A Study to assess the effect of Simulation-based Education on Critical thinking and Clinical competency regarding the management of Obstetric Emergencies among undergraduate Midwifery Nursing students.

Research Statement

A Study to assess the effect of Simulation-based Education on Critical thinking and Clinical competency regarding the management of Obstetric Emergencies among undergraduate Midwifery Nursing students.

Objectives

1.     To assess the effect of simulation-based education on Critical thinking skills regarding the management of Obstetric Emergencies among Undergraduate Midwifery nursing students.

2.     To assess the effect of simulation-based education on Clinical Competency regarding the management of Obstetric Emergencies among Undergraduate Midwifery nursing students.

3.     To assess the relationship between Clinical Competency and Critical thinking regarding the management of Obstetric Emergencies among Undergraduate Midwifery nursing students

Hypothesis

H1: There will be a significant difference between the mean post-test Critical thinking score in the experimental and control groups at 0.05 level of significance.

H2: There will be a significant difference between the mean post-test Clinical Competency score in the experimental and control groups at 0.05 level of significance.

H3: There will be a significant relationship between the post-test Critical thinking and Clinical Competency score at 0.05 level of significance

Assumptions

1.      Undergraduate Midwifery Nursing students may be lacking critical thinking skill and Clinical Competency for the management of obstetric emergencies.

2.     Simulation-based education will enable students to develop adequate critical thinking skills and Clinical Competency for managing obstetric emergencies.

Delimitations

1.     The study will be delimited to undergraduate Midwifery Nursing students.

2.     The study will be delimited to selected colleges of Delhi NCR.

Operation Definitions

1.     Simulation-based Education refers to a module that will include Skill Training, Case Studies, and Simulation Scenario related to Obstetric Emergencies.

2.     Clinical Competency: It refers to Psychomotor skills that enable a Nursing student to deliver high-quality patient care as assessed by Objective structured clinical examination.

3. Critical Thinking: It refers to the ability of students to thoughtfully analyze and evaluate complex situations and make informed clinical judgments as assessed by EMOC-CTAT (Emergency Obstetric Care-Critical Thinking Tool)

4.     Operation Definitions

5.     Undergraduate Midwifery Students: It refers to B.Sc. Nursing Final year students studying Midwifery/Obstetrics and Gynecological nursing and Post Basic B.Sc. Nursing 1st year students studying Maternal Nursing in institutions recognized by the Indian Nursing Council.

6.     Obstetric Emergencies: Obstetric emergencies refer to critical and potentially life-threatening situations that can occur during pregnancy, labor, childbirth, or the postpartum period, including Abruptio Placenta, Postpartum Hemorrhage, Eclampsia, and Shoulder Dystocia.

Research Methodology

Research Approach: Quantitative approach

Research Design: Non-equivalent Pretest-Post-test Control group Design

Research Setting: Selected Nursing colleges of Delhi NCR

Target Population: Undergraduate Midwifery Nursing students

Accessible Population: Undergraduate Midwifery Nursing students of Delhi NCR

Sample: Undergraduate Midwifery Nursing students of selected nursing colleges of Delhi NCR who fulfill inclusion and exclusion criteria

Sampling Technique: Simple Random sampling

Sample Size: 62(31 in each group) A priori sample size is calculated by G* Power software with 80% power, 5% significance level, 15% attrition rate)

Subjects will be allocated to experimental and control groups using computer-generated random numbers

Independent Variable: Simulation Based Education

Dependent Variables

·       Clinical Competency of Undergraduate Midwifery Nursing Students

·       Critical Thinking of Undergraduate Midwifery Nursing Students

Inclusion Criteria

·       Students who have cleared all subjects till the third year of B.Sc. Nursing Programme.

·       Students with a minimum 80% attendance in theory classes of Midwifery/Obstetrics and Gynecological Nursing Subject.

Exclusion Criteria

·       Students who are not willing to participate.

