Dissertations & Theses (Open Access)

Date of Award

Summer 8-2017

Degree Name

Doctor of Philosophy in Nursing (PhD)


Diane Wardell, PhD - Chair

Second Advisor

Joan Engebretson, DrPH

Third Advisor

Byron Wycke Baker, MD

Fourth Advisor

Lynda Tyer-Viola, PhD


Purpose: The obstetric hemorrhage rate has risen steadily in the U.S. accounting for 11.4% of maternal deaths between 2011 and 2013, and remains a leading cause of maternal morbidity. Improving the quality and safety of care could prevent much of the morbidity and potential mortality associated with obstetric hemorrhages. An interprofessional obstetric team developed, tested, and implemented obstetric hemorrhage and massive transfusion protocols. Multi-modal team training occurred before service-wide implementation of the protocols, including didactic, skills stations, on-line educational modules, and in situ simulation team training. Early quantitative results were promising.

Methods: To augment understanding of the quantitative results and to understand the experience of interprofessional team members after participating in obstetric hemorrhage training; an exploratory, medically-focused, ethnographic qualitative study was conducted in a five-year old obstetric service within a large, metropolitan, tertiary, free-standing pediatric hospital. Participants were purposively sampled from interprofessional obstetric team members who cared for obstetric hemorrhage patients and participated in hemorrhage training. Data was generated during field observations, and individual and focus group interviews.

Results: Twenty (n = 89 participants) semi-structured interviews were conducted. An inductive, descriptive thematic analysis of the data revealed two central themes: Knowing, and Teaming. Knowing was influenced by training and experience with obstetric hemorrhages, and was further influenced by interactions among members of the interprofessional obstetric team within the complex, non-linear environment. Teaming was reported as a compelling benefit of engaging the interprofessional obstetric team in simulation team training. Simulation training helped the team know how to use the protocols, and improved team functioning during obstetric hemorrhages.

Conclusions: Similar to Benner’s model, training and experience influenced the knowing that obstetric team members applied during an obstetric hemorrhage event. Simulation team training promoted teaming, which helped the interprofessional obstetric team to effectively and efficiently manage an obstetric hemorrhage.


obstetric hemorrhage, training, simulation, knowing, teaming

Included in

Nursing Commons



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