Aims and objectives. To examine whether interprofessional simulation training on management of postpartum haemorrhage enhances self-efficacy and collective efficacy and reduces the blood transfusion rate after birth. Background. Postpartum haemorrhage is a leading cause of maternal morbidity and mortality worldwide, although it is preventable in most cases. Interprofessional simulation training might help improve the competence of health professionals dealing with postpartum haemorrhage, and more information is needed to determine its potential. Design. Multimethod, quasi-experimental, pre-post intervention design. Methods. Interprofessional simulation training on postpartum haemorrhage was implemented for midwives, obstetricians and auxiliary nurses in a university hospital. Training included realistic scenarios and debriefing, and a measurement scale for perceived postpartum haemorrhage-specific self-efficacy, and collective efficacy was developed and implemented. Red blood cell transfusion was used as the dependent variable for improved patient outcome pre-post intervention. Results. Self-efficacy and collective efficacy levels were significantly increased after training. The overall red blood cell transfusion rate did not change, but there was a significant reduction in the use of ≥5 units of blood products related to severe bleeding after birth. Conclusion. The study contributes to new knowledge on how simulation training through mastery and vicarious experiences, verbal persuasion and psychophysiological state might enhance postpartum haemorrhage-specific self-efficacy and collective efficacy levels and thereby predict team performance. The significant reduction in severe postpartum haemorrhage after training, indicated by reduction in ≥5 units of blood transfusions, corresponds well with the improvement in collective efficacy, and might reflect the emphasis on collective efforts to counteract severe cases of postpartum haemorrhage.What does this paper contribute to the wider global clinical community?• Research supports future team training on postpartum haemorrhage. Faculty should be aware of the importance of mastery and vicarious experiences, verbal persuasion and psychophysiological state for increased efficacy.• Simulation training can prepare staff to handle clinical emergencies and follow-up after experienced emergencies. Full participation of all staff is likely to be crucial for improved patient outcomes.• Future research should evaluate interprofessional simulation training programmes to identify the crucial factors for improved outcomes related to prevention, identification and treatment of postpartum haemorrhage. Relevance to clinical practice. Interprofessional simulation training in teams may contribute to enhanced prevention and management of postpartum haemorrhage, shown by a significant increase in perceived efficacy levels combined with an indicated reduction of severe postpartum haemorrhage after training.

Aims and objectives To explore chronic heart failure patients’ perceptions of the burden related to treatment and self‐care. Background Living with chronic heart failure entails following a demanding treatment regimen, with daily self‐care, which could make patients vulnerable to experiencing treatment burden. Burden of treatment is defined as the “work” the healthcare system passes on to the patients with respect to self‐care at home, and the impact this has on well‐being and quality of life. However, the burden of treatment is an emergent framework, and further research exploring burden among heart failure patients is required. Design Qualitative study employing semi‐structured interviews and content analysis. The study complied with the Consolidated Criteria for Reporting Qualitative Research (COREQ). Methods A sample of 17 heart failure patients recruited from an outpatient clinic in Norway. Interview transcripts were coded in Nvivo 11 and analysed using Malterud's systematic text condensation. Results Two main themes “emotional challenge” and “troublesome self‐care” emerged from the analysis. The first theme contained the following subthemes: “a new life situation,” “monitoring body signals,” “difficult transitions” and “feelings of guilt.” The second theme consisted of the subthemes “poor care coordination,” “lack of information and education” and “troublesome medication.” Conclusion Heart failure treatment constitutes challenges related both to self‐care and to emotional burden. The latter not previously clearly articulated in the concept of burden of treatment. Many patients are struggling emotionally, and this affects their self‐care ability in addition to affecting their well‐being and quality of life. Relevance to Clinical Practice Nurses are in a strategic position to play a pivotal role in identifying and responding to the emotional burden of treatment in heart failure patients, furthermore to guide and support in discharge planning and in outpatient setting to reduce the patients’ emotional distress and fear of failing.

