Educational Impact of the Neonatal Resuscitation Program in Low-Risk Delivery Centers in a Developing Country

doi:10.1016/j.jpeds.2008.10.005

The Journal of Pediatrics

Volume 154, Issue 4, April 2009, Pages 504-508.e5

https://doi.org/10.1016/j.jpeds.2008.10.005 Get rights and content

Objective

To evaluate the effectiveness of the American Academy of Pediatrics Neonatal Resuscitation Program (NRP) in improving knowledge, skills, and self-efficacy of nurse midwives in low-risk delivery clinics in a developing country.

Study design

We used the content specifications of the NRP material applicable to college-educated nurse midwives working in low-risk clinics in Zambia to develop performance and self-efficacy evaluations focused on principles of resuscitation, initial steps, ventilation, and chest compressions. These evaluations were administered to 127 nurse midwives before and after NRP training and 6-months later.

Results

After training, written scores (knowledge evaluation) improved from 57% ± 14% to 80% ± 12% (mean ± SD; P < .0001); performance scores (skills evaluation) improved the most from 43% ± 21% to 88% ± 9% (P < .0001); self-efficacy scores improved from 74% ± 14% to 90% ± 10% (P < .0001). Written and performance scores decreased significantly 6 months after training, but self-efficacy scores remained high.

Conclusions

As conducted, the NRP training improved educational outcomes in college-educated practicing nurse midwives. Pre-training knowledge and skills scores were relatively low despite the advanced formal education and experience of the participants, whereas the self-efficacy scores were high. NRP training has the potential to substantially improve knowledge and skills of neonatal resuscitation.

Section snippets

Study Design

Qualified NRP instructors administered the NRP course to 127 college-educated (4 years) nurse midwives who were employed in 18 primary-level delivery clinics in Lusaka and Ndola, Zambia in 2005. The midwives had been in practice for 16 ± 9 years (range, 3-30 years; median, 14 years). The midwives were trained previously in neonatal resuscitation, but had not been trained with the NRP course. The midwives were encouraged to read the NRP textbook before the training. The course was conducted in

Results

On the basis of Cronbach's alpha, overall the 3 evaluation scales demonstrated good internal consistency (generally defined as alpha >0.70). The Cronbach's alphas for the scales were: written evaluation (pre-training = 0.80, post-training = 0.84, 6 months = 0.87), performance evaluation (pre-training = 0.87, post-training = 0.60, 6 months = 0.87), and self-efficacy (pre-training = 0.90, post-training = 0.84, 6 months = 0.87). The alpha for the performance evaluation decreased from pre-training

Discussion

We report a comprehensive evaluation of the educational impact of NRP training in the developing world to address several domains of educational outcomes. All 3 evaluations had acceptable internal consistency and thus were valid evaluations of knowledge, skills, and self- efficacy of resuscitation. The improvements in scores between the pre-training period and post-training period demonstrated that the NRP training significantly increased scores on evaluations of knowledge, skills, and

References (24)

J. Lawn et al.
4 million deathsWhen? Where? Why?
Lancet
(2005)
E. Ergenekon et al.
Neonatal resuscitation course experience in Turkey
Resuscitation
(2000)
X.Y. Zhu et al.
The impact of the Neonatal Resuscitation Program Guidelines (NRPG) on the neonatal mortality in a hospital in Zhuhai, China
Singapore Med J
(1997)
A.K. Deorari et al.
Impact of education and training on neonatal resuscitation practices in 14 teaching hospitals in India
Ann Trop Paediatr
(2001)
Basic newborn resuscitation: a practical guide
(1997)
M.E. Wegman
Annual summary of vital statistics—1990
Pediatrics
(1991)
B. Guyer et al.
Annual summary of vital statistics—1998
Pediatrics
(1999)
Improved neonatal resuscitation by TBAs
Afr Health
(1995)
A.T. Bang et al.
Management of birth asphyxia in home deliveries in rural Gadchiroli: the effect of two types of birth attendants and of resuscitation with mouth-to-mouth, tube-mask or bag-mask
J Perinatol
(2005)
B.A. O'Hare et al.
A pilot study to determine if nurses trained in basic neonatal resuscitation would impact the outcome of neonates delivered in Kampala, Uganda
J Trop Pediatr
(2006)

E.M. Dempsey et al.

The effectiveness of neonatal resuscitation training programsPediatr Res

N. Singhal et al.

Evaluation of the effectiveness of the standardized neonatal resuscitation program

J Perinatol

(2001)

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: Supported by the NICHD Global Network for Women's and Children's Health Research (HD43475, HD404636) and the Bill and Melinda Gates Foundation. The authors declare no conflicts of interest.

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Original articleEducational Impact of the Neonatal Resuscitation Program in Low-Risk Delivery Centers in a Developing Country

Objective

Study design

Results

Conclusions

Section snippets

Study Design

Results

Discussion

Lancet

Resuscitation

The impact of the Neonatal Resuscitation Program Guidelines (NRPG) on the neonatal mortality in a hospital in Zhuhai, China

Singapore Med J

Impact of education and training on neonatal resuscitation practices in 14 teaching hospitals in India

Ann Trop Paediatr

Basic newborn resuscitation: a practical guide

Annual summary of vital statistics—1990

Pediatrics

Annual summary of vital statistics—1998

Pediatrics

Improved neonatal resuscitation by TBAs

Afr Health

Management of birth asphyxia in home deliveries in rural Gadchiroli: the effect of two types of birth attendants and of resuscitation with mouth-to-mouth, tube-mask or bag-mask

J Perinatol

A pilot study to determine if nurses trained in basic neonatal resuscitation would impact the outcome of neonates delivered in Kampala, Uganda

J Trop Pediatr

The effectiveness of neonatal resuscitation training programsPediatr Res

Evaluation of the effectiveness of the standardized neonatal resuscitation program

J Perinatol

Original article
Educational Impact of the Neonatal Resuscitation Program in Low-Risk Delivery Centers in a Developing Country