Abstract:

Introduction:
Simulation-based education (SBE) is found to be useful in acquisition of nursing and midwifery skills. Yet, there is limited experience and documentation related to implementation of SBE within nursing and midwifery education in Malawi. The current study therefore explored factors influencing implementation of SBE in nursing and midwifery classroom and clinical settings in Malawi.

Objectives:
The study aimed at identifying factors influencing implementation of simulation-based education among nursing and midwifery lecturers and clinical instructors in the selected training institutions and clinical sites in Malawi.

Methodology:
This cross-sectional study utilized mixed methods to collect data through questionnaires, in-depth interviews, focus group discussions and desk review of nursing and midwifery syllabi and curricula documents in Malawi. Review of Nurses and Midwives Council of Malawi (NMCM - regulatory body of nursing and midwifery education) syllabi, and institutional curricula documents was done to supplement data collected through questionnaires, focus group discussions, and in-depth interviews. Questionnaires were administered to 293 participants, out of which 144 were clinical instructors working at the four central hospitals, Nkhotakota District Hospital and 149 were final year students from the five nursing and midwifery training institutions in Malawi. Ten focus group discussions were conducted with the final year nursing and midwifery students. In-depth interviews were conducted with deputy hospital directors (nursing and midwifery services), college principals, deans, heads of departments, director of nursing and midwifery services (Ministry of Health) and NMCM registrar. Study ethical approval was obtained from College of Medicine Research and Ethics Committee (P.07/21/3362). Quantitative data were entered into SSPS version 23.0 for descriptive statistics and thematic analysis was conducted for qualitative data using NVIVO 12.

Results:
The study revealed that despite 247(83.4%) having theoretical knowledge on simulation in nursing and midwifery education, only 32 (12.9%) mentioned simulations as a current teaching method. Most participants mentioned the didactic teaching methods like lecture (traditional - teacher centred), which they felt did not reinforce acquisition of clinical skills among students. Participants felt that simulation expose students to realistic clinical situations and foster knowledge, skills and confidence development among students and health workers making them safe practitioners.Dearth of simulation in nursing and midwifery syllabi and curricula, lack of simulation guidelines and expertise, lack of appropriate simulation infrastructure, skills laboratories, teaching hospitals and equipment were identified as key factors influencing implementation of SBE in Malawi.

Implications:
While recommending simulation-based education in Malawi as an evidence-based clinical teaching strategy, review of NMCM simulation guidelines, appropriate simulation infrastructure, incorporation of simulation in nursing and midwifery curricula in all training institutions need to be reinforced through policy.

Keywords:

Simulation, nursing, midwifery, education, educators, clinical teaching.