Bleeding during pregnancy and childbirth remains one of the leading causes of maternal death in the world. Pregnancy-related blood loss can occur in women in all trimesters of pregnancy, in the first and postpartum periods of childbirth, as well as in the early and late postpartum periods. Often, postpartum hemorrhage (PPH) is caused by iatrogenic factors associated with “obstetric aggression” during childbirth. To these factors belong unmotivated induction and stimulation of labor; the use of the Christeller method, which promotes trauma; amniotomy with an “immature” cervix, which increases the frequency of cesarean section. Many of these cases are often associated with a lack of specific education among the nurses.
PICOT Question
The quality of healthcare is comprised of clinical safety that is considered a crucial component that identifies and reduces the risks faced by patients. According to Nishimwe et al. (2021), “nurses and midwives are the key clinicians in birth care” (p. 1). Does the provision of education to nurses on preventing postpartum hemorrhage in healthcare facilities help reduce the instances of it? Anca et al. (2020) claim that “incorporation of a standard Hemorrhage Risk Assessment (HRA) has shown improvements in identification of all women at risk for complications and a reduction in the incidence of PPH” (p. 1).
The educational interventions must support policies and guidelines to create a safe environment and reduce risk factors. Ghosh et al.’s (2019) research explores how “in the state of Bihar, India a multi-faceted quality improvement nurse-mentoring program was implemented to improve provider skills in normal and complicated deliveries” (p. 1). The studies show that the prevention strategies explained in the process of education should stimulate engagement in technical aspects to eliminate potential hemorrhage hazards. Finally, the last point of nurses’ education should elaborate on raising awareness among patients and communities on the risk factors and prevention measures of postpartum hemorrhage.
Literature Search Strategy
Relevant articles were retrieved from various sources through search engines that included the GCU library, CINAHL, Google Scholar, Web of Science, and PubMed. The search of these articles involved words related to the topic of the project, such as postpartum hemorrhage prevention, nurses’ education, patient safety, nursing knowledge and skills, and nurses’ learning. The search only considered articles that have been published over the past five years.
Literature Overview
The first article that was chosen for this research is the study by Anca et al. (2020). The authors briefly discussed the problem of postpartum hemorrhage and the role of nursing intervention in it. Anca et al. (2020) state that the issue lies in the “inconsistencies in communication practices of the nurse who led interprofessional perioperative huddles” (p. 1). They emphasize the fact that even when the nurse used a hemorrhage risk assessment on the patient, the information was communicated to the patient in the labor only when the risk of postpartum hemorrhage was high. This influenced heavily my decision to use this article in my research.
According to the authors, as a method of addressing the problem, a clinical specialist in Labor and Delivery department conducted literature research in collaboration with nursing staff and graduate students. After completing the research, the specialist then performed lectures on the best perioperative tactics for the members of the L&D Shared Governance Council and students. According to Anca et al. (2020), “the results of that educational intervention show 100% compliance for HRA scores communication during perioperative huddles, while activation of massive transfusion protocols was decreased by 20%” (p. 1). This research directly shows how important is nursing intervention in preventing postpartum hemorrhage and decreasing maternal mortality risks.
The second article also studies the opportunities the nursing intervention brings into preventing postpartum hemorrhage. Gnosh et al. (2019) explain how a multi-faceted nursing mentoring program influenced the issue. According to the authors (2019), “facilities received one week of mentoring monthly for 7–9 consecutive months; the mentors engaged in a variety of activities including skill demonstrations and bedside mentoring during actual patient care” (p. 3). Moreover, the training program was culturally tailored, which further helped in addressing local contextual needs related to childbirth. In my opinion, this article provided one of the best approaches to the problem of nursing interventions in preventing postpartum hemorrhage.
Additionally, the authors (2019) stated that they used “two data sources, which were collected and maintained by CARE India – the Facility Information System (FIS) and direct observation of deliveries (DOD)” (p. 4). This proves that the research is evidence-based and reliable. The study showed overall positive outcomes: culturally specific educational practices helped nursing staff in identifying and addressing postpartum hemorrhage.
Gnosh et al. (2019) state that “the nurse-mentoring program appears to have built provider’s capacity to identify PPH; moreover, providers seem to be relatively well poised to manage these complications” (p. 12). This study also proves the acute need for proper educational programs for nurses in order to successfully address the issue of postpartum hemorrhage and the maternal mortality associated with it.
The last article by Nishimwe et al. (2021) addresses the use of a specific application – mLearning – in educating nurses and midwives on the necessary skills for postpartum hemorrhage prevention. According to the authors (2021), “one of the recent mobile learning (mLearning) innovations is the safe delivery application (SDA), a smartphone application for Basic Emergency Obstetric and Neonatal Care content” (p. 1).
The study explores the outcomes of this app use as an intervention for educating nurses and midwives of Rwanda on specific skills associated with postpartum care. This research shows the direct possibilities of a specific educational practice, and because of that, I chose this article for my paper. Nishimwe et al. (2021) state that “the study used a pre- and post-test design to compare knowledge and skills of nurses and midwives immediately prior to SDA intervention and after 6 months of SDA intervention” (p. 3). With such an approach, the authors were able to objectively assess the impact of the intervention on the postpartum hemorrhage rates.
The safe delivery application is a program that is designed specifically for training health care workers in low-income countries in managing childbirth complications. Authors (2021) add that “it provides means of visual guidance using animated instructional videos and a self-explanatory learning platform, and also contains a catalog with essential obstetric drugs and equipment” (p. 3). During the study, 54 health care professionals such as nurses and midwives were equipped with SDA and asked to use it in their practice.
The results (2021) show that “a statistically significant increase of the mean knowledge scores was found post-SDA intervention, recording 17.1% for PPH management.” (p. 7). Subsequently, the authors state that the mLearning technologies have an essential value for educating health care workers in low-income countries. This study explicitly shows how important access to education for nurses is in preventing postpartum hemorrhage.
References
Anca, R., Mahoney, M., & Lucarini, E. (2020). Nurse-Driven initiative to increase awareness during perioperative interprofessional huddles of women at risk for postpartum hemorrhage. Journal of Obstetric, Gynecologic & Neonatal Nursing, 49(6). Web.
Ghosh, R., Spindler, H., Morgan, M. C., Cohen, S. R., Begum, N., Gore, A., Mahapatra, T., & Walker, D. M. (2019). Diagnosis and management of postpartum hemorrhage and intrapartum asphyxia in a quality improvement initiative using nurse-mentoring and simulation in Bihar, India. PLOS ONE, 14(7). Web.
Nishimwe, A., Ibisomi, L., Nyssen, M., & Conco, D. N. (2021). The effect of an mLearning application on nurses’ and midwives’ knowledge and skills for the management of postpartum hemorrhage and neonatal resuscitation: Pre–post intervention study. Human Resources for Health, 19(1). Web.