International Journal of Healthcare Simulation

Background:

Approximately 20% of women will reach diagnostic thresholds for mood disorders during the perinatal period, and between 0.1% and 0.2% will experience a psychotic disorder ^[2]. Postnatal psychosis is a dangerous condition with an often rapid onset following a baby’s birth. In severe cases, symptoms may include a mother’s desire to harm herself or her baby. The midwifery profession reports feeling ill-prepared to provide mental healthcare, and the adequacy of mental health content in training curricula has been questioned. The rarity of perinatal psychosis also means that clinical placement opportunities for student midwives are limited. Scenario-based simulated learning provides one possible solution to this challenge.

Aim:

The aim of the study was to explore final-year midwifery students’ experiences of a perinatal psychosis, scenario-based simulation (SBS).

Simulation activity outline:

A 1-day SBS learning activity with two scenarios of women exhibiting psychotic symptoms. Each scenario included a background narrative, actors’ roles with partial scripts and comprehensive patient clinical information. Two midwifery students acted as assessment staff in each scenario whilst their colleagues took observer roles. Guided debriefing followed each scenario.

Method:

The study was conducted in March 2020 at a UK Higher Educational Institute. It employed an exploratory, descriptive design to capture qualitative data from 11 final-year midwifery students who took part in the SBS. Data sources included semi-structured interviews and information shared during scenario debriefings. Data were thematically analysed following the seven-step process of Dahlgren and Fallsberg ^[2]. Ethical approval for the study was granted in July 2019 (LRU-18/19-13171).

Results:

Three main themes emerged from the data. The SBS facilitated learning through different ways of knowing. Students drew on personal experiences to identify communication and care challenges, re-appraised assumptions they held about mental health and ethnicity and articulated the benefits of peer learning. Students held equivocal views concerning the adequacy of mental health content in existing curricula, and not all had encountered women with perinatal psychosis on clinical placements. Clinical environments were highly valued learning contexts for the observation of staff and the gradual, supervised application of practice skills. Both learning mechanisms were replicated in the SBS, which helped the students realize attributes and skills in themselves necessary for the care of women with perinatal psychosis. The SBS facilitated transformative learning through its realism and the development of skillsets not amendable to didactic teaching, e.g. teamwork and communication skills. Debriefing helped to cement learning in the minds of students.

Implications for practice:

The SBS was an effective form of pedagogy that enabled invigorating and deep learning. It is recommended that other educators consider its use, particularly for conditions that students do not always encounter in clinical placements. Well-prepared, detailed scenarios are recommended to promote realism and each SBS should be followed by a structured debrief. Developments should be accompanied by evaluative methodologies to gauge their impact and further research is needed to better understand how SBS can be used more effectively throughout midwifery education.