Nurse perceptions of facilitators and barriers to effective delivery room neonatal resuscitations: a comparison between Zimbabwean and US settings

• Main Author: Valerie Clary-Muronda
• Format: Article
• Language: English
• Published: Elsevier 2018-03-01
• Series: The Lancet Global Health
• Online Access: http://www.sciencedirect.com/science/article/pii/S2214109X18301621

Background: Most babies transition to life outside the uterus with little intervention at the time of birth; however, 4–10% will require some assistance with establishing respirations. Delivery room neonatal resuscitations require prompt, well-coordinated interventions for optimal outcomes. While the importance of timeliness is well documented in the literature, evidence suggests that most delivery room resuscitations do not occur in accordance with the recommended timeline. The purpose of this research was to examine the facilitators for, and barriers to, neonatal resuscitation from the contexts of nurses working in a rural clinic in Zimbabwe and in a hospital in the USA to identify potential areas for improvement that may be similar across resource settings. Methods: Between March 1, 2015, and Feb 1, 2016, nurses working in the Kutama Clinic in the Zvimba District in Zimbabwe and the Virtua Health hospital in Voorhees, NJ, USA were interviewed to explore perceptions of facilitators for, and barriers to, effective neonatal resuscitations in delivery settings. Individual semi-structured interviews using an interview guide were conducted. Interviews were audiotaped and transcribed verbatim for analysis. Data were analysed using qualitative description with a direct content analysis approach. Findings: We interviewed three nurses from Zimbabwe and 12 nurses from the USA. Contextual barriers specific to each setting seemed to affect delivery room neonatal resuscitations. Resources in the Zimbabwe setting were the most prominent barrier, while resuscitation skills for delivery room nurses were identified as the most prominent barrier for nurses working in the USA. Additionally, similarities were identified across settings such as a need for improved competency in neonatal resuscitation, ongoing continuing education, and frequent skills review. Nurses in the Zimbabwean setting use simulation to reinforce neonatal resuscitation skills on a regular basis—a practice that may be useful for skill reinforcement for nurses in the US setting. Interpretation: Targeted bag-mask ventilation training with frequent practice outside of routine training may improve nurse comfort with the crucial skill of positive pressure ventilation and may improve neonatal outcomes across settings. Funding: None.