Advanced Clinical Neonatal Nursing Students’ Transfer of Performance: From Skills Training With Real-Time Feedback on Ventilation to a Simulated Neonatal Resuscitation Scenario
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Date
2022Metadata
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Original version
10.3389/fped.2022.866775Abstract
Background: Advanced clinical neonatal nurses are expected to have technical skills
including bag-mask ventilation. Previous studies on neonatal bag-mask ventilation skills
training focus largely on medical students and/or physicians. The aim of this study was
to investigate whether advanced clinical neonatal nursing students’ bag-mask ventilation
training with real-time feedback resulted in transfer of bag-mask ventilation performance
to a simulated setting without feedback on ventilation.
Materials and Methods: Students in advanced clinical neonatal nursing practiced bagmask
ventilation on a premature manikin (Premature Anne, Laerdal Medical, Stavanger,
Norway) during skills training. A flow sensor (Neo Training, Monivent AB, Gothenburg,
Sweden) was placed between the facemask and the self-inflating bag (Laerdal Medical),
and visual feedback on mask leak (%), expiratory tidal volume (VTe in ml/kg), ventilation
rate and inflation pressure was provided. Two months later, the students participated
in a simulated neonatal resuscitation scenario. The same variables were recorded, but
not fed back to the students. We compared ventilation data from skills- and simulation
training. A structured questionnaire was used to investigate the students’ self-perceived
neonatal ventilation competence before and after the skills- and simulation training.
Results: Mask leakage and ventilation rate was higher, and VTe lower and highly
variable in the simulated scenario compared with skills training (all p < 0.001).
There was no statistically significant difference in inflation pressure (p = 0.92). The
fraction of ventilations with VTe within the target range was lower during simulation
(21%) compared to skills training (30%) (p < 0.001). There was no difference in the
students’ self-perceived competence in bag-mask ventilation before vs. after skills- and
simulation training.
Conclusion: Skills training with real-time feedback on mask leak, ventilation rate, tidal
volume, and inflation pressure did not result in objective or subjective improvements
in bag-mask ventilation in a simulated neonatal resuscitation situation. Incorrect VTe
delivery was common even when feedback was provided. It would be of interest to
study whether more frequent training, and training both with and without feedback,
could improve transfer of performance to a simulated resuscitation setting.