In 1999, the Institute of Medicine released a report, To Err Is Human: Building a Safer Health System, that sent a wake-up call to the healthcare industry. The report estimated that somewhere between 40 000 and 98 000 patients per year were dying because of errors by healthcare systems and workers.1 This sobering news was followed in July 2004 with Sentinel Event Alert Issue #30 from the US Joint Commission on Accreditation of Healthcare Organizations, stating that since 1996, 47 sentinel event cases were submitted for review that involved perinatal death or severe disability. An Editor’s note to Alert Issue #30 at the end of 2005 updates the number of cases reported to 109.

The first recommendation in this issue alert reads "Conduct team training in perinatal areas to teach staff to work together and communicate more effectively."2 What are the best ways to accomplish this? Are there other industries that could provide a template? What has the response been to this alert? In this issue on the topic of Education and Training, these questions have been addressed.

In the article "Crew Resource Management in Healthcare: The Evolution of Teamwork and Medteams," McConaughey reviews the concept of crew resource management from the aviation industry and how it has been applied to healthcare. Miller and colleagues report one facility’s experience with implementing in situ (in-house) team training with a focus on patient safety in "In Situ Simulation: A Method of Experiential Learning to Promote Safety and Team Behavior."

Shoulder dystocia is specifically mentioned in Alert Issue #30 as a high-risk event requiring staff drills and debriefings to identify areas for improvement.2 In the article "Shoulder Dystocia: Using Simulation to Train Providers and Teams," Fahey and Mighty describe how to design and execute these drills. Certainly fetal heart rate monitoring is an important part of patient care in any perinatal unit, and the topic is addressed in recommendations from Alert Issue #30. In particular, standardization of terminology and clear guidelines for interpretation of fetal tracings are listed.2 Collins explores multidisciplinary team training in electronic fetal monitoring from a medical legal angle in the article "Multidisciplinary Teamwork Approach in Labor and Delivery and Electronic Fetal monitoring Education: A Medical Legal Perspective."

Thanks to growing awareness in the healthcare industry and publicly released documents such as those mentioned above, terms such as patient safety, simulation-based training, in situ training, multidisciplinary team training, and effective communication techniques have been introduced into healthcare or have become increasingly more important. The time has come and the articles in this issue address key questions as healthcare education and training evolve to meet these new challenges.

The neonatal articles for this issue focus on exciting areas of education and training. New technology development in response to the complexity of care requires creative ways to teach neonatal healthcare professionals. In addition, nurses need to be prepared for natural disasters that may threaten the safety of neonates.

Lawhon and Hedlund discuss the Newborn Individualized Developmental Care and Assessment Program (NIDCAP). The article describes how the program was developed and the steps required for neonatal intensive care unit (NICU) personnel to become proficient in utilizing NIDCAP. The authors emphasize how NIDCAP has reduced iatrogenic complications of prematurity and enhanced neurobehavioral competence of preterm infants. This is the continuing education article for the issue.

Orlando and colleagues identify lessons learned from the Hurricane Katrina experience and the importance of developing a unit-specific disaster plan. What would you do if a natural disaster occurred and you had to evacuate the neonates in your nursery? In most cases, basic approaches to care must be implemented without the aid of technology. The authors point out that disaster education and training are essential for all NICU nurses.

Yaeger and Arafeh provide an alternate way to teach the neonatal resuscitation program using clinical simulation that incorporates adult learning theory, real-time clinical situations, and video debriefing of clinical scenarios. Emphasis is placed on the improved performance of neonatal resuscitation program providers when learning is simulation-based.

Taylor and Price-Douglas provide a comprehensive review of the S.T.A.B.L.E. Program. After successful neonatal resuscitation, healthcare providers must care for the neonate prior to transportation to a tertiary care facility. This article identifies the history, philosophy, goals, module overviews, and administration of the S.T.A.B.L.E. Program, emphasizing the importance of NICU healthcare providers being proficient in postresuscitation and pretransport care of ill neonates.

Julie M.R. Arafeh, MSN, RN

Karen D'Apolito, PhD, APRN, CNS, NNP

Guest Editors

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