One Size Does Not Fit All: Using Research to Improve the Postpartum Care of Women On Long Term Antepartum Bed Rest
- Discuss postpartum experiences of patients on long term bed rest for complications of pregnancy
- Outline strategies used to elicit staff input and promote engagement in the development of nursing management guidelines for this population
- Describe clinical practice changes that have improved the postpartum care of the patient hospitalized long term for antenatal complications
Despite a lack of proven efficacy, bed rest continues to be prescribed for patients with complications of pregnancy. Physical, psychological and social sequelae of bed rest on the high-risk antepartum patient have been documented. A recent qualitative study provided insight into the postpartum experiences and the physical and psychological needs of this population. The purpose of this program was to empower nurses to take an active role in a cultural change to optimize postpartum care for women on long term antepartum bed rest based on research.
Proposed change:
Our challenge was to provide care to meet the unique needs of this population. Methods included discussion of the study results, examining current practice, recommendations to enhance care and improve processes, and developing standards of care specific to this population. Practice changes included nursing management guidelines, hand-off tool to enhance communication of patient needs between departments, assignments based on synergy characteristics to promote effective relationship building/trust between patient and nurse, emphasis on healing environment through genuine, compassionate, invested nursing and demonstrating respect/validation for the patients’ journey, rounding by management team to evaluate patient experience, discharge instructions specific to this population and post discharge follow-up.
Implementation, outcomes and evaluation:
All nursing and support staffs were educated about the study findings, unique needs of this population and practice changes described above. Staff recommendations were incorporated into the nursing management guidelines. Processes to improve communication between nurses were implemented. Patient education materials were developed. Initial attempts to change the mind-set that these patients are “routine now that they are postpartum” were met with some resistance. However, since receiving education, staff have embraced that they are indeed caring for two separate populations with different needs on the postpartum unit. Nursing management guidelines promote seamless care for this population. Nurse communication has improved. Patients receive individualized preparation for discharge. Research- based practice changes have resulted in improved standards of care, positive healing environment, and patient satisfaction. Engagement of bedside nurses positively impacted the change process and nurse satisfaction.
Implications for nursing practice:
Identification of the unique needs of postpartum women experiencing long term bed rest for antepartum complications has facilitated development of standards of care specific to this population that include physical, psychological, and social components and may serve as a model for healthcare organizations.
Keywords:
Long term bed rest
Knowledge translation
Improved quality of care
Postpartum
High-risk pregnancy
