A scoping review on the contribution of interprofessional collaborative practices on preventing and managing post-partum haemorrhage in the health care system

A scoping review on the contribution of interprofessional collaborative practices on preventing and managing post-partum haemorrhage in the health care system | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article A scoping review on the contribution of interprofessional collaborative practices on preventing and managing post-partum haemorrhage in the health care system Nombulelo Zenani, Patience Mashudu Tulelo, Khathu Netshisaulu, and 4 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4576910/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 24 Apr, 2025 Read the published version in BMC Nursing → Version 1 posted 9 You are reading this latest preprint version Abstract Background Post partum haemorrhage (PPH) is one of the complications that leads to increased morbidity and mortality management is interdependent on various healthcare professions acting according to promote safe and quality outcomes. This scoping review aims to explore and synthesise literature regarding the contribution of interprofessional collaboration practices in preventing and managing post-partum haemorrhage. Design: The review adopted a scoping review which is underpinned by a framework by Arksey and O’Malley that has five stages. Four databases were searched for sources: CINHAL, Scopus, PubMed, and Medline. Only English full-text written articles, across various research designs published between 2000–2024, were part of the inclusion criteria for the review. Results The review has shown that effective interprofessional collaboration has the potential of ensuring prompt diagnosis and management of PPH where the results ensure positive patient and team dynamics outcomes. Moreover, interprofessional collaboration in managing PPH safeguards good use of resource utilisation and team synergy where the is awareness of each healthcare professional roles, mutual trust and respect and shared leadership. Conclusion Preventing post-partum haemorrhage depends on high effective interprofessional collaboration. As a means of promoting safe healthcare delivery when PPH emergency occur, interprofessional collaboration practices is encouraged to be strengthened through various measures. Either through interprofessional collaboration quality improvement initiatives or interprofessional situ simulation training. Adverse events Interprofessional collaborative practices prevention maternal and ubuntu Figures Figure 1 Background Every year, millions of women experience postpartum haemorrhage (PPH), which is defined as a blood loss of 500 ml or more within 24 hours of birth 1 . Despite decades of work and proven lifesaving interventions, this preventable and treatable condition remains the leading cause of maternal mortality worldwide 1 . Despite this, a review of the literature revealed that PPH is more effectively prevented and managed in high-income countries than in low- and middle-income countries. According to a WHO systematic analysis of causes of maternal death, PPH accounts for nearly 73% of maternal deaths in Low Middle-Income Countries (LMICs), with Sub-Saharan Africa accounting for more than 40% 2 . When PPH occurs, early detection and evidence-based management are critical to saving women's lives 3,4 .As a result, interprofessional collaboration practices are required to prevent and manage PPH in the health-care system to assist with the attainment of sustainable developmental goal 3 which is good health and well-being.PPH can be prevented and managed through a variety of interprofessional collaboration practices. Previous research has shown that multidisciplinary professionals such as nurses, midwives, and medical doctors who work in maternity have identified in-service simulation training as one of the interprofessional collaboration practices for managing PPH. These professionals emphasized that receiving multidisciplinary simulation training could foster effective teamwork by ensuring that all team members had a comparable level of clinical understanding of PPH care and the skills to provide it 5 . Interprofessional simulation training is increasingly recognized as a method for improving learning and performance in order to improve patient safety 6 . To bridge the gap between simulation and reality, simulation teams should be representative of real-life teams, including various medical specialities and levels of expertise 7 . Collaboration across disciplines is another form of interprofessional collaboration for PPH prevention and management. Collaboration across disciplines (e.g., midwifery, obstetrics) to develop a shared vision of care for women with PPH and streamline processes may necessitate project leaders understanding the different perspectives and goals of various departments and cadres 8,9 As a result, the goal of this review is to map and summarise the evidence on the role of interprofessional collaborative practices in preventing and managing PPH in the healthcare system. Design A scoping review was conducted according to the five-step framework that was proposed by 10 . The steps are the following: Identification of research objective Search/ Identification of applicable studies Selection of relevant studies Charting of the data and Collating, summarising, and reporting of the results The scoping review was found suitable for this study, to map the literature on the topic and to further identify gaps that can be addressed for future studies 11 . The scoping review included a broad literature regarding the contribution of IPCP in preventing maternal adverse events with an ubuntu perceptive. The PRISMA extension for the Scoping Reviews checklist was used to report the findings. Step 1: Identification of research objective The research objective for this study was to “ Explore and synthesise literature regarding the contribution of IPCP in preventing maternal adverse events in the perceptive of ubuntu”. The Population, content, and context framework as listed below was used to determine the eligibility of the scoping review. Population: Interprofessional birth team / maternal or child healthcare professionals: This can be a team consisting of midwives, physicians, gynaecologists, or community/ traditional birth assistants Intervention: Interprofessional collaboration practices in maternal care Comparison: N/A Outcome: Prevented and managed post-partum haemorrhage occurrences Step 2: Search applicable studies The authors searched for articles in the following databases: CINHAL, PubMed, Scopus, and Medline. The search terms were level keywords:1st: Interprofessional collaboration OR healthcare teamwork OR interdisciplinary teamwork OR obstetric teamwork OR interprofessional education OR interprofessional relationships OR prenatal care collaboration OR postnatal care teamwork OR interprofessional training OR health care coordination OR interdisciplinary communication OR collaborative health care models OR Obstetric care teamwork. 2nd AND postpartum haemorrhage prevention Or Maternal health OR Obstetric care OR maternal mortality OR perinatal care OR patient safety in obstetrics OR obstetric emergencies OR maternal outcomes. 3rd AND haemorrhage OR rapid blood loss OR bleeding OR bleed OR uncontrollable bleeding. The search was done by the two of the authors alongside the research assistant of the Health Science faculty till the 16th of January 2024. Step 3: Selection of relevant studies In this step, the authors decide on the inclusion and exclusion criteria and the criteria are to be based on the specifics of the research question and aligned with the subject matter through familiarizing with the obtained studies 12 . See below the inclusion and exclusion criteria of the review. Inclusion criteria The study included peer-reviewed qualitative, quantitative, mixed methods, multi-mixed methods, reviews, and unpublished dissertations. The empirical studies were included to validate multiple hypotheses and increase knowledge on the current topic. The reviews provided the authors with summaries of the state of research, the gaps, and recommendations for future studies concerning the research question of the scoping review. Grey search data was retrieved using PubMed and CINHAL, considering the PICO framework adopted for the review as stated above and checking the reference list of the identified articles. The timeframe for the included studies was from 2000–2024, the rationale for the timeframe was to note from the commencement of the Millennium development goals what has been the progress of minimising PPH with the inclusion of interprofessional practices. Exclusion criteria We excluded non-peer-reviewed articles, reports, and peer-reviewed articles that were written in languages other than English because all the others understand and read English fluently for a better understanding of the obtained sources. Furthermore, all sources that did not meet the eligibility constructed by the PICO framework of the scoping review were excluded. Thus, all studies outside the maternal care setting did not include intervention of IPC measures to decrease maternal adverse events were excluded. To manage the citations, all sources were imported into a software-based reference management system called Rayaan. The articles were screened by two of the authors and for any disagreements, all the authors were involved to reach a consensus. The articles were screened, first the title, following abstracts, and then the full text by the authors. The duplicates were deleted, and considering the eligibility criteria the sources who did not meet the criteria were excluded by the authors. The figure below represents the data search strategy in a PRISMA diagram. Step 4: Charting of the data In this step, the authors developed a data chart form which was used to extract data from the included studies. See the below Table 1 which is the data extraction , provides a descriptive analysis of the included studies. Two authors charted data separately and compared the findings and revised and finalized the chart on completion. Table 1 Data extraction table detailing the data reduction AUTHOR AND PUBLICATION YEAR TITLE OF THE STUDY AIM OF THE STUDY STUDY POPULATION STUDY SETTING STUDY FINDINGS/OUTCOMES OUTCOME OF IPC MODEL TYPE OF STUDY Brazil V; McLean D; Lowe B; Kordich L; Cullen D; De Araujo V; Eldridge T; Purdy E; 2022 A relational approach to improving interprofessional teamwork in post-partum haemorrhage (PPH) To study and support teams improving the care of women with PPH Junior and senior midwives, junior and senior obstetricians, and anaesthetic doctors. Gold Coast University Hospital (Southport Australia) This study revealed poor mutual respect, knowledge sharing and on-time communication among professionals. The IPC model gave a deeper meaning of productive teamwork and conflict management techniques. Major PPH cases decreased significantly in the labour ward. Mixed Method research (collaborative action research approach) Greer JA; Lutgendorf MA; Ennen CS; Van Petten L; Modzik A; Salas D; Fish J; Middlebrooks R; Spalding CN; Delorey DR; 2023 Obstetric Simulation Training and Teamwork: Immediate Impact on Knowledge, Teamwork, and Adherence to Haemorrhage Protocols. To determine the impact of the OB-STaT program on team member knowledge of diagnosis and management of PPH using pretest and post-test scores, assessment of adherence to established PPH protocols, teamwork, and standardized patient perception scores across a nationwide healthcare system using a combination of travelling simulation experts (proctors) and local clinical subject matter experts to train and debrief participants. Obstetric and gynaecology attending physicians and residents, anaesthesia attending physicians and residents, certified and student nurse anaesthetists, paediatric attending physicians and residents, family practice attending physicians and residents, certified nurse midwives, obstetric and neonatal nurses, Navy hospital corpsmen (who function as medical assistants), blood bank personnel, and operating room personnel 8 US Navy military treatment facilities (MTFs) within the continental United States that provided delivery services The training improved PPH recognition and management amongst obstetric teams. Communication, decision-making, situational awareness, and role taking showed a significant improvement following the training. The multidisciplinary team improved in teamwork and PPH protocol adherence after the OB-STaT program Prospective, multisite, cohort study Wiesehan EC; Keesara SR; Krissberg JR; Main EK; Goldhaber-Fiebert JD; 2023 State Perinatal Quality Collaborative for Reducing Severe Maternal Morbidity From Hemorrhage: A Cost-Effectiveness Analysis To evaluate the cost effectiveness of Cal-ifornia’s statewide perinatal quality collaborative forreducing severe maternal morbidity (SMM) from hemor-rhage Patients' costs records and Nurses in managerial positions who implemented or maintained the PPH–SMM reduction initiative The state of California Implementing the PPH–SMM reduction initiative reduced the possibility of complications from PPH and emergency hysterectomy were reduced. The IPC initiative resulted in a cost effective quality-improvement enterprise that reduced the occurrence of PPH complication in the majority of birthing hospitals. Evaluative study (Economic analysis) Brogaard L; Kierkegaard O; Hvidman L; Jensen KR; Musaeus P; Uldbjerg N; Manser T; 2019 The importance of non-technical performance for teams managing postpartum haemorrhage:video review of 99 obstetric teams To analyse videos of obstetrics teams managing real-life patients with major postpartum haemorrhage Obstetric teams (Obstetricians and Midwives) managing real-life postpartum haemorrhage. A university hospital and a regional hospital in Denmark This study revealed that successful management of postpartum haemorrhage depends on well-coordinated interprofessional teamwork. Communication was poor in some teams during the management of PPH, which could jeopardise the success of management as a lot needs to be done in a short space of time. No results (No IPC model was implemented after the study), but the study recommends continuous interprofessional collaboration and evaluation of teams to prevent PPH. Observational study (Video review) Baayd J; Lloyd M; Garcia G; Smith S; Sylvester H; Clark E; Cross B; Gero A; Cohen S; 2023 Catalyzing Collaboration Among Interprofessional Birth Transfer Teams Through Simulation To develop and pilot an interprofessional birth transfer simulation training Community midwives and doulas, emergency medical technicians, paramedics, emergency dispatch, and hospital-based clinicians (certified nurse-midwives, labour and birth nurses, obstetricians, and maternal-fetal medicine specialists). Utah USA (one community hospital and one tertiary care centre in an urban setting and one in a rural setting) The use of simulation assists in improving the skills required to manage PPH without putting any life patient in danger of losing their life. There was a significant improvement in communication among team members during and