Dissertation
Postpartum Hemorrhage Simulation in a Critical Access Hospital
University of Iowa
Doctor of Nursing Practice (DNP), University of Iowa
Spring 2026
Abstract
Background: Postpartum hemorrhage (PPH) is a leading cause of preventable maternal morbidity and mortality and requires rapid recognition and coordinated team response. In rural and critical-access settings, these events occur infrequently, limiting opportunities for interdisciplinary teams to develop and maintain preparedness. Simulation-based training has been shown to improve readiness for managing low-frequency, high-risk obstetric emergencies such as PPH. Purpose: The purpose of this Doctor of Nursing Practice (DNP) project was to improve interdisciplinary team preparedness for managing postpartum hemorrhage through in situ simulation-based education. Methods: This quality improvement project was conducted at a rural critical-access hospital and included twelve in situ PPH simulation sessions implemented in two phases: nursing-only simulations followed by interdisciplinary simulations. Approximately 55 healthcare providers participated. Simulations were conducted in the labor and delivery unit and operating room and included structured pre-briefing and debriefing. Outcome measures included a one-time retrospective self-assessment survey evaluating perceived knowledge, confidence, teamwork, and likelihood of checklist use, the Perinatal Emergency Team Response Assessment (PETRA) tool to evaluate teamwork performance, and observation of adherence to the facility’s adapted ACOG PPH checklist. Findings: Participants reported improvements across all survey domains, including knowledge, confidence, teamwork, and the likelihood of using the checklist. PETRA scores across domains ranged from 4.49 to 4.62, indicating strong team performance. Checklist adherence improved from 75% in nursing-only simulations to 93.3% in interdisciplinary simulations. Discussion: Simulation-based education improved perceived preparedness, teamwork, and adherence to PPH management protocols. Interdisciplinary training and repeated exposure to simulation enhanced team coordination and protocol utilization. This model is sustainable within existing training structures and adaptable to other low-frequency, high-risk obstetric emergencies.
Details
- Title: Subtitle
- Postpartum Hemorrhage Simulation in a Critical Access Hospital
- Creators
- Emily Eilers - University of Iowa
- Contributors
- Heather Bair (Chair) - University of Iowa
- Resource Type
- Dissertation
- Project Type
- Poster
- Degree Awarded
- Doctor of Nursing Practice (DNP), University of Iowa
- Degree in
- Nurse Anesthesia
- Date degree season
- Spring 2026
- Publisher
- University of Iowa
- Number of pages
- 1 page
- Copyright
- Copyright © 2026 Emily Eilers
- Language
- English
- Academic Unit
- College of Nursing; Doctor of Nursing Practice Projects
- Record Identifier
- 9985217822402771
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