Maternal, Child Health and Neonatal Nursing Commons^™

Implementation Of Postpartum Oral Glucose Testing Follow-Up In Women With Gestational Diabetes, Amanda Rose Metz

Dissertations

Implementation of Postpartum Oral Glucose Testing Follow-up in Women with Gestational Diabetes

Problem One of the most common medical complications of pregnancy is Gestational Diabetes (GDM). After delivery, guidelines recommend follow-up glucose tolerance testing (OGTT) 4-to 12-weeks postpartum. Despite these recommendations, only 16% to 22% of women complete an OGTT postpartum.

Methods The purpose of this quality improvement (QI) project is to pilot a postpartum outreach follow-up via telephone to reach women diagnosed with GDM; the communication will be sent using the institution’s electronic messaging system. Quantitative data were collected prospectively. Data collected included if the patient was contacted and …

Prenatal Education For Black Mothers And Their Support Persons As An Intervention For Improving Initiation Of Breastfeeding, Sandra King

Doctor of Nursing Practice Projects

Background: The benefits of breastfeeding are commonly known; however, the rates of exclusive breastfeeding among the Black community are less than those of other ethnic groups. Providing breastmilk or formula to an infant is an individual decision. Influential factors such as cultural background, employment status, socioeconomic status, level of education, and availability of support from family members and health care providers correlate with the method a mother chooses to feed her infant. Increasing breastfeeding initiation immediately after birth is a necessary precedent for uptake in the exclusivity of breastfeeding.

Purpose: This Doctor of Nursing Practice project aims to improve prenatal …

Every Milliliter Matters: Quantitative Blood Loss In Postpartum, Iana Vatsenko

Master's Projects and Capstones

Postpartum hemorrhage remains a leading cause of maternal mortality in the United States. Postpartum hemorrhage occurs when mothers are bleeding excessively, have uterine atony, or the placenta has failed to come out completely. Research has shown that quantitative methods of blood loss estimation revealed a higher incidence of PPH than visual estimation. That is why using quantitative methods on time is essential for diagnosing PPH. Quantification of blood loss should be replaced by estimated blood loss since it is more accurate. The project's main focus was implementing quantification of blood loss and using the Triton Scale, a smart system to …

Every Milliliter Matters: A Quality Improvement Initiative For Postpartum Quantified Blood Loss, Amy O. Quinones

Master's Projects and Capstones

Problem: The microsystem for maternal-child healthcare in 2020 had 5.9% of deliveries progress to a postpartum hemorrhage. In 2021, the percentage of deliveries that progressed to a postpartum hemorrhage increased to 12.3%. The nearly two-fold increase in postpartum hemorrhage occurrence led to the creation of the Quality Improvement (QI) initiative to identify postpartum hemorrhage at an earlier stage. The QI initiative aims to extend the quantitative blood loss (QBL) measurement beyond labor and delivery, and support identification of postpartum hemorrhage in the postpartum period.

Context: The microsystem that this quality improvement project occurred on were three postpartum units in a …

Counting Every Drop: Preventing Maternal Mortality With Quantifying Blood Loss Through Triton Scale, Summer Le

Master's Projects and Capstones

Postpartum (PP) hemorrhage is one of the leading causes of maternal mortality (AWHONN, 2021). In each of the past three years, the percentage of PP hemorrhage has increased at Hospital X. The PP unit at Hospital X performs around 4,500 total deliveries each year. While the standard of care for PP blood loss is to specifically measure blood in milliliters as Quantifying Blood Loss (QBL) for Labor and Delivery (L&D), it is not yet the standard of care in the 24 hours postpartum after delivery (ACOG, 2019). This quality improvement project involved educating nurses about measuring blood loss – specifically …

Improving Postpartum Hypertension Discharge Education: A Pilot Project, Kathryn Barth

Dissertations

Problem: Hypertensive disorders of pregnancy (HDP) are a leading cause of maternal morbidity, mortality, and postpartum readmission. Several evidence-based algorithms and protocols have been implemented in the inpatient setting to treat severe blood pressure and prevent complications. However, there remains an opportunity to improve the postpartum care transition and discharge education for patients with these conditions in an attempt to decrease 30-day postpartum hypertension readmissions.