after simulated training. Interprofessional training has the potential to improve communication skills, early referral and management of PPH Participatory design principles and the Boller and Fletcher learning experience design framework Lutgendorf MA; Ennen CS; McGlynn A; Spalding CN; Deering S; Delorey DR; Greer JA; 2024 Interprofessional obstetric simulation training improves postpartum haemorrhage management and decreases maternal morbidity: a before-and-after study To determine the impact of the Obstetric Simulation Training and Teamwork (OB-STaT) curriculum on postpartum haemorrhage (PPH) rates and outcomes. Electronic medical records of patients who delivered between February 2018 and November 2019 Maternity care hospitals within the USA. Training did not have a significant effect on the decrease of PPH, but there were lower rates of massive transfusions and the transfer time for PPH was shortened. Management of PPH improved after training. Interprofessional training has a positive effect on multidisciplinary collaboration in the management of PPH Multi-site before-and-after study Nelissen, Ellen; Ersdal, Hege; Mduma, Estomih; Evjen-Olsen, Bjørg; Twisk, Jos; Broerse, Jacqueline; van Roosmalen, Jos; Stekelenburg, Jelle; 2017 Clinical performance and patient outcomeafter simulation-based training inprevention and management ofpostpartum haemorrhage: an educationalintervention study in a low-resource setting To assess the effect of obstetric simulation-based training on the incidence of postpartum haemorrhage and clinical performance of basic delivery skills and managementof postpartum haemorrhage in a low-resource setting. Clinicians, nurse-midwives, medical attendants(nurse aides without formal medical education) and ambulance drivers (without formal education) Haydom Lutheran Hospital, a rural referral hos-pital in Northern Tanzania Following the training programme, there was a significant reduction in the incidence of PPH. No IPC model. Rospective educational interventionstudy Lutgendorf, Monica A; Spalding, Carmen; Drake, Elizabeth; Spence, Dennis; Heaton, Jason O; Morocco, Kristina V; 2017 Multidisciplinary n Situ Simulation-Based Training as a Postpartum Hemorrhage Quality Improvement Project To develop and implement a comprehensive, high fidelity, multidisciplinary obstetric simulation exercise to train obstetric providers obstetric anaesthesia providers and labour and delivery nurses in obstetric emergencies. In addition to assessing medical knowledge and technological skills, reinforce teamwork and communication skills and identify improvement areas within our healthcare system. Obstetric providers: obstetric staff/residents’ midwives, labour and delivery nurses, corpsmen and the remainder were anaesthesia providers San Diego, City of California The collaborative training sessions assisted participants in improving teamwork, communication and documentation. No IPC model was developed during this study Quality improvement project Dillon SJ; Kleinmann W; Fomina Y; Werner B; Schultz S; Klucsarits S; Moreno W; Butsko A; McIntire DD; Nelson DB; 2021 Does simulation improve clinical performance in management of postpartum haemorrhage? To examine the clinical performance and outcomes associated with postpartum hemorrhage because of uterine atony following the implementation of a multidisciplinary simulation program Nursing, obstetrical, and anesthesia providers Parkland Health, Dallas USA There was a reduction in intervention time for women who required uterotonic drugs and blood transfusion after the implementation of the simulation program. Teams also managed to identify women who were bleeding excessively in the first 12 hours after delivery. Management of PPH incidents became more uniform and predictable. Post-partum haemorrhage improved following the implementation of a multidisciplinary simulation program Prospective observational study Egenberg S; Masenga G; Bru LE; Eggebø TM; Mushi C; Massay D; Øian P; 2017 Impact of multi-professional, scenario-based training on postpartum hemorrhage in Tanzania: a quasi-experimental, pre- vs. post-intervention study. To determine whether this multi-professional, scenario-based training in managing PPH was associated with changes in blood transfusion rates. Nurses, midwives, doctors, and medical attendants Kilimanjaro Christian Medical Centre (KCMC) is a zonal consultant hospital in the northern zone of Tanzania This study showed an improvement in the management of PPH and a significant reduction in the whole blood transfusion rate after training. Improved teamwork during emergencies and communication resulted in a higher quality of maternal care. This quasi-experimental, pre-vs. post-interventional study Egenberg S; Karlsen B; Massay D; Kimaro H; Bru LE; 2017 "No patient should die of PPH just for the lack of training!" Experiences from multi-professional simulation training on postpartum hemorrhage in northern Tanzania: a qualitative study To enhance understanding and gain knowledge of important learning features and outcomes related to multiprofessional simulation training on PPH Nurse midwives, doctors, and medical attendants Northern zone of Tanzania The multi-professional training resulted in improved management of clinical PPH. No IPC model was developed during this study Descriptive and exploratory design Bittle M; O'Rourke K; Srinivas SK; 2018 Interdisciplinary Skills Review Program to Improve Team Responses During Postpartum Hemorrhage. To develop an interdisciplinary, interactive, skills review program to improve team responses during a postpartum hemorrhage (PPH) Registered nurses, obstetric and family medicine attending physicians and residents, advanced practice nurses, and ancillary staff Women's Health Department in a quaternary-care Magnet- and Baby Friendly-designated academic medical center in Philadelphia, Pennsylvania After the completion of the program team members demonstrated increased confidence and knowledge of the management of PPH. The program was effective in improving interdisciplinary team responses to PPH Online didactic modules in combination with an interdisciplinary skills program Bell, Amy D.; 22017 An Interprofessional Obstetric Initiative to Prevent and Reduce Maternal Hemorrhage. To implement an obstetric hemorrhage protocol with simulation training for multidisciplinary teams across all system facilities; to increase the incidence of completing quantification of blood loss for all births; and to decrease unplanned peripartum hysterectomy rates Obstetric nursing leaders; obstetric physician leaders; staff from the blood bank, pharmacy, and simulation center; and women who gave birth at these facilities A multifacility large health care system in Northand South Carolina Simulation training of multidisciplinary teams related to PPH management reduces the number of women who had unwarranted postpartum hysterectomies, due to the early identification of PPH. Multidisciplinary teams with nursing and physician champions were formed, obstetric haemorrhage and massive transfusion protocols were created, and mobile simulation of haemorrhage events was more prominent. Retrospective chart review. Main, Elliott K.; Cape, Valerie; Abreo, Anisha; Vasher, Julie; Woods, Amanda; Carpenter, Andrew; Gould, Jeffrey B.; 2017 Reduction of severe maternal morbidity from hemorrhage using a state perinatal quality collaborative. To determine whether these safety tools can be scaled up to reduce severe maternal morbidity in women with obstetric haemorrhage using a large maternal quality collaborative Nurse and physician mentors experienced in quality improvement California hospitals A significant reduction in maternal morbidity due to PPH was noticed. Improved outcomes for women were noted in all hospital types Before-and-after model Step 5: Collating, summarising, and reporting of the results In this step, the authors collated and summarised the results and drew a conclusion from the review 12 . The authors analysed the results using thematic analysis, after reaching a consensus on the themes and subthemes a descriptive discussion was done. Results Three themes with each subtheme emerged from the review after thematic data analysis. Namely Promotes prompt diagnosis and management of PPH; Promotes patient safety and quality standards in managing PPH and lastly Enhances a positive and effective interprofessional team collaboration in managing PPH. Table 2 below presents a narrative description of the themes and the subthemes. Table 2 Themes and subthemes that emerged from the review Theme Sub-themes Promotes prompt diagnosis and management of PPH ● Early Identification of patient at risk (antenatal & intrapartum stage ) and diagnosis ● Fast administration of the uterotonic medication and blood transfusion Promotes patient safety & quality standards in managing PPH ● Promotes adherence to clinical protocols for the management of PPH ● Positive patient outcomes Enhance a positive and effective interprofessional team collaboration in managing PPH ● Clear roles and responsibilities in managing PPH as a team ● Promotes relational coordination in the team that manages PPH ● Promotes accurate timelines of interprofessional communication among obstetrics team Theme 1: Promotes prompt diagnosis and management of PPH The adoption of interprofessional collaborative practices in the healthcare system plays a significant role in promoting prompt diagnosis and management of PPH 13 . According to 14 , interprofessional collaboration facilitates efficient coordination and communication among medical professionals including nurses, midwives, doctors and other team members. Studies on interprofessional team simulation and training demonstrate that collaborative practices can enhance prompt diagnosis and management of PPH 15,16,17 . This review highlights two significant sub-themes that relate to the promotion of prompt diagnosis and management of PPH. The first sub-theme relates to the early identification and diagnosis of patients at risk of PPH. The second sub-theme is associated with the fast administration of uterotonic medication and blood transfusion. Early identification of patients at risk and timely diagnosis of PPH While PPH is apparent during labour some of the risk factors such as multiple pregnancies and previous history of PPH are identifiable during the Ante Natal Care (ANC) period. Recent research by 18 asserts the importance of intensive training of healthcare professionals in improving the identification of patients at increased risk of PPH. This finding is corroborated by a prospective observational study by 19 , which reported a marked improvement in blood volume estimation following onsite training of obstetric personnel. Moreover, the recommendation from the consensus statement by the Advancement of Patient Blood Management, Haemostasis and Thrombosis (NATA) in collaboration with the International Federation of Gynaecology and Obstetrics (FIGO), the European Board and College of Obstetrics and Gynaecology (EBCOG), and the European Society of Anaesthesiology (ESA) stress the importance of developing an individualised management plans based on the patient’s specific risk factors 20 . To achieve this goal there should be seamless communication and collaboration among members of the multidisciplinary team throughout the perinatal period. 21 also state that collaboration with the anaesthetic team during the antepartum period can significantly aid the preparation and management of patients who are at a higher risk of PPH, facilitating a proactive rather than a reactive approach to care and prevention of PPH. Fast administration of the uterotonic medication and blood transfusion A multimethod, quasi-experimental, pre-post intervention study by 22 revealed that hands-on training helped familiarize trainees with each step of the PPH procedure, which enabled them to retrieve skills automatically in a demanding emergency. Interprofessional collaborative practices, especially those implemented through simulation training have been proven to be important in improving the administration of uterotonic medications and blood transfusion during PPH 22 . The results of the same study indicated a significant improvement in clinical responses PPH after the implementation of a training program. Both 22 and 23 studies observed a notable reduction in the need for whole blood transfusions, suggesting better initial management of PPH that potentially reduced the severity of bleeding episodes. Moreover, 22 study observed a decline in maternal deaths related to PPH from seven to four, indicating enhanced effectiveness in managing life-threatening haemorrhages through prompt and efficiently coordinated care. In conclusion, providing uterotonic medication and blood transfusion swiftly in a case of PPH needs a coordinated approach that includes a multi-disciplinary team. By ensuring effective collaboration and continuous training health care professionals can be assured that every patient receives the right care promptly during this critical period. Theme 2 : Promotes patient safety & quality standards in managing PPH The second theme that emerged from the study was that interprofessional collaborative practices promotes patient safety and quality standards in managing PPH. Below, the authours discuss the two subthemes. Promotes adherence to clinical protocols for the management of PPH The findings of a study about an interprofessional simulation-based training in the prevention and management of postpartum haemorrhage, conducted in a rural referral hospital in Northern Tanzania revealed that compliance to clinical interventions for the management of PPH increased. This was seen as the number of women who received 10 IU of oxytocin after the training (91.7%) was significantly higher compared to before training (87.8%). The proportion of women with postpartum haemorrhage receiving 10 IU of oxytocin as part of the management of postpartum haemorrhage significantly increased from 43.0% before training to 61.2% after training 24 . The authors further reported that after the interprofessional simulation-based training, a significantly greater percentage of women who received uterotonic drugs within one minute after birth was noted as 44.3% as compared to 40.4% noted before training which is a requirement stipulated in the clinical protocol in managing PPH 24 . This was confirmed by 25 , whose findings revealed that before interprofessional obstetric simulation training about management of postpartum haemorrhage, 82% of deliveries received no medications for the treatment of haemorrhage, which decreased to 49% after training. The use of Tranexamic acid (TXA) in deliveries also significantly increased from 2.72–4.76%, after the Interprofessional simulation training 25 .Removal of placenta by controlled cord traction and subsequent uterine massage were more frequently performed after training (98.8% and 99.0% respectively) compared to before training (96.5% and 93.0% respectively). In the United States 26 also revealed that the interprofessional collaborative practice intervention significantly improved knowledge for the obstetrics interprofessional team in managing PPH and adhering to PPH protocols by the obstetric, anesthesia, and the nursing team that manage PPH. Positive outcomes According to 27 , timely and effective team coordination optimises the response and improves clinical outcomes for PPH with team-based drills and haemorrhage bundles. Safety programmes and bundles, including interprofessional simulation, protocols and algorithms, have been associated with improved outcomes for PPH 27 .The findings of the studies conducted in Tanzania and western Kenya revealed a significant improvement in active management of third stage of labour and management of postpartum haemorrhage after introduction of interprofessional obstetric training programme; resulting in a marked decrease in postpartum haemorrhage 28,29,30 .This is in line with what has been reported by 31 that, interprofessional simulation-based training had the best impact on decreasing severe PPH of more than 1500ml and decreasing blood transfusions of more than 4 units. Literature also showed a reduction in maternal mortality after a interprofessional collaborative practices, thus the intervention to prevents maternity death instead promotes comprehensive patient care 32 . Based on the findings regarding interprofessional obstetric simulation training about management of postpartum haemorrhage 33 ; shared the same sentiments reporting a significant decrease in maternal morbidity ranging from 6.35% before training to 5.28% thereafter; postpartum patients’ length of hospital stay also decreased from 2.05 to 2.01 days. Furthermore, as part of positive outcomes the review has shown that interprofessional collaborative practices prevent complications associated with PPH. 34 eluded that implementing interprofessional collaborative initiative reduced probable complications from PPH and their sequale including emergency hysterectomy, resulting in longer quality adjusted life expectancy. 