The learning needs of staff in intrapartum units are varied from students, to new graduates, to experienced nurses. Intrapartum units require different types of programs to meet the educational needs of the staff. This text has been designed to address different educational levels in a variety of formats.

This module reviews the basic concepts of adult learning theory including characteristics of the adult learner, application of theories in practice, and how the text can be used to support the development of cognitive, technical, and behavioral skills in intrapartum staff or students of intrapartum nursing.

In the development of any educational program, the needs of adult learners should be considered and concepts of adult learning theory utilized in designing the program. The characteristics of the adult learner reflect a group that is internally motivated, is self-directed, and seeks new knowledge for immediate application.¹ It is important to be cognizant of the need to develop critical thinking skills through the use of this text. The cognitive domain can be broken into two levels: the primary and the most basic level consisting of knowledge, comprehension, and application, and the higher level consisting of analysis, synthesis, and evaluation.² Traditionally, the bulk of education has concentrated on the lower level despite the fact that practitioners operate at the higher level during patient care. It is important to challenge the learners with an opportunity to put the new knowledge gained from reading this text into practice either through case review or simulation. Much of the literature in adult education reflects the importance of hands-on experience as a means to acquire and refine new knowledge. Experiential learning also leads to longer retention of new skills for a longer period of time when compared with traditional didactic presentations.^3,4,5,6,7,8

Simulation-based training (SBT) is an education methodology that incorporates experiential learning. During SBT, the learner is placed in a realistic setting that supports practice of concepts that have been studied. The objectives for the learner in SBT are often divided into three categories: cognitive, technical, and behavioral.

Experts in human performance training have suggested that 10 behaviors are critical to effective, efficient, and safe team performance.¹⁰ These skills can best be taught in SBT. Behavioral skills identified as important include the following:

These three categories of learning objectives inform all aspects of SBT and are the most important part of the scenario, the working tool of SBT. The scenario contains the topic of the SBT (such as shoulder dystocia or eclampsia) in the form of the patient story or history and learning objectives
written to cover critical aspects of that topic. For any given topic of SBT, learning objectives can be written to cover a wide range of learner experience from nursing student to expert.

Debriefing occurs immediately after the end of the scenario and is facilitated by one of the instructors. Debriefing allows the learners to review and reflect on the events that occurred during the scenario. The debriefing should occur in a location that provides confidentiality to encourage an honest and open discussion about the events in the scenario. In addition to a secure location, all attending the debriefing should sign a confidentiality agreement that states the performances in the scenario, and the conversation in the debriefing will not be discussed outside of SBT. Assurance that performance issues or discussion during SBT will be held confidential creates a safe learning environment for those involved.¹¹

SBT is uniquely able to combine cognitive, technical, and behavioral skill practices. The addition of video recording of training scenarios allows all participants to constructively review the session and discuss actions of the team during debriefing. These sessions can advance individual performance and performance of the interdisciplinary team as a whole. All learners and instructors should sign a consent form before video recording giving permission for the recording and detailing if the recording will be destroyed after debriefing or retained. If retained, the learners need to be informed how the recording will be used. The learners have the right to deny any use of the recording outside of debriefing without their permission. Samples of confidentiality and consent to video forms can be found in Displays 22.1 and 22.2.

Topics for intrapartum scenarios can include shoulder dystocia, precipitous birth, hemorrhage, or any of the topics covered in the modules of this text. Sample scenarios can be found in the Skills Units at the end of this module. The sample scenarios can be used as a template to create other scenarios for the different modules in the text. Educators running an SBT program
should have experience with SBT or attend a simulation instructor program. In addition, evaluation of the program is important to improve future simulations. An example evaluation tool is outlined in Table 22.1.

The goal of nursing education is to facilitate development of individual knowledge, attitude, and skills that allow a nurse to provide safe, effective, evidence-based care.^12,13 There continues to be a decrease in focus on specialty area education such as obstetrics or pediatrics in pre licensure nursing education; however, a generalist knowledge base may be assumed of the graduate nurse. Any graduate or experienced nurse entering an intrapartum unit should be teamed with a mentor/preceptor for support and guidance. Ongoing, continuing education provides nurses with the opportunity to further develop and refine nursing skills leading to expertise; a comprehensive knowledge base, experience with common and less common technical skills and well versed in team and leadership skills.