Improving quality and efficiency of postpartum hospital education

Creating Healing-Centered Spaces for Intimate Partner Violence Survivors in the Postpartum Unit: Examining Current Practices and Desired Resources Among Health Care Providers and Postpartum People

Background: Intimate partner violence (IPV) has negative health impacts for pregnant people and their infants. Although inpatient postpartum units offer an opportunity to provide support and resources for IPV survivors and their families, to our knowledge, such interventions exist. The goal of this study is to explore (1) how IPV is currently discussed with postpartum people in the postpartum unit; (2) what content should be included and how an IPV intervention should be delivered; (3) how best to support survivors who disclose IPV; and (4) implementation barriers and facilitators. Materials and Methods: We used individual, semistructured interviews with postpartum people and health care providers (HCPs). Interview transcripts were coded and analyzed using an inductive-deductive thematic analysis. Results: While HCPs reported using a variety of practices to support survivors, postpartum people reported that they did not recall receiving resources or education related to IPV while in the inpatient postpartum unit. While HCPs identified a need for screening and disclosure-driven resource provision, postpartum people identified a need for universal IPV resource provision in the postpartum unit to postpartum people and their partners. Participants identified several barriers (i.e., staff capacity, education already provided in the postpartum unit, and COVID-19 pandemic) and facilitators (i.e., continuity of care, various HCPs) to supporting survivors in the postpartum unit. Conclusion: The inpatient postpartum unit is a promising setting to implement an intervention to support IPV survivors and their infants. Future research and intervention development should focus on facilitating universal education and promoting resource provision to IPV survivors.

Postnatal Unit Care and Safe Transition Home

The United States has the highest maternal mortality rate among developed nations with 60% of deaths occurring during the postpartum period. This chapter presents the case study of Maya Howard. Maya represents of composite of qualitative research studies that reveals missteps, gaps, and oversights of Black mothers and birthing people during birth and the postpartum period. Using a Black feminist framework, the chapter offers solutions to improve postnatal unit care and the transition home, a critical step in improving care and saving lives for all mothers and birthing people.

Scoping Review of Postpartum Discharge Education Provided by Nurses

OBJECTIVE

To determine what is known about postpartum education provided by nurses to women before discharge from the hospital after birth and whether current nursing practices are effective to prepare women to identify warning signs of complications, perform self-care (physical and emotional), prepare for parenting a newborn, and establish infant feeding.

DATA SOURCES

We conducted a systematic search of CINAHL Plus and MEDLINE for relevant sources, including peer-reviewed articles, conference presentations, and guidelines from professional organizations, that were published in English from January 2010 through November 30, 2020.

STUDY SELECTION

We included sources if participants were women who had given birth to a healthy, liveborn, term infant and were receiving education in whole or in part by a nurse during the maternity hospitalization. We excluded sources with samples of high-risk women or those who gave birth to high-risk infants (preterm, congenital anomalies, neonatal abstinence syndrome). Forty-six of the sources met the inclusion criteria.

DATA EXTRACTION

We extracted citation, type of document, country of origin, context (prenatal/postpartum or both and inpatient/outpatient or both), aim, participants (mother/father or both, sample characteristics), content of education and who provided it, outcomes or key themes, and main results.

DATA SYNTHESIS

Infant topics included breastfeeding and safe sleep, and maternal topics included breastfeeding, postpartum mood, and self-care after birth. Nurses prioritized safety, including safe sleep; preventing infant falls; decreasing infection; screening for postpartum depression; and avoiding adverse outcomes after discharge. Women focused on self-care, pain management, infant care, and parenting. Women and nurses prioritized breastfeeding. Authors of the included sources measured effectiveness by patient satisfaction, chart audit, pre- and posttests of nurses' knowledge, and breastfeeding duration. Women reported barriers to postpartum education such as limited nursing time or conflicting information.

CONCLUSION

Postpartum education is a priority, but its effectiveness is not well studied. Few maternal or infant health-centered outcomes have been measured beyond breastfeeding duration. Nursing care and nurse expertise are not easily quantified or measured. Research is needed to inform best practices for postpartum education.