35 affirmed similar findings in North and South Carolina and stated that implementation of an interprofessional obstetric heamorrhage protocol led to an increase in quantification of bloodloss and a reduction in the number of woman who experience unplanned peripartum hysterectomies. 36 also joined the discourse and elaborated that interprofessional collaborative practices provides safety tools to reduce unplanned hysterectomies and severe maternal morbidity through effective and comprehensive maternal interprofessional collaboration. Theme 3: Enhance a positive and effective interprofessional team collaboration in managing PPH Interprofessional collaborative practices in the healthcare system is guided by principles of patient centred care, shared vision by the attending interprofessional team, role clarity and members who are accountable and demonstrate effective interprofessional communication 37 . The review has shown that effective interprofessional collaboration practices in healthcare system results in clarity of roles, effective work processes amongst the team members that manages PPH emergency. The awareness of the roles across the various team members enables a shift workflow where the is no confusion nor conflict when managing PPH 38 . A mixed method study in the United State of America where the nurses, obstetrician were involved in an interprofessional simulation study in managing PPH revealed that Interprofessional collaboration (IPC) has an immediate impact in improving team performance and interprofessional collaboration, where the team demonstrate an awareness on each other’s role, display mutual respect and trust in each other’s clinical practice. The effective interprofessional collaboration enables a safety culture and makes managing PPH a team based effort as the team work in allignment and according to set protocols in managing PPH. 39 in Denmark confirmed the above study and revealed that successful management of PPH is highly dependent on highly interprofessional collaboration effort, where each healthcare profession is accountable on their role and responsibility when managing PPH. Promotes relational coordination in the team that manages PPH The second subtheme that emerged in the review, was that effective interprofessional collaborative practices promoting relational coordination when managing PPH. In relational coordination in managing PPH, there needs to be a well-coordinated implementation of numerous tasks within a short space of time. The effective interprofessional collaboration from relational coordination enables good outcomes when managing PPH 40 . In a multi-site before and after study conducted in USA, across 8 hospitals where the was an Interprofessional simulation-based simulation training (Obs-STAT training). The training was conducted on the obstetrics team members that respond to obstetric emergencies this included but not limited to obstetrics, certified midwives, gynaecologist etc. The interprofessional collaboration enabled the obstetrics team to be well coordinated when managing PPH, demonstrating improvement in coming quickly to the emergency site, acting on time and within their roles, having close loop communication in the process. In northern Tanzania in a qualitative study, the interprofessional team who attended the interprofessional collaboration programme in managing PPH stated that interprofessional collaboration improved their relational coordination and ability to use team work approach effectively when managing PPH. Regardless of their job roles or tasks, the participants expressed that the was synergy in tasks allocation post the IPC intervention which made them to provide efficient PPH management for improved maternal and neonatal health 41 . Co-ordination in Utah among the obstetrics team managing PPH is critical because of the births which are approximately 3% of all births in the USA. A study in Utah by 42 affirms the above, the authors discussed that interprofessional collaboration has potential to improve coordination which leads to early referral and management of PPH. Promotes accurate timelines of interprofessional communication among obstetrics team The last subtheme was accurate timeliness of interprofessional communication among obstetrics team. 43 in a collaborative action research revealed that an IPC model in managing PPH promotes frequent communication among the health professionals in different disciplines. Furthermore, the author outlines that the IPC model gives a deeper comprehension of teamwork and provides the team with conflict resolution techniques to uphold effective interprofessional communication. Similarly, in a quality improvement project in California. 44 affirms that an IPC model in managing PPH reinforces positive interprofessional communication between the interprofessional obstetrics teams which creates a safe space for the team to self correct and identify areas of improvement without prejudice or being hostile with each other. Discussion This review emphasizes the significance of early detection and diagnosis of postpartum haemorrhage to reduce its severity. Studies have indicated that training programs using simulation can provide healthcare professionals with the necessary skills to identify patients at risk of PPH early 45,46,47 . Moreover, involving anaesthetic teams during the antepartum period has been recognized as a critical factor in proactively preparing and managing high-risk patients, potentially averting severe hemorrhagic complications. Hence, it is crucial to expand collaboration beyond obstetric personnel to include other members of the multidisciplinary team such as physicians and dieticians. In a study conducted in Nigeria, it was found that training obstetric personnel on blood loss estimation was essential for managing PPH and was shown to enhance their skills 48 . Furthermore, 49 suggests utilizing the clinical signs and symptoms of the patient along with weighing drapes and swabs for estimating blood loss. Therefore, providing interprofessional training on blood loss estimation through collaboration and simulation in obstetric settings is pivotal for preventing and identifying PPH early. Fast administration of uterotonic medication and blood transfusion is crucial in managing postpartum haemorrhage 50 . These interventions can help restore normal hemostasis and prevent complications. Studies have demonstrated significant improvements in clinical outcomes, including reduced need for whole blood transfusions and maternal deaths related to PPH, when uterotonic medication is promptly administered 51 . Overall, the findings of this review accentuate the critical role of interprofessional collaboration in promoting prompt diagnosis and management of PPH. Interprofessional collaborative practices has proved to be of importance regarding promotion of compliance to clinical protocols for the management of PPH. Marked improvement in compliance following interprofessional simulation training has been noted. The findings revealed that there has been a marked increase in the routine administration of 10 IU of oxytocin to women post-delivery following the training as compared to before the training. This symbolises a positive impact of interprofessional collaborative practices on administration of oxytocin post-delivery.Improvement in the management of postpartum haemorrhage was also marked as evidenced by increased compliance in the administration of 10 IU of oxytocin as part of management of interprofessional collaborative practices, such as the interprofessional in suti simulation training. Not only did compliance increased in terms of drug administration, the interprofessional collaborative simulation practices increased the time within which uterotonic drugs were administered was reduced as health care professionals were able to administer uterotonic drugs within one minute. Implementation of protocols such as removal of placenta by controlled cord traction and subsequent uterine massage, increased after the training and with positive results. The findings also revealed that introduction of interprofessional obstetric training programme led to cost effectiveness as there was a significant decrease in severe PPH resulting in decreased blood transfusions. Patients’ length of stay in hospitals as well as maternal mortality were also reduced. The positive outcomes of interprofessional obstetric training programme were not only seen in compliance with protocols, reduction in maternal mortality and blood transfusions, but positive interprofessional relationships and effective communication amongst professionals boosted their confidence regarding the management of PPH, consequently leading to a reduction of stress and anxiety. Acknowledgement and appreciation messages of improvements in PPH management and teamwork were ushered by post-natal women, their relatives, the community, and the health authorities 51 . Moreover, the study has revealed that effective interprofessional collaboration when managing PPH in the healthcare system enables awareness of clear roles and responsibilities when managing PPH as a team this awareness is a prerequisite for successful management of the rapid and coordinated response by the nurses, obstetrics and other healthcare professionals working under time-critical, high risk and emergency situations such as managing PPH 52 . Moreover, the review has shown that effective interprofessional collaborative practices promotes relational coordination in a team when managing PPH. This competency enables the team to communicate effectively, collaborate well in teamwork, share leadership and is able to cope with the stressfull situation and in the process be able to make safe clinical reasons and actions for positive patient outcomes 53 . Recommendations Interprofessional in situ simulation training programs/Standardized Obstetric simulation training and teamwork (OB-STAT) management of PPH came out prevalent in the study as a recommendation in strengthening interprofessional collaborative practices in managing PPH. The training promotes interprofessional communication, awarness of roles in managing PPH through prompt diagnosis and management of PPH. Moreover, the study has revealed that for teambased consultation and management of PPH the safety bundles required in managing PPH should be developed bu an interprofessional obstrectic team inorder to include all important aspects of the management. To socialise the interprofessional team in working effectively together in emergencies such as PPH the study also recommends a use of Standardised interprofessional semi-annual drills related to PPH ( with realistic scenarios, triggers, tasks to solve and sufficient resources ) to practice in simulation to develop the skill in a control environment where the patient will not be injuired. Subsequently investments in relational approach training in managing PPH (ubuntu practices ) in promoting mutual trust and respect, culture sensitive care among the team that manages PPH in efforts of minimising power dynamics and strengthening teamwork performance is recommended. Such training will create positive psychological working environment where the team functions well. The were limited studies from and African/ South African perspective on the research question of this review, randomised control trial studies to measure the effectiveness of the interprofessional approach in patient outcomes when managing PPH as an interprofessional team can be conducted. Furthermore, for policy and national quality assurance in meeting with the sustainable goals formulation of interprofessional maternal safety collaborative forums can be adopted by nations and include but not the limit obstetricians, pharmacies, physicians and midwives to review state protocols and guidelines on maternal emergencies for public and private healthcare sectors for evidence based practices the recommendation is inspired by 54 findings on interprofessional maternal safety collaborative forums. Conclusion Interprofessional collaborative practices is a requirement in ensuring that maternal and child emergency such as post partum heamorrhages are managed effectively to ensure positive patient outcomes which lessen the occurance of maternal morbidity. Interprofessional collaborative practices promotes relational coordination, effective interprofessional communication, shared leadership, effective decision making and holistic team based intervention.The practice leads to early diagnosis and management of post partum heamorrhage. Not only is interprofessional collaborative practice good for the mother and child but it benefits the healthcare system by ensuring cost effective care practices, where resources are utilised correctly, lessen hospital stay and in this context the patient experiencing post partum heomarrhage receives prompt blood transfusion and comprehensive management to prevent complications such as unplanned hysterectomies. Thus, the quality and safe healthcare derived from interprofessional collaborative practice when managing PPH is a necessity that must be intentionally strengthened in all healthcare settings. Declarations Data Availability All the data analysed during this review are included in this published article and from the corresponding author on reasonable request. Ethics approval The study did not make use of human participants and thus no ethical approval or consent was required. The sources that have been used in the review have been acknowledged in-text references and on the list of references. All authors are aware of the submission and have provided consent to submit the manuscript to the journal. Competing Interest All authors do not have any competing interests to declare. Consent for Publication Not applicable (N/A) Funding The Ubuntu nursing model chaired by Professor Mavis Mulaudzi at the University of Pretoria provided a platform for the authors to collaborate, conceptualise and write the manuscript in a writing retreat. Acknowledgments To the Ubuntu nursing model chaired by Professor Mavis Mulaudzi, thank you for creating a community of unity in academia. Author Contribution NZ conceptualised and designed the study. MM & PMT contributed towards the database search and article screening. NZ, PMT & MM did the data extraction and all the authors were involved in the data synthesis. NZ, NS, KM,FM, RG. contributed to the writing of the manuscript. The critical review and revision were made by FM& RG. References Abd Hamid NZ, Rasid SZ. The relationship between collaborative competencies and interprofessional collaboration among professionals in maternal care. Int J Social Sci Res. 2019;1(2):59–67. Adeyemo OO, Morelli EE, Kennedy HP. How to foster effective midwife–obstetrician collaboration on labor and birth units: qualitative analysis of experiences of clinicians in the United States. J Midwifery Women's Health. 