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Stelwagen M, Westmaas A, Van Kempen A, Scheele F. In-hospital education of parents of newborns may benefit from competency-based education: A qualitative focus group and interview study among health professionals. J Clin Nurs 2023; 32:1076-1088. [PMID: 35460132 DOI: 10.1111/jocn.16334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Revised: 03/28/2022] [Accepted: 03/31/2022] [Indexed: 11/28/2022]
Abstract
AIMS/OBJECTIVES The aim of this study was to appraise health professionals' self-reported practices in educating parents of hospitalised newborns from the perspective of competency-based education and to identify areas for improvement of parental learning. BACKGROUND Patient education is essential to achieve autonomy in parents of hospitalised newborns. The literature provides descriptions of the use of various components of competency-based education in patient education. This suggests that competency-based education is a valuable concept for patient education. DESIGN A case-based qualitative study. METHODS Three focus group discussions were conducted and 28 semi-structured interviews with 45 health professionals who practice in a hospital setting that is designed to empower parents. The data were analysed with a framework analysis approach, using a framework of competency-based education themes for a combined inductive and deductive content data analysis. The recommendations of the Standards for Reporting Qualitative Research checklist were followed. FINDINGS Two themes of competency-based education emerged as evidently operationalised: (1) 'Learning climate' and (2) 'Role modeling'. Five themes emerged as incompletely operationalised: (1) 'Parent curriculum based on inter-professional consensus'; (2) 'Transparency about the competencies needed'; (3) 'Access to teaching'; (4) 'Assessing and reporting results'; and (5) 'Proficiency statements based on autonomy expectations'. Two themes did not emerge: (1) 'Empowering parents to be active learners' and (2) 'Evaluation and improvement of the education program'. CONCLUSIONS Parent education is at risk of being merely on a master-apprentice model and may be more effective if it is designed on competency-based education principles. Identified areas for improvement are empowering parents to be 'active learners' and by involving them in the evaluation and improvement of the educational program. Parent education in neonatal health care may benefit from an appraisal based on competency-based education themes. RELEVANCE TO CLINICAL PRACTICE Appraising parent education based on competency-based education principles is feasible for improving the learning process towards parent autonomy.
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Affiliation(s)
- Mireille Stelwagen
- Department of Teaching and Department of Pediatrics at OLVG Hospital, Amsterdam, The Netherlands
| | - Alvin Westmaas
- Department of Social Psychology, Maastricht University, Maastricht, The Netherlands.,Faculty of Health, University of Applied Sciences Leiden, Leiden, The Netherlands
| | - Anne Van Kempen
- Department of Pediatrics at OLVG Hospital, Amsterdam, The Netherlands
| | - Fedde Scheele
- Department of Gynecology and Department Teaching at OLVG Hospital, Health systems innovation and education at the VU University Amsterdam and Amsterdam University Medical Center, Amsterdam, The Netherlands
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Mitchell KA, Haddock AJ, Husainy H, Walter LA, Rajapreyar I, Wingate M, Smith CH, Tita A, Sinkey R. Care of the Postpartum Patient in the Emergency Department: A Systematic Review with Implications for Maternal Mortality. Am J Perinatol 2023; 40:489-507. [PMID: 34327686 PMCID: PMC10961102 DOI: 10.1055/s-0041-1732455] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE Approximately one-third of maternal deaths occur postpartum. Little is known about the intersection between the postpartum period, emergency department (ED) use, and opportunities to reduce maternal mortality. The primary objectives of this systematic review are to explore the incidence of postpartum ED use, identify postpartum disease states that are evaluated in the ED, and summarize postpartum ED use by race/ethnicity and payor source. STUDY DESIGN We searched PubMed, Embase, Cumulative Index of Nursing and Allied Health Literature (CINAHL), ClinicalTrials.gov, Cochrane CENTRAL, Social Services Abstracts, and Scopus from inception to September 19, 2019. Each identified abstract was screened by two authors; the full-text manuscripts of all studies deemed to be potential candidates were then reviewed by the same two authors and included if they were full-text, peer-reviewed articles in the English language with primary patient data reporting care of a female in the ED in the postpartum period, defined as up to 1 year after the end of pregnancy. RESULTS A total of 620 were screened, 354 records were excluded and 266 full-text articles were reviewed. Of the 266 full-text articles, 178 were included in the systematic review; of these, 108 were case reports. Incidence of ED use by postpartum females varied from 4.8 to 12.2% in the general population. Infection was the most common reason for postpartum ED evaluation. Young females of minority race and those with public insurance were more likely than whites and those with private insurance to use the ED. CONCLUSION As many as 12% of postpartum women seek care in the ED. Young minority women of lower socioeconomic status are more likely to use the ED. Since approximately one-third of maternal deaths occur in the postpartum period, successful efforts to reduce maternal mortality must include ED stakeholders. This study is registered with the Systematic Review Registration (identifier: CRD42020151126). KEY POINTS · Up to 12% of postpartum women seek care in the ED.. · One-third of maternal deaths occur postpartum.. · Maternal mortality reduction efforts should include ED stakeholders..
