Introduction
Neonatal heel prick is a widely utilized blood collection method for newborns, facilitating early health assessments. However, research indicates this procedure can elicit mild to moderate pain in neonates, necessitating the advancement of training approaches, such as simulation-based education, to prepare healthcare personnel better [1].
Patient simulators are advanced training methods for healthcare professionals to improve knowledge, skills, and attitudes [2]. They are suitable for limited resources or risky situations. Simulation training in nursing education reduces job performance mistakes, enhances critical thinking, and boosts self-confidence. Human patient simulators can help students develop critical thinking capacity. However, simulations can be expensive and only partially mimic therapeutic settings [3].
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The neonatal foot or newborn heel prick test simulator can simulate the newborn blood spot test. This device allows nurses to practice the proper method of drawing blood from a newborn for screening. The simulator accurately simulates the softness and structure of a baby’s heel, allowing for repeated blood droplets [4, 5].
The heel stick is the most commonly used technique for drawing blood from a newborn for neonatal screening testing, usually within three to seven days of birth. Neonatal nurses are specialists with specific training and knowledge in caring for newborns and their families. However, technological advancements have led to longer stays in Neonatal Intensive Care Units (NICUs), resulting in more intrusive procedures, constant demands for light and background noise, and increased manipulation during treatment. These effects can alter the development of babies, especially preterm neonates [6].
The Saudi Arabian government initiated the National Transformation Program in 2016 to achieve the Kingdom’s Vision 2030. Health promotion against health risks (public health system and health disaster management) is one of the strategic goals. To eradicate impairments, the Ministry of Health (MOH) is still implementing the National Newborn Screening Program [7].
Pediatric nurses performing heel pricks for newborns require talent and knowledge, as it is a complex psychomotor task. Equipment, technique, and site selection must be considered when choosing a site. Simulation as a teaching tool can provide valuable feedback on nurses’ strengths and weaknesses, enhancing their clinical competency. Improving the knowledge and performance of newly trained healthcare staff, particularly nurses, can decrease errors and enhance patient safety [8].
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The Objective Structured Clinical Examination (OSCE) is a test format that assesses nursing students’ clinical abilities in a standardized, objective, and reliable manner. It fosters positive perspectives, learning, and autonomy in nursing students, improving the delivery of high-quality healthcare [9]. Teaching nurses the technique of accurately pricking the heel for newborns through OSCE increases efficiency, especially if done using modern training models. This results in reduced errors during sample collection, pain for children during pricking, and correct sample placement in the heel. If nurses are not taught how to perform the technique correctly, children may suffer from pain and infection, potentially causing further injury [10].
The training of pediatric nurses is increasingly including simulation-based learning. Pediatric nurses can acquire and enhance abilities in a secure, non-threatening, hands-on setting with simulation technology, which also offers chances for critical thinking, decision-making, and team building [11]. There is also a lack of previous studies examining methods for training nurses on pricking the heels of newborn babies. Hence, the purpose of this study was to assess the effect of simulation-based training on pediatric nurses’ knowledge and performance regarding the heel-pricks technique during newborn blood screening tests in hospitals in the Maternity & Children Hospital Bisha, Al-Namas General Hospital, Kingdom of Saudi Arabia, and Pediatric Assiut University Hospital in Egypt.
Research hypothesis
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Simulation-based training will increase the pediatric nurses’ knowledge of newborn blood screening tests compared to traditional training methods.
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Simulation-based training will significantly improve the nurses’ performance in newborn blood screening tests after the intervention.
Aim of the study
This study aimed to assess the effect of simulation-based training on pediatric nurses’ knowledge and performance regarding the heel-pricks technique during newborn blood screening tests.
The theoretical framework of the study
The theoretical framework for this investigation (Fig. 1) suggests that using a newborn blood spot test simulator for simulation training can enhance nursing knowledge and performance during heel-prick for the newborn blood spot screening test. Both knowledge and performance were measured using a questionnaire and observational checklist administered to nurses before and after simulation training.
Fig. 1
The conceptual framework of the simulation training study variables
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On the other hand, simulation training’s design is based on the theoretical framework, which comprises several theories, such as social learning theory, adult learning theory, communication theory, and patient-centered care concepts.
