Obstetrik Acillerde Simülasyon Eğitimi ve İnterdisipliner Yaklaşım

Yıl 2019, Cilt: 8 Sayı: 2, 62 - 71, 29.06.2019

Merve Mert Karadaş , Füsun Terzioğlu

Öz

Obstetrik
aciller, gebelikte veya doğumda anne ve çocuğun sağlığını tehdit edebilen
gebelik ile ilgili durumlardır. Bu tür acil durumlar,  her zaman meydana gelebilir hem anne hem de
fetüs/yenidoğan için sınırlı bir zamanda uygun müdahale, doğru ve etik karar
vermeyi gerektirir. Yaşamı tehdit eden obstetrik acillerin uygun şekilde
yönetilmesi, ekip içerisinde hızlı bir koordinasyon, beceri ve etkili bir
iletişim gerektirdiği için riskli bir durumdur. Bu nedenle, her ekip üyesi
obstetrik acillerin yönetiminde, diğer ekip üyelerinin rolleri ve
sorumlulukları konusunda bilgi sahibi olmalıdır. Obstetrik acillerin
yönetiminde interdisipliner eğitim ise, mesleklerarası işbirliğinin
sağlanmasında ve hasta bakımının güçlendirilmesinde  etkili bir yaklaşımdır. Sağlık hizmetlerinde,
hasta güvenliğinin sağlanması, bütüncül bakım anlayışıyla ekip yaklaşımının
sunulması ancak nitelikli yetişmiş sağlık profesyonelleri ile mümkündür. Sağlık
profesyonellerinin bu anlayış ile yetiştirilmesinde en etkili öğretim yaklaşımı
ise simülasyon eğitimidir. İnterdisipliner simülasyon eğitimi, hasta
güvenliğini sağlama ve hasta sonuçlarını iyileştirmek için etkili bir
potansiyele sahiptir ve sağlık personelinin işbirliği içeresinde çalışabileceği
gerekli bilgi ve beceriye katkıda bulunabilir. Sağlık alanında eğitim alan
öğrencilerin hastayla karşılaşmadan önce uygulama becerilerini arttırmak,
deneyimli sağlık personelinin becerilerini geliştirmek veya ekiplerin acil
durumlara hazırlanmalarını sağlamak için simülasyon eğitiminde interdisipliner
yaklaşım pratik ve güvenilir bir yoldur. Bu derlemede, obstetrik acillerde
simülasyonun kullanım alanları ve interdisipliner simülasyon eğitimi ele
alınacaktır.

Anahtar Kelimeler

Obstetrik Aciller, İnterdisipliner Eğitim, Ekip Yaklaşımı, Simülasyon

Kaynakça

• 1. Noblot, E., Raia-Barjat, T., Lajeunesse, C., Trombert, B., Weiss, S., Colombié, M., Chauleur, C. (2015). “Training program for the management of two obstetric emergencies within a French perinatal care network”. European Journal of Obstetrics Gynecology and Reproductive Biology, 189, 101–105. https://doi.org/10.1016/j.ejogrb.2015.03.019
• 2. Zhang, C., Miller, C., Volkman, K., Meza, J., Jones, K. (2015). “Evaluation of the team performance observation tool with targeted behavioral markers in simulation-based interprofessional education”. Journal of Interprofessional Care, 29(3), 202–208. https://doi.org/10.3109/13561820.2014.982789
• 3. Liaw, S. Y., Siau, C., Zhou, W. T., Lau, T. C. (2014). “Interprofessional simulation-based education program: A promising approach for changing stereotypes and improving attitudes toward nurse-physician collaboration”. Applied Nursing Research, 27(4), 258–260. https://doi.org/10.1016/j.apnr.2014.03.005
• 4. Joint Commission on Accreditation of Healthcare Organizations. (2017). Joint Commission on Accreditation of Healthcare Organizations: Sentinel Event Alert Inadequate hand-off communication. Erişim Adresi: https://www.jointcommission.org/assets/1/18/SEA_58_Hand_off_Comms_9_6_17_FINAL_(1).pdf
• 5. Freeth, D., Ayida, G., Berridge, E. J., Mackintosh, N., Norris, B., Sadler, C., Strachan, A. (2009). “Multidisciplinary Obstetric Simulated Emergency Scenarios (MOSES): Promoting Patient Safety in Obstetrics with Teamwork-Focused Interprofessional Simulations”. Journal of Continuing Education in The Health Professions, 29(2), 98–104. https://doi.org/10.1002/chp