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Affiliation(s)
- Kellie A. Mitchell
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, Alabama
- Center for Women’s Reproductive Health, Birmingham, Alabama
| | - Alison J. Haddock
- Department of Emergency Medicine, Baylor College of Medicine, Houston, Texas
| | | | - Lauren A. Walter
- Department of Emergency Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | - Indranee Rajapreyar
- Division of Cardiovascular Diseases, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | - Martha Wingate
- School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama
| | - Catherine H. Smith
- Division of Library Sciences, University of Alabama at Birmingham, Birmingham, Alabama
| | - Alan Tita
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, Alabama
- Center for Women’s Reproductive Health, Birmingham, Alabama
| | - Rachel Sinkey
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, Alabama
- Center for Women’s Reproductive Health, Birmingham, Alabama
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Lancaster CA, Flynn HA, Johnson TRB, Marcus SM, Davis MM. Peripartum length of stay for women with depressive symptoms during pregnancy. J Womens Health (Larchmt) 2012; 19:31-7. [PMID: 20088656 DOI: 10.1089/jwh.2009.1383] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Approximately 1 in 10 women suffers from depression during pregnancy. Little is known about whether antepartum depression affects a mother's length of stay at delivery. We aimed to compare peripartum length of stay in women with and without depressive symptoms during pregnancy. METHODS This study involved secondary data analysis of a larger study exploring antepartum depression. Each subject completed the Center for Epidemiological Studies Depression Scale (CES-D). We used bivariate analyses to compare patient characteristics of women with and without an elevated CES-D, and we used a multivariate Poisson regression to evaluate predictors of length of stay. RESULTS The study sample included 867 pregnant women. Overall, 18% of study subjects scored >or=16 on the CES-D. In bivariate analyses, a longer stay was associated with an elevated CES-D and minority race, antepartum complications, cesarean delivery, prematurity, multiple gestation, and neonatal length of stay. In the final multivariate model adjusting for sociodemographic, antepartum, and obstetric factors, an elevated CES-D was associated with a significantly longer peripartum stay (0.26 days, CI 0.04-0.48). CONCLUSIONS Depressive symptoms during pregnancy predict an increase in peripartum length of stay.
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Affiliation(s)
- Christie A Lancaster
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, Michigan 48109-5604, USA.
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van der Pol M, Shiell A, Au F, Jonhston D, Tough S. Eliciting individual preferences for health care: a case study of perinatal care. Health Expect 2009; 13:4-12. [PMID: 19691462 DOI: 10.1111/j.1369-7625.2009.00551.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE To demonstrate how a discrete choice experiment (DCE) can be used to elicit individuals' preferences for health care and how these preferences can be incorporated into a cost-benefit analysis. METHODS A DCE which elicited preferences for three perinatal services: specialist nurse appointments; home visits from a trained lay visitor; and home-help. Cost was included to obtain a monetary measure of the value that individuals place on the services. In total, 292 women who had previously participated in a randomized trial of alternative forms of pre-natal care were interviewed. RESULTS The most preferred service configuration consisted of three nurse appointments and two home visits before birth and 4 h of home-help per week for the first 4 weeks after birth. On average, women are willing to pay $371 for this package. A package that excluded home-help was valued at $122 whilst provision of three nurse appointments only was valued at $97. The predicted uptake of the services ranged from 37% to 93% depending on the woman's experience with the service, whether or not it was her first child and her level of education. CONCLUSION The willingness to pay values were much higher than the costs for nurse appointments, suggesting this service produces a net social benefit. The willingness to pay for the package including both the nurse appointments and home visits only just exceeded the costs of the package, suggesting there is a relatively high chance that this package produces a net social loss.
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Phillippi JC. Women's perceptions of access to prenatal care in the United States: a literature review. J Midwifery Womens Health 2009; 54:219-25. [PMID: 19410214 DOI: 10.1016/j.jmwh.2009.01.002] [Citation(s) in RCA: 75] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2008] [Revised: 01/05/2009] [Accepted: 01/05/2009] [Indexed: 11/17/2022]
Abstract
Women report many barriers to accessing prenatal care. This article reviews the literature from 1990 to the present on women's perceptions of access to prenatal care within the United States. Barriers can be classified into societal, maternal, and structural dimensions. Women may not be motivated to seek care, especially for unintended pregnancies. Societal and maternal reasons cited for poor motivation include a fear of medical procedures or disclosing the pregnancy to others, depression, and a belief that prenatal care is unnecessary. Structural barriers include long wait times, the location and hours of the clinic, language and attitude of the clinic staff and provider, the cost of services, and a lack of child-friendly facilities. Knowledge of women's views of access can help in development of policies to decrease barriers. Structural barriers could be reduced through changes in clinic policy and prenatal care format, and the creation of child-friendly waiting and examination rooms. Maternal and societal barriers can be addressed through community education. A focus in future research on facilitators of access can assist in creating open pathways to perinatal care for all women.
