title: Managing women with acute physiological deterioration: student midwives performance in a simulated setting.
abstract: OBJECTIVE
  Midwives' ability to manage maternal deterioration and 'failure to rescue' are of concern with questions over knowledge, clinical skills and the implications for maternal morbidity and, mortality rates. In a simulated setting our objective was to assess student midwives' ability to assess, and manage maternal deterioration using measures of knowledge, situation awareness and skill, performance.
  
  
  METHODS
  An exploratory quantitative analysis of student performance based upon performance, ratings derived from knowledge tests and observational ratings. During 2010 thirty-five student, midwives attended a simulation laboratory completing a knowledge questionnaire and two video, recorded simulated scenarios. Patient actresses wearing a 'birthing suit' simulated deteriorating, women with post-partum and ante-partum haemorrhage (PPH and APH). Situation awareness was, measured at the end of each scenario. Applicable descriptive and inferential statistical tests were, applied to the data.
  
  
  RESULTS
  The mean total knowledge score was 75% (range 46-91%) with low skill performance, means for both scenarios 54% (range 39-70%). There was no difference in performance between the scenarios, however performance of key observations decreased as the women deteriorated; with significant reductions in key vital signs such as blood pressure and blood loss measurements. Situation, awareness scores were also low (54%) with awareness decreasing significantly (t(32)=2.247, p=0.032), in the second and more difficult APH scenario.
  
  
  CONCLUSIONS
  Whilst knowledge levels were generally good, skills were generally poor and decreased as the women deteriorated. Such failures to apply knowledge in emergency stressful situations may be resolved by repetitive high stakes and high fidelity simulation.
authors.affiliation: Monash University School of Nursing and Midwifery, Gippsland: Churchill, Victoria 3842, Australia. simon.j.cooper@monash.edu
authors.forename: Simon
authors.initials: S
authors.lastname: Cooper
authors.forename: Bree
authors.initials: B
authors.lastname: Bulle
authors.forename: Mary Anne
authors.initials: MA
authors.lastname: Biro
authors.forename: Jan
authors.initials: J
authors.lastname: Jones
authors.forename: Maureen
authors.initials: M
authors.lastname: Miles
authors.forename: Carole
authors.initials: C
authors.lastname: Gilmour
authors.forename: Penny
authors.initials: P
authors.lastname: Buykx
authors.forename: Rosemarie
authors.initials: R
authors.lastname: Boland
authors.forename: Leigh
authors.initials: L
authors.lastname: Kinsman
authors.forename: Julie
authors.initials: J
authors.lastname: Scholes
authors.forename: Ruth
authors.initials: R
authors.lastname: Endacott
mesh_terms: D000328:Adult; D001315:Australia; D001364:Awareness; D002983:Clinical Competence; D003657:Decision Making; D004521:Educational Measurement / Q000379:methods; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008875:Middle Aged; D008880:Midwifery / Q000193:education*; D009721:Nurse Midwives / Q000193:education / Q000523:psychology; D009730:Nursing Assessment; D016544:Patient Simulation; D006473:Postpartum Hemorrhage / Q000628:therapy; D011247:Pregnancy; D013338:Students, Nursing / Q000523:psychology*; D011795:Surveys and Questionnaires