Shoulder Dystocia and Postpartum Hemorrhage Simulations: Student Confidence in Managing These Complications

Improving the recognition and management of hemorrhage: A scoping review of nursing and midwifery education

BACKGROUND

Hemorrhage is a frequent complication that nurses and midwives must recognize and manage to avoid life-threatening consequences for patients. There is currently no synthesis of evidence on educational interventions in nursing and midwifery regarding hemorrhage, thus limiting the definition of best practices.

OBJECTIVE

To map the literature on nursing and midwifery education regarding the recognition and management of hemorrhage.

DESIGN

Scoping review based on the Joanna Briggs Institute guidelines.

DATA SOURCES

Quantitative studies evaluating the effect of educational interventions with students, nurses, or midwives published in English or French, with no time limit.

REVIEW METHODS

Study selection, data extraction, and quality assessment were conducted by two independent reviewers. We characterized educational interventions based on the Guideline for Reporting Evidence-Based Practice Educational Interventions and Teaching. We categorized learning outcomes using the New World Kirkpatrick Model. Methodological quality appraisal was performed with tools from the Joanna Briggs Institute. Findings were synthesized using descriptive statistics and graphical methods RESULT: Most of the 38 studies used a single-group design (n = 26, 68%) and were conducted with professionals (n = 28, 74%) in hospital settings (n = 20, 53%). Most were of low (n = 14; 37%) or moderate (n = 18, 47%) methodological quality. Most interventions focused on postpartum hemorrhage (n = 34, 89%) and combined two or more teaching strategies (n = 25, 66%), often pairing an informational segment (e.g., lecture, readings) with a practical session (e.g., workshop, simulation). Learning outcomes related to the management (n = 27; 71%) and recognition of hemorrhage (n = 19, 50%), as well as results for patients and organizations (n = 9, 24%).

CONCLUSION

Considerable heterogeneity in interventions and learning outcomes precluded conducting a systematic review of effectiveness. High-quality, controlled studies are needed, particularly in surgery and trauma. Reflection on the contribution of nurses and midwives to the detection, monitoring, and management of hemorrhage could enrich the content and expected outcomes of hemorrhage education.

Development and evaluation of virtual reality simulation education based on coronavirus disease 2019 scenario for nursing students: A pilot study

Aim

This research is designed to establish and evaluate the effectiveness of a virtual reality simulation program using COVID‐19 scenario for nursing students.

Design

This is a quasi‐experimental study using a non‐equivalent control group pre‐test‐posttest design.

Methods

The participants were 65 students in their fourth year in nursing college. The knowledge about communicable infectious diseases in the respiratory system, self‐efficacy, clinical reasoning capacity and learning satisfaction was evaluated.

Results

The experimental group showed a significantly higher learning satisfaction (t = 3.01, p = .004). Both groups presented statistically significant differences in knowledge on infectious respiratory diseases, self‐efficacy and clinical reasoning between pre‐test and posttest. However, knowledge (t = 0.47, p = .643), self‐efficacy (t = 0.70, p = .944) and clinical reasoning were not different between the groups.

Game-Based Learning and Nursing Students' Clinical Judgment in Postpartum Hemorrhage: A Pilot Study

BACKGROUND

Nurse educators are searching for ways to deliver and evaluate the clinical judgment model (CJM) into undergraduate education to adequately prepare students for the Next Generation NCLEX project.

METHOD

A game-based learning (GBL) activity, including seven postpartum hemorrhage (PPH) stations, was developed and implemented in an undergraduate nursing course. Following the design of the Minute to Win It^® game show, teams of students participated in timed challenges to facilitate engagement with the CJM.

RESULTS

Student scores improved significantly for every aspect of the CJM applied to PPH (recognition, analysis, action, evaluation) from the pre- to posttest after using the PPH Minute to Win It. The teaching-learning strategy was positively received by students for the purposes of enhancing engagement and retaining knowledge.

CONCLUSION

GBL is effective for incorporating the CJM into the classroom and enhances exposure, knowledge, and retention for specific topics such as PPH. Students associate GBL with increased engagement and learning related to complex course content. [J Nurs Educ. 2021;60(3):159-164.].

