الفهرس 
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Abstract
Preeclampsia is a most frequently encountered of pregnancy and it is characterized by hypertension, proteinuria and edema, usually by the last trimester of pregnancy. When it remains untreated, it moves towards more serious condition known as eclampsia, which defined by the presence of seizures in the preeclamptic women and is still one of the leading causes of maternal and neonatal mortality. The majority of deaths due to preeclampsia and eclampsia are avoidable through the provision of timely and effective care to the women presenting with these complications, which may be greatly influenced by proactive and competent nursing care.The National Advisory Council on Nurse Education and Practice (2010) supported the use of simulation training to prepare future nurses to be able to provide safe nursing care in today’s healthcare system. Therefore, the recent use of high fidelity simulation hasa great effect on clinical nursing education. This is due to the fact that simulation basedtraining program helps nursing students to improve their knowledge and skills.The aim of this study is to determine effect of high fidelity simulation based training program on intern students’ knowledge and skills about eclamptic patients’ management.The following hypotheses were examined in the present study:1. Intern students who attend simulation based training program exhibit higherknowledge score than those who didn’t attend it.2. Intern students who attend simulation based training program exhibit higher skills score than those who didn’t attend it.The study is a quasi experimental research design. It was conducted at ObjectiveStructure Clinical Examination (OSCE) lab at the Faculty of Nursing, Alexandria University for training by using high fidelity simulator (the Noelle- Gaumard) abouteclamptic patients’ management and El-Shatby Maternity University Hospital affiliated to University of Alexandria for assessing the routine clinical training in the hospital about
eclamptic patients’ management. It comprised a convenience sample of 60 intern students
who trained in eclamptic unit and intensive care units. They were randomly assigned to
either control or study group about 30 for each group; Study group who was received both
theoretical part and routine clinical training in the hospital as well as training about
eclamptic patients’ management using high fidelity simulator and Control group who was
received only theoretical part through power point presentation on the subject about
eclamptic patients’ management and their skills according to routine clinical training in the
hospital.
Two tools were developed and used by the researcher to collect the necessary data.
Tool one; Intern student’ knowledge about eclamptic patients’ management
Questionnaires: this tool was comprised two parts as follow: Part I: Intern student
profile, which included age, educational level, previous academic achievement and
experience in nursing and Part II: Intern student’ knowledge about eclamptic patients’
management Questionnaires to assess intern students’ knowledge about eclamptic
patients’ management. Tool two; Intern student’ skills about eclamptic patients
management observational checklist to assess intern students’ skills about eclamptic
patients’ management.
Reliability of the tools was tested by the Cronbach alpha coefficient test, the two
tool reliable as α = (0.994) for tool I and α = (0.995) for tool II. Tools content validity was
tested by 5 experts in the related field, The validity was 97% for tool I and 100% for tool
II. A pilot study was carried out on 6 intern students were collected before actual time of
data collection to exclude from the selected subjects to ascertain the clarity and the
applicability of the tools. The researcher was attended training on the using of high fidelity
simulator by expert in the related field.
The study was conducted through three phases:
A. Pre assessment phase:
Intern students of both groups were assessed for their socio-demographic and knowledge
about eclamptic patients’ management by using tool I.
Program development phase:
High fidelity simulation based training program was entailed two main parts:
1. Theoretical part was included general knowledge about preeclampsia and eclampsia,
knowledge about MgSO4, nurse role regarding administration of MgSO4, nurse role
before the seizure, nurse role during the seizure and nurse role after the seizure.
2. Clinical part was included High fidelity simulators, Software eclamptic scenarios that
was prepared by the researcher based on extensive review of recent and relevant literature
and tested for content validity by a jury of 5 experts in the related field then the necessary
modifications was done which included eclamptic cases as well as actions taken for these
conditions.
B. Implementation phase: all intern students were assigned randomly into ten subgroups;
each group was contained six intern students for the purpose of the demonstration.