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Affiliation(s)
- Julia C Phillippi
- Vanderbilt University School of Nursing, 345 First Hall, 461 21st Ave. S., Nashville, TN 37240, USA.
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Erci B, Ivanov L. The relationship between women's satisfaction with prenatal care service and the characteristics of the pregnant women and the service. EUR J CONTRACEP REPR 2009; 9:16-28. [PMID: 15352691 DOI: 10.1080/13625180410001696241] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
OBJECTIVE The purpose of this descriptive correlational study was to investigate the relationship between women's satisfaction with prenatal care services and the demographic characteristics of the women and the service's features. METHODS The population studied consisted of Turkish women living in Erzurum, Turkey, who had delivered their infants and were still hospitalized. The women had received prenatal care, had no complications during pregnancy, carried their pregnancies to term, and were considered to have had normal deliveries. The sample size was determined as 367 women, and 350 women responded to the questionnaire. Question items consisted of women's satisfaction with prenatal care services, the demographics characteristics of the pregnant women, and the characteristics of prenatal care. The questionnaire was given to the women in the birthing house. The researchers collected data using an interview method between 1 January and 30 April, 2002. RESULTS In terms of the mean item score and total scale, the women were 'somewhat satisfied' with the prenatal care service. The women were more satisfied with health-care information and the 'cost of the service' dimension of the scale. There was an association between women's satisfaction with prenatal care services and the characteristics of both prenatal care and those of the pregnant women. CONCLUSION The sample of women in this study reflects only the study population in this area of Turkey. The findings of the study should be limited to this population. The scale would be useful for further studies investigating how prenatal care providers can better identify women's satisfaction with prenatal care service. A satisfaction measurement scale of prenatal care services would be helpful as an interview form that could identify the satisfaction scale and rate the scale's importance in the health-care provider's office, hospital, during a home visitation, or a primary health-care center, private clinic or maternity and child health center.
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Affiliation(s)
- B Erci
- Public Health Nursing Department, School of Nursing, Atatürk University, Erzurum, Turkey
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Johnson TRB, Pituch K, Brackbill EL, Wan J, van de Ven C, Pearlman MD. Why and How a Department of Obstetrics and Gynecology Stopped Doing Routine Newborn Male Circumcision. Obstet Gynecol 2007; 109:750-2. [PMID: 17329529 DOI: 10.1097/01.aog.0000255667.94730.c0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
In 2004, the Department of Obstetrics and Gynecology at the University of Michigan decided to stop offering routine circumcision for specialty and disciplinary, logistic, and educational reasons. The Pediatric Hospitalist Service assumed responsibility for the procedures and the educational process with resultant patient and staff satisfaction, educational, logistical and economic benefits.
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Affiliation(s)
- Timothy R B Johnson
- Department of Obstetrics and Gynecology, Hospitalist Service, University of Michigan, Ann Arbor, Michigan 48109, USA.
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De Vries CA, De Vries RG. Childbirth education in the 21st century: an immodest proposal. J Perinat Educ 2007; 16:38-48. [PMID: 18769525 PMCID: PMC2174394 DOI: 10.1624/105812407x244958] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Childbirth education was an important social movement in the 20th century but has lost its way in recent years. We describe the reasons for the dwindling importance of childbirth education and offer a proposal for reform that will align childbirth education with the needs of today's birthing mothers. Our plan will create "Centers for the Childbearing Year" (CCBYs) and a new model of childbirth educator, which we call the "birth coach." The CCBY is the place for women to go to for information and support related to fertility, pregnancy, childbirth, and newborn care; the birth coach combines the role of childbirth educator, doula, and postpartum caregiver. In creating a fresh model of childbirth education, we not only honor our pioneers but also rediscover the wisdom in community and relationship that childbirth offers us, and we learn in new ways to journey alongside each other to create new possibilities for birthing families.
