Leena is a 20-year-old pregnant woman. When she arrived at Tigoni Health Center two hours ago she explained that she thinks she is “almost nine months pregnant” and she has presented to Tigoni to deliver her baby. Before long, she’s lying on the delivery table with the urge to push. Her HIV status is unknown. You are the nurse on duty and deliver the baby, which is silent, blue and limp. The mother starts pleading “Why isn’t he crying? What’s wrong with my baby?!” What should you do next?
Leena and her baby are characters being played by a volunteer actress and baby doll in a simulated delivery. Participating health care providers must assess the situation, prepare for delivery, and simulate essential clinical care skills for delivering mothers and newborns. In the simulations, participants practice communicating effectively with their teammates, the patient, and her birth companion. In this case, the nurse calls for help as she is giving life-saving breaths to the newborn using a bag-valve mask. The whole simulation is recorded on a smartphone and then debriefed by the team immediately afterwards.
At Jacaranda, we’ve learned that one-off training sessions seldom lead to sustained skill capacity over time. Supported with a grant from the Pfizer Foundation, we’ve been implementing a Nurse Champion program that empowers public facility nurses to lead their teams in regularly scheduled simulation drills. The nurse champions use evidence-based simulation techniques developed by PRONTO International and Helping Babies Breathe. Four nurses from two separate public facilities were selected as “Nurse Champions” and went through an Emergency Obstetric and Newborn Care (EmONC) training, PRONTO simulation facilitation training, and a week-long mini-residency program at Jacaranda’s hospital in Kahawa West. Now they are back in their health facilities, implementing simulations with their teams and addressing gaps in EmONC care using information from debriefs after simulations and actual deliveries.
Jacaranda is empowering the nurse champions to take lead in an area that is critical to patient care outcomes. We are also establishing a formalized network of champions and building a platform for them to share their experiences and encourage one another through peer support.
Of course, we are tracking the impact of the Nurse Champion program on multiple levels including the Nurse Champion level, public facility staff level, and overall facility level. We hope to see improvements in EmONC preparedness over time as well as effective communication and team work. So far, we saw the Nurse Champions increase their average scores on a neonatal resuscitation skills check by 15% and increase their EmONC knowledge test scores by an average of 23% after their mini-residency at Jacaranda. And, at the end of their PRONTO training, all 12 participants rated that they were either “very confident” or “confident” in their ability to facilitate simulations. In December we will see if their colleagues have increased their neonatal and EmONC skills and knowledge from baseline assessments in September.
Fortunately, the providers knew how to manage the simulated complication described above. But, this scenario could have been an actual delivery. Through Jacaranda’s program, nurse champions are preparing staff for real emergencies in obstetric and newborn care.