• 6. Monod, C., Voekt, C. A., Gisin, M., Gisin, S., Hoesli, I. M. (2014). “Optimization of competency in obstetrical emergencies: A role for simulation training”. Archives of Gynecology and Obstetrics, 289(4), 733–738. https://doi.org/10.1007/s00404-013-3111-6
• 7. Sarfati, L., Ranchon, F., Vantard, N., Schwiertz, V., Larbre, V., Parat, S., … Rioufol, C. (2018). “Human-simulation-based learning to prevent medication error: A systematic review”. Journal of Evaluation in Clinical Practice. https://doi.org/10.1111/jep.12883
• 8. Siassakos, D., Fox, R., Bristowe, K., Angouri, J., Hambly, H., Robson, L., Draycott, T. J. (2013). “What makes maternity teams effective and safe? Lessons from a series of research on teamwork, leadership and team training”. Acta Obstetricia et Gynecologica Scandinavica. https://doi.org/10.1111/aogs.12248
• 9. Schmitt, M., Blue, A., Aschenbrener, C. A., Viggiano, T. R. (2011). “Core Competencies for Interprofessional Collaborative Practice”. Academic Medicine, 86(May), 1351. https://doi.org/10.1097/ACM.0b013e3182308e39
• 10. Reeves, S., Perrier, L., Goldman, J., Freeth, D., Zwarenstein, M. (2013). “Interprofessional education: effects on professional practice and healthcare outcomes (update)”. Cochrane Database of Systematic Reviews (Online), 3(3), CD002213. https://doi.org/10.1002/14651858.CD002213.pub3
• 11. Prasad, D., Nishat, H., Tiwary, B., Nisha, S., Sinha, A., Goel, N. (2018). “Review of obstetrical emergencies and fetal out come in a tertiary care centre”. International Journal of Research in Medical Sciences, 6(5), 1554–1558. http://dx.doi.org/10.18203/2320-6012.ijrms20181467
• 12. Levine, A. I., DeMaria Jr, S., Schwartz, A. D., Sim, A. J. (2013). The Comprehensive Textbook of Healthcare Simulation. London: Springer Science & Business Media. https://doi.org/10.1007/978-1-4614-5993-4
• 13. Fransen, A. F., Banga, F. R., van de Ven, J., Mol, B. W. J., Oei, S. G. (2015). “Multi-professional simulation-based team training in obstetric emergencies for improving patient outcomes and trainees’ performance”. Cochrane Database of Systematic Reviews, 2015(2). https://doi.org/10.1002/14651858.CD011545
• 14. Maslovitz, S., Barkai, G., Lessing, J. B., Ziv, A., Many, A. (2007). “Recurrent obstetric management mistakes identified by simulation”. Obstetrics and Gynecology, 109(6), 1295–1300. https://doi.org/10.1097/01.AOG.0000265208.16659.c9
• 15. Gaba, D. M. (2007). “The future vision of simulation in healthcare. Simulation in Healthcare”. Journal of the Society for Simulation in Healthcare, 2(2), 126–135. https://doi.org/10.1097/01.SIH.0000258411.38212.32
• 16. Grable, I. A., Ochoa, P. (2011). “Simulations in obstetrics”. Disease-a-Month, 57(12), 763–774. https://doi.org/10.1016/j.disamonth.2011.08.005
• 17. Physicians American Academy of Family, American Academy of Pediatrics, American College of Nurse-Midwives, American College of Obstetricians and Gynecologists, American College of Osteopathic Obstetricians & Gynecologists, Association of Women’s Health, O. and N. N., Medicine, S. for M.-F. (2011). Quality Patient Care on Labor and Delivery: A Call to Action. Erişim Adresi: https://www.acog.org/About-ACOG/ACOG-Departments/Patient-Safety-and-Quality-Improvement/Quality-Patient-Care-in-Labor-and-Delivery-A-Call-to-Action, Erişim Tarihi: 22.08.2018
• 18. Terzioğlu, F., Tuna, Z., Duygulu, S., Boztepe, H., Kapucu, S., Ozdemir, L., … Festini, F. (2013). “Use of Simulation in Nursing Education: Initial Experiences on a European Union Lifelong Learning Programme - Leonardo da Vinci Project”. Journal of Curriculum and Teaching, 2, 34–41.
