Abstract:

Introduction:
Nursing and midwifery are complex professions that require a nurse/midwife to acquire knowledge and skills, to demonstrate affective attitudes, and to perfect psychomotor skills for safe professional practice and optimal patient outcomes. All these, demand thoroughly preparation of the students before their first encounter with actual patients. Simulation-based education is found to be useful in acquisition of nursing and midwifery skills even in resource limited countries. However, evidence shows that clinical teaching has been marred with staff shortage, limited clinical sites, lack of material resources and skilled educators. This study therefore, explored how simulation-based education could be a solution to challenges encountered with clinical teaching in nursing and midwifery education in Malawi.

Objectives: The study aimed at exploring how simulation-based education could be a solution to challenges encountered with clinical teaching in nursing and midwifery education in Malawi. Specifically, the study intended to identify:
1) benefits of simulation-based education in nursing and midwifery education and practice; and
2) how could simulation improve clinical teaching in nursing and midwifery education in Malawi.

Methodology:
This cross-sectional study adopted qualitative approach to collect data through in-depth interviews and focus group discussions. Thirty-five 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, and ten focus group discussions with final year nursing and midwifery students. Study ethical approval was obtained from College of Medicine Research and Ethics Committee (P.07/21/3362). Thematic analysis was done using NVIVO 12.

Results:
The study revealed that simulation exposes students to realistic clinical situations using multidisciplinary approach, fosters knowledge, skills and confidence development making them safe practitioners. Simulation was evidently also found to be a ‘gap-filler’ in nursing and midwifery education as it proved to be both a supervisory and assessment tool of students’ clinical performance; could be used to train rare conditions, and mitigate language barriers in teaching international students who could not fluently speak English. With use of scenarios, students could practice and master skills at their own time without engaging educators/clinical instructors in simulation centres/corners. Where clinical sites were congested, some students would get into simulation centres/corners to practice and still accumulate required clinical credits.

Conclusion:
This study therefore, recommends simulation-based education in Malawi as an evidence-based and innovative clinical teaching strategy. With guidelines/standards, appropriate infrastructure and material resources and skilled educators, simulation could tremendously improve quality and outcome of clinical teaching in nursing and midwifery education.

Keywords:

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