The effectiveness of medium-fidelity simulation on the clinical readiness of student midwives

Simulation affords the student a safe and supportive environment in which to practise skills repeatedly without causing any harm to a real patient. The Department of Nursing Sciences at the University of Fort Hare has a laboratory that offers lowto medium-fidelity simulation in the form of task trainers and mannequins. These task trainers and mannequins are used in general nursing, and in community and midwifery nursing sciences, for the demonstration of skills, the practising of skills by students and for formative assessments. In midwifery, task trainers are used for vaginal examinations, abdominal palpation breech and vaginal deliveries and the management of post-partum haemorrhage (PPH). Given that in a real-life clinical environment limited opportunities exist for students to practise during an obstetrical emergency, medium-fidelity simulation (MFS) in midwifery ideally positions the student in a practical environment without risking the patient’s safety. Despite the availability of MFS at UFH, its benefit on the clinical readiness of student midwives is not known. The present study was designed to assess the effectiveness of MFS in enhancing the clinical readiness of student midwives at the University of Fort Hare. The main research objective of the study was to explore, describe and analyse the effect of medium-fidelity simulation on student midwives’ confidence, critical thinking ability, communication, satisfaction and team work in an obstetrical clinical emergency environment. This was a qualitative, interpretive, phenomenological analysis designed to explore the student midwives’ lived experiences regarding the effectiveness of mediumfidelity simulation and the effect of these experiences on clinical readiness. The target population was fourth-year Bachelor of nursing student midwives at the University of Fort Hare. Purposive sampling was used to select five student midwives who were team leaders during the management of PPH using MFS. Ethical approval was granted by the University of Fort Hare Ethics Committee. Informed consent was obtained from the participants prior to data collection. Trustworthiness was ensured by observing the principles of transferability, credibility, confirmability and dependability. Data was collected through individual face-to-face interviews and a semi-structured interview guide. All fourth-year student midwives had viewed an on-line video entitled Essential Steps in Management of Obstetrical Emergency(ESMOE) Postpartum Haemorrhage, in which the procedure was demonstrated. The video, sent via Backboard, was presented in such a way that student midwives had the opportunity to watch it repeatedly in order to thoroughly comprehend the demonstrated skill. A semi-structured interview guide was used for data collection. Interviews were conducted in the simulation laboratory. A Samsung smartphone was used to record interviews and a notepad was used to make notes of gestures, such as smiles or other facial expressions. Data was analysed using thematic content analysis applicable to interpretative phenomenological analysis (IPA) studies using the six steps: reading and re-reading; initial noting taking; developing emergent themes; searching for connections across the emergent themes; moving to the next case and lastly, looking for patterns across cases. The major findings indicated that the participants had differing views regarding the concept of clinical readiness; some held that clinical readiness meant being ready or prepared to handle any eventuality in the course of work, others opined that it was a state of being conversant with the policies and procedures in the clinical ward. Participants believed that clinical readiness was parallel to being competent and that midwives should always be ready to anticipate complications that might arise with the patient, endeavouring to analyse and interpret such conditions clinically. Participants expressed the need to see the simulation skill demonstrated repeatedly for thorough understanding of the technique, so that they could work independently in an obstetrical emergency situation. During simulation, participants were confident in delegating duties to team members, affirming that in order to ensure that tasks were carried out, team leaders should receive regular updates from team members

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

Abstract 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