Elsevier

Nurse Education in Practice

Volume 29, March 2018, Pages 8-14
Nurse Education in Practice

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

https://doi.org/10.1016/j.nepr.2017.10.027Get rights and content

Abstract

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.

Introduction

In midwifery practice, neonatal emergency situations are relatively common, and include neonatal asphyxia and respiratory distress (Cusack and Fawke, 2012). Approximately 20 percent of all newborn infants require some breathing assistance (AIHW, 2014) and a small proportion of these neonates require active resuscitation in order to survive (AIHW, 2014). This means that neonatal resuscitation skills are vitally important for midwives and midwifery students. In Australia, where this study was conducted, neonatal resuscitation skills are mandatory competencies for midwifery graduates (ANMAC, 2014).

Preparing students to manage clinical emergencies poses a number of difficulties for educators (DeBourgh and Prion, 2011) who aim to bridge the gap between theory and practice (Garrett et al., 2011). Students are often well prepared in terms of theory, but a lack of exposure to emergency situations contributes to a lack of real-life skills practice (Cooper et al., 2012a, Cooper et al., 2012b). This lack of exposure causes major concerns for midwifery students and new graduates (Skirton et al., 2012), who may be required to perform neonatal resuscitation without previous clinical experience (Carolan-Olah and Kruger, 2014).

Simulation, which involves the re-creation of real-world clinical emergencies in simulated environments (Cooper et al., 2012a, Cooper et al., 2012b), may offer one solution to issues of inadequate exposure to clinical emergencies. This approach is recognised as an important tool in health education (Motola et al., 2013) as it allows students and health professionals to practice, test, and learn a range of clinical skills (Gaba, 2007). Simulation exercises use a simulator (mannequin/actor) that functions like a patient and responds to the user's actions. For neonatal resuscitation exercises, students are given a scenario and respond by appraising the information and performing resuscitation on a neonatal mannequin.

Although the use of simulation in midwifery education is relatively recent, existing studies indicate that this approach helps to prepare students for real life emergency situations without putting women and neonates at risk (Freeth et al., 2009). Simulation is associated with positive outcomes in student learning (Andrighetti et al., 2012, Deegan and Terry, 2013, Reynolds et al., 2010) including greater interaction between students and educators, an enhanced capacity to link theory to practice (Deegan and Terry, 2013), and improved knowledge retention (Reynolds et al., 2010). Andrighetti et al. (2012) additionally suggest that simulation increases student confidence and this is an important finding as student confidence is linked to greater ability to manage emergencies in both simulated and clinical environments (Abdo and Ravert, 2006, Tyer-Viola et al., 2012). Fountain and Alfred (2009) found that simulations led to an increase in student satisfaction which, in turn, is linked to increased self confidence and preparedness for managing emergency situations (Abdo and Ravert, 2006, Reynolds et al., 2010). Finally, simulation exercises are considered valuable in promoting teamwork skills and collaboration, both of which are critical for the effective management of emergency situations (Freeth et al., 2009).

Mindful of all these factors, the current project sought to develop and evaluate 2 simulation scenarios to better prepare 3rd year midwifery students to participate in neonatal resuscitation. Additional aims were to evaluate the scenarios for usefulness and to gain insight into students' experiences and concerns in relation to simulation for neonatal resuscitation.

Section snippets

The simulation exercise

Simulation scenarios were developed by midwifery lecturers using the National Health Education Training (NHET)-Sim Program guidelines (2012; 2013). Prior to proceeding with the exercise, students were briefed on the learning objectives and key roles in the scenarios. An overview was provided and students had an opportunity to ask questions and clarify any concerns (Table 1). Scenarios were facilitated by 2 midwifery lecturers and the simulation was conducted twice with each group of 20

Methods

The study used a qualitative descriptive approach. Ethics approval was obtained from the University ethics committee. Questionnaires were self-administered, pre and post simulation scenario. There were 5 pre and 10 post simulation questions (Table 2). Questions were developed by the midwifery lecturers and covered areas not well served by quantitative questionnaires used in an earlier phase of the study (Carolan-Olah et al., 2016). All questions were free-text and students were encouraged to

Findings

Participants were aged between 18 to more than 50 years (Table 3). All participants were female and this gender profile is consistent with the demographics of midwifery students and midwives in Australia. In 2012, approximately 98.2% of practicing midwives in Australia were female (AIHW, 2012).

Discussion

During this project, 2 simulation scenarios for neonatal resuscitation were developed and evaluated for usefulness. Students were invited to describe their experiences and concerns in relation to the simulation.

Prior to the simulation exercises, most students reported a lack of confidence in performing neonatal resuscitation and many were unsure of both the process and the steps involved. A lack of clarity about the principles of neonatal resuscitation was evident. Following the simulation

Conclusions

Students considered that they benefitted from the neonatal resuscitation simulation, in terms of gains in knowledge, confidence and skills. For the future, a program of simulation exercises is advocated, over a longer period of time, to encourage familiarity and build on knowledge and skills. Other recommendations included repeated simulations among small groups of students, with each student having an active role in the exercise. Clear, ‘out loud’ communication is optimal during simulation,

Ethics approval and consent to participate

Ethics approval was obtained from the University human ethics committee. Participants were advised that their participation was entirely voluntary and anonymous. Students indicated their consent to participate by choosing coloured rather than plain questionnaires to fill in.

Consent for publication

Students were advised that the data provided to the research team would be analysed, written up and submitted for publication. Participating students gave implicit consent.

Funding

There was no funding for this project.

Conflicts of interest

The authors have no conflicts of interest to declare.

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