Evaluating the Use of a Postpartum Hemorrhage Simulation as a Teaching Strategy in an Undergraduate Nursing Program

Abstract

A recurring theme in the literature is that simulation is a positive teaching strategy when compared to other methods of instruction and produces positive student outcomes (Jefferies, 2016). Simulation provides educators a way to reproduce a clinical teaching experience in a safe, supportive learning environment. The purpose of this quantitative research study was to determine whether an obstetrical simulation educational experience is an effective strategy for educating undergraduate nursing students in the management of a postpartum hemorrhage. A quasi-experimental study using a pre-test and post-test design was employed in a Women’s Health Course and Pediatrics course over one semester. A single convenience sample (N=81) of junior baccalaureate nursing students was used for this study. There were 41 students in the control group and 40 in the experimental group. Both the control and experimental groups received the traditional didactic session, case study, skills lab instruction, and clinical. In addition, the experimental group received the postpartum simulation. This simulation study tested the differences in knowledge, satisfaction, and confidence level between junior nursing students who did and did not participate in the simulation. There were three instruments used during this study; a pre-test/post-test for knowledge acquisition, the National League for Nursing (NLN) (2005) student satisfaction and confidence level survey, and the Creighton Competency Evaluation Instrument (C-CEI) (Todd, Manz, Hawkins, Parsons, & Hercinger, 2008). The pre-test/post-test measured the knowledge acquisition obtained from the didactic session. NLN (2005) student satisfaction and confidence level survey measured students’ satisfaction and confidence level from either the interactive skills lab sessions or the simulation. The C-CEI tool measured the students’ performance during the simulation. There were four categories: assessment, communication, clinical judgment, and patient safety that the researcher measured the students’ performance during the simulation. Data for the knowledge acquisition, revealed both the experimental and control groups significantly increased between the pre-test and the post-test. The post-test showed statistically significant differences between groups, with the control group outperforming the experimental group. As such, the data demonstrate that the simulation did not have a significant effect on knowledge. Data from the NLN (2005) student satisfaction and confidence level survey were analyzed using a two group MANOVA. Although the results of the MANOVA were not significant, as a follow up analysis, the individual questions were used as the dependent variables in a MANOVA. When the individual questions were used as the dependent variables in a MANOVA, the experimental group performed significantly better in two out of the five questions on student satisfaction and five out of the nine questions on student self-confidence. There was a strong positive correlation between satisfaction with current learning and self–confidence. Data for the students’ performance were analyzed using the C-CEI tool. A perfect score on the C-CEI instrument was 14 points, 100%. The overall group average was 8.1 points or 58%. Of the four sections in the C-CEI tool, the lowest mean was Communication (0.5185), followed by Patient Safety (mean = 0.5333). Although student groups were able to communicate with the patient effectively 67% of the time, none of the simulation groups provided an organized report to the healthcare provider with minimal prompting. During the postpartum simulation, 33% of the students administered medications safely. The wrong dosage and incorrect technique were seen in 67% of the simulations. Communication and safe medication practice are essential to ensuring patient safety; it is important that faculty prepare nursing graduates to provide safe care. Even though there were limitations to this study, a convenience sample at one public university, the findings are informative and have implications for future teaching and learning strategies. The results of this study add to the body of knowledge that supports the use of simulation as a teaching strategy in undergraduate nursing education.