Opportunities and challenges for family-centered postpartum care during the COVID-19 pandemic: a qualitative study of nurse perspectives

Background

The global COVID-19 pandemic has forced the health care sector to make wide-ranging changes to protect patients as well as providers from the risk of infection. Many of these changes are likely to have greatest impact in contexts of care that employ family-centered care (FCC) models, including perinatal and maternity care. Research conducted in perinatal care settings during the pandemic has shown that some of these restrictions have negatively impacted patient and family experiences and outcomes, while others have been perceived as beneficial. The present qualitative study aimed to understand what changes have occurred in postpartum nursing practice during the pandemic, and how these changes have affected nurses, women and families during their stay in the hospital following a new birth.

Methods

Structured interviews were completed with 20 postpartum nurses from five hospitals across Texas. The interview protocol was designed to elicit information about changes to hospital policies in postpartum units during the pandemic, nurses’ attitudes about these changes, perceived benefits and challenges for performance of their duties, and perceived effects on patients and their families. Nurses were recruited for the study using a purposive sampling approach. Interviews were conducted by video conference using Zoom and lasted approximately 30 to 45 min. Data were analyzed using a qualitative descriptive approach.

Results

Participants reported that their hospitals placed restrictions on the number and mobility of support persons allowed to stay with the mother in the unit and prohibited all other visitation. Some challenges of these policies included reduced opportunities for hands-on learning and an increased number of patients opting for early discharge. Perceived benefits for patient education and outcomes included improved frequency and effectiveness of nurse-family communication, increased father involvement, and greater opportunities for maternal rest, breastfeeding, skin-to-skin care and family bonding.

Conclusions

Study findings suggest that some limitations on postpartum hospital visitation may achieve important, family-centered goals. Protected time for family-bonding, maternal rest, breastfeeding, father involvement and individualized education are critical to quality FCC. Research must examine which visitation policies maximize these benefits while preserving patient access to family and social support.

Mothers' Perceptions of the Quality of Postnatal Care Provided in Health Centers and the Associated Factors: A Cross-Sectional Study

Background

Postnatal care plays a great role in the health of mothers and their neonates. This study aimed to evaluate the mothers' perceptions of the provided postnatal care and the associated factors.

Methods

In this cross-sectional study, the health centers of Sirik city in Hormozgan province, Iran, were selected using convenience sampling. The study was conducted on 160 mothers who had referred to the selected centers for postnatal care from 7 August 2018 to 2 August 2020 and had given birth to live full-term neonates (>37 weeks of gestation) 40 days to 12 months before sampling. The Mothers' Perceptions of the Quality of Postnatal care questionnaire was designed by the research team; it included 18 questions about mothers' perception of care. The collected data were analyzed using the SPSS software, version 21.

Results

The mothers' mean score of perception was 69.84±16.04; most mothers rated the provided postnatal care and their relationship with the personnel as good or excellent. The mean total scores of the mothers' perceptions were not different based on their satisfaction with postnatal care (P=0.646) and time of the first referral after birth (P=0.251), but they were significantly different according to the number of referrals (P=0.023) and their satisfaction with the health personnel (P<0.001).

Conclusion

The study results revealed that mothers had a good perception about postnatal care provided by health center staff. Hence, it is necessary to educate all health staff in this regard to provide high-quality postnatal care to all mothers who refer to these centers.