Effect of simulation training on students' childbirth skills and satisfaction in Turkey

This study examined the effects of simulation training on student midwives' management skills for normal childbirth and their satisfaction. This study utilized a quantitative, quasi-experimental, comparison group research design. Students were placed into two groups according to the last digit of their school identity number (odd versus even), given by The Directorate of Student Affairs. Lots were drawn to decide which simulation model the odd and even numbers would represent. One group received simulation training for normal birth skills using a low-fidelity pelvic model (n = 37) while the other group used a high-fidelity computer-based mannequin (n = 38). After the skills training, each student midwife managed the second and third stages of a simulated normal childbirth. The skill checklists were used to evaluate the students' second and third stage labor midwifery skills. After the simulation activity, the Students' Satisfaction and Self-confidence Scale was used to measure their levels of satisfaction with the simulation activity and their self-confidence in learning. There were no significant differences between the groups in terms of childbirth management skills and satisfaction in learning (p > 0.05). Thus, both methods can be recommended for simulation training of student midwives.

Obstetric simulation in undergraduate nursing education: An integrative review

BACKGROUND

Simulation as an innovative teaching method is an effective form of pedagogical approach. A wealth of evidence shows that simulation in nursing education provides an opportunity for undergraduate students to improve learning outcomes.

AIM

The aim of this review was to systematically appraise and synthesize evidence that examine the effects of obstetric simulation in an undergraduate nursing program.

METHODS

Integrative review method guided this review. Four electronic databases were searched using "CINAHL (EBSCOhost)," "Science Direct," "OVID," and "WILEY" to identify original research published between 2008 and 2018. Search and MeSH terms included: obstetric, maternal, simulation, nursing, and student.

RESULTS

Seventeen articles were included in this review. The results of content analysis revealed three essential themes: cognitive and psychomotor (knowledge-skills) skill, affective (self-confidence, anxiety, critical thinking-self-efficacy) skill, and students' views on obstetric simulation. In all of the studies, it was determined that the simulation method was a safe and effective teaching strategy.

CONCLUSION

The use of obstetric simulation in an undergraduate nursing program has a positive effect on the level of self-confidence, anxiety, critical thinking-self-efficacy, psychomotor skills, and level of anxiety.

Simulation in midwifery education: A descriptive explorative study exploring students' knowledge, confidence and skills in the care of the preterm neonate

Undergraduate midwifery programs across Australia have embedded simulation into their curriculum although there is limited but emerging evidence to support the use of simulation as an effective teaching strategy. The purpose of this study was to evaluate the impact that a simulated learning activity (insertion and management of a neonatal nasogastric tube), had on midwifery students' knowledge, confidence and skills post-simulation, and on completion of a clinical placement. A descriptive explorative study was undertaken in two phases. Phase 1: Midwifery students (n = 60) completed a purpose-designed questionnaire to assess their knowledge, confidence and skills, pre and post simulation. Phase 2: Students (n = 46) repeated the questionnaire to reassess their knowledge, confidence and skills after the completion of a neonatal nursery placement. The findings demonstrate that simulation is an effective learning strategy in an undergraduate midwifery program. Students' knowledge, confidence and skills increased significantly post-simulation activity (p0.001). A further increase in these areas was noted post-placement. Key aspects that contributed to student learning included; the demonstrators' level of knowledge, expertise and currency of practice, as well as the role the student assumes in the simulation activity.