BackgroundPostpartum hemorrhage (PPH) is a major cause of maternal morbidity and mortality. In Tanzania, PPH causes 25% of maternal deaths. Skilled attendance is crucial to saving the lives of mothers and their newborns during childbirth.This study is a follow-up after multi-professional simulation training on PPH in northern Tanzania. The purpose was to enhance understanding and gain knowledge of important learning features and outcomes related to multi-professional simulation training on PPH.MethodsThe study had a descriptive and exploratory design. After the second annual simulation training at two hospitals in northern Tanzania, ten focus group discussions comprising 42 nurse midwives, doctors, and medical attendants, were carried out. A semi-structured interview guide was used during the discussions, which were audio-taped for qualitative content analysis of manifest content.ResultsThe most important findings from the focus group discussions were the importance of team training as learning feature, and the perception of improved ability to use a teamwork approach to PPH. Regardless of profession and job tasks, the informants expressed enhanced self-efficacy and reduced perception of stress. The informants perceived that improved competence enabled them to provide efficient PPH management for improved maternal health. They recommended simulation training to be continued and disseminated.ConclusionLearning features, such as training in teams, skills training, and realistic repeated scenarios with consecutive debriefing for reflective learning, including a systems approach to human error, were crucial for enhanced teamwork. Informants’ confidence levels increased, their stress levels decreased, and they were confident that they offered better maternal services after training.

ObjectiveTo investigate whether inter-professional simulation training influenced the rate of red blood cell (RBC) transfusions after birth.DesignTwo cohorts were compared retrospectively using a pre–post design.SettingNorwegian university hospital with 4800 deliveries annually.PopulationWomen with estimated blood loss >500 mL within 24 h after birth in 2009 and 2011.MethodsIn 2010, all maternity staff attended a 6-h, scenario-based training on emergency obstetrics including postpartum hemorrhage, using a birthing simulator. The simulation focused on prevention, identification, and treatment of postpartum hemorrhage and on communication and leadership. Debrief immediately after the scenarios involved reflection and self-assessment.Main outcome measuresThe frequency of women receiving RBC transfusions as a marker for blood loss. Secondary outcome was the frequency of surgical procedures in the management of postpartum hemorrhage.ResultsIn 2009, 111/534 (20.8%) women with estimated blood loss >500 mL after birth received RBC transfusions vs. 67/546 (12.3%) in 2011 (p < 0.01). The adjusted odds ratio for women receiving RBC transfusions in 2011 vs. 2009 was 0.53 (95% CI 0.38–0.74). Parity, oxytocin augmentation, duration of second stage, episiotomy, operative vaginal delivery, and sphincter injury were included in the final model. The odds ratio was stable in all combinations of possible confounders. We observed a significant reduction in the frequencies of curettage (p < 0.01) and uterine artery embolizations (p = 0.01).ConclusionWe found a significant reduction in RBC transfusions after birth, which might be associated with mandatory simulation training. A causal link cannot be documented because of complex interactions of several variables.

BackgroundTanzania has a relatively high maternal mortality ratio of 410 per 100,000 live births. Severe postpartum hemorrhage (PPH) is a major cause of maternal deaths, but in most cases, it is preventable. However, most pregnant women that develop PPH, have no known risk factors. Therefore, preventive measures must be offered to all pregnant women.This study investigated the effects of multi-professional, scenario-based training on the prevention and management of PPH at a Tanzanian zonal consultant hospital. We hypothesized that scenario-based training could contribute to improved competence on PPH-management, which would result in improved team efficiency and patient outcome.MethodsThis quasi-experimental, pre-vs. post-interventional study involved on-site multi-professional, scenario-based PPH training, conducted in a two-week period in October 2013 and another 2 weeks in November 2014. Training teams included nurses, midwives, doctors, and medical attendants in the Department of Obstetrics and Gynecology. After technical skill training on the birthing simulator MamaNatalie®, the teams practiced in realistic scenarios on PPH. Each scenario was followed by debriefing and repeated scenario. Afterwards, the group swapped roles and the observers became the participants.To evaluate the effects of training, we measured patient outcomes by determining blood transfusion rates. Patient data were collected by randomly sampling Medical birth registry files from the pre-training and post-training study periods (n = 1667 and 1641 files, respectively). Data were analyzed with the Chi-square test, Mann-Whitney U-test, and binary logistic regression.ResultsThe random patient samples (n = 3308) showed that, compared to pre-training, post-training patients had a 47% drop in whole blood transfusion rates and significant increases in cesarean section rates, birth weights, and vacuum deliveries. The logistic regression analysis showed that transfusion rates were significantly associated with the time period (pre- vs. post-training), cesarean section, patients tranferred from other hospitals, maternal age, and female genital mutilation and cutting.ConclusionsWe found that multi-professional, scenario-based training was associated with a significant, 47% reduction in whole blood transfusion rates. These results suggested that training that included all levels of maternity staff, repeated sessions with realistic scenarios, and debriefing may have contributed to reduced blood transfusion rates in this high-risk maternity setting.