Tools and Techniques

Tools will be divided into three parts

Part A

Socio-demographical Profile

Part B

Tool to assess Critical thinking

Part C

Tool to assess clinical Competence

 

Sr. No.

Tool

Description of tool

Technique

Purpose

|A

Socio-demographic profile

It will consist of 5 items and collects data about socio-demographic profiles like Age, Gender, Area of Residence, Marks in Higher Secondary, Previous experience with Simulation

Self report, Paper and Pencil

To assess baseline variables and comparability of experimental and control group

|B

EMOC-CTAT

(Emergency Obstetric Care-Critical Thinking Assessment Tool)

A self-structured tool will be developed consisting of 20 problem-based Multiple-choice questions (5 questions for each obstetric emergency) Participants will be given 30 minutes to complete the Questionnaire

Self report, Paper and Pencil

To assess Critical thinking

|C

OSCE

Objective Structured Clinical Examination

A structured OSCE will be developed after an extensive literature review.

Direct One to One Observation at 4 stations

To assess clinical Competency

Reliability and Validity of the tools

·       Experts in the field of obstetrics and Gynecological Nursing will validate self-structured tools.

·       The Reliability of OSCE Checklist will be checked by interrater Reliability.

·       The Reliability of EMOC-CTAT (Emergency Obstetric Care-Critical Thinking Tool) will be assessed by split half method.

Intervention

Simulation based education

A simulation-based education module for the Management of Obstetric Emergencies will be developed consisting of:

Part A

Skill training checklists of Management of Abruptio Placenta, Postpartum Haemorrhage, Eclampsia and Shoulder Dystocia

Part B:

Case Studies of Abruptio Placenta, Postpartum Haemorrhage, Eclampsia and Shoulder Dystocia

Part B

Simulation Scenario of Abruptio Placenta, Postpartum Haemorrhage, Eclampsia and Shoulder Dystocia

The module will be developed after an extensive literature review following Govt. of India Guidelines. It will be validated by experts from the field of Obstetrics and Gynaecology The Simulation-based Education Module will be imparted over a training period of 5 days (5hours/day) Students in Experimental group will be divided into 5 subgroups  during the training period  Each group will attend training for 5 days (5hours/day)

Pilot Study Plan

After obtaining the ethical clearance and testing the validity and reliability of the tools, a pilot study will be conducted on 10 Post Basic B.Sc. Nursing 1st year students  5 in each group.

Data Collection

Phase I: Recruitment of Subjects

·       Subjects will be enrolled using Simple Random sampling techniques from selected colleges of Delhi NCR.

·       Students from the institution where the Simulation Facility is available will be placed in the Experiment group, and the Students from the institution where the Simulation Facility is not available will be placed in the Control group.

·       31 subjects will be placed in each group according to inclusion-exclusion criteria using computer-generated random numbers.

·       Students will be explained about the purpose of the study, and all queries will be addressed and Informed consent will be taken.

·       Sociodemographic Data will collected to ensure the homogeneity of groups.

Phase II: Pretest

·       Pretest will taken from both groups to obtain baseline information one week before the intervention.

Phase III- Intervention

·       Simulation based education will be given to experiment group.

·       Students of the control group will receive traditional midwifery training as per the syllabus.

Phase IV- Post test

·       Post test will be conducted after one week of the intervention and before clinical posting of both control and experimental group.

Plan of Data Analysis and Statistical Application

·       After the data collection, descriptive and inferential statistics will be used for the data analysis using a statistical program- IBM’s Statistical Package for the Social Sciences (SPSS).

·       A statistical significance of 0.05 (p< 0.05) will be adopted throughout the study.

·       Descriptive statistics like frequency percentage will be used to describe demographical characteristics of both groups.

·       Independent t test will be used to test Hypothesis 1 and 2

·       Karl Pearson’s coefficient of correlation will be used to test Hypothesis 3