Effectiveness of a Preparedness Training Program for Postpartum Hemorrhage Prevention and Management Among Nursing Students Prior to Clinical Practice in Maternal–Newborn and Midwifery Nursing II Course

Abstract

Introduction Postpartum hemorrhage (PPH) is an obstetric emergency and the leading cause of maternal mortality worldwide, accounting for 27.10% of maternal deaths. This figure is consistent with data from Thailand, where PPH contributes to 25.86% of maternal deaths. Effective prevention and management require rapid, accurate decision-making in accordance with the World Health Organization (WHO) guidelines. Data from fourth-year nursing students at the Faculty of Nursing, Rajamangala University of Technology Thanyaburi, revealed that 28.50% demonstrated clinical decision-making skills in obstetric emergencies at a level below the expected standard. This highlights the urgent need to develop a preparedness program that integrates Kolb’s Experiential Learning Theory, Tanner’s Clinical Judgment Model, and WHO evidence-based nursing practices for the prevention and management of postpartum hemorrhage.

Objectives The objectives of this study were to: (1) compare nursing analytical thinking and clinical decision-making scores related to the prevention and management of PPH among nursing students before and after participating in the preparedness program; (2) compare nursing students’ confidence scores in performing nursing practices for the prevention and management of PPH before and after participating in the preparedness program; and (3) describe nursing students’ satisfaction with the preparedness program.

Design This study employed a quasi-experimental design with one-group pretest–posttest.

Methodology The population and sample consisted of all fourth-year nursing students enrolled in the course Maternal, Infant, and Midwifery Nursing Practice II during the first semester of the 2025 academic year at the Faculty of Nursing, Rajamangala University of Technology Thanyaburi, totaling 87 students. Students who were unable to participate throughout the program, withdrew from the course, or took academic leave were excluded. The research was conducted between June and September 2025. The preparedness program was developed by the researcher and implemented over two days. It comprised four main activities: (1) a two-hour session was conducted to enhance knowledge of postpartum hemorrhage (PPH) based on WHO guidelines (4Ts), corresponding to Kolb’s stage of concrete experience; (2) students engaged in small-group case study analysis of four scenarios for two hours, applying Tanner’s model of noticing, interpreting, responding, and reflecting, which aligned with Kolb’s stage of reflective observation; (3) three progressively complex PPH simulation scenarios were carried out in small groups over three hours, followed by structured debriefing. This activity integrated Tanner’s framework and encompassed all four stages of Kolb’s experiential learning cycle, and (4) a one-hour session was devoted to summarizing and discussing learning outcomes. The program was validated by five experts and pilot-tested with 15 nursing students, yielding a Content Validity Index (CVI) of .96. Research instruments were tested for reliability with 30 nursing students outside the sample group. Five instruments were employed: (1) a demographic questionnaire; (2) a nursing analytical thinking assessment (CVI = .95, ICC = .88); (3) a clinical decision-making assessment (CVI = .92, ICC = .89); (4) a confidence in nursing practice scale (CVI = .96, Cronbach’s alpha coefficient = .91); and (5) a program satisfaction questionnaire (CVI = .94, Cronbach’s alpha coefficient= .89). Data analysis was performed using descriptive statistics, Paired t-test, and One-sample t-test, with the level of significance set at .05.

Results The majority of participants were female (94.25%), with a mean age of 22.45 years (SD = 0.68). The average theoretical course grade point average was 2.85 (SD = 0.42). The findings revealed that, following participation in the preparedness program, nursing students demonstrated significantly higher scores in analytical thinking (M = 17.86, SD = 1.62) compared to before the program (M = 11.38, SD = 2.85), t = 28.512, p < .001. Similarly, clinical decision-making scores were significantly higher after the program (M = 17.82, SD = 1.68) than before (M = 11.08, SD = 2.92), t = 28.847, p < .001. Confidence in nursing practice also increased significantly, with post-program scores (M = 41.93, SD = 4.82) exceeding pre-program scores (M = 24.39, SD = 5.68), t = 31.244, p < .001. In addition, students reported a very high level of satisfaction with the program (M = 4.46, SD = 0.48), which was significantly higher than the criterion score of 3.50, t = 18.734, p < .001.

Recommendation The preparedness program, which integrated Kolb’s Experiential Learning Theory, Tanner’s Clinical Judgment Model, and the World Health Organization’s evidence-based guidelines, was effective in enhancing nursing students’ competence and confidence. Nursing education institutions may incorporate this program into clinical practice courses prior to actual clinical training. Successful implementation requires access to a nursing laboratory equipped with clinical mannequins, simulation scenarios designed according to the 4Ts causes of postpartum hemorrhage, and faculty members with expertise in midwifery to facilitate post-simulation debriefing and reflective learning.