2022;67(5):552–60. Avery MD, Montgomery O, Brandl-Salutz E. Essential components of successful collaborative maternity care models. Obstet Gynecol Clin. 2012;39:423–34. Bogossian F, Craven D. A review of the requirements for interprofessional education and interprofessional collaboration in accreditation and practice standards for health professionals in Australia. J Interprof Care. 2021;35(5):691–700. Brazil V, McLean D, Lowe B, Kordich L, Cullen D, De Araujo V, Eldridge T, Purdy E. A relational approach to improving interprofessional teamwork in post-partum haemorrhage (PPH). BMC Health Serv Res. 2022;22(1):1108. Brogaard L, Kierkegaard O, Hvidman L, Jensen KR, Musaeus P, Uldbjerg N, Manser T. The importance of non-technical performance for teams managing postpartum haemorrhage: video review of 99 obstetric teams. BJOG: Int J Obstet Gynecol. 2019;126(8):1015–23. Dillon SJ, Kleinmann W, Fomina Y, Werner B, Schultz S, Klucsarits S, Moreno W, Butsko A, McIntire DD, Nelson DB. Does simulation improve clinical performance in management of postpartum hemorrhage? Am J Obstet Gynecol. 2021;225(4):435–e1. Egenberg S, Karlsen B, Massay D, Kimaro H, Bru LE. No patient should die of PPH just for the lack of training! Experiences from multi-professional simulation training on postpartum hemorrhage in northern Tanzania: a qualitative study. BMC Med Educ. 2017;17:1–2. Egenberg S, Masenga G, Bru LE, Eggebø TM, Mushi C, Massay D, Øian P. Impact of multi-professional, scenario-based training on postpartum hemorrhage in Tanzania: a quasi-experimental, pre-vs. post-intervention study. BMC Pregnancy Childbirth. 2017;17:1–1. Filby A, McConville F, Portela A. What prevents quality midwifery care? 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InHealthcare 2021 Feb 5 (Vol. 9, No. 2, p. 170). MDPI. Thurston LA, Stone J, Mileski M, Abrams D, William Huggins II. An interprofessional approach to prevent recurrent obstetric anal sphincter injury (OASIS): A case report. Clin Case Rep. 2018;6(12):2326. Mulaudzi FM, Sepeng NV, Moeta ME, Ramavhoya TI, Rikhotso S. Improving Research Outputs for a University Nursing Department using Mutingati: An Ubuntu Perspective. Afr J Dev Stud. 2022;12(1). Munn Z, Peters MD, Stern C, Tufanaru C, McArthur A, Aromataris E. Systematic review or scoping review? Guidance for authors when choosing between a systematic or scoping review approach. BMC Med Res Methodol. 2018;18:1–7. Munro S, Kornelsen J, Grzybowski S. Models of maternity care in rural environments: Barriers and attributes of interprofessional collaboration with midwives. Midwifery. 2013;29(6):646–52. Nicolaides A. Considering the philosophy of Ubuntu in South African healthcare ethical practices. J Med Lab Sci Technol South Afr. 2023;5(1):71–6. Pandin MG. Nursing Treatments and Collaboration of Postpartum Hemorrhage Patients as Efforts to Prevention of Maternal Mortality: A Literature Review. Pickering K, Gallos ID, Williams H, Price MJ, Merriel A, Lissauer D, Tobias A, Hofmeyr GJ, Coomarasamy A, Roberts TE. Uterotonic drugs for the prevention of postpartum haemorrhage: a cost-effectiveness analysis. PharmacoEconomics-open. 2019;3:163–76. Saftner MA, Neerland C, Avery MD. Enhancing women's confidence for physiologic birth: maternity care providers’ perspectives. Midwifery. 2017;53:28–34. Sageer R, Kongnyuy E, Adebimpe WO, Omosehin O, Ogunsola EA, Sanni B. Causes and contributory factors of maternal mortality: evidence from maternal and perinatal death surveillance and response in Ogun state, Southwest Nigeria. BMC Pregnancy Childbirth. 2019;19:1–8. Shaw D, Guise JM, Shah N, Gemzell-Danielsson K, Joseph KS, Levy B, Wong F, Woodd S, Main EK. Drivers of maternity care in high-income countries: can health systems support woman-centred care? Lancet. 2016;388(10057):2282–95. Smith DC. Interprofessional collaboration in perinatal care: The future of midwifery. J Perinat Neonatal Nurs. 2016;30(3):167–73. Wallace J, Hoehn-Velasco L, Jolles D, Stapleton S, Flynn C, Bauer K, Wright J. Assessment of interprofessional collaboration at free-standing birth centers: Does collaboration influence outcomes? J Interprofessional Educ Pract. 2021;25:100479. Wieczorek CC, Marent B, Dorner TE, Dür W. The struggle for inter-professional teamwork and collaboration in maternity care: Austrian health professionals’ perspectives on the implementation of the Baby-Friendly Hospital Initiative. BMC Health Serv Res. 2016;16:1–5. Ahmad N, Shaheen N, Hussain S, Women Education. A Real obstacle in achieving universal primary education in Pakistan. J Elementary Educ. 2023;33(1):1–0. World Health Organization. The network for improving quality of care for maternal, newborn and child health: evolution, implementation and progress: 2017–2020 report. InThe network for improving quality of care for maternal, newborn and child health: evolution, implementation and progress: 2017–2020 report 2021. Disch J. Interprofessional education and collaborative practice. Nurs Outlook. 2013;61(1):3–4. Yamuragiye A, Wylie L, Kinsella EA, Donelle L. A scoping review of interprofessional collaboration in hospital-based obstetric care with a particular focus on Africa. J Interprofessional Educ Pract. 2021;24:100456. Yamuragiye A, Wylie L, Kinsella EA, Donelle L, Ndayisenga JP. Interprofessional collaboration experience among healthcare professionals providing emergency obstetric and neonatal care in Rwanda. A qualitative descriptive case study. J Interprofessional Educ Pract. 2023;32:100648. Zenani NE, Sehularo LA, Gause G, Chukwuere PC. The contribution of interprofessional education in developing competent undergraduate nursing students: integrative literature review. BMC Nurs. 2023;22(1):315. Zielinski RE, Brody MG, Low LK. The value of the maternity care team in the promotion of physiologic birth. J Obstetric Gynecologic Neonatal Nurs. 2016;45(2):276–84. Moher D, Liberati A, Tetzlaff J, Altman DG, Prisma Group. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Int J Surg. 2010;8(5):336–41. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Published Journal Publication published 24 Apr, 2025 Read the published version in BMC Nursing → Version 1 posted Editorial decision: Revision requested 04 Sep, 2024 Reviews received at journal 03 Sep, 2024 Reviewers agreed at journal 02 Sep, 2024 Reviews received at journal 07 Aug, 2024 Reviewers agreed at journal 23 Jul, 2024 Reviewers invited by journal 07 Jul, 2024 Editor assigned by journal 05 Jul, 2024 Submission checks completed at journal 04 Jul, 2024 First submitted to journal 13 Jun, 2024 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4576910","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":331136613,"identity":"416c234a-1bfe-4153-b2e4-f85f392a8f34","order_by":0,"name":"Nombulelo Zenani","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAABAElEQVRIie2OsUoDQRRF3zIw1YZpX1jd+YW3BBYLIb+SNG4zK/sBQacam6Tfz4iV2gkDW+0HBBTUZqtYBUTBgLOFkmaMdinmVO/BPdwLEAgcKAzo58b0/8roj8oOU70vLuvSbqrqMQVhm+eP25PiBhXB+wzGwiPT6vwsqalze5oiW7RY3tWKonkDDO89CqqcxWSnOprnODBYLh9cy0ADB48iazXaOOVSM/E23BosyCnRVkMsPQqsFCVOmQCPeeJaJr3CXAuSb1i7znslMzHPk2OD2fKpq+xRg5T5hl31wz6tFMJ2w1dzIam11y/r2ek49Q37hu8+Lox78oFAIBD4jS9gY09GShrZ2wAAAABJRU5ErkJggg==","orcid":"","institution":"North-West University","correspondingAuthor":true,"prefix":"","firstName":"Nombulelo","middleName":"","lastName":"Zenani","suffix":""},{"id":331136614,"identity":"d55b8874-bf44-45b6-9874-fec866a9fcae","order_by":1,"name":"Patience Mashudu Tulelo","email":"","orcid":"","institution":"University of Pretoria","correspondingAuthor":false,"prefix":"","firstName":"Patience","middleName":"Mashudu","lastName":"Tulelo","suffix":""},{"id":331136615,"identity":"d26bd00e-31b6-4e98-9efd-f787eab047d3","order_by":2,"name":"Khathu Netshisaulu","email":"","orcid":"","institution":"University of Venda","correspondingAuthor":false,"prefix":"","firstName":"Khathu","middleName":"","lastName":"Netshisaulu","suffix":""},{"id":331136616,"identity":"45e02363-74a1-45db-b6f4-9d749357d33b","order_by":3,"name":"Nombulelo Sepeng","email":"","orcid":"","institution":"University of Pretoria","correspondingAuthor":false,"prefix":"","firstName":"Nombulelo","middleName":"","lastName":"Sepeng","suffix":""},{"id":331136617,"identity":"2605d2d6-f0e6-405c-ba28-e37b6955efcc","order_by":4,"name":"Maurine Musie","email":"","orcid":"","institution":"University of Pretoria","correspondingAuthor":false,"prefix":"","firstName":"Maurine","middleName":"","lastName":"Musie","suffix":""},{"id":331136618,"identity":"59cbda2a-b540-4c21-8f50-3f34b347dcee","order_by":5,"name":"Rodwell Gundo","email":"","orcid":"","institution":"North-West University","correspondingAuthor":false,"prefix":"","firstName":"Rodwell","middleName":"","lastName":"Gundo","suffix":""},{"id":331136619,"identity":"7a5027a5-4094-4583-8d6c-5ac8525fe262","order_by":6,"name":"Fhumulani Mulaudzi","email":"","orcid":"","institution":"North-West University","correspondingAuthor":false,"prefix":"","firstName":"Fhumulani","middleName":"","lastName":"Mulaudzi","suffix":""}],"badges":[],"createdAt":"2024-06-13 14:40:22","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4576910/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4576910/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1186/s12912-025-02988-z","type":"published","date":"2025-04-24T15:57:44+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":61357936,"identity":"0871cb9f-fece-48a7-8d12-18cabd9450e7","added_by":"auto","created_at":"2024-07-29 21:14:24","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":53021,"visible":true,"origin":"","legend":"\u003cp\u003eThe PRISMA flow diagram describing the screening process is adapted from the PRISMA Group (2009) by \u0026nbsp;Moher D, Liberati A, Tetzlaff J, Altman DG, and The PRISMA Group (2009). Preferred Reporting Items for Systematic Reviews and Meta-Analyses: The PRISMA Statement. PLoS Med 6(7): e1000097. https://doi.org/10.1371/journal.pmed1000097\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-4576910/v1/22b062230bb527dfad413700.png"},{"id":81570267,"identity":"45d6306c-3667-4471-aca6-075026d995c2","added_by":"auto","created_at":"2025-04-28 16:13:02","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1103770,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4576910/v1/ffdfbe35-32ba-4438-9735-c69511969e7d.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"A scoping review on the contribution of interprofessional collaborative practices on preventing and managing post-partum haemorrhage in the health care system","fulltext":[{"header":"Background","content":"\u003cp\u003eEvery year, millions of women experience postpartum haemorrhage (PPH), which is defined as a blood loss of 500 ml or more within 24 hours of birth\u003csup\u003e1\u003c/sup\u003e. Despite decades of work and proven lifesaving interventions, this preventable and treatable condition remains the leading cause of maternal mortality worldwide\u003csup\u003e1\u003c/sup\u003e. Despite this, a review of the literature revealed that PPH is more effectively prevented and managed in high-income countries than in low- and middle-income countries. According to a WHO systematic analysis of causes of maternal death, PPH accounts for nearly 73% of maternal deaths in Low Middle-Income Countries (LMICs), with Sub-Saharan Africa accounting for more than 40%\u003csup\u003e2\u003c/sup\u003e. When PPH occurs, early detection and evidence-based management are critical to saving women's lives\u003csup\u003e3,4\u003c/sup\u003e.As a result, interprofessional collaboration practices are required to prevent and manage PPH in the health-care system to assist with the attainment of sustainable developmental goal 3 which is good health and well-being.PPH can be prevented and managed through a variety of interprofessional collaboration practices.\u003c/p\u003e \u003cp\u003ePrevious research has shown that multidisciplinary professionals such as nurses, midwives, and medical doctors who work in maternity have identified in-service simulation training as one of the interprofessional collaboration practices for managing PPH. These professionals emphasized that receiving multidisciplinary simulation training could foster effective teamwork by ensuring that all team members had a comparable level of clinical understanding of PPH care and the skills to provide it\u003csup\u003e5\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eInterprofessional simulation training is increasingly recognized as a method for improving learning and performance in order to improve patient safety\u003csup\u003e6\u003c/sup\u003e. To bridge the gap between simulation and reality, simulation teams should be representative of real-life teams, including various medical specialities and levels of expertise\u003csup\u003e7\u003c/sup\u003e. Collaboration across disciplines is another form of interprofessional collaboration for PPH prevention and management. Collaboration across disciplines (e.g., midwifery, obstetrics) to develop a shared vision of care for women with PPH and streamline processes may necessitate project leaders understanding the different perspectives and goals of various departments and cadres\u003csup\u003e8,9\u003c/sup\u003e As a result, the goal of this review is to map and summarise the evidence on the role of interprofessional collaborative practices in preventing and managing PPH in the healthcare system.