Simulation-Based Training Improves Student Assessment of Oral Feeding Skills in Preterm Infants

Courtney Broadfoot,Julie Estis

doi:10.30707/tlcsd4.3/fvmx2142

Abstract

Advancements in medical technology have contributed to increased rates of preterm birth. Prematurity places infants at high risk for feeding difficulties, however. Early identification and assessment of preterm infant dysphagia is critical to maximize nutrition and hydration, feeding safety, and growth and development. The purpose of this study was to assess the ability of a simulation-based training toolto increase non-health care and entry-level clinical student sensitivity to signs of feeding distress in preterm infants. Data were collected from 60 students (20 masters-level Speech-Language Pathology, 20 undergraduate nursing, 20 undergraduate non-health care) in a pre-test/post-test design. All participants completed a brief simulation training protocol, and accuracy percentages were calculated based on their ability to determine the following: physiological and behavioral signs of feeding distress, oral feeding skill level (OFS), and clinical recommendation for further feeding evaluation. Our results revealed that this simulation-based training improved the identification of behavioral (p < 0.001) and physiological (p < 0.001) signs of feeding distress, OFS level (p < 0.001), and ability to make appropriate clinical recommendations (p < 0.001).This study has identified a successful method to effectively train entry-level clinical and non-clinical students to screen feeding skills in preterm infants. This training approach has the potential to improve identification of feeding distress and to recognize the need for a dysphagia evaluation to optimize clinical outcomes in this fragile population.

Highlights

While advancements in medical technology have substantially improved clinical outcomes, preterm birth rates have risen world-wide over the last decade (Blencowe et al, 2012; Liu et al, 2016)
We hypothesized that this simulation-based training protocol would be an effective method to train graduate level speech-language pathology and undergraduate level nursing and non-health care students to accurately identify signs of feeding distress, use an objective assessment tool to categorize infant feeding skill level, as well as make appropriate clinical recommendations regarding infant feeding safety
The results of this study indicated that all student groups demonstrated significant improvement in accuracy scores for all outcome variables post-training

Summary

Introduction

While advancements in medical technology have substantially improved clinical outcomes, preterm birth rates have risen world-wide over the last decade (Blencowe et al, 2012; Liu et al, 2016). Infants born prematurely face increased risks of developmental concerns and subsequent need for healthcare (Bird et al, 2010; Glass et al, 2015; Petrou, 2005; Schmitt et al, 2016). Dysphagia increases the risk for malnutrition, dehydration, and aspiration, which can lead to aspiration pneumonia and other complex respiratory conditions (Eun Uhm et al, 2013; Groher & Crary, 2010; Kakodkar & Schroeder, 2013; Lefton-Greif, 2008; Volpe, 2008). Feeding ability is a major concern for parents of infants in the Neonatal Intensive Care Unit (NICU) and significantly contributes to maternal psychological distress (Park et al, 2016)

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