Creation of virtual patients for midwifery education

A pilot study to evaluate the effect of classroom-based high-fidelity simulation on midwifery students' self-efficacy in clinical lactation and perceived translation of skills to the care of the breastfeeding mother-infant dyad

BACKGROUND

Midwives are expected to provide timely and skilled support to breastfeeding mothers, yet it is not clear whether and how midwifery students receive training in clinical lactation. The primary objective of this pilot study was to evaluate the impact of a classroom-based breastfeeding simulation on nurse-midwifery students' self-efficacy in lactation skills. The secondary objective was to describe students' exposure to breastfeeding patients in the classroom and in clinical settings.

METHODS

A pilot study using a prospective cohort study design and convenience sampling was completed between September 2017 and April 2018. Two simulation-based workshops were developed for the classroom setting in alignment with breastfeeding-focused competencies for midwives and lactation professionals. The workshops were integrated into the nurse-midwifery curriculum at a US-based program. Two Self-Efficacy Surveys (defined, 7-point Likert Scale) were developed and used to measure baseline and continuing self-efficacy in breastfeeding skills among students. Two Practice Patterns instruments, adapted from the American Academy of Pediatrics breastfeeding curriculum, were used to define the setting, quantity, and types of nurse-midwifery students' breastfeeding-related exposures. Students participated in a one-hour focus group upon completion of the study.

RESULTS

In this pilot study, nurse-midwifery student participants (N = 9) reported a 14% increase (P < .0001) in their perceived self-efficacy in basic and advanced clinical lactation skills after completing both workshops. The nurse-midwifery students reported dozens of encounters with diverse breastfeeding patients over a six-month period during which they performed a wide variety of clinical lactation skills. The focus group revealed most students (n = 5/9) would like more time to practice clinical lactation skills in a simulated environment and some indicated a desire to have more exposure to challenging versus common (n = 2/9) of breastfeeding concerns.

CONCLUSIONS

In this work, we demonstrate the first high-fidelity lactation simulation in a classroom setting in a healthcare professional training program. Midwifery educators and researchers can adapt the framework and instruments presented in this pilot study to determine the effect of educational interventions on students' translation of skills to breastfeeding mother-infant dyads. Likewise, this is the first study to define the number and type of breastfeeding-related clinical exposures among nurse-midwifery students.

Designing Virtual Patients for Education of Nursing Students in Cancer Course

Background:

One of the best approaches to promote clinical reasoning in nursing education is Virtual Patient (VP). The purpose of this study was to design and implement VPs for nursing student's education in caring for cancer patients.

Materials and Methods:

In the first stage, through a descriptive-exploratory qualitative study using a focus group method, topics with higher priority in cancer nursing were identified. Then, based on the VP Nursing Design Model (VPNDM) for each of these topics, a scenario and then an interactive VP was designed and implemented in the Open Labyrinth application. The content validity of VPs was evaluated by eight experts and then the face validity was examined in the pilot group including 15 nursing students.

Results:

Topics with higher priority in cancer nursing courses were mastectomy, chemotherapy, radiotherapy, hypercalcemia, spinal cord compression, cardiac tamponade, and superior vena cava syndrome. For five scenarios based on the nursing process in three sequences (signs and symptoms, diagnosis and interventions) the VPs were designed. In this process, learning objectives, determining the critical path, adding branches at the decision point, adding feedback, completing the clinical course and related data, and adding multimedia were considered. VPs were revised based on the proposed modifications following face and content validity.

Conclusions:

This article presents VP design steps for use in a nursing student training course. The researchers were able to provide and validate five VPs to care for cancer patients based on the VPNDM.