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孕妇新生儿玛纳塔利 孕妇新生儿玛纳塔利

如何在模拟中少做更多的事情

改善孕产妇和新生儿护理

What High-Resource Organizations Can Learn From Low-Resource Simulation Success

2015年,怀孕期间和分娩后立即死亡30万妇女死亡。1这些死亡中有99%发生在发展中国家。2由Laerdal Medical资助的非营利组织Laerdal Global Health(LGH)制定了降低低资产社国家的母亲和婴儿死亡188体育直播比分率的计划。我们认为,可以从LGH的经验中学到很多东西,这些经验可以转移到高级课程的环境中。

LGH成立于2010年。与Jhiepego,美国儿科学会和后期圣徒教会合作,LGH帮助了发展中国家的新母亲和新生儿的健康。例如,在坦桑尼亚进行的一项研究测量了帮助婴儿呼吸计划的成功,在24小时内,新生儿死亡率持续降低了47%,两年后新生的死亡人数降低了24%。3these same solutions that have made a difference in Tanzania can do the same in the United States and elsewhere.

47%

早期新生儿死亡率的降低

24%

reduction in fresh stillbirths

尽管在美国,医疗设施和专业培训更加先进,但总有改进的余地。每年在美国,由于怀孕或分娩并发症,每年约有700名妇女死亡。4世界卫生组织(WHO)计算出大约一半是可以预防的。5幸运的是,使用仿真训练是识别和减少可预防错误的验证方法。

在本文中,我们分享了如何将Laerdal Global Health及其合作伙伴的经验转移到您的培训环境中,以改善孕产妇和新生儿护理。

the Fundamentals of Simulation Will Never Let You Down

In low-resource areas, educators have no choice but to do more with less. The experience of teaching with less in this case, though, has inspired educators to return to the basics of curricular design and the fundamentals of simulation.

大多数教育者会认为学习目标是任何班级中最重要的要素。提醒一句,没有有目的的学习目标,就没有理定的结果将您与学习者统一为教育者。

many experts recommend that you start with what your desired outcome is. Then, use thesm一个rtframework to craft your learning goals accordingly. Ask yourself if your learning goals are…

s特定 m可靠 一个可见 r真实 time绑定

LGH的目标是通过提供支持卫生工作者的工具和培训来帮助到2020年每年挽救40万人的生命。6By clearly defining what the organization aims to achieve, LGH can create solutions and programs to help get you there. You, too, can set yourself up for success by using the SMART method to create strong learning goals and, subsequently, strong learning objectives.

当您开始计划单个模拟时,请记住学习者的经验水平以及学习的设置。您可能没有专门的模拟实​​验室的资金 - 没关系!考虑一下LGH在坦桑尼亚的培训的设置,并以此为灵感来获得创造性的创造力,以利用您拥有的现有资源,教师和设备。

One study compared two simulations – one using a standardized patient at a local hospital and one using a high-fidelity simulator in a simulation lab. In both settings, there were equal improvements among the learners.7这证明了这一点模拟而不是模拟器的类型是开发学习者的关键。

Worldwide each year, 140 million women give birth.8为了改善新母亲和婴儿的生存,需要给予医疗保健专业人员参与和实现培训。遵守成人学习中最佳实践的模拟可以提供这一点。并非每种情况都需要高保真才能获得很高的学习回报。专家建议将模拟的水平与您创建的有效学习的经验相匹配。

使用低保真模拟作为起点

高保真模拟培训可以导致学习者技能获得的巨大改进。因此,许多教育工作者采用隧道视觉的形式只要高保真模拟和可以忽略ir desired outcome in the process. Those new to simulation may find funding such high-fidelity simulators challenging and those experienced in simulation may be blind to other, complimentary methods of teaching.

LGH的经验证明了低保真任务培训师和模拟器可以极大地提高学习者的技术技能和人际交往能力。没有电气要求或复杂的设置。通过与JHPIEGO合作开发的帮助母亲生存计划,我们看到产后出血降低了17%,保留胎盘降低了47%,降低了34%的胎盘静止病。9因此,您不应忽略低保真模拟作为选项。


有许多仿真方法可以选择...关键是选择提供与学习者积极参与的技术或方法。


在美国,产假费用超过600亿美元,但妇女在怀孕或分娩时仍在死亡。10一个nd, an estimated 60,000 women suffer complications that are near-fatal.11In response, some hospitals are beginning to implement more hands-on training to manage obstetric emergencies – and they are using simulation to accomplish this.

孕妇新生 - 释放 -  lgh1.jpg

If your simulation program does not have access to a full-body birthing simulator, low-fidelity simulation might be the answer. Birthing simulators and task trainers that can be used with a standardized patient offer an opportunity for learners to engage in real patient interactions. Learners can also practice essential skills for normal and complicated deliveries so that they are prepared to act in an emergency.

One study found that only 43% of learners could successfully address shoulder dystocia emergencies.12Following a simulated shoulder dystocia scenario, learners improved in the use of basic maneuvers, good patient communication, and higher successful delivery rate.13

Low-fidelity simulation is also a great supplement to your program if you具有一个完全发出的分娩模拟器。全身模拟器的技术可能会淹没母亲劳动母亲的护理程序的学习者。在这种情况下,在向他们介绍更身临其境的培训经验之前,使用低保真分娩模拟器或任务培训师可以确保您的学习者对自己的技能充满信心。

LGH’s experience training midwives and other healthcare professionals in rural areas shows the impact low-fidelity solutions can have. Whether your simulation experience level is high or low – or your facility is large or small – low-fidelity simulation is something to consider.

