Photo and video credit: Atrium Health

Maternal mortality in the United States continues to rise, with 1,205 deaths in 2021, compared to 861 in 2020 and 754 in 2019.[1] Many of these deaths are preventable, as chronic conditions like hypertension play a significant role in the increase. However, many women do not receive early and regular prenatal care, which is key to managing these conditions and improving the chances of a healthy pregnancy.[2] If left untreated, these conditions become life-threatening complications, stressing the need for timely diagnosis and intervention by healthcare providers in the LDR. To address this increase, Atrium Health implemented a new OB nurse training program to help improve outcomes. The innovative program will incorporate online training, in-person lectures, and simulation-based training at the Carolinas Simulation Center. This approach enhances OB nurses’ clinical competence and confidence, equipping them with the skills to effectively handle time-sensitive scenarios, ultimately contributing to improved patient outcomes and maternal mortality prevention.

Provider Training is Crucial to Maternal Mortality Prevention

The U.S. is unique among high-income nations as incidences of maternal deaths persist. These deaths occur from a pregnancy-related health issue or an existing condition exacerbated by pregnancy.[1] Early diagnosis and treatment are vital to managing pregnancy-related health complications and improving maternal mortality prevention efforts. Otherwise, these conditions can cause severe consequences to the patient’s health over time, contributing to morbidity and mortality.

Complications can also occur during childbirth, such as shoulder dystocia or hemorrhaging. These events are challenging for OB teams, requiring fast and accurate intervention to avoid adverse outcomes. The urgency of these events necessitates high-level interdisciplinary teamwork and communication. Moreover, providers must handle the stress inherent in these events to think critically and work effectively, underscoring the need for ongoing training and preparedness.

Simulation-based training in essential obstetric skills is effective in improving the knowledge and self-efficacy of providers.[3] However, these experiences are difficult to attain during traditional clinical hours. These sessions are typically passive as students observe and learn from experienced clinicians. Some students may never encounter these low-frequency, high-risk events during clinical hours. Both circumstances mean students enter the workforce without hands-on experience treating obstetric emergencies.

Simulation can help fill the experience gap by providing students with an environment to practice obstetric interventions safely. Therefore, Atrium Health developed a new training program for OB nurses that incorporates practice using Gaumard’s VICTORIA® simulator, as it can accurately recreate complicated deliveries that require the participants to use practical (technical) and soft (non-technical) skills that may be difficult to teach through didactic lectures or clinical settings.[4] Thus, nurses will receive hands-on experience managing some of the biggest contributors to maternal morbidity and mortality, including hypertension, hemorrhaging, and sepsis.

VICTORIA® simulates a full range of obstetric events to facilitate teamwork and deepen critical thinking skills in learners of all levels.

Why Integrate Simulation into OB Nurse Training

In early 2023, Attrium Health instituted a new program for OB nurse training. Praxis will focus on developing the skills and proficiency that help providers diagnose and treat pregnancy complications and obstetric events. The program combines online training, lectures, and simulation at the Carolinas Simulation Center. Thus, participants can acquire knowledge from an educator and put it into practice in the simulation center.

The Carolinas Simulation Center is a multidisciplinary simulation center founded in 2007 to train providers from Atrium Health’s Carolinas Medical Center and those from the surrounding area. With the help of advanced simulation equipment, OB nurses can rehearse obstetric procedures and clinical patient care scenarios hands-on in a safe environment. The goal is to improve safety and ensure they are ready to provide effective care.

According to Crystal Bencken, the simulation education manager at the Carolinas Simulation Center, “Simulation allows our teammates to practice what they would be doing in real life in a safe environment so that they can hone their skills, improve their comfort, and get better at what they are doing so that we can make sure that when we take care of our patients, we are taking care of them to the best of our abilities.”[5]

The features in the VICTORIA simulator help educators recreate real-life scenarios, allowing the participants to experience the challenges of obstetric care. Unlike traditional clinical hours, learning is not passive in simulation. Participants must think critically and work as a team to complete the scenarios successfully. Repeated exposure to these scenarios helps build their confidence and competence so they will enter the workforce without gaps in their knowledge or lack of experience with specific events.