Methods: This pilot project utilized a descriptive design and took place on a postpartum unit at a Midwest metropolitan high-risk obstetrical teaching hospital. Interventions included patient-specific discharge education, distribution of a home blood pressure …

Comparing The Effectiveness Of Methods Meant To Reduce Perineal Laceration Rates, Danielle E Horovitz

Nursing | Senior Theses

Background

Perineal lacerations are a common occurrence in childbirth- with tears occurring in 53-79% of women. Trauma to the perineum is classified into 4 categories, with each class increasing in severity. Severe perineal lacerations have long term consequences for the women who experience them.

Objectives

To compare the effectiveness of methods which aim to reduce the rate and severity of perineal lacerations, including: hands on vs hands off technique, slow and controlled birth, use of lubrication, perineal massage, etc.

Summary of Findings

The literature review suggests that it is critical to employ methods to reduce laceration incidence and severity as …

Preventing Maternal Falls, Blair Burkhart

Master's Projects and Capstones

Patient falls are unfortunate events in healthcare that are an essential quality improvement focus during patients’ hospital stays. At Hospital X, a private institution located in the suburbs of a large city, there had been 23 maternal falls within the last three years. This increase in maternal fall rate puts this hospital’s maternity unit above the average of other hospital’s fall rates according to the National Database of Nursing Quality Indicators. This quality improvement project aimed to reduce the rate of maternal falls on postpartum units through various forms of staff education. Education included Morse Fall Scale scoring, Sara Stedy …

Reducing Postpartum Maternal Falls: A Quality Improvement Project, Sarah L. Iroz

Master's Projects and Capstones

Falls are an unfortunate, common occurrence in the healthcare system and are often not thought to be a problem in the obstetrics population. Key stakeholders in a Northern California hospital brought the issue of maternal falls to leaders of the quality improvement team on the maternity unit. In the last three years, there have been 23 falls on the maternity floor, making their fall rate above the national average. It is the purpose of this project to aid the quality improvement team in reducing postpartum maternal falls over the next three years. After conducting a unit assessment, performing a literature …

Increasing Lactation Consultant Support To The Mch Unit, Daniella Grace Mcclendon

Master's Projects and Capstones

Problem: Breastfeeding is the most beneficial feeding choice for newborns and one of the best ways for mothers to bond with their newborns. In the current Maternal Child Health (MCH) unit, exclusive breastfeeding rates have fallen lower than the unit’s goal of 82%.

Context: Exclusive breastfeeding, when a newborn consumes only human breastmilk, is not always an easy process to initiate immediately after birth and in the early postpartum period. On this specific unit, there is not enough lactation consultant support to provide all patients on the unit.

Interventions: This project considers adding additional lactation consultants to support the MCH …

Assessing The Impact Of Covid-19 Restrictions On The Perinatal Experience In Mississippi, Baylee Grimsley

Honors Theses

The purpose of this study is to assess how COVID-19 restrictions affected the perinatal experience of women in Mississippi. A flyer detailing the purpose and inclusion criteria of the study was sent via social media platforms. Five postpartum women from the Hattiesburg, Mississippi area participated in this study. Eight open-ended questions were asked in an interview format, and a seven-question demographic survey was given to each participant at the conclusion of the interview. Five restrictions related to COVID-19 were identified: visitor restrictions in the hospital, mask requirements in healthcare facilities, screening of patients upon admission to the Labor and Delivery …

Columbia-Suicide Severity Rating Scale (C-Ssrs) Inpatient Perinatal Clinical Pathway, Kristin M. Schoen

Master's Projects and Capstones

Problem: The potential harm to women and infants due to untreated perinatal anxiety and mood disorders is both a patient safety and a public health concern. Studies show that mental health decline during the postpartum period is associated with increased morbidity and mortality for both the mother and infant. The project aim was to utilize the initial screening of perinatal patients using the Columbia-Suicide Severity Rating Scale (C-SSRS) as the baseline screening tool. The tool will help implement a standardized workflow for patients who screen low, moderate, or high, as this workflow had yet to be developed.

Context: In July …

Decreasing Floor Morphine Equivalents Per Day Rates In The Mother/Baby Department, Jessica Welsh

Master's Projects and Capstones

Problem: Cesarean sections (C/S) are among the most common operations in the United States and result in moderate visceral and somatic pain. Historically, C/S pain has been treated with opioid pain relievers. The U.S. Department of Health and Human Services declared the misuse of opioids an epidemic in 2017, leading healthcare providers and organizations to look inward at how opioids are prescribed and used at all levels of patient care.

