Simulation project on Postpartum Hemorrhage (PPH)

Relate simulation practice on management of hemorrhage
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Relate simulation practice on management of hemorrhage
Executive Summary
The study focuses on the simulation practice on the management of Postpartum Hemorrhage (PPH). The introduction details the necessary background of the study and definition of key concepts such as simulation as a useful tool that bridges the gap that exists between the knowledge of the student and their understanding of the process required. The objectives of the study focus on providing an evaluation of the benefits of the simulation on PPH processes. The literature review details various concepts from different research studies on the benefits and the myriad of challenges faced by the clinicians in the management of PPH that demands a skilled approach. This entails clear definition as well as having consistent terminology that determines timely diagnosis alongside appropriate intervention measures. It is important to note that the nature of treatment accorded varies depending on the etiology. Such requires that the clinicians become aware of the different optimal assessment methods that determine the real cause. The situation where medications are considered warranted the first-line nature of medications alongside the order that follows the subsequent medications at times becomes unclear. In conclusion, the aspect of a better understanding of the required procedures applicable as well as surgeries including an appropriate selection from the management options is found to be a requirement. In such cases, the purpose of the clinical dilemma of the management of PPH focuses on balancing the minimally invasive and conservative treatment that gears towards the preservation of fertility alongside control of bleeding in patients.
Introduction
Simulation is referred to as “ activities capable of mimicking the reality of a clinical environment and designed to demonstrate decision-making, procedures as well as critical thinking through techniques that involve role-playing as well as the use of interactive mennequins” (Jeffries, 2016). In such a case, student nurses provide medical care to some medically complex patient situations within environments that are conditioned to reduce the harmful outcome from the missteps. Simulation as a teaching strategy is crucial especially in assisting nurse students to develop skills as well as required competencies necessary for the delivery of high standard care on patients. The concept of High Fidelity Simulation (HFS) ensures that students have a clear focus on various complicated medical scenarios through interventions that reduce the level of risk to patients (Gates et al., 2012). Such experiences are considered important for nursing programs before competitive clinical placements that tend to limit quality preceptors alongside the level of experience for student nurses. However, the aspect of ensuring improvement on the fidelity of simulations that are in use is crucial alongside the evaluation of student outcomes owing to the rise in the challenges related to clinical placements. In this case, it is important to examine the consequences resulting from High Fidelity Simulation (HFS) on the knowledge, confidence alongside clinical judgment of the student nurse. On the other side, the management of the maternal hemorrhage either during pregnancy or after delivery is key in preventing the occurrence of such complications. The research study by the National Council of State Boards of Nursing (NCSBN) asserted that high standard simulation replaces approximately half of the clinical hours with consideration of academic as well as clinical integrity (World Health Organization, 2015). However, continued discussion has been continually put across relating to the measurement of student outcomes in simulation. At the same time, the improvement of the simulation that is currently in use, as well as the evaluation of student outcomes, becomes important following existing challenges in clinical placement.
Purpose of the project
The paper focuses on the simulation project on Postpartum Hemorrhage (PPH) that provides an evidence-based project that helps in examination of the various effects of HFS on student performance. The project investigates a simulation practice scenario that supports the implementation of practice change. The purpose of nurse educators involves the promotion of education amongst the future generation of nurses that guarantees patient safety (Crawford & Lopez, 2014). According to Sheldon et al. (2013), there exists an incidence of postpartum hemorrhage between 5% and 10% majorly amongst healthy women devoid of significant risk factors. Such an aspect that involves relative infrequency on the occurrence of postpartum hemorrhage amongst women may tempt to make students ignore the aspect of caring for women with such experiences. However, simulation has been proved to be viable especially in such low-frequency, risky events as postpartum hemorrhage. The aspect of simulation has become increasingly sophisticated over the years especially in their capacity that shifts the focus towards simulation design elements capable of promoting learner outcomes that involve scenario complexity, objectives as well as cues. The present simulation needs to utilize the high fidelity HPS that is already existing and has the capability of improving the situation standardization, therefore, promoting the aspect of consistency within the experience of students. The aspect of enhancing student confidence, abilities as well as skills towards the making of rapid decisions under pressure within a safe environment is some of the crucial outcomes required of simulation. In this case, simulation provides one of the safest strategies that allow students the choice of adopting their roles as a nurse practicing professional behaviors.