- For the study group: The program was implemented in 2 weeks by the researcher. Six
sessions was scheduled 3 session / week in the morning (4hours each). The training course
was reflected an 8hour didactic with a 16 hour clinical experience at simulate clinical
environment SCE, over a period of approximately 20 weeks from 15/9 to 20/1/2018. All
didactic content in the course was frontloaded followed by simulation. The program was
conducted on six sessions as follow:
- Session (1) was included a didactic part about eclamptic patients’ management was
followed by demonstration nursing student role in administer magnesium sulphate and
managing of eclamptic fits.
- Session (2) was included a didactic part about obstetric emergency in eclamptic patients.
- Sessions (3-6) were an included emergency intervention that was applied in case of
eclamptic fits. Then the study subjects were exposed to a variety of scenarios about
eclamptic patients’ management as well as fits management.
- Each scenario was ran for approximately 15 to 20 minutes, during which time the intern
student was able to ask questions, perform interventions for eclamptic patients as well as
redemonstrated it by using high fidelity simulator. Illustrate handout about caring for
eclamptic patients’ knowledge was distributed after implementation of the program as areference
C. Evaluation of the effectiveness of training program:
- Intern student’ knowledge about eclamptic patients’ management was reassessed twice
immediately and after two months following the training program using tool I.
- Intern student’ skills about eclamptic patients’ management was observed by the
researcher twice immediately and two months following the training program using tool II.
The main findings of the study were as follows:
Socio demographic characteristics:
No statistically significant differences were found between the study subjects in
relation to their socio-demographic characteristics.
Knowledge about eclamptic patients’ management:
No statistical significant difference was found between the study subjects regarding
their knowledge about eclamptic patients’ management before intervention (P=
0.917).
Highly statistical significant difference between the study and control groups in the
favor of the study group regarding their knowledge about eclamptic patients’
management immediately after and two months after intervention (P= 0.000).
Total mean knowledge score of the study group increased significantly after didactic
part (p=0.000) than the control group (p=0.001).
Skills about eclamptic patients’ management:
No statistical significant difference between the study subjects regarding their skills
about eclamptic patients’ management before intervention(P=0.752).
Highly statistical significant difference between the study and control groups in the
favor of the study group regarding their skills about eclamptic patients’ management
immediately after and two months after intervention (P= 0.000).
Total mean skills score of the study group increased significantly after training using
high fidelity simulator (P= 0.000).
Relationship between total knowledge score and total skills score about eclamptic
patients’ management among study group before, immediately after and two months
after intervention:
There was a negative statistically correlation between total knowledge score and total
skills score before intervention. Where, There was statistical significant difference
(p=0.052).
There was a positive statistically correlation between total knowledge score and total
skills score immediately after intervention. Where, There was no statistical
significant difference (p=0.097).
There was a positive statistically correlation between total knowledge score and total
skills score two months after intervention. Where, The difference was statistical
significant (p=0.030).
Summary
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Relationship between total knowledge score and total skills score about eclamptic
patients’ management among control group before, immediately after and two
months after intervention:
There was a positive statistically correlation between total knowledge score and total
skills score before intervention. Where, There was statistical significant difference
(p=0.019).
There was a negative statistically correlation between total knowledge score and total
skills score immediately after intervention and two months after intervention. Where,
There was statistical significant difference (p=0.000) respectively.
Based on the findings of this study, the following are recommended:
- Evidence-based information about simulation based learning should be integrated
within the curriculum of basic and continuing nursing / midwifery education.
- Ensure an adequate number of dedicated simulation faculty with training and
expertise in the pedagogy of simulation.
- Pre-service and in-service competency-based training on the high fidelity
simulation based training should target all maternity nurses.
- Support the development of simulation leaders among the faculty.
- Evaluate simulation experiences using valid and reliable instruments.
- Collaborate with key stakeholders to develop and disseminate best practices in the
use of simulation in teaching and learning throughout the curriculum to better
engage students in the learning process.
- Further researches should be carried out to:
. Conduct a similar study at different maternity settings on a large scale. Explore the effect of high fidelity simulation based training program on other problems encountered during the maternity cycle e.g. postpartum hemorrhage.