Helping babies breathe: Providing an evidence-based education intervention at a tertiary referral hospital in Liberia

Abstract

Background: Helping Babies Breathe (HBB) is a neonatal resuscitation program that utilizes an active learning pedagogy to increase knowledge and skills for nurses and midwives in resource-limited areas. Two faculty members from the Tubman National Institute of Medical Arts in Liberia became certified as HBB trainers while completing a graduate nurse educator degree in the US. The aim of the current study was to use an academic program requirement for a graduate practicum and research experience to determine the effect of implementing the HBB program on the level of neonatal resuscitation knowledge and skills of students and staff at the John F. Kennedy Medical Center (JFKMC) in Liberia.

Methods: The HBB program was provided to 154 participants from the JFKMC and the co-located Tubman National Institute of Medical Arts for a period of six weeks. Assessment of the participants’ neonatal resuscitation skills and knowledge included pre/post scores on multiple choice questions and evaluation of the bag and mask ventilation skills using an objective structured clinical examination (OSCE) approach.

Results: Participants expressed satisfaction with the program and the skills acquired. A paired t test for the multiple choice items indicated significant knowledge difference between the pretest (2.36 ± 2.21) and posttest (15.27 ± 1.24) scores, p = .000. On the skills checklist for OSCE A, all participants achieved final competency rates of 100% on six items, 90%-
99% on two, 70%-79% on one, and <69% on four items; on OSCE B, they achieved final competency rates of 100% on 12 checklist items, 90%-99% on one, 80%-89% on three, 70%-79% on one, and <69% on one item.

Conclusions: Implementing the HBB training is an important initial step in providing delivery room staff with the skills and knowledge to reduce neonatal mortality from asphyxia. The training needs to be supplemented with additional, ongoing practice and institutional support. The model of allowing internationally educated nurses completing graduate nurse educator degrees in the US to complete practicum and research requirements at their home institution was successful. Nurse and midwifery faculty who are certified in providing the HBB can effectively provide this training. We recommend that HBB training be provided in all health care facilities in developing countries with high neonatal mortality rates.