Elsevier

Women and Birth

Volume 32, Issue 4, August 2019, Pages 346-355
Women and Birth

Effect of an in-situ simulation workshop on home birth practice in Australia

https://doi.org/10.1016/j.wombi.2018.08.172Get rights and content

Abstract

Problem

Interprofessional training programs for obstetric emergencies have been introduced for up-skilling birth unit staff in hospitals but not frequently used in training midwives and paramedicine staff for home birth emergency.

Background

Practical Obstetric Multiprofessional Training (PROMPT) has previously been described in the home birth setting using in-situ simulation training of home births for midwifery and paramedicine staff.

Aim

The aim of this study was to evaluate the benefit of the home birth simulation in clinical practice and to explore how the simulation program prepared the midwives for a birth-related emergency in a publicly funded home birth program.

Methods

Midwives conducting home births, the midwifery educator and the simulated woman in labour (n = 9) attended an interview that explored how the midwives’ learning through simulation affected their home birth clinical practice. The simulated woman and the facilitator who conducted the simulation for more than six years were also interviewed to comment on the observed change in performance in simulation. The interview transcripts were thematically analysed.

Findings

The themes that were identified and agreed upon, were applying learning to clinical practice, learning in teams, valuing realism, facilitating simulation based education and managing variation.

Discussion

In-situ nature of simulation with home birth midwives and paramedical staff facilitated learning transfer and team-based approach to practice. The careful simulation design provided a breadth of experience in emergencies.

Conclusion

Applying learning to prepare for clinical emergency situations changed the midwives’ approach in managing home births. This provided evidence for a change in behaviour (Level 3 Kirkpatrick’s framework) and transfer of learning, leading to changed protocols (Level 4a Kirkpatrick’s framework).

Introduction

Multidisciplinary simulation programs have influenced birth practice in the developed world1, 2 as they offer hands-on training experience in managing emergency situations. These programs usually work on principles of mastery learning and deliberate practice3, 4 with simulation of various obstetric emergency scenarios in a team-based setting. They have been reported to improve clinical technical skills,5 teamwork, leadership and communication.1, 6, 7 Recently these initiatives have demonstrated improvements in client-reported quality of care.8

Whilst these simulations have formed the main-stay of clinical up-skilling for obstetric emergency in hospitals, this approach has had little application for low risk births at home.9 One reason may be due to fewer numbers of women having access to a safe birthing service in a home environment or their choice of not opting for birth at home, even where facilities are available. As a result, in Australia, only 0.5% of pregnant women had a planned home birth in 2010.10 However, even in other high-resourced countries where home births are relatively more prevalent, like the United Kingdom or Netherlands, this type of interprofessional simulation is rarely reported as a means to encourage safer home birth practices.

In situ simulation refers to “a team based simulation that occurs in the actual health care units involving actual team members within their own working environment”.11 We have previously described an in situ simulated home birth training workshop using a modification of the Practical Obstetric Multi-Professional Training program.5, 9, 12 The interprofessional team commences with the presence of the attending midwife accompanied by another support midwife.13 After diagnosing an emergency, she would call for the ambulance staff, with attendance of the paramedic. The paramedical staff attending the session, were undertaking this in their working hours and were on call for duty at the time. The scenarios mimicked the way an emergency could present at home and were conducted in an actual home-based setting. Our previously published study has already established the participants’ responses regarding the major learning acquired from the workshop. This was found to be useful by both midwifery and paramedicine participants and the key learning messages were based on teamwork, communication, prioritization, sharing of tasks and optimum utilization of available resources.9

The current study aims to explore how the learning acquired through this workshop influenced the participants’ subsequent clinical practice. We based our research on the theoretical framework of experiential learning.14 According to Kolb’s theory of experiential learning,15 new learning is created by addition of new experiences. Learning is created by acquisition of abstract concepts that can be applied to a variety of real life situations. Simulation based learning can also be explained using Kolb’s learning cycle.16 The different phases of learning, from the initial step of participation in the simulation activity and debrief, is followed by the next step of reflection on the learning acquired. A connection is drawn between the theoretical learning concepts learnt in simulation. The retained concepts can eventually be applied to clinical practice, which can contribute further to concrete experience.

We evaluated the effect of an in-situ simulation workshop on the clinical practice of home birth midwifery staff and how that experience further influenced their learning. A secondary outcome was to assess how this training workshop was perceived in relation to their attitude towards managing rare, but challenging life-threatening obstetric emergencies at home. The research questions were “What did the midwives learn in the home birth simulation that could be applied to their home birth practice?” and “What was the role of the home birth simulation in relation to preparing for obstetric emergencies in a home birth situation?”

Section snippets

Methods

Monash University and Monash Health, Victoria, Australia conducted the study jointly. Given the nature of the question, we adopted a qualitative research paradigm. This enabled us to explore in depth how the learning affected participant’s attitude and practice of managing home births. The study was approved as a quality assurance project by the Monash Health Human Research Ethics framework.

Results

Nine interviews were conducted, including the home birth midwives, the simulated woman and the midwifery facilitator. We identified five key themes (Table 1). The overarching theme was “applying learning to clinical practice”. Learning in teams, realism offered, facilitation of the simulation and managing variation were the other common themes.

Discussion

The findings, illustrated through five key themes identified in this study, show positive impacts of simulation on home birth practices and how midwives perceived greater confidence in home birth emergency management after attending the simulation workshop. The participants’ perception of working in real clinical teams with management of variety of emergency situations in real time and space, using real equipment, seemed to facilitate application of learning from simulation to routine clinical

Conclusion

This study addressed two research questions on how the learning from home birth simulation could be applied to midwifery home birth practice and how it prepared them for obstetric emergencies at home. The themes that were agreed upon provide the following findings. Home birth simulation resulted in midwives making practical adjustments to their birth practice that they learned and retained from this in situ simulation workshop. Midwives reported being better equipped to prepare for a home birth

Ethical statement

The study complies with Monash Health Quality Assurance framework. Participants gave informed and free consent to participate in the study. They were verbally consented (as per guidelines from Monash Health Ethics Review Committee) for the interview and reassured about confidentiality.

Acknowledgements

We would like to thank for help with running the simulation sessions and the paramedical staff of Ambulance Victoria for participating in the sessions. The study received no specific funding but the women’s health program was supported by the Victorian Government Operational Infrastructure program.

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