Methods
Design and setting
The current study used a quantitative approach and an experimental two-group pre-test post-test research design to evaluate the impact of simulated OSCE-based clinical skill education on the heel-prick method for newborn bloodspot screening. We collected samples at the Pediatric Assiut University Hospital in Egypt, Al-Namas General Hospital in the Kingdom of Saudi Arabia, and Maternity & Children Hospital in Bisha from 1st June to 30th August 2023. The featured public hospitals provide various services and departments capable of implementing newborn bloodspot screening tests, such as prenatal care, NICUs, pediatric outpatient clinics, and pediatric inpatient departments.
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Intervention phases
Pre-intervention phase
The recruited pediatric nurses were divided into two groups using random sampling because each nurse had an equal chance of being chosen. Randomization was chosen by balancing the study group using blinding, random allocation of nurses in the study or the control group were assures that all participants’ known and unknown characteristics were similar and balanced between groups at the beginning of the study and to avoid the selection bias the randomization process was applied by a coin toss randomized method: the control and the experimental. Two groups of the nurses under study were formed: Group 1 (control group) had 25 pediatric nurses from all selected hospitals who received traditional training procedures, testing, and random assignment for each numerical group) Group 2 (experimental group): 25 pediatric nurses with simulation-based learning made up this group.
Sample size and sampling method
The G*Power Program® Version 3.1.9.4 was utilized to ascertain the necessary sample size to accomplish the goal of the investigation. The sample size was determined to be 50 nurses, assuming an α level of 0.05, a β level of 0.20, and a desired power of 80%. Because of this, 50 pediatric nurses were chosen for the surveys proportionately depending on the total number of nurses in each institution. The multistage sampling technique started with cluster sampling for hospitals and was followed by a stratified random sample technique within each selected hospital.
Participants
The study targeted 52 pediatric nurses who worked in the previously mentioned settings. However, 2 participants withdrew due to scheduling conflicts with the clinical practicum and the intervention’s content needing to meet their expectations. The total number of participants in the study was 50; 9 nurses worked at the Al-Namas General Hospital in the Kingdom of Saudi Arabia, 15 nurses worked at the Maternity & Children Hospital in Bisha, and 26 nurses worked at the Pediatric Assiut University Hospital in Egypt. The researchers chose these hospitals because they were accessible and had the same quality level.
The study’s inclusion criteria encompassed nurses, regardless of their age, gender, education, experience, part-time status, or administrative responsibilities, who gave their consent to participate. Pediatric nurses in experimental and control groups had recently graduated, worked for less than 6 months, and did not have any training program by simulation-based training for using the Newborn Blood Spot Test Simulator regarding heel-pricks during newborn blood screening tests.
The exclusion criteria included nursing experience for more than six months and non-consenting participants.
Implementation phase
The conventional newborn blood spot test simulator training for screening testing was performed by the researchers who collaborated with each hospital’s head of the in-service health education department to apply this intervention. PowerPoint, videos, and interactive exercises using mannequins for the newborn blood spot test simulator were used. Each group received two hours of instruction every 5 days. The pre-test was given before the training sessions, and the post-test 1 was given immediately after finishing the intervention sessions, reassessed after 20 days of intervention sessions (post-test 2), and followed up after 40 days of intervention (post-test 3). Each group received material on intervention, and all pre-tests and post-tests were the same.
Data collection tools
The data was gathered using two tools. The first tool was tool I, which the researcher established after rereading the related literature to assess the new pediatric nurses’ knowledge about heel-pricks for newborn bloodspot screening sample collection [12]. It included two main parts: part I, socio-demographic characteristics of the studied nurses, which included age, gender, residence, place of work, educational level, and month of experience. Part II questionnaire measured the nurses’ knowledge regarding heel-prick for a newborn bloodspot screening test. Seven areas of nursing knowledge were addressed included (the meaning of the newborn screening test, timing of the test, nurses’ responsibility before collection, general sampling guidelines, methods of heel-prick technique, documentation, and sending samples and recommended newborn blood screening test sequence) which had “49” multiple-choice, The total score for this tool was between 0 and 49, where a higher score indicated a deeper comprehension of the newborn blood spot test. The knowledge scoring method assigned a “1” for a correct response and a “zero” for an improper response for each item. The overall score for each knowledge area was calculated by dividing the number of items by the sum of the scores. This resulted in the mean score for the area, which was then translated into a percent score. If the nurses’ percent score was ≥ 80%, their knowledge was good; if it was less than 80%, it was poor.
