In a high-risk OB department doing 3600  births in 2010, the vaginal exams for cervical assessment were routinely performed by residents, attendings, and physician assistants employed by the teaching service.  Nurse managers in the department were anxious to change this practice, citing the need for labor and delivery nurses to be an active participant in the planning of their patient’s care.  This practice would also be an integral part of the Team Performance Plus concept which was being initiated at the hospital.

Proposed change:

The original request was to have the nurses be taught by the residents and then observed doing the skill.  A literature review revealed a number of different ways to approach this which seemed to have more validity in the education process.

Implementation, outcomes and evaluation:

    Cervical models were made, using directions from a website dedicated to education for residents and medical students.  An instructional video was also available on this site, to provide didactic content for the learners.  The Simulation Lab at the health system was able to purchase a teaching model to also be used in this program.  Nursing staff are assigned to this monthly course, taught by staff experienced in vaginal exams.  They view the video, look at some models of a cervix at various dilatations, and practice the exams on a clay model placed in a paper bag and on the purchased model, all of which have various degrees of dilatation and effacement.  Staff then take the skills checklist with this information documented, and are required to be signed off on 3 patient exams by a physician or resident.  This checklist is given to the educator as proof of their skill, which is a required competency for 2012.  These staff will then be expected to perform exams on their patients.

    Pre and post education surveys are being completed by staff to determine effectiveness of the training.  When all staff have completed the course, there will  be an evaluation of how this practice has changed patient outcomes.  This course has also been utilized in the Simulation lab by  the new OB residents who entered the hospital’s program in July of 2011.

Implications for nursing practice: This program shows how healthcare disciplines can share knowledge about teaching practices and insure better communication among healthcare providers.  

Keywords: cervical assessment, simulation, nursing skills, competency