• 19. Terzioğlu, F., Yücel, C., Koç, G., Şimşek, S., Yaşar, B. N., Şahan, F. U., … Yildirim, S. (2016). “A new strategy in nursing education: From hybrid simulation to clinical practice”. Nurse Education Today, 39. https://doi.org/10.1016/j.nedt.2016.01.009
• 20. Mert, M. (2015). Postpartum Kanamanın Yönetiminde Hemşirelik Öğrencilerinin Bilgi ve Becerilerinin Geliştirilmesinde Farklı Simülasyon Yöntemlerinin Etkinliğinin Değerlendirilmesi. Sağlık Bilimleri Enstitüsü. Yüksek Lisans Tezi, Ankara.
• 21. Mehta, S. H., Blackwell, S. C., Bujold, E., Sokol, R. J. (2006). “What factors are associated with neonatal injury following shoulder dystocia?”. Journal of Perinatology, 26(2), 85–88. https://doi.org/10.1038/sj.jp.7211441
• 22. Mehta, S. H., Sokol, R. J. (2014). “Shoulder dystocia: Risk factors, predictability, and preventability”. Seminars in Perinatology, 38(4), 189–193. https://doi.org/10.1053/j.semperi.2014.04.003
• 23. Deering, S., Poggi, S., Macedonia, C., Gherman, R., Satin, A. J. (2004). “Improving resident competency in the management of shoulder dystocia with simulation training”. Obstetrics and Gynecology, 103(6), 1224–1228. https://doi.org/10.1097/01.AOG.0000126816.98387.1c
• 24. Crofts, J. F., Bartlett, C., Ellis, D., Hunt, L. P., Fox, R., Draycott, T. J. (2006). “Training for shoulder dystocia: A trial of simulation using low-fidelity and high-fidelity mannequins”. Obstetrics and Gynecology, 108(6), 1477–1485. https://doi.org/10.1097/01.AOG.0000246801.45977.c8
• 25. Goffman, D., Heo, H., Chazotte, C., Merkatz, I. R., Bernstein, P. S. (2008). “Using simulation training to improve shoulder dystocia documentation”. Obstetrics and Gynecology, 112(6), 1284–1287. https://doi.org/10.1097/AOG.0b013e31818c177b
• 26. Draycott, T. J., Crofts, J. F., Ash, J. P., Wilson, L. V., Yard, E., Sibanda, T., Whitelaw, A. (2008). “Improving neonatal outcome through practical shoulder dystocia training”. Obstetrics and Gynecology, 112(1), 14–20. https://doi.org/10.1097/AOG.0b013e31817bbc61
• 27. Deering, S., Rowland, J. (2013). “Obstetric emergency simulation”. Seminars in Perinatology. https://doi.org/10.1053/j.semperi.2013.02.010
• 28. Say, L., Chou, D., Gemmill, A., Moller, A. B., Daniels, J., Metin, A., … Alkema, L. (2014). “Global causes of maternal death: A WHO systematic analysis”. The Lancet Global Health, 2(6), 323–333. https://doi.org/10.1016/S2214-109X(14)70227-X
• 29. Halk Sağlığı Genel Müdürlüğü. (2017). Anne Ölümleri İzleme Programı. Erişim Adresi: http://www.tuseb.gov.tr/tacese/yuklemeler/ekitap/Anne Ölümleri İzleme Programı.pdf, Erişim Tarihi: 10.09.2018