\u003c/p\u003e"},{"header":"Design","content":"\u003cp\u003eA scoping review was conducted according to the five-step framework that was proposed by\u003csup\u003e10\u003c/sup\u003e. The steps are the following:\u003c/p\u003e \u003cp\u003e \u003col\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eIdentification of research objective\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eSearch/ Identification of applicable studies\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eSelection of relevant studies\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eCharting of the data and\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eCollating, summarising, and reporting of the results\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003c/ol\u003e \u003c/p\u003e \u003cp\u003eThe scoping review was found suitable for this study, to map the literature on the topic and to further identify gaps that can be addressed for future studies\u003csup\u003e11\u003c/sup\u003e. The scoping review included a broad literature regarding the contribution of IPCP in preventing maternal adverse events with an ubuntu perceptive. The PRISMA extension for the Scoping Reviews checklist was used to report the findings.\u003c/p\u003e \u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStep 1: Identification of research objective\u003c/h2\u003e \u003cp\u003eThe research objective for this study was to \u0026ldquo; Explore and synthesise literature regarding the contribution of IPCP in preventing maternal adverse events in the perceptive of ubuntu\u0026rdquo;. The Population, content, and context framework as listed below was used to determine the eligibility of the scoping review.\u003c/p\u003e \u003cp\u003ePopulation: Interprofessional birth team / maternal or child healthcare professionals: This can be a team consisting of midwives, physicians, gynaecologists, or community/ traditional birth assistants\u003c/p\u003e \u003cp\u003eIntervention: Interprofessional collaboration practices in maternal care\u003c/p\u003e \u003cp\u003eComparison: N/A\u003c/p\u003e \u003cp\u003eOutcome: Prevented and managed post-partum haemorrhage occurrences\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003eStep 2: Search applicable studies\u003c/h2\u003e \u003cp\u003eThe authors searched for articles in the following databases: CINHAL, PubMed, Scopus, and Medline. The search terms were level keywords:1st: Interprofessional collaboration OR healthcare teamwork OR interdisciplinary teamwork OR obstetric teamwork OR interprofessional education OR interprofessional relationships OR prenatal care collaboration OR postnatal care teamwork OR interprofessional training OR health care coordination OR interdisciplinary communication OR collaborative health care models OR Obstetric care teamwork. 2nd AND postpartum haemorrhage prevention Or Maternal health OR Obstetric care OR maternal mortality OR perinatal care OR patient safety in obstetrics OR obstetric emergencies OR maternal outcomes. 3rd AND haemorrhage OR rapid blood loss OR bleeding OR bleed OR uncontrollable bleeding. The search was done by the two of the authors alongside the research assistant of the Health Science faculty till the 16th of January 2024.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003eStep 3: Selection of relevant studies\u003c/h2\u003e \u003cp\u003eIn this step, the authors decide on the inclusion and exclusion criteria and the criteria are to be based on the specifics of the research question and aligned with the subject matter through familiarizing with the obtained studies\u003csup\u003e12\u003c/sup\u003e. See below the inclusion and exclusion criteria of the review.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003eInclusion criteria\u003c/h2\u003e \u003cp\u003eThe study included peer-reviewed qualitative, quantitative, mixed methods, multi-mixed methods, reviews, and unpublished dissertations. The empirical studies were included to validate multiple hypotheses and increase knowledge on the current topic. The reviews provided the authors with summaries of the state of research, the gaps, and recommendations for future studies concerning the research question of the scoping review. Grey search data was retrieved using PubMed and CINHAL, considering the PICO framework adopted for the review as stated above and checking the reference list of the identified articles. The timeframe for the included studies was from 2000\u0026ndash;2024, the rationale for the timeframe was to note from the commencement of the Millennium development goals what has been the progress of minimising PPH with the inclusion of interprofessional practices.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003eExclusion criteria\u003c/h2\u003e \u003cp\u003eWe excluded non-peer-reviewed articles, reports, and peer-reviewed articles that were written in languages other than English because all the others understand and read English fluently for a better understanding of the obtained sources. Furthermore, all sources that did not meet the eligibility constructed by the PICO framework of the scoping review were excluded. Thus, all studies outside the maternal care setting did not include intervention of IPC measures to decrease maternal adverse events were excluded. To manage the citations, all sources were imported into a software-based reference management system called Rayaan. The articles were screened by two of the authors and for any disagreements, all the authors were involved to reach a consensus. The articles were screened, first the title, following abstracts, and then the full text by the authors. The duplicates were deleted, and considering the eligibility criteria the sources who did not meet the criteria were excluded by the authors. The figure below represents the data search strategy in a PRISMA diagram.\u003c/p\u003e\u003cp\u003eStep 4: Charting of the data\u003c/p\u003e \u003cp\u003eIn this step, the authors developed a data chart form which was used to extract data from the included studies. See the below Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e \u003cb\u003ewhich is the data extraction\u003c/b\u003e, provides a descriptive analysis of the included studies. Two authors charted data separately and compared the findings and revised and finalized the chart on completion.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eData extraction table detailing the data reduction\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"8\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAUTHOR AND PUBLICATION YEAR\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTITLE OF THE STUDY\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eAIM OF THE STUDY\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eSTUDY POPULATION\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eSTUDY SETTING\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eSTUDY FINDINGS/OUTCOMES\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003eOUTCOME OF IPC MODEL\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e \u003cp\u003eTYPE OF STUDY\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBrazil V; McLean D; Lowe B; Kordich L; Cullen D; De Araujo V; Eldridge T; Purdy E; 2022\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eA relational approach to improving interprofessional teamwork in post-partum haemorrhage (PPH)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eTo study and support teams improving the care of women with PPH\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eJunior and senior midwives, junior and senior obstetricians, and anaesthetic doctors.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eGold Coast University Hospital (Southport Australia)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eThis study revealed poor mutual respect, knowledge sharing and on-time communication among professionals.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eThe IPC model gave a deeper meaning of productive teamwork and conflict management techniques. Major PPH cases decreased significantly in the labour ward.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eMixed Method research (collaborative action research approach)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGreer JA;\u0026nbsp;Lutgendorf MA;\u0026nbsp;Ennen CS;\u0026nbsp;Van Petten L;\u0026nbsp;Modzik A;\u0026nbsp;Salas D;\u0026nbsp;Fish\u0026nbsp;J;\u0026nbsp;Middlebrooks R;\u0026nbsp;Spalding CN;\u0026nbsp;Delorey DR; 2023\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eObstetric Simulation Training and Teamwork: Immediate Impact on Knowledge, Teamwork, and Adherence to Haemorrhage Protocols.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eTo determine the impact of the OB-STaT program on team member knowledge of diagnosis and management of PPH using pretest and post-test scores, assessment of adherence to established PPH protocols, teamwork, and standardized patient perception scores across a nationwide healthcare system using a combination of travelling simulation experts (proctors) and local clinical subject matter experts to train and debrief participants.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eObstetric and gynaecology attending physicians and residents, anaesthesia attending physicians and residents, certified and student nurse anaesthetists, paediatric attending physicians and residents, family practice attending physicians and residents, certified nurse midwives, obstetric and neonatal nurses, Navy hospital corpsmen (who function as medical assistants), blood bank personnel, and operating room personnel\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e8 US Navy military treatment facilities (MTFs) within the continental United States that provided delivery services\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eThe training improved PPH recognition and management amongst obstetric teams. Communication, decision-making, situational awareness, and role taking showed a significant improvement following the training.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eThe multidisciplinary team improved in teamwork and PPH protocol adherence after the OB-STaT program\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eProspective, multisite, cohort study\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWiesehan EC;\u0026nbsp;Keesara SR;\u0026nbsp;Krissberg JR;\u0026nbsp;Main EK;\u0026nbsp;Goldhaber-Fiebert JD; 2023\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eState Perinatal Quality Collaborative for Reducing Severe Maternal Morbidity From Hemorrhage: A Cost-Effectiveness Analysis\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eTo evaluate the cost effectiveness of Cal-ifornia\u0026rsquo;s statewide perinatal quality collaborative forreducing severe maternal morbidity (SMM) from hemor-rhage\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003ePatients' costs records and Nurses in managerial positions who implemented or maintained the PPH\u0026ndash;SMM reduction initiative\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eThe state of California\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eImplementing the PPH\u0026ndash;SMM reduction initiative reduced the possibility of complications from PPH and emergency hysterectomy were reduced.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eThe IPC initiative resulted in a cost effective quality-improvement enterprise that reduced the occurrence of PPH complication in the majority of birthing hospitals.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eEvaluative study (Economic analysis)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBrogaard L; Kierkegaard O; Hvidman L; Jensen KR; Musaeus P; Uldbjerg N; Manser T; 2019\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eThe importance of non-technical performance for teams managing postpartum haemorrhage:video review of 99 obstetric teams\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eTo analyse videos of obstetrics teams managing real-life patients with major postpartum haemorrhage\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eObstetric teams (Obstetricians and Midwives) managing real-life postpartum haemorrhage.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eA university hospital and a regional hospital in Denmark\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eThis study revealed that successful management of postpartum haemorrhage depends on well-coordinated interprofessional teamwork. Communication was poor in some teams during the management of PPH, which could jeopardise the success of management as a lot needs to be done in a short space of time.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eNo results (No IPC model was implemented after the study), but the study recommends continuous interprofessional collaboration and evaluation of teams to prevent PPH.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eObservational study (Video review)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBaayd J;\u0026nbsp;Lloyd M;\u0026nbsp;Garcia G;\u0026nbsp;Smith S;\u0026nbsp;Sylvester H;\u0026nbsp;Clark E;\u0026nbsp;Cross B;\u0026nbsp;Gero A;\u0026nbsp;Cohen S; 2023\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCatalyzing Collaboration Among Interprofessional Birth Transfer Teams Through Simulation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eTo develop and pilot an interprofessional birth transfer simulation training\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eCommunity midwives and doulas, emergency medical technicians, paramedics, emergency dispatch, and hospital-based clinicians (certified nurse-midwives, labour and birth nurses, obstetricians, and maternal-fetal medicine specialists).\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eUtah USA (one community hospital and one tertiary care centre in an urban setting and one in a rural setting)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eThe use of simulation assists in improving the skills required to manage PPH without putting any life patient in danger of losing their life. There was a significant improvement in communication among team members during and after simulated training.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eInterprofessional training has the potential to improve communication skills, early referral and management of PPH\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eParticipatory design principles and the Boller and Fletcher learning experience design framework\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLutgendorf MA; Ennen CS; McGlynn A; Spalding CN; Deering S; Delorey DR; Greer JA; 2024\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eInterprofessional obstetric simulation training improves postpartum haemorrhage management and decreases maternal morbidity: a before-and-after study\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eTo determine the impact of the Obstetric Simulation Training and Teamwork (OB-STaT) curriculum on postpartum haemorrhage (PPH) rates and outcomes.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eElectronic medical records of patients who delivered between February 2018 and November 2019\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eMaternity care hospitals within the USA.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eTraining did not have a significant effect on the decrease of PPH, but there were lower rates of massive transfusions and the transfer time for PPH was shortened. Management of PPH improved after training.