Context: A microsystem assessment on a 60-bed mother/baby unit indicated one of the highest average opioid administration rates per day for postoperative C/S patients in the organization’s region for the …

Telehealth Breastfeeding: Best Practice Guideline, Laura Amabile

Doctor of Nursing Practice Final Manuscripts

Background: Only 24.9% of United Stated infants are exclusively breastfed through six months. Healthy People 2020 breastfeeding goals include increasing the proportion of infant breastfed through six months to 60.6%. The Surgeon General’s Call to Action identified increasing access to International Board-Certified Lactation Consultants as a priority to improve breastfeeding percentages.

Purpose: Implementation of an evidence-based telehealth breastfeeding guideline, will provide mothers with consistent education regarding breastfeeding practices and guidance to overcome common obstacles, which will then result in increased confidence levels regarding breastfeeding and increase breastfeeding durations.

Study and Design: The Iowa model was utilized to guide this project. …

Postpartum Support: Application Of A Local Peer Support, Community Care Model, Stephanie E. Ward

Theses and Graduate Projects

The postpartum period is one of the most influential developmental stages of a women’s life and represents a time of heightened risk for mental health decline. Perinatal mood and anxiety disorders have been implicated as a key influence of negative parenting experiences, poor newborn psychological outcomes, delayed newborn development, and inadequately adaptive family development behaviors. Integrating established resiliency components against mental illness, such as social support, into a postpartum care model can benefit postpartum women and secondarily positively impact the aforementioned outcomes. A community care model highlighting social support for postpartum mothers was integrated into a rural Minnesota region and …

Assessment Of Postpartum Nurses' Knowledge And Teaching Habits Of Maternal Morbidity And Mortality, Mikayla Dodson

DNP Projects

The postpartum period is a joyous time of mother-infant bonding, but it can also be a risky time for women. Despite the education that is provided to postpartum women after birth, many women are still questioning whether or not the signs and symptoms they are experiencing are sufficiently alarming to alert a health care provider. Any delay in seeking care can contribute to poor health outcomes and even maternal mortality. Registered nurses oftentimes provide the bulk of discharge education to postpartum patients. When their knowledge or confidence levels regarding specific topics are low, this can negatively impact the education they …

Improving Quality Of Care Through Discharge Planning, Maria Pasillas

Master's Projects and Capstones

Providing good education for the new mother is key to improving the quality of care for both mom and baby. Since nurses are frontline health care providers who perform the most postpartum education, it is imperative they work to improve discharge education so information provided is consistent, appropriate, and evidence based (Suplee et al., 2016).

The aim of this project is to improve the discharge planning process of a local community hospital utilizing evidence-based research (EBR) with the intent to increase patient satisfaction scores in care transitions to above 65% within 3 months.

The community hospital is a 122-bed acute …

Alternatives In Magnesium Sulfate Treatment Courses: An Investigation Of Physician Prescribing Behaviors, Erin Williams

Dissertations

Problem: The gold standard for managing preeclampsia in the postpartum patient is 24- hours of magnesium sulfate as this is the time the patient is most susceptible to experiencing a seizure (American College of Obstetricians & Gynecologists, 2013). However, these patients are at an increased risk for experiencing adverse health outcomes, as well as interruptions in maternal-infant bonding due to the mother requiring a higher level of care. Methods: A one group pretest-posttest design was conducted to gain a better understanding of the current practice while also assessing the willingness of physicians to change prescribing behavior after receiving the research-based …

Perceptions Of Chinese Women Coming To The United States To Give Birth: Birth Tourism, Juanita Childs Jaramillo

Doctoral Projects

Birth experiences and perceptions vary greatly among different cultures. There has been an increase in Chinese women who specifically come to the United States (US) to give birth to their child and return back to their native country after being cleared at the postpartum checkup. This practice is known as birth tourism. The aim of this study is to explore the perceptions of childbirth and postpartum experiences among Chinese birth tourists. Twelve women self-identifying as Chinese, between the ages of twenty-four and thirty-eight, who came to the US to give birth to their child, and who were able to read …

An Examination Into The Relationship Between Iron Deficiency And Postpartum Depression, Sara A. Burroughs

Senior Honors Theses

Postpartum depression is recognized as the most common complication of childbearing; however, its etiology remains fairly undetermined. Many different influences have been hypothesized as to what may cause postpartum depression, including changes in levels of various hormones (such as estrogen and progesterone), a decrease in serotonin, low levels of vitamin D, social factors, and iron deficiency. The lack of strong evidence for one specific cause makes it fairly clear that there are many factors that play a role in the development of postpartum depression. Iron deficiency is one issue that is thought to contribute to the development of postpartum depression …