Objectives
The objectives of the postpartum hemorrhage project involved the following:
* To ensure the upgrade of participant knowledge regarding management of postpartum hemorrhage
* To ensure the development of student nurse confidence and satisfaction in learning
* To evaluate student clinical judgment capacity
Review of Literature
A study by NCSBN in 2014 provided a clear consideration for such project development (WHO, 2015). The study was randomized and controlled and examined the aspect of replacing the traditional clinical hours with the concept of simulation hours especially in pre-licensure nursing programs. The data evaluated from this study comprised of over 600 students involved in ten different nursing programs. The study focuses on evaluating the extent of knowledge, clinical competency, and the extent of preparedness to assume clinical practice. The results show the effects of high-quality simulations as appropriate in the replacement of close to half of the traditional clinical hours without any loss of efficiency and integrity as per the clinical ethics.
Terry (2015), asserts that the various tools that relate to simulation should be applicable alongside opportunities that allow processes such as skill rehearsals as conditioned by scenarios. Such aspects help in the preparation of students towards providing care for the present as well as future patients. This is crucial to adequately serve the population that is increasingly becoming complex in terms of age and medical requirements. The study by Terry (2015), shows that there was a significant improvement in responses of nurses towards various clinical emergencies especially after they participated in a simulation that recognized debriefing as one of the significant factors. In this case, the aspect of using debriefing provided students with time to reflect and correct, therefore, the opportunity of deepening the understanding of material alongside available procedures. The participants were allowed to develop critical understanding abilities that clarified the misunderstood concepts; therefore, serving the purposes of reflection-on-action that ensured upgraded thinking abilities.
The study utilizes the application of the four-level Kirkpatrick model have proved useful over the years especially in the evaluation of training programs. In most cases, the publications on the evaluation of training programs only focus on the first two levels of the model. In this case, the ultimate goals involve the level of improvement in the clinical performance of nurses alongside the results of patient care. The research result encompasses the concerns of neonatal and maternal outcomes. Therefore, the assessment of the effects of obstetric simulation-based training on management of hemorrhage that relates to Kirkpatrick level 4, and level of clinical performance on basic skills of management of delivery relating to Kirkpatrick level 3 is the main focus (Terry, 2015).
The aspect of enhanced communication is also a key and common subtheme within the concept of simulation. In this case, the student report shows their ability to communicate clearly with the patient’s colleagues, family members within the confines of the simulation. This allows for improvement in the level of awareness concerning verbal as well as non-verbal communication with those involved and the potential influence on care. Further, the application of simulation provided a good opportunity that ensures repeated rehearsals capable of optimizing the student learning outcomes alongside knowledge and skills.
The study by Jeffries (2016) asserts that postpartum is one of the major causes of maternal mortality with the prevalence ranging from 11% to approximately 25% for those with blood loss of more than 500ml and approximately 4% for blood loss of over 1000ml. Research by Jeffries (2016) shows that the number of pregnant women in Africa suffering from anemia during pregnancy is approximately 55%. This means that such a number does not seem to have an adequate reserve of blood at the occurrence of postpartum hemorrhage making the management of such occurrence important. The simulation-based training package developed by Jhpiego and the Laerdal Global Health targets healthcare workers within remote areas and focuses on basic delivery, active management, and treatment of postpartum hemorrhage.
The Jeffries (2016) evaluated and reviewed the simulation framework alongside other researchers providing a middle-range theory instead of a conceptual framework for the same. However, the major tenets of the project remained the same despite the expansion and refining of outcomes that were modified to identify the impact of simulation. In this case, the outcome encompasses a larger spectrum that entails the improvement of knowledge, skills, confidence, as well as referring to the nature of learning directly affecting patient care and health system in general (Jeffries, 2016).
According to Devi et al. (2015), PPH as one of the most common primary postpartum forms of blood loss occurs in approximately 3% of vaginal delivery and 7% of cesarean deliveries. Conversely, the secondary postpartum hemorrhage relates to the bleeding that is excess of normal lochia usually after close to 24 hours and six weeks of postpartum. However, in both cases, there is the tendency of underestimating the true loss owing to difficulties encou...