Helping Babies Breathe (HBB) training: What happens to knowledge and skills over time?
Helping Babies Breathe (HBB) training: What happens to knowledge and skills over time?
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DOI：
10.1186/s12884-016-1141-3
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发表时间：
2016-11-22
影响因子：
3.1
通讯作者：
Hibberd, Patricia L.
中科院分区：
文献类型：
--
作者：
Bang, Akash;Patel, Archana;Hibberd, Patricia L.
背景：出生后的第一分钟对于降低新生儿死亡率至关重要。帮助婴儿呼吸(HBB)是一个基于模拟的新生儿复苏计划，适用于低资源环境。方法：我们在NICHD全球网络研究站点(印度那格浦尔和贝尔高姆和肯尼亚埃尔多雷特)的71个设施中进行了HBB培训，设施学员与高级培训师(MT)的比例为6：1。由于工作人员更替，一些助产士(BA)在完成初步培训(追赶初步培训)后，在加入产房工作人员时接受了培训。我们比较了在HBB初始培训前后和在活跃的BA中的进修培训之后的技能和知识的通过率。客观结构化临床考试(欧安组织)B通过比较初始训练后和复习前的训练表现来测试复苏技能的保持。我们使用多变量Logistic回归分析确定了与复习前培训表现中技能丧失相关的因素。结果：105人(每个机构1.6人)进行了835人的HBB初始培训和复习培训；76%的患者以前没有接受过复苏培训。初步培训提高了知识和技能：知识测试的通过率从74%提高到99%(p<；0.001)。只有5%的人能够在最初的训练前正确地给新生模特换气，但97%的人通过了初始训练后的换气测试(p<；0.0001)，99%的人通过了欧安组织B的复苏评估。在复习前评估中，初始培训后平均6.7(SD 2.49)个月，99%的人通过了知识测试，但欧安组织B复苏技能测试的成功率下降到81%。与复苏技能下降相关的特征是来自三级护理机构、没有接受过复苏培训以及培训的时机(初始培训与追赶培训)。结论：HBB培训显著提高了新生儿复苏知识和技能。然而，随着时间的推移，技能的下降超过了知识的下降。为了保持新生儿复苏技能，需要进行持续的技能练习和监测、更频繁的复测和进修培训。
Background: The first minutes after birth are critical to reducing neonatal mortality. Helping Babies Breathe (HBB) is a simulation-based neonatal resuscitation program for low resource settings. We studied the impact of initial HBB training followed by refresher training on the knowledge and skills of the birth attendants in facilities.Methods: We conducted HBB trainings in 71 facilities in the NICHD Global Network research sites (Nagpur and Belgaum, India and Eldoret, Kenya), with a 6: 1 ratio of facility trainees to Master Trainers (MT). Because of staff turnover, some birth attendants (BA) were trained as they joined the delivery room staff, after the initial training was completed (catch-up initial training). We compared pass rates for skills and knowledge pre- and post-initial HBB training and following refresher training among active BAs. An Objective Structured Clinical Examination (OSCE) B tested resuscitation skill retention by comparing post-initial training performance with pre-refresher training performance. We identified factors associated with loss of skills in pre-refresher training performance using multivariable logistic regression analysis. Daily bag and mask ventilation practice, equipment checks and supportive supervision were stressed as part of training.Results: One hundred five MT (1.6 MT per facility) conducted initial and refresher HBB trainings for 835 BAs; 76% had no prior resuscitation training. Initial training improved knowledge and skills: the pass percentage for knowledge tests improved from 74 to 99% (p < 0.001). Only 5% could ventilate a newborn mannequin correctly before initial training but 97% passed the post-initial ventilation training test (p < 0.0001) and 99% passed the OSCE B resuscitation evaluation. During pre-refresher training evaluation, a mean of 6.7 (SD 2.49) months after the initial training, 99% passed the knowledge test, but the successful completion rate fell to 81% for the OSCE B resuscitation skills test. Characteristics associated with deterioration of resuscitation skills were BAs from tertiary care facilities, no prior resuscitation training, and the timing of training (initial vs. catch-up training).Conclusions: HBB training significantly improved neonatal resuscitation knowledge and skills. However, skills declined more than knowledge over time. Ongoing skills practice and monitoring, more frequent retesting, and refresher trainings are needed to maintain neonatal resuscitation skills.