Challenges and Feasibility of Co-Design Methods for Improving Parent Information in Maternity Care

This study explored the feasibility of using experience-based co-design methods (EBCD), based on participatory action principles, to improve service delivery regarding parent information needs within a metropolitan postnatal maternity unit. Data were collected from January 2018 to March 2019 from parents and staff using surveys, video interviews, a focus group and ward observations of episodes where parents were provided information. Participants included postnatal mothers who had recently given birth, their partners and hospital staff. Survey results (n = 31) were positive regarding content and satisfaction with information delivery. Data from the staff focus group (seven participants) and in-depth video interviews with mothers (n = 4) identified common themes, including challenges to information delivery due to time pressures, the value of breastfeeding advice and environmental influences. Overall, parents were satisfied with the information delivered; however, inconsistencies were present, with time pressures and other environmental factors reported as influencing the process. Staff and parents both identified the amount of content being delivered in such a short time frame as a major challenge and tailoring information was difficult due to individual experiences and circumstances. Additional resources or alternative methods are suggested for conducting future studies to capture patient experience within a similar busy hospital setting.

Pilot Feasibility Study of a Hospital-Based Post-Natal Educational Intervention on New Mothers in a BFHI-Compliant Tertiary Referral Center for Neonatal Care

The immediate post-partum period offers a valuable opportunity for parental education on various health topics. The aim of this study was to pilot test the feasibility in a tertiary referral center for neonatal care of a post-natal educational intervention (the Diary) designed to provide mothers with basic information concerning newborn care and breastfeeding. Furthermore, we aimed to evaluate its effect on exclusive breastfeeding rates at discharge and at 48 h post-discharge, and on maternal perceived support during hospital stay, compared to standard care. A single-center two-phase interventional study was carried out from 1 December 2018 to 2 June 2019. The Diary was given to mothers enrolled in Phase 2, together with the Nurse-Parent Support Tool (NPST). The Diary-NPST couples analyzed were 269. The Diaries filled out and returned were 62.2%. Overall, mothers rated the information received through the Diary as "clear and comprehensive". Exclusive breastfeeding rates at discharge resulted in being higher in Phase 1 than in Phase 2 (80.6% vs. 72.5%, p = 0.04), whereas no difference emerged in terms of exclusive breastfeeding rates at 48 h. In both phases, the median NPST total score (4.05) was high. In conclusion, we propose a new instrument of in-hospital post-natal maternal education and, in line with the current literature, we support well-designed written educational materials to promote mothers' knowledge and satisfaction with post-partum hospital assistance. Further studies that are multicentric and with a longer follow-up period are needed to evaluate the potential impact of the Diary on exclusive breastfeeding duration.

Primiparous Adaptation with Postpartum Health Issues in Jeddah City, Kingdom of Saudi Arabia: A Quantitative Study

Background: The postpartum or puerperium period is the first 6 weeks after giving birth to an infant. The postpartum period can have negative implications, especially in first-time mothers. With their transition into motherhood, new mothers adopt new lifestyles, which can affect their physical wellbeing. Childbirth has physical, psychological, and emotional effects on women as they try to adapt to their new roles in order to get through this period with no or minimal health issues. Study Aim: The current study aims to explore primiparous adaptations with postpartum health issues in Jeddah City at Kingdom of Saudi Arabia. Methods: The research design is quantitative cross-sectional. A structured questionnaire was developed to collect data in relation to depression and weight gain, which consider the most common postpartum health issues. The inclusion criteria of the participants are: primipara, 2 to 6 months postpartum, and living in Jeddah. Results: 140 participants were included in the study. Mothers gained approximately 9.2 kg within the fifth to ninth month after giving birth. Discussion: Postpartum weight retention is a primary challenge in the majority of primiparous mothers and results in reduced quality of life. Nurses were always available to answer questions related to the postpartum health issues and explained the expectations to the family members. Conclusions: Childbirth and the postpartum period for first-time mothers are crucial in their lives as they try to adapt to a new way of life. The postpartum period can have negative implications, especially in first-time mothers. With their transition into motherhood, new mothers adopt new lifestyles, which can affect their physical wellbeing. More research is needed to explore the impact of postpartum health issues in Saudi Arabia.

Leveraging the universal newborn hearing screen to impact parental knowledge of childhood speech development in low socioeconomic populations: A randomized clinical trial

OBJECTIVE

To determine the impact of a video intervention administered at the time of the universal newborn hearing screen on caregiver knowledge of infant cognitive and language development in low socioeconomic status English-speaking parents.