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The items were scored based on previously published literature. The researchers who created the questionnaire after studying current and past relevant literature [12] conducted the study’s content validity. Internal consistency reliability was deemed sufficient; the knowledge scale’s Cronbach alpha coefficient was 0.908. A tool was used to measure knowledge related to the heel-prick technique and newborn bloodspot screening sample collection in detail in all aspects related to this.
The World Health Organization’s recommendations on the translation and adaption of instruments (Process of translation and adaptation of instruments “translated tool”) were followed in translating the items into Arabic, the official language of Saudi Arabia, for use in this study [13]. The Arabic versions of the questionnaires were then subjected to a critical review by highly qualified academics and medical professionals with varying levels of expertise in genetic newborn nursing and practices associated with the newborn screening program. The reviewers (Arabic professor of pediatric nursing and neonatologist) looked for face and content validation and terminology appropriate for Arabic speakers.
Tool II
Observational checklist for heel-prick technique in newborn bloodspot screening sample collection: The researchers developed this tool following a survey of relevant literature. The nurses’ clinical performance during bloodspot sample collection, including getting consent, reducing the child’s pain, worming the heel, determining the side of the card should have blood applied on it, cleaning the heel, using an automated retractable lancet, piercing the heel at the planter surface’s edge, squeeze the heel gently, avoid soaking from both sides, documentation, and send the dried card to the lab as soon as possible to avoid delays. The checklist consists of 11 steps on nursing actions that must be performed according to the simulation situations. Content validity test of questions was performed by creating an expert group of five nursing professors majoring in fundamental or adult nursing [14, 15]. The Cronbach alpha coefficient test was used to assess the reliability of the instruments and ascertain how closely the items linked to one another, which was 0.811.
Based on the actions performed, scores were given as follows: “complete work” meant two points, “incomplete work” one point, and “incorrect work” zero points. The scores ranged from zero to a maximum of 22 points, and the average was 10.94; based on this average. Scores were categorized as follows: Above average (17–22), average (11–16), and below average (0–10) [17].
The researcher evaluated the nurses’ performance three times during the newborn bloodspot screening sample collection process, as discussed in the previous section.
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Measures and data collection
The inquiry was approved by the appropriate authorities in writing. To assess the tools’ applicability and feasibility, a pilot study with five nurses (10% of the study sample) was conducted. No modifications were made to estimate the time needed to complete the study tools. The nurses who were selected for the pilot study were included as study subjects.
Based on the results, the appropriate modifications were made. About 25 to 30 min were needed to complete the questionnaire and 30 min to complete the observational checklists. In the clinical skills training section of the selected hospitals, participants in the experimental group received training using a simulation-based learning module based on physical newborn blood spot test simulator mannequins (Fig. 2) with a high level of fidelity. The neonatal foot, also known as the newborn heel prick test simulator, was created to replicate the newborn blood spot test. Nurses can learn and practice the proper method by using this infant foot with realistic blood sampling. When light pressure is applied to the internal reservoir, a tiny trickle of blood is released, accurately simulating the softness and structure of a baby’s heel. Using a newborn heel prick test simulator with a simulated blood-filling tank and special internal foam, a baby’s foot can release blood drops when pressured, allowing a nurse to repeatedly squeeze blood from the same spot until the reservoir is empty. This is an alternative to repeated needle sticks, which can result in multiple bleed sites. Participants in the control group were given traditional instruction. The simulation-based learning module was implemented for the study group through subsequent sessions based on the actual needs and evaluation of the researched nurses.
Fig. 2
Newborn blood spot test simulator
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The research group’s simulation-based learning module was implemented by conducting subsequent sessions on the real demands and evaluations of the nurses under study. The training programme and content were standardized for the nurses in the previously mentioned settings.