• 30. Joint Commission on Accreditation of Healthcare Organizations. (2004). Joint Commission on Accreditation of Healthcare Organizations: Sentinel Event Alert Preventing infant death and injury during delivery. Erişim Adresi: https://www.jointcommission.org/assets/1/18/SEA_30.PDF, Erişim Tarihi: 10.09.2018
• 31. Kato, C., Kataoka, Y. (2017). “Simulation training program for midwives to manage postpartum hemorrhage: A randomized controlled tria”l. Nurse Education Today, 51, 88–95. https://doi.org/10.1016/j.nedt.2017.01.005
• 32. Carvalho Pinto de Melo, B., Rodrigues Falbo, A., Sorensen, J. L., van Merriënboer, J. J. G., van der Vleuten, C. (2018). “Self-perceived long-term transfer of learning after postpartum hemorrhage simulation training”. International Journal of Gynecology and Obstetrics. https://doi.org/10.1002/ijgo.12442
• 33. Cunningham, F. G., Leveno, K. J., Bloom, S. L., Hauth, J. C., Rouse, D. J., Spong, C. Y. (2010). Pregnancy Hypertension. In Williams Obstetrics, 23e. New York, NY: The McGraw-Hill Companies. Erişim adresi: accessmedicine.mhmedical.com/content.aspx?aid=6032899
• 34. Sibai, B. M. (2004). “Magnesium sulfate prophylaxis in preeclampsia: Lessons learned from recent trials”. American Journal of Obstetrics and Gynecology. https://doi.org/10.1016/j.ajog.2003.12.057
• 35. Hilton, G., Daniels, K., Carvalho, B. (2016). “Simulation Study Assessing Healthcare Provider’s Knowledge of Pre-Eclampsia and Eclampsia in a Tertiary Referral Center”. Simulation in Healthcare : Journal of the Society for Simulation in Healthcare, 11(1), 25–31. https://doi.org/https://dx.doi.org/10.1097/SIH.0000000000000125
• 36. Ellis, D., Crofts, J. F., Hunt, L. P., Read, M., Fox, R., James, M. (2008). “Hospital, simulation center, and teamwork training for eclampsia management: A randomized controlled trial”. Obstetrics and Gynecology, 111(3), 723–731. https://doi.org/10.1097/AOG.0b013e3181637a82
• 37. Royal College of Obstetricians and Gynaecologists. (2011). Maternal Collapse in Pregnancy and the Puerperium. Royal College of Obstetricians and Gynaecologists - Guideline, (56), 1–24.
• 38. Dichtwald, S., Matot, I., Einav, S. (2009). I”mproving the outcome of in-hospital cardiac arrest: The importance of being earnest”. Seminars in Cardiothoracic and Vascular Anesthesia. https://doi.org/10.1177/1089253209332212
• 39. Adams, J., Cepeda Brito, J. R., Baker, L., Hughes, P. G., Gothard, M. D., McCarroll, M. L., … Ahmed, R. A. (2016). “Management of Maternal Cardiac Arrest in the Third Trimester of Pregnancy: A Simulation-Based Pilot Study”. Critical Care Research and Practice, 2016. https://doi.org/10.1155/2016/5283765
• 40. Hazinski, M., Shuster, M., Donnino, M., Travers, A., Samson, R., Schexnayder, S., … Atkins, D. (2015). Highlights of the 2015 American Heart Association - Guidelines Update for CPR and ECG. American Heart Association, 1–36.