METHODS

A parallel-group, single-blind randomized clinical trial was conducted from April to August 2016. Eligible participants were at least 18 years, delivered a singleton neonate, English speaking, and designated as low socioeconomic status based on household income and level of education. A total of 112 patients, 54 treatment and 58 control, completed the study and were included in the analysis. The Baby Survey of Parent/Provider Expectations and Knowledge, a validated 24-item questionnaire assessing child development knowledge, was the primary study outcome. The survey was conducted at baseline, 1 day after intervention, and 4-6 weeks later. A one-way, repeated measures analysis of variance (ANOVA) was employed to evaluate for differences in the three time points.

RESULTS

The average age of participants was 25.6 years and 85% identified as African-American. There was no significant difference in scores prior to and following the intervention for the control group (N = 58, F = 1.67, p = 0.19); however, a significant difference in scores was found in the treatment group (N = 54, F = 7.95, p < 0.001). Post-hoc analysis showed a significant improvement in scores 1 day after intervention, but no difference 4-6 weeks later.

CONCLUSION

Educational video intervention for low socioeconomic mothers at the time of the universal newborn hearing screen can positively increase knowledge related to hearing and language development in the short term.

TRIAL REGISTRATION

Pilot Study of Novel Postpartum Educational Video Intervention NCT02267265 https://clinicaltrials.gov/ct2/show/NCT02267265.

How nurses and other health professionals use learning principles in parent education practice: A scoping review of the literature

Background

Health Professionals (HPs) play an important role in supporting parents to care for their children, by facilitating parents' knowledge and skills development through parent education. This is achieved through teaching, whereby planned strategies, based on principles of how people learn, enable learning. Despite Learning Principles being the fundamental tenets of the learning process, how HPs perceive and use Learning Principles in their practice is neglected in the healthcare literature.

Objective

To identify, describe and map the existing literature on nurses' and HPs' perceptions and use of Learning Principles in parent education practice.

Method

A scoping review was performed using the Joanna Briggs Institute approach. A comprehensive search of 10 databases and the grey literature was undertaken between March and June 2017 to identify pertinent English-language publications. The search was limited to literature published between 1998 and 2017. Following a screening and inclusion criteria eligibility check, 89 articles were selected for inclusion.

Results

HPs' perceptions of Learning Principles were diverse, somewhat disorganised, divergent in meaning and implicit. This was until the Dimensions of Learning construct was applied to guide the analyses and mapping. This revealed that HPs, of whom 60.7% were nurses, used Learning Principles in parent education, but only referred to them in the context of Adult Learning. Enablers to HPs using Learning Principles included shared partnerships between parents and HPs, while barriers included parents' health beliefs, psychological issues and organisational assumptions about learning. Evaluation of parents' learning also represented implicit use of Learning Principles by HPs.

Conclusion

This scoping review is the first to examine HPs' perceptions and use of Learning Principles within parent education practice. The findings reveal a significant gap in this body of knowledge. The paucity of studies containing any explicit descriptions of Learning Principles strongly supports the need for further exploration and codification of Learning Principles, through qualitative methods, whereby a deeper understanding of what is happening in healthcare practice can be established.

A 3-Dimensional Anatomical Education Model in Postpartum Perineal Laceration Care: A Pre-Post Intervention Study

OBJECTIVE

The aim of this study was to investigate the effects of postpartum patients introduction to and interaction with a virtual 3-dimensional (3D) pelvic model on the self-care, knowledge, and anxiety parameters.

METHODS

The model was designed from computed tomography data displaying the involvement of the levator ani in a fourth-degree perineal laceration. This 3D model was used to educate postpartum day 1 patients at the bedside. Patient data were collected using a pre and post questionnaire assessing knowledge, anxiety, and confidence in perineal wound self-care.