The researchers began by introducing themselves, outlining the purpose and design of the study, and getting a sense of the nurses’ expectations. For 20 days, the researchers were on duty in the study setting, alternating between the morning and afternoon shifts. They assessed nurses’ knowledge through individual interviews and observed the nurses’ performance during heel stick punctures.
Before instruction sessions for both groups, a tool I assessed nurses’ knowledge of the heel-prick test for newborn bloodspot screening. The creation of the content, which addressed the rationale for the sessions’ application, and goal-setting were the first phases in the simulation-based learning process using the newborn blood spot test simulator. Under the guidance of the trainers, each participant practiced newborn blood spot test stages for five minutes and at least twenty minutes in each group after practicing on mannequins. Every subject is taught as a critical skill and is practiced individually. The majority of the instruction included role-playing and simulation.
The five performance criteria that each OSCE station uses to evaluate nurses’ performance were assessment of nurses’ knowledge/performance about newborn blood spot test, preparation for training by using the newborn blood spot test simulator, implementation of the training steps by giving knowledge and clarify the correct performance, after-care by feedback, and documentation the intervention. There were two sessions of simulation-based learning modules every 5 days. Each session lasted roughly thirty minutes. Various instructional techniques were employed, with the control group receiving lectures and power points and the study group receiving a simulation-based learning module that included a newborn blood spot test simulator, demonstration, and re-demonstration. The newborn bloodspot screening test procedure was the main topic of instruction for the experimental group.
Researchers assessed the nurses’ performance and knowledge of the heel-prick technique for newborn bloodspot screening; it was clearly explained in the previous section.
Evaluation phase
The evaluation was done three times after the implementation of simulation-based training by using a newborn blood spot test simulator on pediatric nurses’ knowledge and clinical performance during heel-prick for the newborn bloodspot screening test and was compared with a control group.
The flowchart illustrates how the experimental and control groups participated in a simulation-based training study using a newborn blood spot test simulator (Fig. 3).
Fig. 3
Flowchart of simulation-based training by using newborn blood spot test simulator participation by the experimental and control groups
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Ethics consideration
The initial ethical protocol was obtained in 2023, and the final ethics certificate was received upon completion and submission of the report. Ethical approval was obtained from the IRB at the University of Bisha with the code number (UB-RELOC H-06-BH-089)/ 1204.24). This study adhered to the ethical principles followed at the College of Applied Medical Sciences at the University of Bisha and the concerned authorities from the hospitals in the Kingdom of Saudi Arabia (Aseer Province). The study methodology was approved by Faculty of Nursing ethics committee at Assiut University; this research adheres to the highest ethical standards. ClinicalTrials.gov Identifier: NCT06685471. The purpose of the study was explained to nurses and their supervisors, and they were asked to share information voluntarily and without receiving payment. The pediatric nurses were informed that they could leave the trial at any moment and that there would be no negative repercussions. Informed consent was obtained from all participants in the study, and their participation was entirely voluntary and non-for-profit. The research conforms to the provisions of the Declaration of Helsinki (as revised in Brazil in 2013). The questionnaire’s initial page displayed the electronic informed consent option. The researchers generated and maintained the code numbers. Data confidentiality was ensured by the study’s anonymized production participant information.
Statistical analysis
The statistical package for social sciences (SPSS) software, version 16, was used to enter and analyze the data. The Kolmogorov-Smirnov test was utilized to evaluate the data’s normality, and descriptive statistics in the form of frequencies and percentages were used to illustrate the results. The arithmetic mean and standard deviation were employed for continuous variables, whereas percentages were used for categorical variables. ANOVA and t-tests were utilized to compare the differences in the effectiveness of the intervention program between and within the intervention and control groups. The Chi-square test (χ2) was used to compare two groups and more for qualitative data. Multivariate regression analysis was used for demographic variables. At p < 0.05, statistical significance was established.
Results
Characteristics of participants
The percentage distribution of pediatric nurses by socio-demographic items is shown in Table 1. The mean age of the participants was 25.58 ± 0.63 years; most models were female and were characterized by Bachelor’s education. In addition, most of the participants are working at healthcare centers.
