RESUMO
Background: Advanced clinical neonatal nurses are expected to have technical skills including bag-mask ventilation. Previous studies on neonatal bag-mask ventilation skills training focus largely on medical students and/or physicians. The aim of this study was to investigate whether advanced clinical neonatal nursing students' bag-mask ventilation training with real-time feedback resulted in transfer of bag-mask ventilation performance to a simulated setting without feedback on ventilation. Materials and Methods: Students in advanced clinical neonatal nursing practiced bag-mask ventilation on a premature manikin (Premature Anne, Laerdal Medical, Stavanger, Norway) during skills training. A flow sensor (Neo Training, Monivent AB, Gothenburg, Sweden) was placed between the facemask and the self-inflating bag (Laerdal Medical), and visual feedback on mask leak (%), expiratory tidal volume (VT e in ml/kg), ventilation rate and inflation pressure was provided. Two months later, the students participated in a simulated neonatal resuscitation scenario. The same variables were recorded, but not fed back to the students. We compared ventilation data from skills- and simulation training. A structured questionnaire was used to investigate the students' self-perceived neonatal ventilation competence before and after the skills- and simulation training. Results: Mask leakage and ventilation rate was higher, and VT e lower and highly variable in the simulated scenario compared with skills training (all p < 0.001). There was no statistically significant difference in inflation pressure (p = 0.92). The fraction of ventilations with VT e within the target range was lower during simulation (21%) compared to skills training (30%) (p < 0.001). There was no difference in the students' self-perceived competence in bag-mask ventilation before vs. after skills- and simulation training. Conclusion: Skills training with real-time feedback on mask leak, ventilation rate, tidal volume, and inflation pressure did not result in objective or subjective improvements in bag-mask ventilation in a simulated neonatal resuscitation situation. Incorrect VT e delivery was common even when feedback was provided. It would be of interest to study whether more frequent training, and training both with and without feedback, could improve transfer of performance to a simulated resuscitation setting.
RESUMO
The purpose of this study was to investigate how postgraduate neonatal nursing students transfer learning from in-situ resuscitation simulation with interprofessional teams to clinical practice. It is essential that healthcare professionals involved in stabilization and resuscitation of newborns master technical (e.g.bag-mask ventilation) and non-technical skills (e.g. teamwork and communication). Simulation plays an important role in education as it allows healthcare professionals safe practicing of skills and teamwork under direct supervision. Debriefing is a central component. Eighteen postgraduate neonatal nursing students participated in in-situ simulation with interprofessional team. Subsequently, five students were interviewed individually. A qualitative content analysis was performed. Three descriptive categories were identified, representing the manifest content:'Non-technical skills','Task management in an acute situation', and 'Learning through reflection'. The interviewees highlighted a deeper understanding of the collaboration and mutual dependency in the team after in-situ simulation. One latent content was identified: "Trust and competence in a relational collaboration". It is challenging to choose the best suited learning activities for learning different subject matters, like skills and competencies needed in clinical neonatal resuscitation.Despite this being a small study, the findings can be transferred to similar educational contexts.
