Monash University School of Nursing and Midwifery, Gippsland: Churchill, Victoria 3842, Australia.
Women Birth. 2012 Sep;25(3):e27-36. doi: 10.1016/j.wombi.2011.08.009. Epub 2011 Sep 22.
Midwives' ability to manage maternal deterioration and 'failure to rescue' are of concern with questions over knowledge, clinical skills and the implications for maternal morbidity and, mortality rates. In a simulated setting our objective was to assess student midwives' ability to assess, and manage maternal deterioration using measures of knowledge, situation awareness and skill, performance.
An exploratory quantitative analysis of student performance based upon performance, ratings derived from knowledge tests and observational ratings. During 2010 thirty-five student, midwives attended a simulation laboratory completing a knowledge questionnaire and two video, recorded simulated scenarios. Patient actresses wearing a 'birthing suit' simulated deteriorating, women with post-partum and ante-partum haemorrhage (PPH and APH). Situation awareness was, measured at the end of each scenario. Applicable descriptive and inferential statistical tests were, applied to the data.
The mean total knowledge score was 75% (range 46-91%) with low skill performance, means for both scenarios 54% (range 39-70%). There was no difference in performance between the scenarios, however performance of key observations decreased as the women deteriorated; with significant reductions in key vital signs such as blood pressure and blood loss measurements. Situation, awareness scores were also low (54%) with awareness decreasing significantly (t(32)=2.247, p=0.032), in the second and more difficult APH scenario.
Whilst knowledge levels were generally good, skills were generally poor and decreased as the women deteriorated. Such failures to apply knowledge in emergency stressful situations may be resolved by repetitive high stakes and high fidelity simulation.
助产士处理产妇恶化和“救援失败”的能力令人担忧，这涉及到知识、临床技能以及对产妇发病率和死亡率的影响。在模拟环境中，我们的目标是评估学生助产士使用知识、情境意识和技能、表现来评估和处理产妇恶化的能力。
对学生表现进行探索性定量分析，依据表现、知识测试和观察评分得出的评分。2010 年，35 名学生助产士参加了模拟实验室，完成了知识问卷和两个视频记录的模拟场景。佩戴“分娩服”的患者女演员模拟恶化的产妇和产后及产前出血（PPH 和 APH）产妇。在每个场景结束时测量情境意识。对数据进行了适用的描述性和推论性统计检验。
平均总知识得分为 75%（范围为 46-91%），技能表现平均值为 54%（范围为 39-70%）。两个场景之间的表现没有差异，但是随着妇女恶化，关键观察的表现下降；关键生命体征如血压和失血量测量显著下降。情境意识评分也较低（54%），第二和更困难的 APH 场景中，意识显著下降（t(32)=2.247，p=0.032）。
虽然知识水平普遍较高，但技能普遍较差，而且随着妇女的恶化而下降。在紧急紧张情况下应用知识的这种失败可能通过重复高风险和高保真度模拟来解决。