Table 1
Socio-demographic characteristics of pediatric nurses’ percentage distribution
Variable | Percentage Distribution of the Pediatric Nurses (n = 50) | |
|---|---|---|
Experimental group (n = 25) | Control group (n = 25) | |
N = (25) (%) | N = (25) (%) | |
Age (years): | ||
• < 25 • 25–30 • > 30 | 12 (48) 11 (44) 2 (8) | 13 (52) 11 (44) 1 (4) |
Range Mean ± SD | 25–30 25.58 ± 0.63 | 25–30 25.35 ± 0.56 |
Gender: | ||
Males Females | 3 (12) 22 (88) | 2 (8) 23 (92) |
Residence: | ||
Rural Urban | 12 (48) 13 (52) | 9 (36) 16 (64) |
Educational level | ||
Bachelor’s education Post-graduate education Others | 14 (56) 9 (36) 2 (8) | 13 (52) 10 (40) 2 (8) |
Place of work | ||
Hospitals Healthcare centers | 9 (36) 16 (64) | 10 (40) 15 (60) |
Experience (months) | ||
• < 2 • 2–5 • 6˃ | 15 (60) 9 (36) 1 (4) | 16 (64) 9 (36) 0 (0) |
Knowledge of the pediatric nurses regarding training of heel-prick
The weighted mean score in the pre-test ranged from 51.1 to 74.1%, while in the post-test, they ranged from 86.5 to 98.2%. The nurses’ weighted mean score was higher on the post-test in the 7 Items with min = 7 and max = 49.
Table (2) shows the mean scores of pediatric nurses’ total knowledge regarding heel-prick training for newborn bloodspot screening tests. It was observed that the mean scores of nurses’ total knowledge regarding heel-prick for newborn bloodspot screening test after 20 days of training were 40.16 ± 1.11 and 33.55 ± 1.18 in the experimental and control group, respectively, with statistically significant differences (P-value 0.0001); also 40 days after training statistically significant difference (P-value 0.0001) was found. No statistically significant difference was found before training (P-value 0.765) and immediately after training (P-value 0.644).
Table 2
Mean scores of pediatric nurses’ total knowledge regarding training of heel-prick for newborn bloodspot screening test
Assessment Time | Total Nurses’ Knowledge Regarding Heel-Prick (n = 50) | t-test | P | |
|---|---|---|---|---|
Experimental group (Simulation-based learning) (n = 25) | Control group (n = 25) | |||
Mean ± SD | Mean ± SD | |||
Pre-training | 9.22 ± 4.09 | 9.32 ± 2.72 | 3.991 | 0.765 |
Immediately after training (post-test1) | 37.86 ± 1.28 | 34.84 ± 1.22 | 0.199 | 0.644 |
20 days after training (post-test2) | 40.16 ± 1.11 | 33.55 ± 1.18 | 3.866 | 0.0001* |
40 days after training (post-test3) | 39.54 ± 1.09 | 29.66 ± 1.32 | 4.486 | 0.0001* |
F P value | 116.922 0.0001* | 251.879 0.0001* | ||
Table : (3) as regards knowledge, this table clarifies that educational level (bachelor’s education, post-graduate education, or others there is no statistically significant relation affected nurses’ knowledge regarding heel-prick for a newborn bloodspot screening test. No statistical significance was shown between nurses’ knowledge about heel-prick for a newborn bloodspot screening test and their age (< 25 to > 30).
