It Takes a Village to Mother the New Mother: Development of a Support Program to Address the Mental...
-
Upload
alison-palmer -
Category
Documents
-
view
214 -
download
0
Transcript of It Takes a Village to Mother the New Mother: Development of a Support Program to Address the Mental...
to recognize/respond to nonreassuring fetal status,
failure to do a timely delivery, failure to conduct a
proper resuscitation, failure to prevent and manage
shoulder dystocia, negligence with a vacuum or for-
ceps, and improper use of Oxytocin.
As a large health care system in NorthTexas we have
a diverse patient and sta¡/provider population. Ele-
ven entities provide OB services to small rural and
large urban communities. Nursing sta¡ £oat from
small to large facilities, and we saw the need to stan-
dardize recognition and response to management of
OB emergencies within our system. We also recog-
nized that smaller facilities could bene¢t from the
educators and resources available at the larger hos-
pitals. In addition, it was clear there was a need to
have all sta¡ nurses trained to interpret fetal moni-
tor strips using the same language and to have
physicians use this language. The program started
with nurses and physicians collaborating to create
a system wide guideline for training of sta¡ and
recommended management of emergencies. After
the guideline was approved and implemented, we
received funding from the hospital foundations to
purchase patient simulators to enhance the learn-
ing experience and to elevate the skill of the sta¡.
The goal of this project was to spread best practices
and lessons learned across the system. The project
was launched in the ¢rst quarter of 2008. The drills
are video taped, and participants are debriefed. A
summary of the debrie¢ng and lessons learned are
then shared at the entity level at the appropriate
safety/quality committees and at the system level.
There have been eye-opening results: determining
that not all operating rooms were equipped with
Code Blue pull stations, dose amounts and routes
for Cytotec for postpartum hemorrhage were
inconsistent with evidence-based literature recom-
mendations, nursing sta¡ were surprised at how
muchmore di⁄cult it was to compress and ventilate
the simulator than it was the cardiopulmonary
resuscitation chest, logistics of getting from one
£oor to another when the OR is on a di¡erent £oor,
and the need to educate supporting departments
about mock codes and the simulator.
It Takes a Village to Mother the New
Mother: Development of a Support
Program to Address the Mental Health
Needs of Women along the Continuum of
Perinatal Care
Poster Presentation
The unfortunate reality in our society is that it is
okay to have a ‘‘medical’’ condition, but mental
health diagnoses often result in negative stigma. It’s
okay to have a postpartum hemorrhage, but your
ability to parent may be questioned if you have post-
partum depression (PPD). Education is required to
address attitudes and knowledge de¢cits regarding
perinatal mental health for the community and health
care providers.Women su¡ering from PPDoftenneed
medication, talk therapy to discuss psychological
struggles related to motherhood, and support from
PPD support groups to have a safe place to share
experiences with other mothers in similar situations.
The position statement, ‘‘The Role of the Nurse in
Postpartum Mood and Anxiety Disorders’’ of the
Association of Women’s Health, Obstetric, and Neo-
natal Nurses (AWHONN) says, ‘‘Health care facilities
that serve pregnant women, new mothers and new-
borns should have routine screening protocols and
educational mechanisms for sta¡ training and client
education related to postpartum mood and anxiety
disorders.’’ The development of the Postpartum Emo-
tional Support Program at Elliot Hospital supports
these initiatives. Our hospital-based perinatal mental
health support program includes components of
screening, referral, education, phone and group sup-
port, and a community-based taskforce.
Our PPD Support Group provides a safe, nonjudg-
mental forum in which mothers can share their
feelings of depression and anxiety, while bene¢ting
from social support and learning about self-care
practices to enhance their current therapy and
Cindy Cochrane, MS, RNC-
OB, WHNP-BC, Perinatal,
Texas Health Harris Methodist
Hospital Fort Worth, Fort
Worth, TX
Childbearing
Alison Palmer, RN, MS,
WHNP-BC, Maternity Center,
Elliot Hospital, Manchester,
NH
Childbearing
JOGNN 2010; Vol. 39, Supplement 1 S33
Palmer, A. I N N O V A T I V E P R O G R A M S
Proceedings of the 2010 AWHONN Annual Convention
treatment.The purpose of our multidisciplinary task
force is to develop a coordinated structure across
our health system for perinatal mental health. Some
of our goals include assisting practice settings in
establishing care pathways and protocols to guide
practice, enhancing referral resources for repro-
ductive mental health therapy, and collaborating
with our psychiatric unit and emergency depart-
ment on models of care for perinatal patients
admitted for acute psychiatric illness.