RESULTS

Thirty-six patients were enrolled with a median age of 28.5 years (interquartile range, 31, 21.75 years) and a median parity of 1 (interquartile range, 2, 1). Patient use of the tool significantly decreased patient anxiety regarding perineal lacerations (P < 0.01) and significantly increased patient knowledge on what part of their vagina was lacerated during vaginal delivery (P < 0.01).

CONCLUSIONS

Reviewing a 3D model of perineal lacerations with patients on postpartum day 1 is associated with less anxiety and increased knowledge of pelvic floor anatomy. These pilot data represent a preliminary investigation into the relations between 3D model of perineal lacerations and a range of patient outcomes.

Educating Parents About Infant Language Development: A Randomized Controlled Trial

A total of 427 women (aged 18-45 years) who delivered a singleton neonate without serious medical complications were randomized to watch either an educational intervention (n = 225) or the sudden infant death syndrome (n = 202) video. Linear mixed models showed that the intervention women significantly gained knowledge over time. Knowledge gain was largest among high-socioeconomic status (high-SES) and middle-SES English-speaking, smaller among low-SES Spanish-speaking, and nonsignificant among low-SES English-speaking women. Analysis of deviance revealed that the intervention women of all SES learned strategies fostering secure attachment and language acquisition. Participants considered watching an educational video alongside the universal newborn hearing screening (UNHS) conveniently timed. The intervention women were more likely than the control women to recognize the importance of timely UNHS follow-up.

The Challenges of Providing Postpartum Education in Dar es Salaam, Tanzania: Narratives of Nurse-Midwives and Obstetricians

Postpartum education can save lives of mothers and babies in developing countries, and the World Health Organization recommends all mothers receive three postpartum consultations. More information is needed to better understand how postpartum education is delivered and ultimately improves postpartum health outcomes. The purpose of this qualitative study was to examine how postpartum care was delivered in three postnatal hospital clinics in Dar es Salaam, Tanzania. Semistructured interviews with 10 nurse-midwives and three obstetricians were conducted. Feminist poststructuralism guided the research process. Postpartum education was seen to be an urgent matter; there was a lack of supportive resources and infrastructure in the hospital clinics, and nurse-midwives and obstetricians had to negotiate conflicting health and traditional discourses using various strategies. Nurse-midwives and obstetricians are well positioned to deliver life-saving postpartum education; however, improvements are required including increased number of nurse-midwives and obstetricians.

A Practice Improvement Project to Reduce Cesarean Surgical Site Infection Rates

We implemented an evidence-based practice improvement project at a health care facility in the Midwestern United States to address the increasing rate of cesarean surgical site infections. Women who experienced cesarean birth were cared for using a standardized evidence-based protocol including preoperative and postoperative care and education. In addition, a team-created educational video was used by both women and their families during the postoperative period and at home after discharge. This new protocol resulted in a decrease in the rate of cesarean surgical site infections from 1.35% in 2013 to 0.7% in 2014 and 0.36% in 2015. Our interdisciplinary approach to integrate best-practice strategies resulted in decreased infection rates and improved patient satisfaction scores.

Development and evaluation of a newborn care education programme in primiparous mothers in Nepal

BACKGROUND

the health and survival of newborns depend on high levels of attention and care from caregivers. The growth and development of some infants are unhealthy because of their mother's or caregiver's lack of knowledge or the use of inappropriate or traditional child-rearing practices that may be harmful.

OBJECTIVE

to develop a newborn care educational programme and evaluate its impact on infant and maternal health in Nepal.

DESIGN

a randomised controlled trial.

PARTICIPANTS

one hundred and forty-three mothers were randomly assigned to the intervention (n=69) and control (n=74) groups. Eligible participants were primiparous mothers who had given birth to a single, full-term, healthy infant, and were without a history of obstetric, medical, or psychological problems.

METHODS

prior to being discharged from the postnatal unit, the intervention group received our structured newborn care education programme, which consisted of one-on-one educational sessions lasting 10-15minutes each and one postpartum follow-up telephone support within two weeks after discharge, in addition to the hospital's routine general newborn care education. The control group received only the regular general newborn care education. Outcomes were measured by using Newborn care Knowledge Questionnaires, Karitane Parenting Confidence Scale, State-Trait Anxiety Inventory for Adults and infant health and care status.