Becoming Baby Friendly: Rooming-In For Patient Centered Care In The Maternal Setting, Liana Macdonald

Honors College Theses

This thesis paper discusses the concept of rooming in on the maternity unit while pertaining to the QSEN nursing competency of patient centered care. Through an extensive review of the literature, the following question will be addressed: On the post-partum unit, does having the newborn rooming in with his or her mother improve patient-centered care compared to rooming in the nursery? After an introduction of the problem and its significance to patient-centered care, research that was conducted will be reviewed that discusses the importance of rooming in. A case example of a maternal-newborn couplet is provided, demonstrating the relevance of …

Risk Factors In Women For Postpartum Depression Versus Postpartum Psychosis: An Integrative Literature Review, Briana Jamieson

Honors Undergraduate Theses

The purpose of this literature review was to identify differentiating risk factors in women for postpartum depression and postpartum psychosis. By understanding differentiating risk factors health care professionals, and nurses in particular, can be alert to women who are at higher risk for postpartum depression or postpartum psychosis. This information allows for early nursing intervention and the development of appropriate treatment plans. Fifteen peer-reviewed, English language research articles published between 2000 and 2015 were analyzed for the purpose of this literature review. Study results were inconclusive for the intention of this review, but do provide valuable information on independent risk …

Improved Satisfaction On Postpartum Unit By Implementing A Discharge Nurse Role, Nicole Ware Rn, Msn

Master's Projects and Capstones

A three-month time period was used to develop a postpartum education program change by designing a discharge nurse role on the postpartum unit at University of North Carolina Women’s Hospital. The goal of the education change is to increase patient satisfaction scores of discharged post-natal mothers on the postpartum unit by having HCAPS and Press Ganey to improve up to10% over the next 6 months.

An observational assessment revealed a fragmented and antiquated discharge process. This process was paper based and difficult to complete in light of the short stay and high volume patient population. Informal nurse feedback as well …

The Relationships Among Perceived Stress, Birth Satisfaction, And Breastfeeding Self-Efficacy In Early Postpartum Women, Katherine Hinic

Seton Hall University Dissertations and Theses (ETDs)

This descriptive correlational study examined the relationships among perceived stress, birth satisfaction, and breastfeeding self-efficacy in women in the early postpartum period. The study, guided by self-efficacy and stress and coping theories, aimed to identify factors related to breastfeeding self-efficacy, an important psychological variable in sustained breastfeeding. The sample (N =107) was comprised of primarily well-educated, higher income, non-Hispanic White (69.8%) women recruited from a single New Jersey hospital in the first four days postpartum. The sample was comprised of nearly equal numbers of primiparous and multiparous women, all of whom expressed an intention to breastfeed, with an overall …

Postpartum Depression And Help‐Seeking Behaviors In Immigrant Hispanic Women, Lynn Clark Callister, Renea Beckstrand, Cheryl A. Corbett

Faculty Publications

Objectives: To describe perceptions of immigrant Hispanic women experiencing symptoms of postpartum depression (PPD) and to identify barriers to seeking mental health services.

Design: Qualitative descriptive.

Setting: Community health clinic.

Participants: Twenty immigrant Hispanic women scoring positive for symptoms of PPD receiving health care at a community health clinic who declined mental health services participated in audiotaped interviews held in their homes.

Methods: Following Institutional Review Board approval and informed consent, interviews were conducted with study participants. Transcribed data were analyzed as appropriate for qualitative inquiry.

Results: Some of the women did not recognize and/or denied their symptoms attributing their …

Postpartum Patients Reports Of Satisfaction With A Welcome Meal After A Vaginal Delivery, Jessica R. Pinilla

Master's Projects

Objective: The purpose of this research study was to assess patient perspectives regarding a special Welcome Meal. The focus was on patients' feeling welcomed and important because prior research has shown that when a patient's expectations are exceeded, patient satisfaction increases. This study suggests that receiving a Welcome Meal may improve their experience on a postpartum unit. Design: Prior to discharge, each patient on the maternity unit was served a special Welcome Meal. A questionnaire was given to patients that consisted of six questions. The six questions incorporated six themes found in research literature on improving patient satisfaction. These themes …