Project SOAR: Using Virtual Simulation to Support Rural Emergent Obstetric Care

Abstract : Maternal morbidity increases risk of maternal death. Rural women are at greater risk compared to urban women. Little evidence exists about simulation's effectiveness in increasing rural nurses' confidence and competence during obstetric emergencies.

Using a community-based participatory research framework, the purpose was to design and pilot a screen-based, rural health equity-focused obstetric simulation program for generalist rural nurses.

A mixed methods pre-post-test design was used. Through seven focus groups, the team identified postpartum hemorrhage and shoulder dystocia as obstetric emergencies for simulation training. Nineteen nurses were provided 4-hour repeated screen-based simulations aligned with INACSL Healthcare Simulation Standards of Best Practice. Kirkpatrick’s four-level training evaluation model (reaction, learning, behavior, and results) was used to evaluate simulation through a post-intervention questionnaire including the Simulation Effectiveness Tool-Modified, simulation performance scores, and a nurse leader questionnaire 3 months post-intervention.

Reaction: learners (95%) indicated training met or exceeded their expectations and would be beneficial for other rural nurses. Learning: average knowledge scores improved (pre-quiz (52%), post-quiz 1 (42%), and post-quiz 2 (72%) and average scenario performance improved (attempt 1 (51%) and attempt 2 (70%)). On average, learners 'somewhat agreed' or 'strongly agreed' training increased confidence and competence to respond to similar scenarios. Behavior: all learners reported intentions to apply knowledge/skills in the next 3 months. Nurse leaders reported training as effective, and a desire to increase complexity of the hemorrhage simulation for future training. Simulation holds promise to elevate rural nurse competence in managing infrequent, high-risk obstetric emergencies.





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