Purpose for the Program
To improve the ability of nurses in the postpartum and antepartum units to respond in the event of a maternal code. Even very experienced nurses expressed that though they knew how to perform cardiopulmonary resuscitation, the maternal code experience was overwhelming and they felt unprepared.
The leadership of the antepartum and postpartum units and the nursing simulation faculty at the hospital collaborated to propose a simulation-based learning experience for the registered nurse (RN) staff of these units. Simulation-based learning provides an opportunity to practice skills in a safe environment while helping the nurse develop critical thinking skills, promote effective communication, and work collaboratively with other members of the team.
Implementation, Outcomes, and Evaluation
Over a period of months, the program faculty (simulation staff, nurse educators, and staff nurses) created two maternal code simulations. The final program involved three stages: skills sessions, simulated code scenarios, and debriefings. During the skill sessions the staff reviewed skills, such as use of the defibrillator, contents of the code cart, medications used in a code, and communication techniques. The participants toured the simulation lab before the actual simulation to see how the room was set up and how the manikin worked. When it was time for each scenario, participants were given role cards to remind them of critical activities during a code. The primary nurse received a report on the mock patient and the simulation started. One half of the group participated in each simulation whereas the other half watched the scenario on a live feed in a conference room. Immediately after each scenario a debriefing session took place. Consistent themes during debriefing included discussions about the role of the nurse in a code situation, effective communication in an emergency, and the value of effective team work. Without exception, results of the 196 written evaluations indicated that staff nurses felt more knowledgeable and confident about adult codes after the simulation.
Implications for Nursing Practice
Based on the overwhelming positive feedback of simulation-based learning, the program was offered again the following year to all RN staff. Anecdotally, many nurses in the second year of the simulation program commented that they also felt more confident in other emergencies in the units after having participated in the maternal code simulation the previous year. The current plan is to offer simulation-based learning experiences to all RNs in the antepartum and postpartum units annually.