Date of Award


Document Type


Degree Name

Doctor of Philosophy (PhD)


College of Nursing

First Advisor

Susan D. Newman

Second Advisor

Leonard Goldsmith

Third Advisor

Charlene Pope


Purpose: The purpose of this dissertation was to explore the facilitators of, and barriers to, neonatal resuscitation to identify areas for improvement. First, an integrative review of measurement instruments for delivery room neonatal resuscitation simulations was conducted, followed by a qualitative study examining interprofessional neonatal resuscitation team member perceptions of facilitators and barriers to delivery room neonatal resuscitations. The first qualitative study informed the second qualitative study, an examination of the enablers and barriers to effective bag-mask ventilation as perceived by labor and delivery nurses. Problem: Birth asphyxia continues to remain a cause of neonatal deaths worldwide (Te Pas, Somotka, & Hooper, 2016). Simulation is a potentially powerful means of maintaining competence in individual neonatal resuscitation skills and team performance (Halamek, 2016). However, a review of the literature revealed a lack of standardized measurement of outcomes related to simulation-based training (Clary-Muronda & Pope, 2016). Moreover, a paucity of research has been conducted to link simulation-based education programs, often costly to implement, with neonatal outcomes. The specific aims of this dissertation were: - Aim1: To conduct an integrative review of measurement instruments for delivery room neonatal resuscitation simulations - Aim 2: To examine the facilitators of, and barriers to, delivery room neonatal resuscitation from the perspectives of interprofessional neonatal resuscitation team members - Aim 3: To explore the barriers and enablers of bag-mask ventilation from the perspectives of labor and delivery nurses. Design: This research employs qualitative methodology to explore the barriers and enablers of effective delivery room neonatal resuscitation, using two qualitative studies, with the first study informing the second. The Theoretical Domains Framework (TDF), an intuitive guide to examine the barriers and enablers to implementation of best practices, was used to frame this research. Findings: This two part qualitative study examining facilitators of, and barriers to, delivery room neonatal resuscitations revealed a skills deficit for labor and delivery nurses in bag-mask ventilation skills. Several contextual factors affected the ability of labor and delivery nurses to implement best practices in delivering bag-mask ventilation to newborns in the delivery room, ranging from individual factors such as comfort with skills, practice, and ability to use the algorithm to guide action in a timely fashion, to organizational factors such as staffing, equipment, and logistics. Conclusion: The TDF provided a comprehensive guide to frame enablers and barriers to best practices in this understudied population. Standardized guidelines do not take into account the contextual factors that may impede the implementation of best practices. Prior to intervention implementation, assessment of organization and population specific factors and consideration of such factors in designing interventions is more likely to promote a sustainable improvement in clinician practices and adherence to the Neonatal Resuscitation Program algorithm.


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