Khang Duy Ricky Le
Principles of Effective Simulation-Based Teaching Sessions in Medical Education: A Narrative Review
Cureus
2017 ministry health gaza introduced early essential newborn care eenc primary maternal neonatal care strategy eenc comprises package simple evidencebased interventions delivered labour delivery early postpartum period prevent treat important causes morbidity mortality newborn babies four public maternity hospitals gaza responsible approximately 75 deliveries began implementation eenc june 2017 clinical coaching delivered national facilitators 2 days targeted clinical staff maternity neonatal units subsequently eenc quality improvement teams formed address contextual factors influence practice study aimed determine whether introduction eenc resulted changes clinical practices vaginal births preintervention postintervention design used review key clinical practices eenc introduction four hospitals trained data collection staff visited hospital 1 day months march june 2017 eenc implementation january april 2018 early stages eenc implementation september 2018 june 2019 full eenc implementation standard data collection methods tools used gather practice data using exit interviews chart reviews 1015 randomly selected postpartum mothers delivered vaginally previous 224 h experienced newborn death stillbirth delivery observations conducted five ten randomly selected vaginal deliveries using standard clinical skills observation checklist beginning second stage labour ministry health gaza approved eenc assessments programme use informed verbal consent obtained maternal interviews personal identifiers used assessments 259 maternal postpartum interviews 139 observations birth practices done across four maternity hospitals representing 88 259 2940 47 139 expected vaginal births observation periods respectively comparing practices baseline early implementation full implementation significant trend improvements noted proportion babies receiving thorough drying 0 0 12 49 32 66 72 43 60 respectively p00004 immediate skintoskin contact ssc less 1 min 0 0 14 33 43 127 66 72 110 p00001 uninterrupted ssc least 60 min 0 0 14 21 27 129 48 53 111 p00001 uninterrupted ssc least 90 min 0 0 14 10 13 129 36 39 110 p00001 early breastfeeding 1590 min birth 0 0 15 39 50 130 61 65 107 p00001 breastfeeding separation 0 0 15 28 36 131 52 56 108 p00001 exclusive breastfeeding discharge 33 5 15 68 89 131 81 87 107 p00010 average clinical practice scores rose five 42 12 16 42 38 24 42 57 practice improvements supported updated clinical guidelines hospital policies routines reorganisation work provision simple supplies including gowns mothers caps newborn babies eenc clinical coaching approach coupled regular selfassessments action hospital teams significantly improved care practices delivery early postpartum period possible periodic crosssectional practice reviews representative routine practices may varied time day case load case complexity limitations mitigated assessing systematic random sample postpartum women delivering throughout previous 24 h measuring practices two different time periods phase implementation postpartum interviews used limit hawthorne effect maternal newborn initiatives introduced study period additional staff training available therefore eenc approach primary influence health worker practices support work provided occupied palestinian territory