Responding to the Unexpected: Tag Team Patient Safety Simulation

Midwives' recognition and response to maternal deterioration: A national cross-sectional study

BACKGROUND

Early warning systems (EWS) are used across health care settings as a tool for the early identification of clinical deterioration and to determine the need to escalate care. Early detection of clinical deterioration and appropriate escalation of care in maternity settings is critical to the safety of pregnant women and infants; however, underutilization of EWS tools and reluctance to escalate care have been consistently reported. Little is known about midwives' use of EWS in the Australian context.

METHODS

Using a cross-sectional approach, we elicited the attitudes, beliefs, and behaviors of a purposive sample of Australian midwives (n = 87) with respect to the Maternal Early Warning Trigger Tool (MEWT). Participants answered a 25-question Likert scale survey and one open-ended question. Qualitative answers were analyzed using consensus coding.

RESULTS

Midwives reported positive attitudes toward the MEWT, describing it as a valuable tool for identifying clinical deterioration, especially when used as an adjunct to clinical judgment. However, midwives also identified training gaps; 25% had received no training, and only half of those who had received training felt it was effective. In addition, professional tension can create a significant barrier to the effective use of the MEWT. Midwives also reported feeling influenced by their peers in their decision-making with respect to use of the MEWT and being afraid they would be chastised for escalating care unnecessarily.

CONCLUSIONS

Although the MEWT is valued by Australian midwives as a useful tool, barriers exist to its effective use. These include a lack of adequate, ongoing training and professional tension. Improving interdisciplinary collaboration could enhance the use of this tool for the safety of birthing women and their infants.

Implications of the COVID-19 pandemic: Virtual nursing education for delirium care

Background

Technology is increasingly used in nursing education, particularly during the SARS-CoV-2 (COVID-19) pandemic. COVID-19 also brought new challenges to patient care and limited access to in-person clinical experiences for nursing students. Pivoting to virtual simulation (VS) for clinical was necessary during the height of the pandemic. With students' return to clinical settings, VS experiences continue to be needed, due to quarantine of clinical settings and/or shortage of available clinical sites. VS clinical experiences have been successfully utilized over the past decade; however, the literature lacks resources on the use of VS for delirium care of patients.

Method

In this article, the authors describe the creation and provision of a VS clinical day using interactive computer-based technology to educate nursing students to prevent, recognize, and manage delirium. The VS clinical was in conjunction with a Behavioral Health course.

Results

Evaluation of students demonstrated attainment of objectives. Students reported satisfaction with the VS experience.

Conclusion

Technology in nursing education and use of VS clinical provide effective strategies for clinical learning when in-person clinical experiences are unavailable, either due to access limitations or lack of patients with specific health needs.