Abstract:
Maternal morbidity (i.e., postpartum hemorrhage) increases risk of maternal death. Compared to urban women, rural women are at greater risk of maternal morbidity. Little evidence exists about simulation’s effectiveness to increase confidence and competence among rural nurses to intervene during an obstetric emergency.
Using a community-based participatory research framework, the purpose was to design and pilot a screen-based, rural health equity-focused obstetric simulation program for generalist rural hospital nurses. A mixed methods pre-post-test design was used. Through seven focus groups, the team identified postpartum hemorrhage and shoulder dystocia as obstetric emergencies to use in simulation testing. Nineteen nurses were provided a 4-hour repeated screen-based simulation training aligned with INACSL Healthcare Simulation Standards of Best Practice. Kirkpatrick’s four-level training evaluation model (reaction, learning, behavior, and results) was used to evaluate simulation through a post-intervention questionnaire including the Simulation Effectiveness Tool-Modified, simulation performance scores, and a nurse leader questionnaire 3 months post intervention.
Learners (95%) indicated training met or exceeded their expectations and would be beneficial for other rural nurses. Learning: average knowledge scores improved (pre-quiz (52%), post-quiz 1 (42%), and post-quiz 2 (72%) and average scenario performance improved (attempt 1 (51%) and attempt 2 (70%)). On average, learners ‘somewhat agreed’ or ‘strongly agreed’ simulation training helped increase confidence and competence to respond to similar scenarios. Behavior: all learners reported intentions to apply knowledge/skills in the next 3 months. Results: nurse leaders reported training as effective, and a desire to increase complexity of the hemorrhage simulation for future trainings. Simulation holds promise to elevate rural nurse competence in managing infrequent, high-risk obstetric emergencies.
Learning Objectives:
- Discuss how to assess clinical community stakeholders’ learning needs, current practices for obstetric care, and perception regarding the need for high-quality obstetric care.
- Describe the steps to design a tailored, health equity-focused obstetric simulation-based training program for generalist nurses
- Describe the steps to pilot and evaluate the health equity-based informed obstetric simulation-based training program