Table 3
Multivariate regression analysis affecting knowledge (n = 50)
Knowledge | Educational level | Age | ||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|
Bachelor’s education | Post-graduate education | Others | < 25 years | 25–30 years | > 30 years | |||||||
R value | P Value | R value | P value | R value | P value | R value | P value | R value | P value | R value | P value | |
The meaning of the newborn screening test | 0.74 | 0.642 | 0.33 | 0.543 | 0.39 | 0.432 | 0.27 | 0.523 | 0.27 | 0.111 | 0.31 | 0.222 |
Timing of the test, | 0.66 | 0.288 | 0.74 | 0.765 | 0.53 | 0.178 | 0.55 | 0.255 | 0.53 | 0.733 | 0.54 | 0.391 |
Nurses’ responsibility before collection | 0.87 | 0.365 | 0.27 | 0.356 | 0.29 | 0.176 | 0.43 | 0.232 | 0.33 | 0.278 | 0.91 | 0.262 |
General sampling guidelines | 0.94 | 0.543 | 0.28 | 0.167 | 0.74 | 0.865 | 0.66 | 0.274 | 0.29 | 0.237 | 0.45 | 0.391 |
Methods of heel-prick technique | 0.33 | 0.567 | 0.29 | 0.987 | 0.33 | 0.832 | 0.34 | 0.252 | 0.66 | 0.482 | 0.78 | 0.268 |
Documentation | 0.98 | 0.277 | 0.27 | 0.654 | 0.35 | 0.276 | 0.45 | 0.251 | 0.34 | 0.391 | 0.74 | 0.111 |
Sending samples | 0.29 | 0.987 | 0.77 | 0.285 | 0.35 | 0.765 | 0.46 | 0.251 | 0.33 | 0.397 | 0.74 | 0.229 |
Performance of the pediatric nurses regarding training of heel-prick
Table (4) demonstrated that the total performance score of Heel-Pick for the Newborn Bloodspot Screening Test was 22.
Table 4
Mean, median, and standard deviation of performance score in heel-prick for newborn bloodspot screening test
Range of Score | Mean | Median | SD |
|---|---|---|---|
0–22 | 10.94 | 10 | 5.48 |
Table (5) As regards performance, this table clarifies that experience (< 2 to 6˃ months) there is no statistically significant relation affected nurses’ performance regarding heel-prick for a newborn bloodspot screening test in all steps. Also, no statistical significance was found between nurses’ age (< 25 to > 30) and nurses’ performance regarding heel-prick for a newborn bloodspot screening test in each step.
Table 5
Multivariate regression analysis affecting performance (n = 50)
Performance steps | Experience (months) | Age | ||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|
< 2 months | 2–5 months | > 6 months | < 25 years | 25–30 years | > 30 years | |||||||
R value | P value | R value | P value | R value | P value | R value | P value | R value | P value | R value | P value | |
Getting consent | 0.88 | 0.642 | 0.52 | 0.389 | 0.31 | 0.227 | 0.31 | 0.225 | 0.39 | 0.288 | 0.31 | 0.276 |
Reducing the child’s pain | 0.76 | 0.288 | 0.91 | 0.262 | 0.54 | 0.391 | 0.54 | 0.391 | 0.54 | 0.391 | 0.54 | 0.391 |
Worming the heel | 0.57 | 0.365 | 0.45 | 0.391 | 0.91 | 0.262 | 0.91 | 0.262 | 0.91 | 0.262 | 0.91 | 0.262 |
Determining the side of the card should have blood applied to it | 0.54 | 0.543 | 0.78 | 0.268 | 0.45 | 0.391 | 0.45 | 0.391 | 0.45 | 0.391 | 0.45 | 0.391 |
Cleaning heel | 0.83 | 0.567 | 0.33 | 0.397 | 0.33 | 0.832 | 0.34 | 0.252 | 0.66 | 0.482 | 0.78 | 0.268 |
Use of an automated retractable lancet | 0.68 | 0.277 | 0.31 | 0.222 | 0.35 | 0.276 | 0.45 | 0.251 | 0.34 | 0.391 | 0.74 | 0.111 |
Piercing the heel at the planter surface’s edge | 0.49 | 0.987 | 0.54 | 0.391 | 0.31 | 0.223 | 0.31 | 0.381 | 0.45 | 0.391 | 0.45 | 0.391 |
Squeeze the heel gently | 0.88 | 0.278 | 0.91 | 0.262 | 0.54 | 0.391 | 0.54 | 0.391 | 0.54 | 0.391 | 0.54 | 0.391 |
Avoid soaking from both sides | 0.76 | 0.237 | 0.45 | 0.391 | 0.91 | 0.777 | 0.91 | 0.262 | 0.91 | 0.262 | 0.91 | 0.262 |
Documentation | 0.57 | 0.482 | 0.78 | 0.268 | 0.45 | 0.391 | 0.45 | 0.391 | 0.45 | 0.391 | 0.45 | 0.391 |
Send the dried card to the lab as soon as possible to avoid delays | 0.54 | 0.391 | 0.74 | 0.111 | 0.78 | 0.268 | 0.78 | 0.268 | 0.78 | 0.268 | 0.78 | 0.278 |
Table (6) shows the distribution of pediatric nurses’ performance levels in heel-prick training for a newborn bloodspot screening test. Regarding the level of nurses’ performance in heel-prick after training for a newborn bloodspot screening test, immediately after simulation-based learning, 20 and 40 days later, the majority of pediatric nurses in the experimental group have a good level of performance after training (80%, 76%, and 76% respectively) compared to nurses in the control group (32%, 12% and 12% respectively), with statistically significant difference (P-value 0.001) was found. It was clear that, compared to traditional training, retention is higher following simulation-based training.
