Decision making and situational awareness in neonatal resuscitation in low resource settings

Maria Elena Cavicchiolo; Francesco Cavallin; Alex Staffler; Damiano Pizzol; Eduardo Matediana; Olivier Manzungu Wingi; Liviana Da Dalt; Giovanni Putoto; Daniele Trevisanuto

doi:10.1016/j.resuscitation.2018.10.034

Decision making and situational awareness in neonatal resuscitation in low resource settings

Resuscitation. 2019 Jan:134:41-48. doi: 10.1016/j.resuscitation.2018.10.034. Epub 2018 Nov 1.

Authors

Maria Elena Cavicchiolo¹, Francesco Cavallin², Alex Staffler³, Damiano Pizzol⁴, Eduardo Matediana⁵, Olivier Manzungu Wingi⁶, Liviana Da Dalt⁷, Giovanni Putoto⁴, Daniele Trevisanuto⁸

Affiliations

¹ Department of Woman's and Child's Health, University of Padua, Padua, Italy; Doctors with Africa CUAMM, Padua, Italy.
² Independent Statistician, Solagna, Italy.
³ Division of Neonatology, Central Teaching Hospital of Bolzano/Bozen, Italy.
⁴ Doctors with Africa CUAMM, Padua, Italy.
⁵ Department of Obstetrics and Gynaecology, Beira Central Hospital, Beira, Mozambique.
⁶ Pediatric Department, Beira Central Hospital, Beira, Mozambique.
⁷ Department of Woman's and Child's Health, University of Padua, Padua, Italy.
⁸ Department of Woman's and Child's Health, University of Padua, Padua, Italy. Electronic address: daniele.trevisanuto@unipd.it.

PMID: 30391367
DOI: 10.1016/j.resuscitation.2018.10.034

Abstract

Introduction: Data on non-technical skills (i.e. task management, team working, situation awareness and decision-making) of healthcare providers during real-life newborn resuscitation in low-resource settings are lacking. We aimed to assess non-technical skills of trained midwives during real-life newborn resuscitation in a low-resource setting before and after participation in a modified NRP course, and after a low-dose/high-frequency training.

Methods: One-hundred and fifty video-recorded resuscitations (50 before and 50 after participation in a modified NRP course, and 50 after a low-dose/high-frequency training) collected at the Beira Central Hospital (Mozambique) were independently viewed and rated by two neonatologists with expertise in high fidelity simulation. Non-technical skills regarding task management, situation awareness and decision-making were evaluated using the modified Anesthetists' Non-Technical Skills tool.

Results: Overall, most non-technical skills were scored as poor or marginal. Small improvements were observed in task management (planning and preparing p = 0.02; providing/maintaining standards p = 0.03) after the course. Limited improvements were observed in task management (prioritizing p = 0.03; providing/maintaining standards p = 0.04; identifying and utilizing resources p = 0.02) and decision-making (identifying options p = 0.04; balancing risk/selecting options p = 0.02) after the low-dose/high-frequency training. No differences were observed in situation awareness, apart from a small improvement in recognizing/understanding (p = 0.04) after the low-dose/high-frequency training.

Conclusion: An educational intervention including a modified NRP course and a low-dose/high-frequency training on neonatal resuscitation had a limited impact on non-technical skills of participants. All items remained significantly under the recommended standards. Behavioral skills should be considered in training programs in order to improve the quality of neonatal resuscitation in low resource settings.

Keywords: Education; Low-resource setting; Neonatal resuscitation; Non-technical skills.

MeSH terms

Adult
Awareness
Clinical Competence*
Decision Making*
Female
Humans
Infant, Newborn
Midwifery / education*
Mozambique
Postnatal Care / standards
Poverty Areas
Pregnancy
Resuscitation / education*
Task Performance and Analysis
Video Recording
Young Adult