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Affiliation(s)
- Charlotte A De Vries
- CHARLOTTE DE VRIES is co-author of The Official Lamaze(R) Guide: Giving Birth with Confidence and a past president of Lamaze International. Together with Judith Lothian, Charlotte De Vries blogs on birth ( http://birthwithconfidence.blogs.lamaze.org/ )
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Tough SC, Johnston DW, Siever JE, Jorgenson G, Slocombe L, Lane C, Clarke M. Does supplementary prenatal nursing and home visitation support improve resource use in a universal health care system? A randomized controlled trial in Canada. Birth 2006; 33:183-94. [PMID: 16948718 DOI: 10.1111/j.1523-536x.2006.00103.x] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND The addition of supplementary prenatal support may improve the health and well-being of high-risk women and families. The objective of this randomized controlled trial was to examine the impact of supplementary prenatal care on resource use among a community-based population of pregnant women. METHODS Pregnant women from three urban maternity clinics were randomized (a) to current standard of physician care, (b) to current standard of care plus consultation with a nurse, or (c) to (b) plus consultation with a home visitor. Participants were 1,352 women who received 3 telephone interviews. The primary outcome was resource use (e.g., attended prenatal classes, used nutritional counseling). RESULTS Overall, those in the nurse intervention group were more likely to attend an "Early Bird" prenatal class and parenting classes, and to use nutrition counseling and agencies that assist with child care. Women provided with extra nursing and home visitation supports were more likely to use a written resource guide, nutrition counseling, and agencies that assist with child care. Among women at higher risk (e.g., language barriers, young maternal age, low income), the nurse intervention significantly increased use of early prenatal classes, whereas the nurse and home visitor intervention significantly increased use of the written resource guide and nutrition counseling. The intervention substantially increased the amount of information received on numerous pregnancy-related topics but had little impact on resource use for mental health and poverty-related needs. Among those with added support, resource use among low-risk women was generally greater than among high-risk women. CONCLUSIONS Additional support provided by nurses, or nurses and home visitors, can successfully address informational needs and increase the likelihood that women will use existing community-based resources. This finding was true even for high-risk women, although this intervention did not reduce the difference in resource use between high- and low-risk women.
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Gregory KD, Johnson CT, Johnson TRB, Entman SS. The content of prenatal care. Womens Health Issues 2006; 16:198-215. [PMID: 16920524 DOI: 10.1016/j.whi.2006.05.001] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2005] [Accepted: 05/22/2006] [Indexed: 10/24/2022]
Abstract
INTRODUCTION The Content of Prenatal Care report of the US Preventative Health Service (USPHS) Expert Panel established an important benchmark when published in 1989, but has not been significantly updated since that time. METHODS The literature since 1989 is reviewed to assess which recommendations have been validated and/or implemented. Additionally, new findings that support the recommendations put forth or expand the scope of prenatal care outlined in the 1989 report are examined and discussed. RESULTS The USPHS recommendation of a reduced prenatal visit schedule has support, and new content for the preconception visit has been identified, although this preconception visit has not been validated or widely implemented. CONCLUSIONS We identified new opportunities and initiatives for the content of prenatal care, particularly improvement in the electronic medical record, attention to multidisciplinary approaches to patient education and improved patient literacy, and an extended maternal life span approach, including postgestation visits.
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Affiliation(s)
- Kimberly D Gregory
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Cedars Sinai Medical Center, Los Angeles, California, USA
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Ellberg L, Lundman B, Persson MEK, Hogberg U. Comparison of Health Care Utilization of Postnatal Programs in Sweden. J Obstet Gynecol Neonatal Nurs 2005; 34:55-62. [PMID: 15673646 DOI: 10.1177/0884217504273128] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE To describe the utilization of health care services, based on number of outpatient visits and readmissions, by mothers and newborns following discharge postnatally after having received various types of maternity care. DESIGN The design was a cohort of Swedish women giving birth at full term. All together, 773 women and 782 newborns were followed using questionnaires, registry data, and medical chart notes. The information served as a basis for analyzing utilization of health care services during the first 28 days post-delivery. RESULTS Of the women, 15% sought medical care and 1.7% were readmitted, whereas 17% of the newborns received medical care and 2.9% were readmitted. At 6 months, about half were exclusively being breastfed. There was no difference in need to seek health care or breastfeeding outcome owing to type of maternity care. CONCLUSION Mothers with newborns sought care relatively frequently but rarely needed to be readmitted after discharge from the maternity care. The risk of readmission during the first month after childbirth was not greater for mothers and children who received care through the family suite or early discharge programs.
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Affiliation(s)
- L Ellberg
- Kvinnokliniken Norrlands Universitetssjukhus, S-90185 Umea, Sweden.
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Johnson TRB, Weisman CS. In support of shorter hospital stays for selected high-risk obstetric patients. Int J Gynaecol Obstet 2002; 78:105-6. [PMID: 12175710 DOI: 10.1016/s0020-7292(02)00138-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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