FINDINGS

the number of mothers attending the health centre due to the sickness of their babies was significantly decreased in the intervention group compared to the control group. Moreover, the intervention group had significant increases in newborn care knowledge and confidence, and decreases in anxiety, compared with the control group.

CONCLUSIONS

the structured newborn care education programme enhanced the infant and mother health. Moreover, it increased maternal knowledge of newborn care and maternal confidence; and reduced anxiety in primiparous mothers. Thus, this educational programme could be integrated into routine educational programs to promote maternal and infant well-being in Nepalese society.

Perinatal Education and Support Program: Baystate's New Beginnings

Parent education traditionally focuses on childbirth, whereas the perinatal period gets little attention despite parents' reports of feeling unprepared. Lack of education surrounding newborn behavior leads to decreased maternal confidence and ineffective responsiveness to infant cues for feeding, crying, and sleep. This can cause overfeeding, lowered breastfeeding success, and contributes to parental stress which can impact maternal-infant bonding. Lack of postpartum maternal support adds to fatigue and stress which contributes to poor maternal well-being. This article describes an innovative perinatal program, Baystate's New Beginnings, modeled after the education from the 2011 California Baby Behavior Campaign and The Secrets of Baby Behavior that combines newborn behavior education and maternal support in the first 3 months postpartum to improve maternal role transition.

Patient Satisfaction With Postpartum Teaching Methods

Postpartum discharge instructions are a crucial part of a mother's birth experience. Finding the method to provide those discharge instructions in a manner that increases the mother's satisfaction with her hospital experience is important. This quasi-experimental study examined the relationship between new mothers' interaction with nurses providing postpartum instructions by the traditional and class methods and their satisfaction with discharge teaching. The results indicated new mothers were satisfied with both methods of discharge teaching; however, they were more likely to report stronger agreement with overall satisfaction with the traditional method of discharge teaching than with attending the discharge class.

Process evaluation of a statewide abusive head trauma prevention program

The current study used four dimensions of the RE-AIM framework (Reach, Adoption, Implementation, and Maintenance) to evaluate the implementation of a statewide abusive head trauma prevention program. Numerous methods, including telephone surveys, paper and pencil questionnaires, site visits, and program administrative data were used to conduct the process evaluation. Results indicate that the intervention was successfully implemented in all birthing hospitals (n=86) across the state with a high degree of fidelity. Furthermore, the majority of the hospitals reported incorporating the program into unit procedures and employee training. More than three-fourths indicated that they plan to continue the program after the study ends. The RE-AIM framework was applied and served as a useful guide for the process evaluation of a multifaceted, multi-system, universal public health intervention.

Low-income, urban minority women's perceptions of self- and infant care during the postpartum period

OBJECTIVE

To describe low-income, urban, first-time mothers' perceptions about self-care and infant care during the first 6-months postpartum.

DESIGN

Naturalistic approach.

SETTING

Recruitment from community centers and churches.

PARTICIPANTS

Thirteen Hispanic and African American women who delivered their first infants within the past 6 months.

METHODS

Demographic and health information data were collected and analyzed using descriptive statistics. Semistructured interviews were conducted; data were coded and then clustered conceptually into categories.

RESULTS

Postpartum maternal self- and infant care issues included four categories: preparedness for discharge, confidence and satisfaction with mothering, concerns about infant care, and indifference to maternal self-care. Women were confident in caring for themselves and their infants and reported few unmet learning needs or health concerns. External sources of stress included finances, uncertain living arrangements, and relationship issues.

CONCLUSION

Health care providers who care for low-income postpartum women need to acknowledge the influence of external stressors that contribute to health outcomes in this population. It is vital that nurses collaborate with other health care providers to make certain that community connections are made for women who might need additional services beyond the postpartum check-up visit.