Date of Award


Document Type



College of Nursing

Degree Name

Doctor of Nursing Practice (DNP)

Project Mentor

Kelly McBroom


Diane Switzer



The purpose of this project is to examine whether a series of three midwifery simulation experiences integrating components of the TeamSTEPPS® toolkit improves students’ self-identified confidence with clinical decision-making over a ten-week period.


This nonexperimental program evaluation project incorporated one formative, quantitative, assessment and a mixed-methods summative framework and took place at a university in the Puget Sound region with a non-random convenience sample of DNP-CNM students in their pre-clinical laboratory skills class. Study participants completed the NASC-CDM© three times during the study and submitted two anonymous reflections about their simulation experiences.


100% of potential participants completed the informed consent and pretest. The first posttest returned seven complete surveys (58.3% response rate) and the final posttest 11 complete surveys (91.7% response rate). Of the possible 24 reflections, 21 were submitted (87.5% response rate). From the first posttest, only one question on the anxiety subscale achieved statistical significance and none from the self-confidence subscale. However, on the final posttest, two items on the anxiety subscale and 14 on the self-confidence subscale achieved statistical significance at P


Student immersion in simulation activities, paired with the concrete communication tools included in TeamSTEPPS®, increased student measures of self-confidence. The lack of a relationship between the two subscales using Pearson’s coefficient at the final posttest implies that while students’ self-confidence increased over the simulation series, their anxiety did not commensurately decrease. This may be due to the exclusive inclusion of emergency scenarios in the simulation series, which confronted students with some of the most stressful situations encountered by midwives. References to TeamSTEPPS® concepts were not included in all reflections, but when present were unanimously positive.