Simulation of Shoulder Dystocia for Skill Acquisition and Competency Assessment: A Systematic Review and Gap Analysis

STATEMENT

Mastery of shoulder dystocia management skills acquired via simulation training can reduce neonatal brachial plexus injury by 66% to 90%. However, the correlation between simulation drills and reduction in clinical injuries has been inconsistently replicated, and establishing a causal relationship between simulation training and reduction of adverse clinical events from shoulder dystocia is infeasible due to ethical limitations. Nevertheless, professional liability insurance carriers increasingly are mandating simulation-based rehearsal and competency assessment of their covered obstetric providers' shoulder dystocia management skills-a high-stakes demand that will require rapid scaling up of access to quality shoulder dystocia simulation. However, questions remain about differing simulation training schemes and instructional content used among clinically effective and ineffective educational interventions. This review of original research compares curricular content of shoulder dystocia simulation and reveals several critical gaps: (1) prescriptive instruction prioritizing maneuvers shown to decrease strain on the brachial plexus is inconsistently used. (2) Proscriptive instruction to avoid placing excessive and laterally directed traction on the head or to observe a brief hands-off period before attempting traction is infrequently explicit. (3) Neither relative effectiveness nor potential interaction between prescriptive and proscriptive elements of instruction has been examined directly. (4) Reliability of high-fidelity mannequins capable of objective measurement of clinician-applied traction force as compared with subjective assessment of provider competence is unknown. Further study is needed to address these gaps and inform efficient and effective implementation of clinically translatable shoulder dystocia simulation.

Medium-fidelity simulation in clinical readiness: a phenomenological study of student midwives concerning teamwork

Background

Teamwork during obstetric emergency ensures good outcomes for both the woman and her baby. Effective teams are characterised by mutual respect, support, and cooperation among team members.

Methods

This qualitative, interpretive, phenomenological analysis study was conducted on a purposive sample of five, fourth-year Bachelor of Nursing Science student midwives at the University of Fort Hare (UFH). In-depth semi-structured interviews were conducted. Data analysis applied the interpretative phenomenological analysis method.

Results

Superordinate theme demonstrated teamwork elicited four clustered themes namely delegation of duties, the importance of teamwork, team support, and confident team leader. The participants recognised that there should be a team leader who is capable of delegating duties to other team members in the management of an obstetric emergency, Participants were confident not only to assign duties but to be kept updated of the intervention. They expressed the need to work collaboratively as a team to achieve the desired goal of providing quality care to the woman. The participants maintained that the team must be supportive and be able to help in decision making during simulation of an obstetric emergency. A sense of mutual respect is echoed by some participants in the process of caring for the woman. Some participants were confident at being team leaders and could see themselves as leaders in the real-life clinical situation.

Conclusion

The participants acknowledge the importance of teamwork in resolving obstetric emergencies. The importance of delegating duties to other team members, providing updated progress report ensures better outcomes for the woman.

Evaluation of the McMahon Competence Assessment Instrument for Use with Midwifery Students During a Simulated Shoulder Dystocia

INTRODUCTION

Intrapartum emergencies occur infrequently but require a prompt and competent response from the midwife to prevent morbidity and mortality of the woman, fetus, and newborn. Simulation provides the opportunity for student midwives to develop competence in a safe environment. The purpose of this study was to determine the inter-rater reliability of the McMahon Competence Assessment Instrument (MCAI) for use with student midwives during a simulated shoulder dystocia scenario.

METHODS

A pilot study using a nonprobability convenience sample was used to evaluate the MCAI. Content validity indices were calculated for the individual items and the overall instrument using data from a panel of expert reviewers. Fourteen student midwives consented to be video recorded while participating in a simulated shoulder dystocia scenario. Three faculty raters used the MCAI to evaluate the student performance. These quantitative data were used to determine the inter-rater reliability of the MCAI.

RESULTS

The intraclass correlation coefficient (ICC) was used to assess the inter-rater reliability of MCAI scores between 2 or more raters. The ICC was 0.86 (95% confidence interval, 0.60-0.96). Fleiss's kappa was calculated to determine the inter-rater reliability for individual items. Twenty-three of the 42 items corresponded to excellent strength of agreement.

DISCUSSION

This study demonstrates a method to determine the inter-rater reliability of a competence assessment instrument to be used with student midwives. Data produced by this study were used to revise and improve the instrument. Additional research will further document the inter-rater reliability and can be used to determine changes in student competence. Valid and reliable methods of assessment will encourage the use of simulation to efficiently develop the competence of student midwives.

