Strategies supporting the implementation of simulation-based education in nursing and midwifery in Malawi: A mixed methods study

Background. Nursing and midwifery training institutions are responsible for preparing the future nursing and midwifery workforce to ensure that they practise in accordance with the applicable patient safety standards. As such, simulation-based education (SBE) is thoughtfully being implemented in many parts of the world to train nursing and midwifery students to help the graduates to acquire the technical and non-technical skills needed to deliver safe patient care. This study, therefore, attempted to identify strategies for implementing SBE in nursing and midwifery in Malawi. Objective. To identify strategies for implementing SBE in nursing and midwifery in selected education institutions and clinical sites in Malawi. Methods. The data were collected using mixed methods with questionnaires, in-depth interviews, focus group discussions and desk reviews of nursing and midwifery syllabuses and curricula documents in Malawi. Two hundred and ninety-three participants responded to the questionnaire (144 clinical instructors and 149 final-year nursing and midwifery students). Ten focus group discussions were held with fourth-year students. In-depth interviews with deputy hospital directors (nursing and midwifery services), college principals, deans, department heads and other key stakeholders were conducted. The College of Medicine Research and Ethics Committee granted ethical approval for the study. Quantitative data were entered into SPSS version 23.0 for descriptive statistics, and qualitative data were thematically analysed using NVivo 12. Results. The study identified several strategies for implementing SBE in Malawi, including building appropriate simulation infrastructure (n=115; 39.3%), training educators on simulation (n=130; 44.4%), training clinical instructors/preceptors (n=106; 36.3%) and purchasing appropriate equipment (n=202; 68.9%). Scenarios with standardised patients and collaborative work in simulation between clinical staff and academics in training institutions and clinical settings were critical strategies for implementing SBE in Malawi. Conclusion. The successful implementation of SBE in nursing and midwifery in Malawi relies on a holistic approach that encompasses infrastructure, educator training, collaboration, scenario development, curriculum integration and ongoing evaluation. The journey towards realising these goals will undoubtedly require dedication, persistence, and the collective efforts of all stakeholders involved in nursing and midwifery education in Malawi.