• 41. Fisher, N., Eisen, L. A., Bayya, J. V., Dulu, A., Bernstein, P. S., Merkatz, I. R., Goffman, D. (2011). “Improved performance of maternal-fetal medicine staff after maternal cardiac arrest simulation-based training”. In American Journal of Obstetrics and Gynecology (Vol. 205). https://doi.org/10.1016/j.ajog.2011.06.012
• 42. Lipman, S. S., Daniels, K. I., Carvalho, B., Arafeh, J., Harney, K., Puck, A., … Druzin, M. (2010). “Deficits in the provision of cardiopulmonary resuscitation during simulated obstetric crises”. Am J Obstet Gynecol, 203, 179.e1-5. https://doi.org/10.1016/j.ajog.2010.02.022
• 43. Siassakos, D., Hasafa, Z., Sibanda, T., Fox, R., Donald, F., Winter, C., Draycott, T. (2009). “Retrospective cohort study of diagnosis-delivery interval with umbilical cord prolapse: The effect of team training”. BJOG: An International Journal of Obstetrics and Gynaecology, 116(8), 1089–1096. https://doi.org/10.1111/j.1471-0528.2009.02179.x
• 44. Vellanki, V. S., Gillellamudi, S. B. (2010). “Teaching surgical skills in obstetrics using a cesarean section simulator - bringing simulation to life”. Advances in Medical Education and Practice, 1, 85–88. https://doi.org/10.2147/AMEP.S14807
• 45. Lipman, S. S., Carvalho, B., Cohen, S. E., Druzin, M. L., Daniels, K. (2013). “Response times for emergency cesarean delivery: Use of simulation drills to assess and improve obstetric team performance”. Journal of Perinatology, 33(4), 259–263. https://doi.org/10.1038/jp.2012.98
• 46. Martijn, L., Jacobs, A., Amelink-Verburg, M., Wentzel, R., Buitendijk, S., Wensing, M. (2013). “Adverse outcomes in maternity care for women with a low risk profile in The Netherlands: a case series analysis”. BMC.Pregnancy.Childbirth., 13, 219--219-.
• 47. World Health Organization. (2010). Framework for Action on Interprofessional Education & Collaborative Practice. Erişim Adresi:http://apps.who.int/iris/bitstream/handle/10665/70185/WHO_HRH_HPN_10.3_eng.pdf?sequence=1, Erişim Tarihi: 18.05.2018
• 48. Jantsch, E. (1947). “Inter‐and transdisciplinary university: a systems approach to education and innovation”. Higher Education Quarterly, 403–428. http://onlinelibrary.wiley.com/doi/10.1111/j.1468 2273.1947.tb02067.x/full, Erişim Tarihi: 18.05.2018
• 49. Palaganas, J. C., Epps, C., Raemer, D. B. (2014). “A history of simulation-enhanced interprofessional education”. Journal of Interprofessional Care. https://doi.org/10.3109/13561820.2013.869198
• 50. Kohn, L. T., Corrigan, J. M., Donaldson, M. S. (2000). To err is human: building a safer health system (Vol. 6). National Academies Press.
• 51. Fung, L., Boet, S., Bould, M. D., Qosa, H., Perrier, L., Tricco, A., … Reeves, S. (2015). “Impact of crisis resource management simulation-based training for interprofessional and interdisciplinary teams: A systematic review”. Journal of Interprofessional Care. https://doi.org/10.3109/13561820.2015.1017555
• 52. Reeves, S., Van Schaik, S. (2012). “Simulation: A Panacea for interprofessional learning?”. Journal of Interprofessional Care. https://doi.org/10.3109/13561820.2012.678183
• 53. Fransen, A. F., van de Ven, J., Schuit, E., van Tetering, A., Mol, B. W., Oei, S. G. (2017). “Simulation-based team training for multi-professional obstetric care teams to improve patient outcome: a multicentre, cluster randomised controlled trial”. BJOG : An International Journal of Obstetrics and Gynaecology, 124(4), 641–650. https://doi.org/10.1111/1471-0528.14369
• 54. Gum, L., Greenhill, J., Dix, K. (2010). “Clinical simulation in maternity (CSiM): Interprofessional learning through simulation team training”. Quality and Safety in Health Care, 19(5). https://doi.org/10.1136/qshc.2008.030767
• 55. Egenberg, S., Øian, P., Eggebø, T. M., Arsenovic, M. G., Bru, L. E. (2017). “Changes in self-efficacy, collective efficacy and patient outcome following interprofessional simulation training on postpartum haemorrhage”. Journal of Clinical Nursing, 26(19–20), 3174–3187. https://doi.org/10.1111/jocn.13666
• 56. Walker, D., Cohen, S., Fritz, J., Olvera, M., Lamadrid-Figueroa, H., Cowan, J. G., … Fahey, J. O. (2014). “Team training in obstetric and neonatal emergencies using highly realistic simulation in Mexico: Impact on process indicators”. BMC Pregnancy and Childbirth, 14(1). https://doi.org/10.1186/s12884-014-0367-1