Department of Pediatrics, University of California San Francisco, 550 16th Street, 4th Floor, 4551, Box 0110, San Francisco, CA, 94143, USA.
Global Health Sciences, University of California San Francisco, 550 16th St, San Francisco, CA, 94158, USA.
BMC Pregnancy Childbirth. 2017 Jul 28;17(1):252. doi: 10.1186/s12884-017-1434-1.
As the global under-five mortality rate declines, an increasing percentage is attributable to early neonatal mortality. A quarter of early neonatal deaths are due to perinatal asphyxia. However, neonatal resuscitation (NR) simulation training in low-resource settings, where the majority of neonatal deaths occur, has achieved variable success. In Bihar, India, the poorest region in South Asia, there is tremendous need for a new approach to reducing neonatal morality.
This analysis aims to assess the impact of a novel in-situ simulation training program, developed by PRONTO International and implemented in collaboration with CARE India, on NR skills of nurses in Bihar. Skills were evaluated by clinical complexity of the simulated scenario, which ranged from level 1, requiring NR without a maternal complication, to level 3, requiring simultaneous management of neonatal and maternal complications. A total of 658 nurses at 80 facilities received training 1 week per month for 8 months. Simulations were video-recorded and coded for pre-defined clinical skills using Studiocode™.
A total of 298 NR simulations were analyzed. As simulation complexity increased, the percentage of simulations in which nurses completed key steps of NR did not change, even with only 1-2 providers in the simulation. This suggests that with PRONTO training, nurses were able to maintain key skills despite higher clinical demands. As simulation complexity increased from level 1 to 3, time to completion of key NR steps decreased non-significantly. Median time to infant drying decreased by 7.5 s (p = 0.12), time to placing the infant on the warmer decreased by 21.7 s (p = 0.27), and time to the initiation of positive pressure ventilation decreased by 20.8 s (p = 0.12). Nevertheless, there remains a need for improvement in absolute time elapsed between delivery and completion of key NR tasks.
PRONTO simulation training enabled nurses in Bihar to maintain core NR skills in simulation despite demands for higher-level triage and management. Although further evaluation of the PRONTO methodology is necessary to understand the full scope of its impact, this analysis highlights the importance of conducting and evaluating simulation training in low-resource settings based on simultaneous care of the mother-infant dyad.
随着全球五岁以下儿童死亡率的下降，越来越多的儿童死亡归因于新生儿早期死亡。四分之一的新生儿早期死亡是由于围产期窒息。然而，在大多数新生儿死亡发生的资源匮乏环境中，新生儿复苏（NR）模拟培训的效果参差不齐。在印度比哈尔邦，南亚最贫穷的地区，急需一种新的方法来降低新生儿死亡率。
本分析旨在评估由 PRONTO International 开发并与 CARE 印度合作实施的新型现场模拟培训计划对比哈尔邦护士 NR 技能的影响。通过模拟场景的临床复杂性来评估技能，范围从 1 级（不需要产妇并发症即可进行 NR）到 3 级（需要同时管理新生儿和产妇并发症）。共有 80 个设施的 658 名护士每周接受一次培训，持续 8 个月。模拟过程被拍摄下来，并使用 Studiocode™对预先定义的临床技能进行编码。
共分析了 298 次 NR 模拟。随着模拟复杂性的增加，即使在模拟中只有 1-2 名提供者，完成 NR 关键步骤的模拟比例也没有改变。这表明，通过 PRONTO 培训，护士能够在面对更高的临床需求时保持关键技能。随着模拟复杂性从 1 级增加到 3 级，完成关键 NR 步骤的时间非显著减少。婴儿干燥时间中位数减少了 7.5 秒（p=0.12），将婴儿放在保暖器上的时间减少了 21.7 秒（p=0.27），开始正压通气的时间减少了 20.8 秒（p=0.12）。然而，在完成关键 NR 任务的时间方面，仍有改进的空间。
PRONTO 模拟培训使比哈尔邦的护士能够在模拟中保持核心 NR 技能，尽管需要更高水平的分诊和管理。尽管需要进一步评估 PRONTO 方法来了解其全部影响，但本分析强调了在资源匮乏环境中基于母婴双重视角同时护理进行和评估模拟培训的重要性。
