Improving Labor and Delivery Nurses Confidence with Unintentional Nurse-Attended Deliveries (UNAD) Through Education and Simulation Skills Training

Background: Every day, babies are born in hospitals around the United States. The safest deliveries are those attended by a trained health care provider with the specific delivery skills to assist mother and baby through the birthing process. Despite the best laid plans to have a trained health care provider at every birth, there are times when unforeseen circumstances make that impossible. These births are considered unintentional nurse attended deliveries (UNAD). These deliveries may pose a safety to risk to patients as most hospitals do not provide training to nurses in adequate delivery skills. Methods: The purpose of this project was to increase labor and delivery (LND) nurses' confidence in adequate delivery skills for UNAD by providing education and training in these skills. According to the Self Efficacy theory, written by Albert Bandura, an increase in self efficacy (i.e. confidence) through training and support leads to improved performance. By teaching the LND nurses adequate delivery skills for UNAD, it was hypothesized that their confidence levels would increase. They, therefore, would be better prepared to use these skills at UNAD with improved performance and mitigate the risk to patient safety. This quality improvement project used a presurvey to assess the LND nurses' current levels of confidence with adequate delivery skills. An educational PowerPoint with a voice over lecture was then sent out to staff via email. Simulation skills training were then developed with the input of experts, current evidence, and the hospital labor and delivery guideline. The simulation skills stations were then implemented on Labor and Delivery on four separate occasions. Results: The findings in from the Pre and Post surveys showed increase in confidence in all areas of adequate delivery skills. Preintervention percentage of the nurses that reported they felt confident to deliver a baby was 30.3% (n=33), post intervention it was 46.7% (n=15). Preintervention, the percentage of nurses that reported they felt confident to clamp and cut cord was 33.3% (n=33); post-intervention, it was 40% (n=15). Preintervention, the percentage of nurses that reported they felt confident to deliver a placenta was 9.1% (n=33); post-intervention, it was 46.7% (n=15). Postintervention, the LND nurses' confidence level increased in all areas of adequate delivery skills by 16.4% (p=0.00024). One month after the simulation skills training, none of the nurses who had received the training had delivered a baby at UNAD. Conclusions:The confidence levels of the LND nurses who participated in the presurvey and simulation skill training with adequate delivery skills were then assessed with a postsurvey. Confidence levels increased in all areas assessed. The intervention was well received by the LND nurses and many expressed gratitude and a desire for it to become mandatory training for all nurses on the unit. Keywords:Unintentional nurse attended deliveries, adequate delivery skills.