Date of Award

Spring 5-31-2026

Document Type

Doctor of Nursing Practice Final Manuscript

Degree Name

Doctor of Nursing Practice

Department

Nursing

First Advisor

Kevin J. Maxwell, PhD, DNP, FNP-BC, RN

Abstract

Maternal mortality in the United States remains a significant and worsening public health concern, with increasing reliance on emergency departments (EDs) as access points for maternal care. Emergency clinicians are therefore more likely to encounter high-acuity obstetric emergencies, including maternal cardiac arrest and amniotic fluid embolism (AFE), yet often receive limited formal training in these conditions. Simulation-based education, interdisciplinary training, and cognitive aids have been identified as effective strategies to improve performance in high-risk, low-frequency events.

The purpose of the evidence-based practice project was to evaluate whether an interdisciplinary simulation with obstetric-led debrief and introduction of the AFE checklist improves emergency clinician preparedness for maternal cardiac arrest. This project utilized a quasi-experimental pre-post design and included 26 emergency medicine residents. Participants completed pre- and post-intervention surveys assessing confidence, preparedness, diagnostic awareness, and interdisciplinary collaboration using a 5-point Likert scale.

Following the intervention, statistically significant improvements were observed across all six domains of confidence (p ≤ .004). Mean confidence in recognizing maternal emergencies increased from 3.12 to 4.08, and confidence in initiating maternal resuscitation increased from 2.42 to 3.92. Confidence in managing maternal emergencies without obstetric support improved from 2.04 to 3.38. Participants also demonstrated increased diagnostic awareness of AFE, with 80.8% reporting they would include AFE in their differential diagnosis following the intervention. Additionally, 92.3% of participants reported that they would use the AFE checklist in clinical practice.

This project demonstrates that interdisciplinary simulation combined with cognitive aids improves preparedness for maternal cardiac arrest and addresses a critical gap in emergency clinician training.

Keywords: Maternal cardiac arrest, emergency department, simulation training, interdisciplinary education, amniotic fluid embolism, cognitive aids

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