Simulation-based training hones clinical skills and teamwork, which is key to maternal mortality prevention.

Simulation-based Training is Key to Maternal Mortality Prevention

Hypertension, hemorrhaging, and sepsis are among the leading underlying causes of pregnancy-related death.[6] Nurses play a vital role in preventing maternal deaths as they spend more time at the bedside with patients than other providers. Since these conditions tend to develop gradually, and a “failure to rescue” contributes to maternal deaths, nurses are in a good position to recognize these ailments and intervene[7].

These emergencies demand rapid and precise decision-making, which places tremendous pressure on providers. This is why simulation is incorporated into Atrium Health’s OB nurse development program. Simulation provides a controlled environment where they can apply what they learn in the online and lecture portions of the program hands-on, practicing and refining their skills in managing these complex scenarios.

VICTORIA’s features allow the nurses to use real tools and equipment during each session to monitor her blood pressure and track her vitals as interventions are applied. Hemorrhaging can also be managed using standard devices and techniques, and the nurses see the consequences of their actions reflected in VICTORIA’s physical presentation and vitals.

Thus, scenarios are engaging and psychologically challenging, requiring the participants to actively use their critical thinking and clinical skills instead of passively observing or absorbing knowledge. The nurses also experience the stress inherent in these time-sensitive scenarios, so not only does simulation help develop clinical competence, but it also helps them develop the ability to work under pressure.

Then, the nurses debrief after each simulation, allowing them to discuss their performance with the educators. These sessions help the nurses receive feedback that reinforces best practices and will enable them to examine errors they may have made. Since simulation scenarios can be repeated, the nurses can take this feedback and put it into action. This repeated practice results in OB nurses being better prepared to enter the workforce, ultimately leading to improved patient outcomes and, most importantly, lives saved.

Conclusion

Atrium Health’s innovative OB nurse development program, incorporating online modules, lectures, and simulation-based training, presents a crucial step toward addressing the escalating maternal mortality rates in the United States. By utilizing advanced simulation technology, the program actively engages nurses in realistic obstetric scenarios, fostering hands-on practice and enhancing their clinical competence, critical thinking, and ability to perform under pressure. This comprehensive approach ensures continuous improvement and better-prepared nurses entering the workforce. This initiative will not only benefit obstetric care education but also holds the potential to significantly contribute to reducing maternal mortality and improving overall patient outcomes.

Learn more about VICTORIA® S2200, Super TORY®, or any other Gaumard simulator on our website.

Learn more about the Carolinas Simulation Center on the Atrium Health webpage.

[1] Hoyert, Donna L. “Maternal Mortality Rates in the United States, 2021.” Centers for Disease Control and Prevention, https://www.cdc.gov/nchs/data/hestat/maternal-mortality/2021/maternal-mortality-rates-2021.htm. Accessed 28 November 2023.

[2] Katella, Kathy. “Maternal Mortality Is on the Rise: 8 Things To Know.” Yale Medicine, www.ehow.com/how_10727_make-vegetarian-chili.html. Accessed 28 November 2023.

[3] Li, Qiang, et al. “Training and financial intervention for encouraging maternal health service utilization.” Medicine, vol. 98, no. 45, 2019, pp. 1-7.

[4] Alalade, Aderemi O and Sindhu Sekar. ” Simulation-Based Education for Enhancing Obstetric Emergency Response: A Needs Impact Evaluation.” Cureus, vol. 15, no. 8, 2023, pp. 1-7.

[5] “Carolinas Simulation Center.” YouTube, uploaded by Atrium Health, 17 February 2023, https://www.youtube.com/watch?v=UGKR4Z6iwj4.

[6] “Four in 5 pregnancy-related deaths in the U.S. are preventable.” Centers for Disease Control and Prevention, 19 Sept. 2022, https://www.cdc.gov/media/releases/2022/p0919-pregnancy-related-deaths.html.

[7] Bernstein, Samantha. “Important Safety Role of Nurses in Improving Maternal Health.” The Joint Commission, https://www.jointcommission.org/resources/news-and-multimedia/blogs/improvement-insights/2022/05/important-safety-role-of-nurses-in-improving-maternal-health/. Accessed 6 December 2023.