低保真模拟人生的成本效益的因素

创建现实的培训环境始终是一个挑战。再加上低资金,稀缺的教学资源以及有限的培训时间的复杂性,这可能会成为一个难题。LGH及其合作伙伴在世界各地亲眼目睹了这些挑战,并帮助医疗保健专业人员克服了这些挑战。

对于许多人来说,模拟培训解决方案是一项投资 - 不仅在改善学习成果方面,而且在不可避免的成本节省和对机构的责任下降。重要的是要记住,这些节省成本将以减少与伤害相关的伤害和成本的形式,而不是直接利润。

我们的目的是培训医疗保健专业人员提供最高质量的护理,并且有一些例子可以降低成本……我们正在教医疗保健专业人员在升级之前接受事情。

James Spaulding, BSN, RN, CCRN, Simulation Lab Coordinator, Saint Peter’s University Hospital**

低保真模拟在学习周期中占有一席之地。如果您的计划没有很多资金选择,则可以是一种有用的培训方法。高保真模拟可能是昂贵的,并且需要更大的初始投资,但是低保真模拟可以提供类似的资源的经验。14一个nd,低保真模拟可以帮助减轻诸如低教师专业知识和可用性之类的实施障碍。

在美国,规划社区外展的低预算诊所和组织可以从相同的成本意识心态中受益。由于众多的医院设施在低收入社区关闭,诊所正在接受高危患者的涌入。15to better prepare healthcare professionals in urban and rural clinics, the same task trainers and birthing simulators that have been used in low-resource countries should be a consideration in developing any training program.

In addition to the affordability of low-fidelity simulators and task trainers, they are simple and easy to use. Educators with little to no simulation experience can quickly learn how to set up a scenario and are able to make the most of their teaching time. This type of training efficiency allows many students to train in a single learning session and reduces a care team’s time off the floor. For organizations struggling to find time for training, we suggest low-fidelity solutions as a start.

选择投资于财务范围内的低保真产品仍可能导致患者伤害的大幅减少。金宝搏官方app下载易用性和生产力只是教育者和学员的额外奖励。

Use LGH's Guidance to Improve the Impact of your Simulations

In the United States, women are more likely to die from childbirth or pregnancy-related causes than other women in the developed world.16许多医院没有进行模拟,很有可能他们认为模拟是一项需要主要设施的昂贵努力。我们在LGH的经验表明,它不一定是。

While Laerdal Global Health’s not-for-profit efforts are focused on low-resource countries, their insight and experience can be used to positively influence training within the U.S. Most importantly, their experience in various communities around the world verifies that simulation can be effective in any learning setting – as long as educators have clear objectives and the tools to match.

references

  1. 世界卫生组织。(2018)。孕产妇死亡率。从...获得:https://www.who.int/news-room/fact-sheets/detail/maternal-mortality
  2. 同上
  3. https://www.aap.org/en-us/Documents/hbs_article_tanzania.pdf
  4. 疾病预防与控制中心。(2018)。与怀孕有关的死亡. Retrieved from:https://www.cdc.gov/reproductivehealth/maternalinfanthealth/pregnancy-relatedmortality.htm
  5. Agrawal,P。(2015年)。美利坚合众国的孕产妇死亡率和发病率。Bulletin of the World Health Organization, 93(3)。doi:http://dx.doi.org/10.2471/blt.14.148627
  6. Laerdal Global Health. (2018).帮助母亲和婴儿生存。从...获得:https://laerdalglobalhealth.com/
  7. Crofts, J.F., Winter, C., & Sowter, M.C. (2011). Practical simulation training for maternity care – where we are and where next. An International Journal of Obstetrics and Gynaecology.https://doi.org/10.1111/j.1471-0528.2011.03175.x
  8. 世界卫生组织。(2018)。making childbirth a positive experience. Retrieved from:https://www.who.int/reproductivehealth/intrapartum-care/en/
  9. https://surviveandthrive.org/about/Documents/Survive%20%20Trive%205%20year%20report%20FINAL.pdf
  10. World Heath Organization. (2018). See reference #8.
  11. 同上
  12. Crofts,J.F.,Bartlett,C.,Ellis,D.,Hunt,L.P.,Fox,R。和Draycott,T.J。(2006)。
  13. 同上
  14. Ellinas, H., Denseon, K., & Simpson, D. (2015). Low-cost simulation: How-to guide.《研究生医学教育杂志》,7(2). DOI:10.4300/JGME-D-15-00082.1
  15. 托马斯(L.公报。从...获得:http://newsinteractive.post-gazette.com/longform/stories/poorhealth/1/
  16. 疾病预防与控制中心。(2018)。see reference #4.

* Aebersold,M。(2018)。基于模拟的学习:不再是本科教育的新颖性. The Online Journal of Issues in Nursing, 23(2). Retrieved from:http://ojin.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/TableofContents/Vol-23-2018/No2-May-2018/Articles-Previous-Topics/Simulation-Based-Learning-Undergraduate-Education.html

**新泽西州医疗保健质量研究所。(2018)。take five with james Spaulding, bsn, rn, ccrn, sim lab coordinator at st. peter’s university hospital.从...获得:http://www.njhcqi.org/take-five-with-with-james-spaulding-bsn-rn-ccrn-ccrn-sim-lab-coordinator-at-s-peters-peters-university--university-hospital/

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