO, USA
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The Influence of Culture on Teamwork and Communication in a Simulation-Based Resuscitation Training at a Community Hospital in Honduras. ACTA ACUST UNITED AC 2018; 13:363-370. [DOI: 10.1097/sih.0000000000000323] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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10
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Vail B, Morgan MC, Spindler H, Christmas A, Cohen SR, Walker DM. The power of practice: simulation training improving the quality of neonatal resuscitation skills in Bihar, India. BMC Pediatr 2018; 18:291. [PMID: 30176831 PMCID: PMC6122678 DOI: 10.1186/s12887-018-1254-0] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2018] [Accepted: 08/15/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Globally, neonatal mortality accounts for nearly half of under-five mortality, and intrapartum related events are a leading cause. Despite the rise in neonatal resuscitation (NR) training programs in low- and middle-income countries, their impact on the quality of NR skills amongst providers with limited formal medical education, particularly those working in rural primary health centers (PHCs), remains incompletely understood. METHODS This study evaluates the impact of PRONTO International simulation training on the quality of NR skills in simulated resuscitations and live deliveries in rural PHCs throughout Bihar, India. Further, it explores barriers to performance of key NR skills. PRONTO training was conducted within CARE India's AMANAT intervention, a maternal and child health quality improvement project. Performance in simulations was evaluated using video-recorded assessment simulations at weeks 4 and 8 of training. Performance in live deliveries was evaluated in real time using a mobile-phone application. Barriers were explored through semi-structured interviews with simulation facilitators. RESULTS In total, 1342 nurses participated in PRONTO training and 226 NR assessment simulations were matched by PHC and evaluated. From week 4 to 8 of training, proper neck extension, positive pressure ventilation (PPV) with chest rise, and assessment of heart rate increased by 14%, 19%, and 12% respectively (all p ≤ 0.01). No difference was noted in stimulation, suction, proper PPV rate, or time to completion of key steps. In 252 live deliveries, identification of non-vigorous neonates, use of suction, and use of PPV increased by 21%, 25%, and 23% respectively (all p < 0.01) between weeks 1-3 and 4-8. Eighteen interviews revealed individual, logistical, and cultural barriers to key NR skills. CONCLUSION PRONTO simulation training had a positive impact on the quality of key skills in simulated and live resuscitations throughout Bihar. Nevertheless, there is need for ongoing improvement that will likely require both further clinical training and addressing barriers that go beyond the scope of such training. In settings where clinical outcome data is unreliable, data triangulation, the process of synthesizing multiple data sources to generate a better-informed evaluation, offers a powerful tool for guiding this process.
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Affiliation(s)
- Brennan Vail
- Department of Pediatrics, University of California San Francisco, 550 16th Street, 4th Floor, Box 0110, San Francisco, CA 94158 USA
| | - Melissa C. Morgan
- Department of Pediatrics, University of California San Francisco, 550 16th Street, 4th Floor, Box 0110, San Francisco, CA 94158 USA
- Maternal, Adolescent, Reproductive, and Child Health Centre, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT UK
- Institute for Global Health Sciences, University of California San Francisco, 550 16th Street, San Francisco, CA 94158 USA
| | - Hilary Spindler
- Institute for Global Health Sciences, University of California San Francisco, 550 16th Street, San Francisco, CA 94158 USA
| | - Amelia Christmas
- PRONTO International, State RMNCH+A Unit, C-16 Krishi Nagar, A.G. Colony, Patna, Bihar 80002 India
| | - Susanna R. Cohen
- College of Nursing, University of Utah, 10 South 2000 East, Salt Lake City, UT 84112 USA
| | - Dilys M. Walker
- Institute for Global Health Sciences, University of California San Francisco, 550 16th Street, San Francisco, CA 94158 USA
- Department of Obstetrics and Gynecology and Reproductive Services, University of California San Francisco, 1001 Potrero Ave, San Francisco, CA 94110 USA
- PRONTO International, 1820 E. Thomas Street APT 16, Seattle, WA 98112 USA
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