Ourorganization has also implemented an Inpatient
Postpartum Depression Risk Assessment Program
to provide universal screening of all new mothers
for risk factors that may predispose them to post-
partum depression. An 11-item self-assessment
questionnaire is distributed to every new mother af-
ter birth. This screening tool identi¢es risk factors
and does not indicate that a woman will de¢nitely
experience PPD. Moms ‘‘at risk’’ view a PPD video,
receive targeted PPD education, follow-up phone
calls at home, are o¡ered Visiting Nurse Associa-
tion visits, and invited to attend the weekly PPD
Support Group if needed.
When screening for depression in the health care set-
ting is based on clinical observation alone, 50% of
women su¡ering from depression are missed. We
cannot rely solely on clinical judgment. Obstetric pro-
viders are encouraged to screen for depressive
symptoms with a validated tool such as the Edinburgh
Postnatal Depression Scale during follow-up visits. If
women become aware of the factors that can poten-
tially make them vulnerable to PPD, they can mobilize
their support network and make use of available re-
sources. By screening universally, we hope to reduce
the stigma of perinatal depression by encouraging
health care providers to talk about it as a common
complication of childbirth.
The Mother/Baby Reunion Project:
Ensuring Timely Reunion After
Cesarean Birth
Poster Presentation
The Mother/Baby Reunion Project was a prac-
tice improvement pilot project carried out
during June and July 2009 at The Women’s Place
at the University of Virginia Health System. It was de-
signed and implemented by the authors (project
team) as a master’s capstone project at the culmi-
nation of the Clinical Nurse Leader program at the
University of Virginia. Baseline data collected by
the project team indicated that birth to reunion time
after Cesarean delivery was 3 hours 7 minutes for
the ¢rst quarter of 2009.
According to the Centers for Disease Control and
Prevention (CDC), the national Cesarean delivery
rate in 2006 was 31.8% and has been climbing
steadily. Research shows that Cesarean delivery is
negatively associated with initiation and quality of
breastfeeding and can be considered a risk factor
for impaired breastfeeding. This indicates that wo-
men who deliver via Cesarean require greater
support in their desire to breastfeed. Best-practice
guidelines indicate that breastfeeding should be
initiated within the ¢rst 2 hours of life. Cesarean de-
livery presents barriers to early mother/infant
bonding as well as true patient- and family-cen-
tered care. The Mother/Baby Reunion Project set a
goal of reuniting healthy mothers and infants within
2 hours of birth by Cesarean delivery.
After consulting with nursing and medical leader-
ship the team settled on two work process interven-
tions to achieve this goal. The ¢rst was to initiate a
call from the operating room or the post anesthesia
care unit (both located within The Women’s Place)
to the newborn nursery when the mother left the
operation room so that the infant could be brought
tomeet the mother in recovery.The second involved
piloting new protocols that allowed infant baths
and radiant warming to be postponed in favor of ex-
pediting the reunion with the mother. Although
these new protocols were not strictly mandatory,
they were explicitly supported by the unit leader-
ship. E-mails and £yers announcing the project
were sent at the outset. The project team attended
Sara Read, MSN, The
Women’s Place, University of
Virginia Health System,
Charlottesville, VA
Lindsey Baskette, MSN, The
Women’s Place, University of
Virginia Health System, Char-
lottesville, VA
Childbearing
S34 JOGNN, 39, S19-S41; 2010. DOI: 10.1111/j.1552-6909.2010.01119.x http://jognn.awhonn.org
I N N O V A T I V E P R O G R A M S
Proceedings of the 2010 AWHONN Annual Convention