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eInterprofessional training has a positive effect on multidisciplinary collaboration in the management of PPH\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eMulti-site before-and-after study\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNelissen, Ellen; Ersdal, Hege; Mduma, Estomih; Evjen-Olsen, Bj\u0026oslash;rg; Twisk, Jos; Broerse, Jacqueline; van Roosmalen, Jos; Stekelenburg, Jelle; 2017\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eClinical performance and patient outcomeafter simulation-based training inprevention and management ofpostpartum haemorrhage: an educationalintervention study in a low-resource setting\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eTo assess the effect of obstetric simulation-based training on the incidence of postpartum haemorrhage and clinical performance of basic delivery skills and managementof postpartum haemorrhage in a low-resource setting.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eClinicians, nurse-midwives, medical attendants(nurse aides without formal medical education) and ambulance drivers (without formal education)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eHaydom Lutheran Hospital, a rural referral hos-pital in Northern Tanzania\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eFollowing the training programme, there was a significant reduction in the incidence of PPH.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eNo IPC model.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eRospective educational interventionstudy\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLutgendorf, Monica A; Spalding, Carmen; Drake, Elizabeth; Spence, Dennis; Heaton, Jason O; Morocco, Kristina V; 2017\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMultidisciplinary n Situ Simulation-Based Training as a Postpartum Hemorrhage Quality Improvement Project\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eTo develop and implement a comprehensive, high fidelity, multidisciplinary obstetric simulation exercise to train obstetric providers obstetric anaesthesia providers and labour and delivery nurses in obstetric emergencies. In addition to assessing medical knowledge and technological skills, reinforce teamwork and communication skills and identify improvement areas within our healthcare system.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eObstetric providers: obstetric staff/residents\u0026rsquo; midwives, labour and delivery nurses, corpsmen and the remainder were anaesthesia providers\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eSan Diego, City of California\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eThe collaborative training sessions assisted participants in improving teamwork, communication and documentation.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eNo IPC model was developed during this study\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eQuality improvement project\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDillon SJ;\u0026nbsp;Kleinmann W;\u0026nbsp;Fomina Y;\u0026nbsp;Werner B;\u0026nbsp;Schultz S;\u0026nbsp;Klucsarits S;\u0026nbsp;Moreno W;\u0026nbsp;Butsko A;\u0026nbsp;McIntire DD;\u0026nbsp;Nelson DB; 2021\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDoes simulation improve clinical performance in management of postpartum haemorrhage?\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eTo examine the clinical performance and outcomes associated with postpartum hemorrhage because of uterine atony following the implementation of a multidisciplinary simulation program\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eNursing, obstetrical, and anesthesia providers\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eParkland Health, Dallas USA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eThere was a reduction in intervention time for women who required uterotonic drugs and blood transfusion after the implementation of the simulation program. Teams also managed to identify women who were bleeding excessively in the first 12 hours after delivery. Management of PPH incidents became more uniform and predictable.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003ePost-partum haemorrhage improved following the implementation of a multidisciplinary simulation program\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eProspective observational study\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEgenberg S; Masenga G; Bru LE; Eggeb\u0026oslash; TM; Mushi C; Massay D; \u0026Oslash;ian P; 2017\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eImpact of multi-professional, scenario-based training on postpartum hemorrhage in Tanzania: a quasi-experimental, pre- vs. post-intervention study.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eTo determine whether this multi-professional, scenario-based training in managing PPH was associated with changes in blood transfusion rates.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eNurses, midwives, doctors, and medical attendants\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eKilimanjaro Christian Medical Centre (KCMC) is a zonal consultant hospital in the northern zone of Tanzania\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eThis study showed an improvement in the management of PPH and a significant reduction in the whole blood transfusion rate after training.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eImproved teamwork during emergencies and communication resulted in a higher quality of maternal care.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eThis quasi-experimental, pre-vs. post-interventional study\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEgenberg S; Karlsen B; Massay D; Kimaro H; Bru LE; 2017\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\"No patient should die of PPH just for the lack of training!\" Experiences from multi-professional simulation training on postpartum hemorrhage in northern Tanzania: a qualitative study\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eTo enhance understanding and gain knowledge of important learning features and outcomes related to multiprofessional simulation training on PPH\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eNurse midwives, doctors, and medical attendants\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eNorthern zone of Tanzania\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eThe multi-professional training resulted in improved management of clinical PPH.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eNo IPC model was developed during this study\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eDescriptive and exploratory design\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBittle M;\u0026nbsp;O'Rourke K;\u0026nbsp;Srinivas SK; 2018\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eInterdisciplinary Skills Review Program to Improve Team Responses During Postpartum Hemorrhage.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eTo develop an interdisciplinary, interactive, skills review program to improve team responses during a postpartum hemorrhage (PPH)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eRegistered nurses, obstetric and family medicine attending physicians and residents, advanced practice nurses, and ancillary staff\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eWomen's Health Department in a quaternary-care Magnet- and Baby Friendly-designated academic medical center in Philadelphia, Pennsylvania\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eAfter the completion of the program team members demonstrated increased confidence and knowledge of the management of PPH.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eThe program was effective in improving interdisciplinary team responses to PPH\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eOnline didactic modules in combination with an interdisciplinary skills program\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBell, Amy D.; 22017\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAn Interprofessional Obstetric Initiative to Prevent and Reduce Maternal Hemorrhage.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eTo implement an obstetric hemorrhage protocol with simulation training for multidisciplinary teams across all system facilities; to increase the incidence of completing quantification of blood loss for all births; and to decrease unplanned peripartum hysterectomy rates\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eObstetric nursing leaders; obstetric physician leaders; staff from the blood bank, pharmacy, and simulation center; and women who gave birth at these facilities\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eA multifacility large health care system in Northand South Carolina\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eSimulation training of multidisciplinary teams related to PPH management reduces the number of women who had unwarranted postpartum hysterectomies, due to the early identification of PPH.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eMultidisciplinary teams with nursing and physician champions were formed, obstetric haemorrhage and massive transfusion protocols were created, and mobile simulation of haemorrhage events was more prominent.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eRetrospective chart review.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMain, Elliott K.;\u0026nbsp;Cape, Valerie;\u0026nbsp;Abreo, Anisha;\u0026nbsp;Vasher, Julie;\u0026nbsp;Woods, Amanda;\u0026nbsp;Carpenter, Andrew;\u0026nbsp;Gould, Jeffrey B.; 2017\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eReduction of severe maternal morbidity from hemorrhage using a state perinatal quality collaborative.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eTo determine whether these safety tools can be scaled up to reduce severe maternal morbidity in women with obstetric haemorrhage using a large maternal quality collaborative\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eNurse and physician mentors experienced in quality improvement\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eCalifornia hospitals\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eA significant reduction in maternal morbidity due to PPH was noticed.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eImproved outcomes for women were noted in all hospital types\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eBefore-and-after model\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eStep 5: Collating, summarising, and reporting of the results\u003c/p\u003e \u003cp\u003eIn this step, the authors collated and summarised the results and drew a conclusion from the review\u003csup\u003e12\u003c/sup\u003e. The authors analysed the results using thematic analysis, after reaching a consensus on the themes and subthemes a descriptive discussion was done.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003eThree themes with each subtheme emerged from the review after thematic data analysis. Namely Promotes prompt diagnosis and management of PPH; Promotes patient safety and quality standards in managing PPH and lastly Enhances a positive and effective interprofessional team collaboration in managing PPH. Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e2\u003c/span\u003e \u003cb\u003ebelow presents a narrative description of the themes and the subthemes.\u003c/b\u003e\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eThemes and subthemes that emerged from the review\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"2\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTheme\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSub-themes\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePromotes prompt diagnosis and management of PPH\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e● Early Identification of patient at risk (antenatal \u0026amp; intrapartum stage ) and diagnosis\u003c/p\u003e \u003cp\u003e● Fast administration of the uterotonic medication and blood transfusion\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePromotes patient safety \u0026amp; quality standards in managing PPH\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e● Promotes adherence to clinical protocols for the management of PPH\u003c/p\u003e \u003cp\u003e● Positive patient outcomes\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEnhance a positive and effective interprofessional team collaboration in managing PPH\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e● Clear roles and responsibilities in managing PPH as a team\u003c/p\u003e \u003cp\u003e● Promotes relational coordination in the team that manages PPH\u003c/p\u003e \u003cp\u003e● Promotes accurate timelines of interprofessional communication among obstetrics team\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cdiv id=\"Sec9\" class=\"Section2\"\u003e \u003ch2\u003e\u003cb\u003eTheme 1: Promotes prompt diagnosis and management of PPH\u003c/b\u003e\u003c/h2\u003e \u003cp\u003eThe adoption of interprofessional collaborative practices in the healthcare system plays a significant role in promoting prompt diagnosis and management of PPH\u003csup\u003e13\u003c/sup\u003e. According to\u003csup\u003e14\u003c/sup\u003e, interprofessional collaboration facilitates efficient coordination and communication among medical professionals including nurses, midwives, doctors and other team members. Studies on interprofessional team simulation and training demonstrate that collaborative practices can enhance prompt diagnosis and management of PPH\u003csup\u003e15,16,17\u003c/sup\u003e. This review highlights two significant sub-themes that relate to the promotion of prompt diagnosis and management of PPH. The first sub-theme relates to the early identification and diagnosis of patients at risk of PPH. The second sub-theme is associated with the fast administration of uterotonic medication and blood transfusion.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec10\" class=\"Section2\"\u003e \u003ch2\u003eEarly identification of patients at risk and timely diagnosis of PPH\u003c/h2\u003e \u003cp\u003eWhile PPH is apparent during labour some of the risk factors such as multiple pregnancies and previous history of PPH are identifiable during the Ante Natal Care (ANC) period. Recent research by\u003csup\u003e18\u003c/sup\u003e asserts the importance of intensive training of healthcare professionals in improving the identification of patients at increased risk of PPH. This finding is corroborated by a prospective observational study by\u003csup\u003e19\u003c/sup\u003e, which reported a marked improvement in blood volume estimation following onsite training of obstetric personnel.