Table 6
Comparison between total performance scores among the studied nurses in training of heel-prick for newborn bloodspot screening test
Time of assessment | Nurses’ Total Performance in Heel-Prick for Newborn (n = 50) | Signif. test | ||
|---|---|---|---|---|
Experimental group (Simulation-Based Learning) (n = 25) | Control group (n = 25) | χ2 | P | |
Before training | ||||
• Below average • Average • Above average | 13 (52%) 7 (28%) 5 (20%) | 14 (56%) 8 (32%) 3 (12%) | 2.07 | 0.853 |
Immediately after training (post-test1) | ||||
• Below average • Average • Above average | 0 (0%) 5 (20%) 20 (80%) | 4 (26%) 13 (52%) 8 (32%) | 18.74 | 0.001* |
20 days after training (post-test2) | ||||
• Below average • Average • Above average | 0 (0%) 6 (24%) 19 (76%) | 9 (36%) 13 (52%) 3 (12%) | 17.89 | 0.001* |
40 days after training (post-test3) | ||||
• Below average • Average • Above average | 0 (0%) 6 (24%) 19 (76%) | 10 (40%) 12 (48%) 3 (12%) | 15.95 | 0.001* |
Discussion
Nursing educators can employ strategies such as simulation to prepare aspiring nurses for professional practice. Performance, defined as completing tasks to established benchmarks, is critical to nursing care. A growing body of research suggests that insufficient nursing knowledge and skills can contribute to adverse patient outcomes, especially in newborns [16].
Mulyadi et al. [17] found that most nurses felt simulation-based education enhanced knowledge retention and created a conducive learning environment. They also demonstrated how applying the simulation technique increases nurses’ knowledge and self-confidence, which is consistent with the outcomes of our study.
Furthermore, additional research revealed that the use of simulation-based learning has increased nurses’ self-reported confidence and understanding of critical medication administration abilities for the pediatric population, and a combination of virtual practice and involvement in a real immunization clinic helped pediatric nurses obtain the information and abilities required for safe injection delivery [18].
The present study also follows recent research reporting that OSCE and standardized patient teaching approaches outperformed the traditional approach in enhancing nursing nurses’ knowledge and preparedness for self-directed learning [19].
The current study found that pediatric nurses in the experimental group, who received simulation-based learning, demonstrated significantly better heel-prick performance for newborn blood spot tests immediately after training and at 20 and 40-day follow-ups compared to the control group. It was clear that, in compared to traditional training, retention is higher following simulation-based training.
Keleekai et al. [20] reported that the number of Pediatric Peripheral Intravenous (PIV) insertion attempts decreased after simulation-based learning compared to traditional teaching methods, suggesting that the use of simulation technologies and debriefing processes at the pediatric PIV insertion program enhanced the PIV insertion skills of the pediatric nursing staff, the current results also suggest that the simulation-based learning techniques by newborn blood spot test simulators have improve the pediatric nurse’s performance and understanding of the blood spot test form the heal abilities for the newborn.
Another research study found a significant difference in the total performance of nurses between the experimental (75%) and control (40%) groups during subcutaneous injection training programs using simulation-based learning as opposed to traditional teaching methods [21]. This is consistent with the results of the current research, which confirm the effectiveness of simulation-based learning in improving nurses’ performance.