Orientation to the Operating Room: An Introduction to the Surgery Clerkship for Third-Year Medical Students

Introduction

The operating room is a complex environment in which individual team members perform specific tasks according to their role. A simulation activity was created to introduce medical students on the surgery clerkship to issues relating to patient safety, infection control, and regulatory requirements.

Methods

This activity takes place prior to general surgery rotation operative experiences, and addresses the need for students to practice roles they will perform while participating in patient care. The activity includes a simulated operation, an assessment, and a scripted debriefing. Among other tasks, students practice safe patient transfer and monitoring, donning sterile garb, preparing the surgical site, and being active participants in a sign-in and time-out. Students are assessed on assigned tasks, their ability to maintain sterility, and the degree to which they engage with their team.

Results

Students reported the simulation helped them better understand how they could become involved on their first day in the operating room. Students also reported they were more confident when in the operating room. This finding also extended to students who had previously been in the operating room during a prior OB/GYN rotation.

Discussion

Patient safety is paramount when in the operating room, and this simulation activity fills a current gap in student's practical knowledge as they prepare to enter their surgery clerkship. Giving medical students the information and skills needed to be safe and effective members of the operating team prior to entering the operating room is of benefit to the surgical team, students, and patients.

Communicating out loud: Midwifery students' experiences of a simulation exercise for neonatal resuscitation

Midwifery students feel unprepared to deal with commonly encountered emergencies, such as neonatal resuscitation. Clinical simulation of emergencies may provide a safe forum for students to develop necessary skills. A simulation exercise, for neonatal resuscitation, was developed and evaluated using qualitative methods. Pre and post-simulation questions focussed on student confidence and knowledge of resuscitation. Data were analysed using a thematic analysis approach. Pre-simulation questions revealed that most students considered themselves not very confident/unsure about their level of confidence in undertaking neonatal resuscitation. Most correctly identified features of the neonate requiring resuscitation. Post-simulation, students indicated that their confidence and knowledge of neonatal resuscitation had improved. Themes included: gaining confidence; understanding when to call for help; understanding the principles of resuscitation; tailoring simulation/education approaches to student needs. Students benefits included improved knowledge, confidence and skills. Participants unanimously suggested a program of simulation exercises, over a longer period of time, to reinforce knowledge and confidence gains. Ideally, students would like to actively participate in the simulation, rather than observe.

Development and evaluation of a simulation exercise to prepare midwifery students for neonatal resuscitation

BACKGROUND

Simulation provides opportunities for midwifery students to enhance their performance in emergency situations. Neonatal resuscitation is one such emergency and its management is a major concern for midwifery students.

OBJECTIVES

This project aimed to develop and evaluate a simulation exercise, for neonatal resuscitation, for 3rd year midwifery students.

DESIGN

A quantitative survey design was employed using questions from two previously validated questionnaires: (1.) Student Satisfaction and Self-Confidence in Learning and (2.) the Clinical Teamwork Scale (CTS).

SETTING

Australian university.

PARTICIPANTS

40 final year midwifery students were invited to participate and 36 agreed to take part in the project.

RESULTS

In pre-simulation questionnaires, students reported low levels of confidence in initiating care of an infant requiring resuscitation. Most anticipated that the simulation exercise would be useful to better prepare them respond to a neonatal emergency. Post-simulation questionnaires reported an increase in student confidence, with 30 of 36 students agreeing/ strongly agreeing that their confidence levels had improved. Nonetheless, an unexpected number of students reported a lack of familiarity with the equipment.

CONCLUSIONS

The single simulation exercise evaluated in this project resulted in improved student confidence and greater knowledge and skills in neonatal resuscitation. However, deficits in handling emergency equipment, and in understanding the role of the student midwife/midwife in neonatal resuscitation, were also noted. For the future, the development and evaluation of a programme of simulation exercises, over a longer period, is warranted. This approach may reduce stress and better address student learning needs.