\u003c/p\u003e \u003cp\u003eMoreover, the recommendation from the consensus statement by the Advancement of Patient Blood Management, Haemostasis and Thrombosis (NATA) in collaboration with the International Federation of Gynaecology and Obstetrics (FIGO), the European Board and College of Obstetrics and Gynaecology (EBCOG), and the European Society of Anaesthesiology (ESA) stress the importance of developing an individualised management plans based on the patient\u0026rsquo;s specific risk factors\u003csup\u003e20\u003c/sup\u003e. To achieve this goal there should be seamless communication and collaboration among members of the multidisciplinary team throughout the perinatal period. \u003csup\u003e21\u003c/sup\u003ealso state that collaboration with the anaesthetic team during the antepartum period can significantly aid the preparation and management of patients who are at a higher risk of PPH, facilitating a proactive rather than a reactive approach to care and prevention of PPH.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003eFast administration of the uterotonic medication and blood transfusion\u003c/h2\u003e \u003cp\u003eA multimethod, quasi-experimental, pre-post intervention study by\u003csup\u003e22\u003c/sup\u003e revealed that hands-on training helped familiarize trainees with each step of the PPH procedure, which enabled them to retrieve skills automatically in a demanding emergency. Interprofessional collaborative practices, especially those implemented through simulation training have been proven to be important in improving the administration of uterotonic medications and blood transfusion during PPH\u003csup\u003e22\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eThe results of the same study indicated a significant improvement in clinical responses PPH after the implementation of a training program. Both\u003csup\u003e22\u003c/sup\u003e and\u003csup\u003e23\u003c/sup\u003e studies observed a notable reduction in the need for whole blood transfusions, suggesting better initial management of PPH that potentially reduced the severity of bleeding episodes. Moreover,\u003csup\u003e22\u003c/sup\u003e study observed a decline in maternal deaths related to PPH from seven to four, indicating enhanced effectiveness in managing life-threatening haemorrhages through prompt and efficiently coordinated care.\u003c/p\u003e \u003cp\u003eIn conclusion, providing uterotonic medication and blood transfusion swiftly in a case of PPH needs a coordinated approach that includes a multi-disciplinary team. By ensuring effective collaboration and continuous training health care professionals can be assured that every patient receives the right care promptly during this critical period.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003eTheme 2 : Promotes patient safety \u0026amp; quality standards in managing PPH\u003c/h2\u003e \u003cp\u003eThe second theme that emerged from the study was that interprofessional collaborative practices promotes patient safety and quality standards in managing PPH. Below, the authours discuss the two subthemes.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec13\" class=\"Section2\"\u003e \u003ch2\u003ePromotes adherence to clinical protocols for the management of PPH\u003c/h2\u003e \u003cp\u003e The findings of a study about an interprofessional simulation-based training in the prevention and management of postpartum haemorrhage, conducted in a rural referral hospital in Northern Tanzania revealed that compliance to clinical interventions for the management of PPH increased. This was seen as the number of women who received 10 IU of oxytocin after the training (91.7%) was significantly higher compared to before training (87.8%). The proportion of women with postpartum haemorrhage receiving 10 IU of oxytocin as part of the management of postpartum haemorrhage significantly increased from 43.0% before training to 61.2% after training\u003csup\u003e24\u003c/sup\u003e .\u003c/p\u003e \u003cp\u003eThe authors further reported that after the interprofessional simulation-based training, a significantly greater percentage of women who received uterotonic drugs within one minute after birth was noted as 44.3% as compared to 40.4% noted before training which is a requirement stipulated in the clinical protocol in managing PPH\u003csup\u003e24\u003c/sup\u003e. This was confirmed by\u003csup\u003e25\u003c/sup\u003e, whose findings revealed that before interprofessional obstetric simulation training about management of postpartum haemorrhage, 82% of deliveries received no medications for the treatment of haemorrhage, which decreased to 49% after training. The use of Tranexamic acid (TXA) in deliveries also significantly increased from 2.72\u0026ndash;4.76%, after the Interprofessional simulation training\u003csup\u003e25\u003c/sup\u003e.Removal of placenta by controlled cord traction and subsequent uterine massage were more frequently performed after training (98.8% and 99.0% respectively) compared to before training (96.5% and 93.0% respectively). In the United States\u003csup\u003e26\u003c/sup\u003e also revealed that the interprofessional collaborative practice intervention significantly improved knowledge for the obstetrics interprofessional team in managing PPH and adhering to PPH protocols by the obstetric, anesthesia, and the nursing team that manage PPH.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec14\" class=\"Section2\"\u003e \u003ch2\u003ePositive outcomes\u003c/h2\u003e \u003cp\u003eAccording to\u003csup\u003e27\u003c/sup\u003e, timely and effective team coordination optimises the response and improves clinical outcomes for PPH with team-based drills and haemorrhage bundles. Safety programmes and bundles, including interprofessional simulation, protocols and algorithms, have been associated with improved outcomes for PPH\u003csup\u003e27\u003c/sup\u003e.The findings of the studies conducted in Tanzania and western Kenya revealed a significant improvement in active management of third stage of labour and management of postpartum haemorrhage after introduction of interprofessional obstetric training programme; resulting in a marked decrease in postpartum haemorrhage\u003csup\u003e28,29,30\u003c/sup\u003e.This is in line with what has been reported by\u003csup\u003e31\u003c/sup\u003e that, interprofessional simulation-based training had the best impact on decreasing severe PPH of more than 1500ml and decreasing blood transfusions of more than 4 units.\u003c/p\u003e \u003cp\u003eLiterature also showed a reduction in maternal mortality after a interprofessional collaborative practices, thus the intervention to prevents maternity death instead promotes comprehensive patient care\u003csup\u003e32\u003c/sup\u003e. Based on the findings regarding interprofessional obstetric simulation training about management of postpartum haemorrhage\u003csup\u003e33\u003c/sup\u003e; shared the same sentiments reporting a significant decrease in maternal morbidity ranging from 6.35% before training to 5.28% thereafter; postpartum patients\u0026rsquo; length of hospital stay also decreased from 2.05 to 2.01 days.\u003c/p\u003e \u003cp\u003eFurthermore, as part of positive outcomes the review has shown that interprofessional collaborative practices prevent complications associated with PPH. \u003csup\u003e34\u003c/sup\u003eeluded that implementing interprofessional collaborative initiative reduced probable complications from PPH and their sequale including emergency hysterectomy, resulting in longer quality adjusted life expectancy.\u003csup\u003e35\u003c/sup\u003eaffirmed similar findings in North and South Carolina and stated that implementation of an interprofessional obstetric heamorrhage protocol led to an increase in quantification of bloodloss and a reduction in the number of woman who experience unplanned peripartum hysterectomies.\u003csup\u003e36\u003c/sup\u003ealso joined the discourse and elaborated that interprofessional collaborative practices provides safety tools to reduce unplanned hysterectomies and severe maternal morbidity through effective and comprehensive maternal interprofessional collaboration.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec15\" class=\"Section2\"\u003e \u003ch2\u003eTheme 3: Enhance a positive and effective interprofessional team collaboration in managing PPH\u003c/h2\u003e \u003cp\u003eInterprofessional collaborative practices in the healthcare system is guided by principles of patient centred care, shared vision by the attending interprofessional team, role clarity and members who are accountable and demonstrate effective interprofessional communication\u003csup\u003e37\u003c/sup\u003e. The review has shown that effective interprofessional collaboration practices in healthcare system results in clarity of roles, effective work processes amongst the team members that manages PPH emergency. The awareness of the roles across the various team members enables a shift workflow where the is no confusion nor conflict when managing PPH\u003csup\u003e38\u003c/sup\u003e. A mixed method study in the United State of America where the nurses, obstetrician were involved in an interprofessional simulation study in managing PPH revealed that Interprofessional collaboration (IPC) has an immediate impact in improving team performance and interprofessional collaboration, where the team demonstrate an awareness on each other\u0026rsquo;s role, display mutual respect and trust in each other\u0026rsquo;s clinical practice. The effective interprofessional collaboration enables a safety culture and makes managing PPH a team based effort as the team work in allignment and according to set protocols in managing PPH. \u003csup\u003e39\u003c/sup\u003ein Denmark confirmed the above study and revealed that successful management of PPH is highly dependent on highly interprofessional collaboration effort, where each healthcare profession is accountable on their role and responsibility when managing PPH.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec16\" class=\"Section2\"\u003e \u003ch2\u003ePromotes relational coordination in the team that manages PPH\u003c/h2\u003e \u003cp\u003e The second subtheme that emerged in the review, was that effective interprofessional collaborative practices promoting relational coordination when managing PPH. In relational coordination in managing PPH, there needs to be a well-coordinated implementation of numerous tasks within a short space of time. The effective interprofessional collaboration from relational coordination enables good outcomes when managing PPH\u003csup\u003e40\u003c/sup\u003e. In a multi-site before and after study conducted in USA, across 8 hospitals where the was an Interprofessional simulation-based simulation training (Obs-STAT training). The training was conducted on the obstetrics team members that respond to obstetric emergencies this included but not limited to obstetrics, certified midwives, gynaecologist etc. The interprofessional collaboration enabled the obstetrics team to be well coordinated when managing PPH, demonstrating improvement in coming quickly to the emergency site, acting on time and within their roles, having close loop communication in the process. In northern Tanzania in a qualitative study, the interprofessional team who attended the interprofessional collaboration programme in managing PPH stated that interprofessional collaboration improved their relational coordination and ability to use team work approach effectively when managing PPH. Regardless of their job roles or tasks, the participants expressed that the was synergy in tasks allocation post the IPC intervention which made them to provide efficient PPH management for improved maternal and neonatal health\u003csup\u003e41\u003c/sup\u003e. Co-ordination in Utah among the obstetrics team managing PPH is critical because of the births which are approximately 3% of all births in the USA. A study in Utah by\u003csup\u003e42\u003c/sup\u003e affirms the above, the authors discussed that interprofessional collaboration has potential to improve coordination which leads to early referral and management of PPH.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec17\" class=\"Section2\"\u003e \u003ch2\u003ePromotes accurate timelines of interprofessional communication among obstetrics team\u003c/h2\u003e \u003cp\u003eThe last subtheme was accurate timeliness of interprofessional communication among obstetrics team. \u003csup\u003e43\u003c/sup\u003ein a collaborative action research revealed that an IPC model in managing PPH promotes frequent communication among the health professionals in different disciplines. Furthermore, the author outlines that the IPC model gives a deeper comprehension of teamwork and provides the team with conflict resolution techniques to uphold effective interprofessional communication. Similarly, in a quality improvement project in California. \u003csup\u003e44\u003c/sup\u003eaffirms that an IPC model in managing PPH reinforces positive interprofessional communication between the interprofessional obstetrics teams which creates a safe space for the team to self correct and identify areas of improvement without prejudice or being hostile with each other.\u003c/p\u003e \u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis review emphasizes the significance of early detection and diagnosis of postpartum haemorrhage to reduce its severity. Studies have indicated that training programs using simulation can provide healthcare professionals with the necessary skills to identify patients at risk of PPH early\u003csup\u003e45,46,47\u003c/sup\u003e. Moreover, involving anaesthetic teams during the antepartum period has been recognized as a critical factor in proactively preparing and managing high-risk patients, potentially averting severe hemorrhagic complications. Hence, it is crucial to expand collaboration beyond obstetric personnel to include other members of the multidisciplinary team such as physicians and dieticians. In a study conducted in Nigeria, it was found that training obstetric personnel on blood loss estimation was essential for managing PPH and was shown to enhance their skills\u003csup\u003e48\u003c/sup\u003e. Furthermore,\u003csup\u003e49\u003c/sup\u003esuggests utilizing the clinical signs and symptoms of the patient along with weighing drapes and swabs for estimating blood loss. Therefore, providing interprofessional training on blood loss estimation through collaboration and simulation in obstetric settings is pivotal for preventing and identifying PPH early.\u003c/p\u003e \u003cp\u003eFast administration of uterotonic medication and blood transfusion is crucial in managing postpartum haemorrhage\u003csup\u003e50\u003c/sup\u003e. These interventions can help restore normal hemostasis and prevent complications. Studies have demonstrated significant improvements in clinical outcomes, including reduced need for whole blood transfusions and maternal deaths related to PPH, when uterotonic medication is promptly administered\u003csup\u003e51\u003c/sup\u003e. Overall, the findings of this review accentuate the critical role of interprofessional collaboration in promoting prompt diagnosis and management of PPH.