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Understanding the Experience of Interprofessional Team Members After Participating in Comprehensive Obstetric Hemorrhage Training

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Understanding the Experience of Interprofessional Team Members After Participating in Comprehensive Obstetric Hemorrhage Training The Texas Medical Center Library DigitalCommons@TMC UT SON Dissertations (Open Access) School of Nursing Summer 8-2017 Understanding the Experience of Interprofessional Team Members after Participating in Comprehensive Obstetric Hemorrhage Training Frances Kelly Follow this and additional works at: https://digitalcommons.library.tmc.edu/uthson_etd Part of the Nursing Commons Recommended Citation Kelly, Frances, "Understanding the Experience of Interprofessional Team Members after Participating in Comprehensive Obstetric Hemorrhage Training" (2017). UT SON Dissertations (Open Access). 22. https://digitalcommons.library.tmc.edu/uthson_etd/22 This is brought to you for free and open access by the School of Nursing at DigitalCommons@TMC. It has been accepted for inclusion in UT SON Dissertations (Open Access) by an authorized administrator of DigitalCommons@TMC. For more information, please contact [email protected]. EXPERIENCE OF INTERPROFESSIONAL TEAM MEMBERS AFTER PARTICIPATING IN A COMPREHENSIVE OBSTETRIC HEMORRHAGE TRAINING PROGRAM __________________________________________________________________ A DISSERTATION SUBMITTED IN PARTIAL FULFILLMENT OF THE REQUIREMENTS FOR THE DEGREE OF DOCTOR OF PHILOSOPHY IN NURSING THE UNIVERSITY OF TEXAS HEALTH SCIENCE CENTER AT HOUSTON SCHOOL OF NURSING BY FRANCES C. KELLY, MSN, RNC-OB, CPHQ, CPPS ___________________________________________________ AUGUST, 2017 Acknowledgements First and foremost I wish to acknowledge the boundless blessings that God has bestowed upon me during my entire doctoral program. He has never left me during this or any other circumstance. Without my gracious and merciful God, I would not have been able to complete this program. And to Him, I will be eternally grateful. Next, I wish to express my deep gratitude to my family and friends. I could not have finished without the steadfast support and encouragement from my husband, Jeff Kelly; and our children Ben and Eden Kelly; Katy and Tyson Young; and Wynn, Clay, Joseph, and Luke Kelly. Thank you to Dona Creech, my mother, for being there into the wee hours listening to my hopes and fears, and to my sisters Dona Kemp and Julia Davis. Thank you Shirley Kelly, my mother-in-law, for always believing in me. Thank you dear friends Cathy Robertson, Vicki Christie, Madelene Ottosen, Leslie Miles, Leisa McMullen, Susan Swart, Charley Elliott, and Suzanne McMurtry Baird. If it had not been for the support and encouragement that I received from my family and friends, I would not have successfully completed this program. I also wish to acknowledge and thank Dr. Diane Wardell, my advisor, and the chairperson of my dissertation committee. Dr. Wardell has supported and encouraged me throughout this doctoral program, and for that I will be forever grateful. Drs. Joan Engebretson, Wycke Baker, and Lynda Tyer-Viola provided invaluable insight and support as members of my dissertation committee. Thank you also to Dr. Nancy Hurst who served as a co-facilitator during my research. They have all helped me to develop as a novice researcher, and to them I extend my thanks. iii And last, but not least, I want to thank Texas Children’s Hospital for allowing me to conduct my research there. I also wish to thank the team members from the Pavilion for Women who trusted me and were willing to share their experiences after participating in the obstetric hemorrhage program. Their feedback is precious, and will be used to improve the care for obstetric patients. iv Frances C. Kelly, PhD(c), MSN, RNC-OB, NEA-BC, CPHQ, CPPS August, 2017 Understanding the Experience of Interprofessional Team Members after Participating in Comprehensive Obstetric Hemorrhage Training Abstract Purpose: The obstetric hemorrhage rate has risen steadily in the U.S. accounting for 11.4% of maternal deaths between 2011 and 2013, and remains a leading cause of maternal morbidity. Improving the quality and safety of care could prevent much of the morbidity and potential mortality associated with obstetric hemorrhages. An interprofessional obstetric team developed, tested, and implemented obstetric hemorrhage and massive transfusion protocols. Multi-modal team training occurred before service- wide implementation of the protocols, including didactic, skills stations, on-line educational modules, and in situ simulation team training. Early quantitative results were promising. Methods: To augment understanding of the quantitative results and to understand the experience of interprofessional team members after participating in obstetric hemorrhage training; an exploratory, medically-focused, ethnographic