Teaching Labor Support: An Interprofessional Simulation

Support for women during labor encompasses the continuous presence of a person who provides psychosocial, emotional, and physical support. Providing labor support to women in the intrapartum setting is a core midwifery competency and a clinical skill that midwifery students are expected to master. Instruction on labor support is a common objective in midwifery education intrapartum courses and skills labs, yet there is no standard for teaching this skill to midwifery students. Thus, in order to accomplish this objective, we created an interprofessional simulation on labor support that involves the use of a standardized patient, a written scenario, an interprofessional team of nursing and midwifery students, faculty observations, and a reflective debrief. The goals of the labor support simulation are to allow midwifery students the opportunity to practice intrapartum labor support techniques and interprofessional communication prior to entering the clinical setting. A postsimulation structured debrief allows for student learning and reflection. This article describes the design, planning, and implementation of this unique simulation experience. This article is part of a special series of articles that address midwifery innovations in clinical practice, education, interprofessional collaboration, health policy, and global health.

Simulation Design: Engaging Large Groups of Nurse Practitioner Students

BACKGROUND

Little has been written about using human patient simulation to teach primary care management to large groups of nurse practitioner (NP) students. This article describes an innovative design for simulated clinical experiences based on a game show format.

METHOD

This large-group design was conceived as a way to overcome several challenges, particularly limited faculty resources, to integrating simulation into NP education. Progressive variations evolved from this foundation, including the use of observer-participant groups; initial and follow-up visits on the same simulated patient; and mentor-mentee collaborations.

RESULTS

Student comments, while consistently positive about the simulated clinical experiences, have been used to guide revisions to strengthen the simulation program.

CONCLUSION

The innovative large-group design enabled faculty to use simulation to enhance students' skills in primary care management. Faculties with similar challenges might find these strategies useful to replicate or adapt.

Effectiveness of patient simulation in nursing education: meta-analysis

BACKGROUND

The use of simulation as an educational tool is becoming increasingly prevalent in nursing education, and a variety of simulators are utilized. Based on the results of these studies, nursing facilitators must find ways to promote effective learning among students in clinical practice and classrooms.

OBJECTIVE

To identify the best available evidence about the effects of patient simulation in nursing education through a meta-analysis.

METHODS

This study explores quantitative evidence published in the electronic databases: EBSCO, Medline, ScienceDirect, and ERIC. Using a search strategy, we identified 2503 potentially relevant articles. Twenty studies were included in the final analysis.

RESULTS

We found significant post-intervention improvements in various domains for participants who received simulation education compared to the control groups, with a pooled random-effects standardized mean difference of 0.71, which is a medium-to-large effect size. In the subgroup analysis, we found that simulation education in nursing had benefits, in terms of effect sizes, when the effects were evaluated through performance, the evaluation outcome was psychomotor skills, the subject of learning was clinical, learners were clinical nurses and senior undergraduate nursing students, and simulators were high fidelity.

CONCLUSIONS

These results indicate that simulation education demonstrated medium to large effect sizes and could guide nurse educators with regard to the conditions under which patient simulation is more effective than traditional learning methods.

A cost-effective approach to simulation-based team training in obstetrics

Many larger facilities regularly stage obstetric drills in modern simulation departments equipped with expensive simulators. Despite lacking these resources, we wanted to provide effective simulation training at our rural hospital. A team of clinicians and educators developed a cost-effective and time-efficient simulation drill for nurses, which included both a didactic review and a simulation day. The drill included obstetric providers and incorporated scenarios for shoulder dystocia, neonatal resuscitation and postpartum hemorrhage. This was a successful multidisciplinary learning experience that was high in creativity and teamwork, but low in cost.

Psychometric testing on the NLN Student Satisfaction and Self-Confidence in Learning, Simulation Design Scale, and Educational Practices Questionnaire using a sample of pre-licensure novice nurses

BACKGROUND

In 2006, the National League for Nursing published three measures related to novice nurses' beliefs about self-confidence, scenario design, and educational practices associated with simulation. Despite the extensive use of these measures, little is known about their reliability and validity.

