The Impact of Pedagogical Framework in Education of Neonatal Resuscitation

Study Overview
=================
Brief Summary
-----------------
Virtually 10% of newborns suffer respiratory distress at birth thus need intervention from proficient health professionals. Pakistan is one of the top ten countries that carry two-thirds of the global burden of neonatal deaths. It is suggested that most of these deaths can be prevented through the provision of trained emergency birth attendants, in which education plays an integral role. Since its inception in the neonatal resuscitation program, we are still in the struggle to find out the best strategies to disseminate NRP knowledge, training, and guidelines that promise the best outcome. Hence, little published data on this phenomenon is available regarding undergraduate students. That determines the best way to educate them in performing the skills that urgently require an infrequent needed such as neonatal resuscitation. Therefore, this study intended to address this gap in the education of neonatal resuscitation through two different approaches. One is a traditional 2-step method and the other is an adapted Pedagogical framework (Lean, See, Practice, Prove, Do and Maintain).

Detailed Description
-----------------
Globally, nurses are the largest workforce in the healthcare system that are directly engaged in the provision of newborn care. They should be conversant and competent in neonatal resuscitation. However, the majority of nurses are not skillful in the respective field. The situation is not very different when we are talking about nursing students. Who are our future workforce, hence are found incompetent in emergency newborn management and neonatal resuscitation. It is well documented that effective educational programs in preservice settings such as schools of midwifery, nursing, and medicine, established more active forms of lifelong learning to improve the quality of care. While the transformation of theoretical knowledge into clinical practice requires effective teaching in the field of resuscitation is a vital element for all undergraduate students. However, like many other developing countries in Pakistan, mostly traditional methods are following in nursing education. While the traditional method of teaching is insufficient to meet the educational demands of nursing students in clinical practice. Hence, Nursing students often are unprepared and lacking confidence in simple, yet life-saving procedures such as neonatal resuscitation. Therefore, incorporating an effective model and framework in nursing education is needed that could enhance nursing students' skills and improve clinical outcomes. The Learn, See, Practice, Prove, Do, and Maintain (LSPPDM) pedagogy is one of such frameworks synthesized after intensely reviewing the literature. This framework is acting as a guiding path for educators in teaching and learning procedural skills. As Knowledge is considering a prerequisite for competence in skill performance and to evaluate the effectiveness of an educational program self -efficacy measurement is an important tool. Thus, the important variables knowledge, self-efficacy, and skill have been selected for this study. Thus, the study objective will be: To compare the knowledge, skill, and self-efficacy among undergraduate nursing students learning of neonatal resuscitation through Learn, See, Practice, Prove, Do, Maintain pedagogy as compared to those who will learn through the traditional method. This study will contribute essentially to determine the effectiveness of an adapted pedagogical framework in the teaching and learning of neonatal resuscitation skills, especially in a resource-limited society. Moreover, the study findings will help the organization to develop strategies for improving nursing education.

Official Title
-----------------
The Efficacy of Pedagogical Framework (Learn, See, Practice, Prove, Do, Maintain) on Knowledge, Skill, and Self-Efficacy of Nursing Students Regarding Neonatal Resuscitation.

Conditions
-----------------
Nursing Students Education on Neonatal Resuscitation

Intervention / Treatment
-----------------
* Other: Pedagogical Framework (Learn, See, Practice, Prove, Do, and Maintain)
* Other: Traditional Method


Participation Criteria
=================
Eligibility Criteria
-----------------
Inclusion Criteria: Are currently enrolled in the Bachelor of Science in Nursing (4 years) 3rd and 4th Professional. Those willing to attend the full course of neonatal resuscitation. Having age 18-25 years. Those willing to give informed consent. Exclusion Criteria: Will be on leave from that period Have already received any educational training on neonatal resuscitation. Working as Nursing Assistants in Clinical Setting.

Ages Eligible for Study
-----------------
Minimum Age: 18 Years
Maximum Age: 25 Years

Sexes Eligible for Study
-----------------
Female

Accepts Healthy Volunteers
-----------------
Accepts Healthy Volunteers

Study Plan
=================
How is the study designed?
-----------------

Design Details

Primary Purpose: Health Services Research
Allocation: Randomized
Intervention Model: Parallel Assignment
Interventional Model Description: The study design is a Single-blind randomized control trial conducted in the College of Nursing, Allama Iqbal Medical College, Lahore, Pakistan. A sample size of 72 nursing students (36 in each group) will be taken through simple random sampling. The students allocated from each professional in group A and group B through the Lottery method. Allocation of participants was concealed using envelop method. A total of 6 weeks of intervention will be provided to both groups. Group A will be taught through the two steps traditional method (2 lectures/week + 1 skill lab/week). On the contrary Group B will learn through the 6-step method constituted 2 lecture/week + video + 2skill lab/week (1 session under instructor + 1 session for skill maintenance).
Masking: Single


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Active Comparator: Traditional Group<br>Group A will be taught through the two steps traditional method (2 lectures/week + 1 skill lab/week). First, learn through didactic Lectures and then practice skills on the Mannequins. The educational lecture content will be the same for both groups. | Other: Traditional Method<br>* The traditional method group learns through 2-step method. didactic lectures on neonatal resuscitation were delivered. Practice skill on mannequins<br>|
| Experimental: Pedagogical Group<br>Group B will learn through the 5-step method [ 2 lectures/week + video + 2skill lab/week (1 session under instructor + 1 session for skill maintenance)], learn skill, see the video on resuscitation, practice on simulator, prove through practice, observe skill on clinical rotation and lastly maintain it through clinical supplemented with simulation. | Other: Pedagogical Framework (Learn, See, Practice, Prove, Do, and Maintain)<br>* The Learn, See, Practice, Prove, Do, and Maintain (LSPPDM) pedagogy is acting as a guiding path for educators in teaching and learning procedural skills. It is synthesized after intensely reviewing the literature comprises steps. In the 1st step, learners learn through didactic lectures, further proceeding to see procedural videos. The 3rd step, Practice expose learners to perform the skill on a simulator. In the 4th step Prove the learner proves the skill. The 5th step Do comprise real-life exposure through the clinical rotation. Then, finally the 6th stepMaintain the learner maintains skill supplemented with simulation as needed.<br>|

What is the study measuring?
-----------------
Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Knowledge Questionnaire | knowledge is considering awareness of Neonatal resuscitation. It will be measured through a 17-item multiple-choice question adopted from Knowledge Question total score ranged from 0 to 17. A higher score means have more knowledge. | before intervention and 6 weeks after intervention | 
| Self-efficacy for Neonatal Resuscitation (SENR) | The SENR instrument is a 23-item scale that measured nursing students' perception of confidence in their capabilities in neonatal resuscitation. All SENR items were valued on a 10-point Likert scale. The total score ranged from 0 to 230. A higher score means have more self-efficacy. | before intervention and 6 weeks after intervention | 
| Neonatal Resuscitation Checklist | A 30 items checklist will be used. Each of the correct actions was graded as 1=yes and for wrong action 0=no. The total score ranged from 0 to 30. The total score ranged from 0 to 30. A higher score means have more skill. | before intervention and 6 weeks after intervention |