qualitative study was conducted in a five-year old obstetric service within a large, metropolitan, tertiary, free-standing pediatric hospital. Participants were purposively sampled from interprofessional obstetric team members who cared for obstetric hemorrhage patients and participated in hemorrhage training. Data was generated during field observations, and individual and focus group interviews. Results: Twenty (n = 91 participants) semi-structured interviews were conducted. An inductive, descriptive thematic analysis of the data revealed two central themes: Knowing, and Teaming. Knowing was influenced by training and experience with obstetric hemorrhages, and was v further influenced by interactions among members of the interprofessional obstetric team within the complex, non-linear environment. Teaming was reported as a compelling benefit of engaging the interprofessional obstetric team in simulation team training. Simulation training helped the team know how to use the protocols, and improved team functioning during obstetric hemorrhages. Conclusions: Similar to Benner’s model, training and experience influenced the knowing that obstetric team members applied during an obstetric hemorrhage event. Simulation team training promoted teaming, which helped the interprofessional obstetric team to effectively and efficiently manage an obstetric hemorrhage. Keywords: obstetric hemorrhage, training, simulation, knowing, teaming vi 1 Summary of the Study Despite a focus on reducing maternal mortality and morbidity, the rate of obstetric hemorrhages has risen steadily in the U.S. accounting for 11.4% of maternal deaths between 2011 and 2013, and remains a leading cause of maternal morbidity. An exploratory, medically-focused, ethnographic qualitative approach was applied to achieve the aim of this dissertation project, which was to understand the experience of the interprofessional team members after participating in a comprehensive obstetric hemorrhage training program. This dissertation is comprised of two sections: 1) the research proposal and 2) an initial manuscript including the findings. The specific aim of the study proposal was to understand the experience among interprofessional obstetric team members who provide care to obstetric hemorrhage patients, and at least some of whom have participated in comprehensive obstetric hemorrhage training. It took longer than anticipated to navigate the preliminary research study proposal review process at the study site. Once this preliminary approval was secured, the study proposal was approved at both relevant institutional review boards (Appendices A and B). Data collection began in February of 2017 and concluded in June of 2017 (Appendices C-G). Iterative analysis began soon after data collection began that incorporated peer debriefing sessions, and concluded in early July 2017. The initial manuscript includes the results which address the aim of the dissertation project. The results were derived through an inductive, descriptive, thematic analysis of the data, supported by coding of the study data. The two central themes of Knowing and Teaming were supported by numerous participant exemplars. Similar to Benner’s model, training and experience influenced the knowing that obstetric team members applied during an obstetric hemorrhage event. As illustrated in a derived 2 conceptual framework, knowing was further influenced by the interactions among members of the interprofessional obstetric team within the complex, non-linear health care environment in which obstetric hemorrhages occurred. Teaming was reported to be a result of communication, team cohesion, role clarity, resource availability, and leading among members of the interprofessional obstetric team; knowing and trusting members of the interprofessional team; and taking prompt actions during an obstetric hemorrhage. Simulation team training helped the team know how to use the obstetric hemorrhage and massive transfusion protocols, and promoted elements of teaming which helped the interprofessional obstetric team to effectively and efficiently manage an obstetric hemorrhage. The results of this dissertation study are transferrable to other interprofessional obstetric teams who are working to reduce mortality and morbidity associated with obstetric hemorrhage. Recommendations for further research were included. 3 Understanding the Experience of Interprofessional Team Members after Participating in Comprehensive Obstetric Hemorrhage Training Frances Kelly, PhD(c), MSN, RNC-OB, NEA-BC, CPHQ The University of Texas Health Science Center at Houston, School of Nursing Submitted in Partial Fulfillment of PhD in Nursing Program June 1, 2016 4 Introduction and Specific Aim Despite the Healthy People 2020 goal to decrease the rate of maternal mortality to no more than 11.4 maternal deaths for every 100,000 live births, this rate has risen steadily in the United States from
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