METHODS

The psychometric properties of the Student Satisfaction and Self-Confidence in Learning Scale, Simulation Design Scale, and Educational Practices Questionnaire were studied among a sample of 2200 surveys completed by novice nurses from a liberal arts university in the southern United States. Psychometric tests included item analysis, confirmatory and exploratory factor analyses in randomly-split subsamples, concordant and discordant validity, and internal consistency.

RESULTS

All three measures have sufficient reliability and validity to be used in education research. There is room for improvement in content validity with the Student Satisfaction and Self-Confidence in Learning and Simulation Design Scale.

CONCLUSION

This work provides robust evidence to ensure that judgments made about self-confidence after simulation, simulation design and educational practices are valid and reliable.

Emergency obstetric simulation training: how do we know where we are going, if we don't know where we have been?

BACKGROUND

Obstetric emergencies contribute significantly to maternal morbidity and mortality. Current training in the management of obstetric emergencies in Australia and internationally focusses on utilising a multidisciplinary simulation-based model. Arguments for and against this type of training exist, using both economic and clinical reasoning.

AIMS

To identify the evidence base for the clinical impact of simulation training in obstetric emergencies and to address some of the concerns regarding appropriate delivery of obstetric emergency training in the Australian setting.

METHODS

A literature search was performed to identify research undertaken in the area of obstetric emergency training. The initial literature search using broad search terms identified 887 articles which were then reviewed and considered for inclusion if they provided original research with a specific emphasis on the impact of training on clinical outcomes.

RESULTS

Ninety-two articles were identified, comprising evidence in the following clinical situations: eclampsia, shoulder dystocia, postpartum haemorrhage, maternal collapse, cord prolapse and teamwork training. Evidence exists for a benefit in knowledge or skills gained from simulation training and for the benefit of training in small units without access to high-fidelity equipment or facilities.

CONCLUSIONS

Evidence exists for a positive impact of training in obstetric emergencies, although the majority of the available evidence applies to evaluation at the level of participants' confidence, knowledge or skills rather than at the level of impact on clinical outcomes. The model of simulation-based training is an appropriate one for the Australian setting and should be further utilised in rural and remote settings.

The confidence of speech-language pathology students regarding communicating with people with aphasia

BACKGROUND

Aphasia is an acquired language disorder that can present a significant barrier to patient involvement in healthcare decisions. Speech-language pathologists (SLPs) are viewed as experts in the field of communication. However, many SLP students do not receive practical training in techniques to communicate with people with aphasia (PWA) until they encounter PWA during clinical education placements.

METHODS

This study investigated the confidence and knowledge of SLP students in communicating with PWA prior to clinical placements using a customised questionnaire. Confidence in communicating with people with aphasia was assessed using a 100-point visual analogue scale. Linear, and logistic, regressions were used to examine the association between confidence and age, as well as confidence and course type (graduate-entry masters or undergraduate), respectively. Knowledge of strategies to assist communication with PWA was examined by asking respondents to list specific strategies that could assist communication with PWA.

RESULTS

SLP students were not confident with the prospect of communicating with PWA; reporting a median 29-points (inter-quartile range 17-47) on the visual analogue confidence scale. Only, four (8.2%) of respondents rated their confidence greater than 55 (out of 100). Regression analyses indicated no relationship existed between confidence and students' age (p = 0.31, r-squared = 0.02), or confidence and course type (p = 0.22, pseudo r-squared = 0.03). Students displayed limited knowledge about communication strategies. Thematic analysis of strategies revealed four overarching themes; Physical, Verbal Communication, Visual Information and Environmental Changes. While most students identified potential use of resources (such as images and written information), fewer students identified strategies to alter their verbal communication (such as reduced speech rate).

CONCLUSIONS

SLP students who had received aphasia related theoretical coursework, but not commenced clinical placements with PWA, were not confident in their ability to communicate with PWA. Students may benefit from an educational intervention or curriculum modification to incorporate practical training in effective strategies to communicate with PWA, before they encounter PWA in clinical settings. Ensuring students have confidence and knowledge of potential communication strategies to assist communication with PWA may allow them to focus their learning experiences in more specific clinical domains, such as clinical reasoning, rather than building foundation interpersonal communication skills.