"I Felt Scared": Achieving Realism with Low-Tech Simulation

Purpose for the program: The use of simulation to increase team confidence and competence in responding to obstetric emergencies is well-documented in the literature.  However, limits on both human and financial resources make the purchase and operation of high-fidelity simulators challenging in many organizations.  Some literature indicates that setting appropriate goals for simulation as well as conducting effective debriefing sessions, rather than the use of high-fidelity simulators, are the most significant drivers of enhanced team performance associated with simulation. 

As a relatively new Perinatal Clinical Educator, I recognized our staff’s need for simulation.  One of my physician partners was convinced that high-fidelity simulation was the only effective way to accomplish this learning modality.  However, after attending a one-day course on the programming and operation of this mannequin, I was daunted by the prospect of learning to use the equipment effectively.  Because the male mannequin cannot simulate hemorrhage like an obstetric simulator can, I held doubts that the staff would not be distracted by the fact that our mannequin was a man.

Proposed change: Wanting to accomplish successful simulation with the means I had available, I worked with our simulation coordinator to develop appropriate goals for a low-fidelity postpartum hemorrhage simulation.   

Implementation, outcomes and evaluation: I concocted non-staining “blood”, developed a realistic scenario, used a colleague as a standardized patient, partnered with the blood bank to obtain expired blood for use during simulation, and garnered the support of two obstetricians to participate in our “hemorrhage”.  Intravenous (IV) arms from the clinical skills lab were used during to allow staff to feel the pressure of having to start IVs in an emergency situation, and the postpartum hemorrhage cart was a key part of our simulation.  The nursing shift manager, anesthesia, pharmacy and the operating room were all included in the simulation to allow testing of the integrity of systems and processes.  Staff completed a brief pre-test prior to a briefing, and then took an identical post-test after the debriefing.  The average improvement in test scores was approximately 10 points. 

Both the staff and the physicians who participated in the simulations were extremely satisfied with the event.  Evaluations indicated improved knowledge and confidence as well as a genuine feeling that the event was “real”.  Several staff members stated “I felt scared”.  Potential communication and process breakdowns were identified and have since been addressed.  

Implications for nursing practice: With proper planning and execution, low-fidelity simulation can be an effective means of team training.

Keywords: simulation, low-fidelity, postpartum hemorrhage