TITLE:
Health Quality Improvement Using Instructional Communication and Teamwork Videos: An Outcome Study
AUTHORS:
Neil Cowie, Angela Bowen, Susan Kuling, Kalyani Premkumar, Mark Burbridge, Jocelyne Martel
KEYWORDS:
Simulation; Video Training; Nursing Education; Anesthesiologists; Obstetrics; Emergency Cesarean Birth; Communication; Teamwork; Human Factors; Health Quality Improvement; Web-Based Training; Acute Care
JOURNAL NAME:
Creative Education,
Vol.5 No.1,
January
26,
2014
ABSTRACT:
Many factors contribute to errors that occur during emergency Cesarean
birth under general anesthesia. The Joint Commission of Accreditation of Health
Care Organizations (JACO) reports that 70% of sentinel events in obstetric
practice are attributable to errors in communication and teamwork. Our
objective was to develop a video training module to address these deficiencies,
and measure its effectiveness. A webbased learning resource was created using professionally made videos
that depicted effective and non-effective communication/teamwork techniques in an obstetrical event. This
resource could be accessed by a facilitator of small group sessions or by self
directed learners. Obstetrical nurses watched this learning resource and were
then debriefed by a facilitator to highlight examples of how human factors
contribute to the evolution of adverse events. The knowledge and skills, as
well as, perceptions of their own behaviors and of other health professionals in the team, were
evaluated preand post intervention. The performance of a subgroup of
participants in a high-fidelity simulation of an emergency Cesarean birth was
assessed to measure the outcome of intervention. Ninety-five obstetrical nurses
were given the pre-intervention
questionnaires, and 52 completed the post-intervention questionnaires one year
later. Participants had significantly higher scores post-intervention (M = 0.78, SD = 0.09) as compared to pre-intervention (M = 0.73, SD = 0.12; t(53) = ?3.07, p d = .47). Following intervention, participants were more conscious
of the behaviors of those they worked with (t(51)
= ?4.99, p d = ?0.66). Ten months after intervention, nurses indicated that
they were able to identify challenges in teamwork and communication in their
practice, and were more willing to
speak up and be more assertive, and use strategies of conflict resolution and
communication that they had learned. There was an improvement in performance of
a sub-group of participant when assessed using a simulation scenario. The video
web-based learning resource used in small group
sessions effectively improved performance of obstetrical nurses as evaluated
using questionnaires and high fidelity simulation. Future work will determine
if the web-based version will be as effective in orienting new staff to the
challenges of working in acute care obstetrical practice.