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Clinical decision-making: Midwifery students' recognition of, and response to, post partum haemorrhage in the simulation environment


Scholes, J and Endacott, R and Biro, M and Bulle, B and Cooper, S and Miles, M and Gilmour, C and Buylx, P and Kinsman, LD and Boland, R and Jones, J and Zaidi, F, Clinical decision-making: Midwifery students' recognition of, and response to, post partum haemorrhage in the simulation environment, Bmc Pregnancy and Childbirth, 12 Article 19. ISSN 1471-2393 (2012) [Refereed Article]


Copyright Statement

Licensed under Creative Commons Attribution 2.0 Generic (CC BY 2.0)

DOI: doi:10.1186/1471-2393-12-19


Background: This paper reports the findings of a study of how midwifery students responded to a simulated post partum haemorrhage (PPH). Internationally, 25% of maternal deaths are attributed to severe haemorrhage. Although this figure is far higher in developing countries, the risk to maternal wellbeing and child health problem means that all midwives need to remain vigilant and respond appropriately to early signs of maternal deterioration.

Methods: Simulation using a patient actress enabled the research team to investigate the way in which 35 midwifery students made decisions in a dynamic high fidelity PPH scenario. The actress wore a birthing suit that simulated blood loss and a flaccid uterus on palpation. The scenario provided low levels of uncertainty and high levels of relevant information. The studentís response to the scenario was videoed. Immediately after, they were invited to review the video, reflect on their performance and give a commentary as to what affected their decisions. The data were analysed using Dimensional Analysis.

Results: The studentsí clinical management of the situation varied considerably. Students struggled to prioritise their actions where more than one response was required to a clinical cue and did not necessarily use mnemonics as heuristic devices to guide their actions. Driven by a response to single cues they also showed a reluctance to formulate a diagnosis based on inductive and deductive reasoning cycles. This meant they did not necessarily introduce new hypothetical ideas against which they might refute or confirm a diagnosis and thereby eliminate fixation error.

Conclusions: The students response demonstrated that a number of clinical skills require updating on a regular basis including: fundal massage technique, the use of emergency standing order drugs, communication and delegation of tasks to others in an emergency and working independently until help arrives. Heuristic devices helped the students to evaluate their interventions to illuminate what else could be done whilst they awaited the emergency team. They did not necessarily serve to prompt the studentsí or help them plan care prospectively. The limitations of the study are critically explored along with the pedagogic implications for initial training and continuing professional development.

Item Details

Item Type:Refereed Article
Keywords:midwifery students, simulation, post partum haemorrhage, emergency response
Research Division:Health Sciences
Research Group:Health services and systems
Research Field:Family care
Objective Division:Health
Objective Group:Provision of health and support services
Objective Field:Nursing
UTAS Author:Kinsman, LD (Professor Leigh Kinsman)
ID Code:97749
Year Published:2012
Web of Science® Times Cited:27
Deposited By:Health Sciences B
Deposited On:2015-01-13
Last Modified:2017-11-06
Downloads:401 View Download Statistics

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