\u003c/p\u003e \u003cp\u003eInterprofessional collaborative practices has proved to be of importance regarding promotion of compliance to clinical protocols for the management of PPH. Marked improvement in compliance following interprofessional simulation training has been noted. The findings revealed that there has been a marked increase in the routine administration of 10 IU of oxytocin to women post-delivery following the training as compared to before the training. This symbolises a positive impact of interprofessional collaborative practices on administration of oxytocin post-delivery.Improvement in the management of postpartum haemorrhage was also marked as evidenced by increased compliance in the administration of 10 IU of oxytocin as part of management of interprofessional collaborative practices, such as the interprofessional in suti simulation training. Not only did compliance increased in terms of drug administration, the interprofessional collaborative simulation practices increased the time within which uterotonic drugs were administered was reduced as health care professionals were able to administer uterotonic drugs within one minute. Implementation of protocols such as removal of placenta by controlled cord traction and subsequent uterine massage, increased after the training and with positive results. The findings also revealed that introduction of interprofessional obstetric training programme led to cost effectiveness as there was a significant decrease in severe PPH resulting in decreased blood transfusions. Patients\u0026rsquo; length of stay in hospitals as well as maternal mortality were also reduced. The positive outcomes of interprofessional obstetric training programme were not only seen in compliance with protocols, reduction in maternal mortality and blood transfusions, but positive interprofessional relationships and effective communication amongst professionals boosted their confidence regarding the management of PPH, consequently leading to a reduction of stress and anxiety. Acknowledgement and appreciation messages of improvements in PPH management and teamwork were ushered by post-natal women, their relatives, the community, and the health authorities\u003csup\u003e51\u003c/sup\u003e. Moreover, the study has revealed that effective interprofessional collaboration when managing PPH in the healthcare system enables awareness of clear roles and responsibilities when managing PPH as a team this awareness is a prerequisite for successful management of the rapid and coordinated response by the nurses, obstetrics and other healthcare professionals working under time-critical, high risk and emergency situations such as managing PPH\u003csup\u003e52\u003c/sup\u003e. Moreover, the review has shown that effective interprofessional collaborative practices promotes relational coordination in a team when managing PPH. This competency enables the team to communicate effectively, collaborate well in teamwork, share leadership and is able to cope with the stressfull situation and in the process be able to make safe clinical reasons and actions for positive patient outcomes\u003csup\u003e53\u003c/sup\u003e.\u003c/p\u003e \u003cdiv id=\"Sec19\" class=\"Section2\"\u003e \u003ch2\u003eRecommendations\u003c/h2\u003e \u003cp\u003eInterprofessional in situ simulation training programs/Standardized Obstetric simulation training and teamwork (OB-STAT) management of PPH came out prevalent in the study as a recommendation in strengthening interprofessional collaborative practices in managing PPH. The training promotes interprofessional communication, awarness of roles in managing PPH through prompt diagnosis and management of PPH. Moreover, the study has revealed that for teambased consultation and management of PPH the safety bundles required in managing PPH should be developed bu an interprofessional obstrectic team inorder to include all important aspects of the management. To socialise the interprofessional team in working effectively together in emergencies such as PPH the study also recommends a use of Standardised interprofessional semi-annual drills related to PPH ( with realistic scenarios, triggers, tasks to solve and sufficient resources ) to practice in simulation to develop the skill in a control environment where the patient will not be injuired. Subsequently investments in relational approach training in managing PPH (ubuntu practices ) in promoting mutual trust and respect, culture sensitive care among the team that manages PPH in efforts of minimising power dynamics and strengthening teamwork performance is recommended. Such training will create positive psychological working environment where the team functions well. The were limited studies from and African/ South African perspective on the research question of this review, randomised control trial studies to measure the effectiveness of the interprofessional approach in patient outcomes when managing PPH as an interprofessional team can be conducted. Furthermore, for policy and national quality assurance in meeting with the sustainable goals formulation of interprofessional maternal safety collaborative forums can be adopted by nations and include but not the limit obstetricians, pharmacies, physicians and midwives to review state protocols and guidelines on maternal emergencies for public and private healthcare sectors for evidence based practices the recommendation is inspired by\u003csup\u003e54\u003c/sup\u003e findings on interprofessional maternal safety collaborative forums.\u003c/p\u003e \u003c/div\u003e"},{"header":"Conclusion","content":"\u003cp\u003eInterprofessional collaborative practices is a requirement in ensuring that maternal and child emergency such as post partum heamorrhages are managed effectively to ensure positive patient outcomes which lessen the occurance of maternal morbidity. Interprofessional collaborative practices promotes relational coordination, effective interprofessional communication, shared leadership, effective decision making and holistic team based intervention.The practice leads to early diagnosis and management of post partum heamorrhage. Not only is interprofessional collaborative practice good for the mother and child but it benefits the healthcare system by ensuring cost effective care practices, where resources are utilised correctly, lessen hospital stay and in this context the patient experiencing post partum heomarrhage receives prompt blood transfusion and comprehensive management to prevent complications such as unplanned hysterectomies. Thus, the quality and safe healthcare derived from interprofessional collaborative practice when managing PPH is a necessity that must be intentionally strengthened in all healthcare settings.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eData Availability\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll the data analysed during this review are included in this published article and from the corresponding author on reasonable request.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics approval\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study did not make use of human participants and thus no ethical approval or consent was required. The sources that have been used in the review have been acknowledged in-text references and on the list of references. All authors are aware of the submission and have provided consent to submit the manuscript to the journal.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting Interest\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll authors do not have any competing interests to declare.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for Publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable (N/A)\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe Ubuntu nursing model chaired by Professor Mavis Mulaudzi at the University of Pretoria provided a platform for the authors to collaborate, conceptualise and write the manuscript in a writing retreat.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgments\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eTo the Ubuntu nursing model chaired by Professor Mavis Mulaudzi, thank you for creating a community of unity in academia.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor Contribution\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNZ conceptualised and designed the study. MM \u0026amp; PMT contributed towards the database search and article screening. NZ, PMT \u0026amp; MM did the data extraction and all the authors were involved in the data synthesis. NZ, NS, KM,FM, RG. contributed to the writing of the manuscript. The critical review and revision were made by FM\u0026amp; RG.\u0026nbsp;\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eAbd Hamid NZ, Rasid SZ. The relationship between collaborative competencies and interprofessional collaboration among professionals in maternal care. Int J Social Sci Res. 2019;1(2):59\u0026ndash;67.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAdeyemo OO, Morelli EE, Kennedy HP. How to foster effective midwife\u0026ndash;obstetrician collaboration on labor and birth units: qualitative analysis of experiences of clinicians in the United States. 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J Elementary Educ. 2023;33(1):1\u0026ndash;0.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWorld Health Organization. The network for improving quality of care for maternal, newborn and child health: evolution, implementation and progress: 2017\u0026ndash;2020 report. InThe network for improving quality of care for maternal, newborn and child health: evolution, implementation and progress: 2017\u0026ndash;2020 report 2021.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDisch J. Interprofessional education and collaborative practice. Nurs Outlook. 2013;61(1):3\u0026ndash;4.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eYamuragiye A, Wylie L, Kinsella EA, Donelle L. A scoping review of interprofessional collaboration in hospital-based obstetric care with a particular focus on Africa. J Interprofessional Educ Pract. 2021;24:100456.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eYamuragiye A, Wylie L, Kinsella EA, Donelle L, Ndayisenga JP. Interprofessional collaboration experience among healthcare professionals providing emergency obstetric and neonatal care in Rwanda. A qualitative descriptive case study. J Interprofessional Educ Pract. 2023;32:100648.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eZenani NE, Sehularo LA, Gause G, Chukwuere PC. The contribution of interprofessional education in developing competent undergraduate nursing students: integrative literature review. BMC Nurs. 2023;22(1):315.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eZielinski RE, Brody MG, Low LK. The value of the maternity care team in the promotion of physiologic birth. J Obstetric Gynecologic Neonatal Nurs. 2016;45(2):276\u0026ndash;84.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMoher D, Liberati A, Tetzlaff J, Altman DG, Prisma Group. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Int J Surg. 2010;8(5):336\u0026ndash;41.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-nursing","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"nurs","sideBox":"Learn more about [BMC Nursing](http://bmcnurs.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/nurs/default.aspx","title":"BMC Nursing","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Adverse events, Interprofessional collaborative practices, prevention, maternal and ubuntu","lastPublishedDoi":"10.21203/rs.3.rs-4576910/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4576910/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003ePost partum haemorrhage (PPH) is one of the complications that leads to increased morbidity and mortality management is interdependent on various healthcare professions acting according to promote safe and quality outcomes. This scoping review aims to explore and synthesise literature regarding the contribution of interprofessional collaboration practices in preventing and managing post-partum haemorrhage.\u003c/p\u003e\u003ch2\u003eDesign:\u003c/h2\u003e \u003cp\u003eThe review adopted a scoping review which is underpinned by a framework by Arksey and O\u0026rsquo;Malley that has five stages. Four databases were searched for sources: CINHAL, Scopus, PubMed, and Medline. Only English full-text written articles, across various research designs published between 2000\u0026ndash;2024, were part of the inclusion criteria for the review.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003e The review has shown that effective interprofessional collaboration has the potential of ensuring prompt diagnosis and management of PPH where the results ensure positive patient and team dynamics outcomes. Moreover, interprofessional collaboration in managing PPH safeguards good use of resource utilisation and team synergy where the is awareness of each healthcare professional roles, mutual trust and respect and shared leadership.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003ePreventing post-partum haemorrhage depends on high effective interprofessional collaboration. As a means of promoting safe healthcare delivery when PPH emergency occur, interprofessional collaboration practices is encouraged to be strengthened through various measures. Either through interprofessional collaboration quality improvement initiatives or interprofessional situ simulation training.\u003c/p\u003e","manuscriptTitle":"A scoping review on the contribution of interprofessional collaborative practices on preventing and managing post-partum haemorrhage in the health care system","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-07-29 21:14:19","doi":"10.21203/rs.3.rs-4576910/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2024-09-04T06:23:54+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-09-03T14:01:18+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"158196885416502290728939233386359075319","date":"2024-09-02T10:21:46+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-08-07T22:06:12+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"181227459395171712115206233529523403633","date":"2024-07-23T10:08:29+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2024-07-07T09:07:08+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2024-07-05T05:24:09+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2024-07-04T11:10:28+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Nursing","date":"2024-06-13T14:39:09+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-nursing","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"nurs","sideBox":"Learn more about [BMC Nursing](http://bmcnurs.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/nurs/default.aspx","title":"BMC Nursing","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"64623f6c-dd25-41d8-b771-43d82ec29720","owner":[],"postedDate":"July 29th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2025-04-28T16:10:03+00:00","versionOfRecord":{"articleIdentity":"rs-4576910","link":"https://doi.org/10.1186/s12912-025-02988-z","journal":{"identity":"bmc-nursing","isVorOnly":false,"title":"BMC Nursing"},"publishedOn":"2025-04-24 15:57:44","publishedOnDateReadable":"April 24th, 2025"},"versionCreatedAt":"2024-07-29 21:14:19","video":"","vorDoi":"10.1186/s12912-025-02988-z","vorDoiUrl":"https://doi.org/10.1186/s12912-025-02988-z","workflowStages":[]},"version":"v1","identity":"rs-4576910","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4576910","identity":"rs-4576910","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}