The current study showed no relation between educational level and age regarding nurses’ knowledge about heel-prick for a newborn bloodspot screening test. Additionally, there was no statistically significant relation between nurses’ experience (< 2 to 6˃ months) and their age (< 25 to > 30) regarding nurses’ performance about heel-prick for a newborn bloodspot screening test. These factors were not influential concerning the nurse’s knowledge and performance regarding newborn blood spot test it may be due to the similar percentage of nurses in each category. It is obvious that only heel-prick training for a newborn bloodspot screening test simulator can perform better for nurses.
Using simulated patients over real patients reduces variability by providing similar challenges to multiple candidates. Additionally, because of their dependability and flexibility, a variety of clinical phenomena can be replicated, each customized to the student’s proficiency level. Employing actual patients for examinations reduces the risk of injury, especially in sensitive areas of medicine like neonatology [22].
Doğan and Şendir [23] highlight the need to create various situations, verify their effectiveness, and employ standardized patients in health assessments. Our research found that a simulator-based teaching approach utilizing standardized patients was more successful than the traditional approach in improving nurses’ competency, preparedness for self-directed learning, and problem-solving skills.
Sinz et al. [24] found that a high-validity simulator is highly accurate and that face validity is crucial for generalizability to real-world clinical settings. High-fidelity simulators mimic complex clinical scenarios and provide a realistic training environment. In addition to providing qualified training and error management, several admirable goals and moral precepts support the use of simulation in medical and nursing education. It provides the greatest standards possible for social justice, patient liberty, and safety [25]. Our research further supports this, suggesting that these simulators enhance training, immersion, and skill performance.
Implications for management and decision-makers
The study’s results can improve knowledge and comprehension of how the simulation-based training program affects nurses’ performance and knowledge during the heel-prick test for newborn blood screening. We provide nursing managers with a few useful takeaways. Advanced simulation-based training programs must applied for all medical professionals, physicians, and nurses employed in hospitals and healthcare facilities on heel-pricking during newborn blood screening tests. Systematic and ongoing training in simulation-based heel-prick testing is required to boost confidence in the application of newborn blood screening tests and save lives. The effectiveness of these interventions must then be assessed. Future studies should encompass non-governmental groups, private institutions, and government hospitals.
Strengths and limitations
This study is one of the few that assesses how simulation-based training affects the performance and knowledge of licensed pediatric nurses working in government hospitals. The study offers significant proof of the benefits of the simulation-based training program on the performance and understanding of pediatric nurses. Furthermore, gathering recently graduated pediatric nurses after 20 and 40 days was challenging to evaluate their clinical performance in the heel-prick test for newborn bloodspot screening and gauge their knowledge retention. Because certain nurses were missing from the relevant clinical training, the training was repeated multiple times. Results could be impacted by unrelated factors such as the nurses’ prior employment at a healthcare facility, their life experiences, and their outside jobs.
Conclusion
The current study’s findings indicate that, following simulation-based training, pediatric nurses significantly improved their heel-prick knowledge and performance during the newborn blood screening test. The results suggest that simulation should be included in pediatric nursing curricula. Additionally, this study should be repeated with a larger sample size and at multiple pediatric care settings to assess the measurable effects of simulation and increase statistical power using a more diverse set of nurses.
Using newborn blood spot test simulators is useful in raising awareness of nurses’ performance concerning patient safety. The findings have several practical implications; one is that pediatric nurses’ performance and knowledge concerning newborn blood screening tests should be prioritized to guarantee patient safety and quality of care in pediatric patient scenarios. It will be interesting to look at how pediatric nurses feel about using simulations for team training to improve patient safety. More research is required to determine how pediatric nurses contribute to newborn blood screening tests.
Acknowledgements
The authors extend their appreciation to the Deanship of Graduate Studies and Scientific Research at University of Bisha for funding this research through the general research project under grant number (UB-GRP- 48 -1444).
Declarations
Human ethics and consent to participate
This study adheres to the highest ethical standard, as the ethical committee approved the study protocol of the IRB at the University of Bisha with the code number (UB-RELOC H-06-BH-089)/ 1204.24). The study was performed under the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments. Informed consent was obtained from all participants in this study, and it was a completely volunteer, non-profit endeavor. Every technique was used in compliance with all applicable rules and regulations.
Consent for publication
Not applicable.
Competing interests
The authors declare no competing interests.
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