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Sunday, June 24, 2012

Title: Preventing Obstetrical Errors: Building Trust and the Nurse - Patient Partnership

Woodrow Wilson (Gaylord National Harbor)
Susan E. Brown Will, MS, RNC , GYN / OB Nursing, Johns Hopkins Hospital, Baltimore, MD
Catharine Treanor, MS, RNC , Department of GYN/OB Nursing, The Johns Hopkins Hospital, Baltimore, MD
Joan Diamond, MSN, RN , OB, Johns Hopkins Hospital, Baltimore, MD
Corrie Ann McKeen, BSN, RNC , United Hospital, Allina Health Systems, St Paul, MN
Yvette C. Pugh, BSN , Department of GYN/OB Nursing, The Johns Hopkins Hospital, Baltimore, MD
Diann L. Snyder, RN, MS , Department of GYN/OB Nursing, The Johns Hopkins Hospital, Baltimore, MD
Sarah J. Shaefer, RN, PhD , Community Public-Health Nursing, Johns Hopkins University School of Nursing, Baltimore, MD

Discipline: Professional Issues (PI)

Learning Objectives:
  1. Identify reasons why patients and families do or do not speak up about their care.
  2. Discuss nurses’ perceptions about patient engagement to prevent obstetrical errors.
  3. Identify behaviors that facilitate nurse patient communication and trust.
Submission Description:
Objective:  

Explore patient and nurse expectations for safe care during labor and birth and factors that encourage patients to speak up about care.

Design:   

Qualitative study utilizing patient interviews and nurse focus group.  Healthy mothers with healthy babies were invited to participate prior to discharge.  Family present were interviewed.  Experienced labor and birth nurses were invited to participate to elicit perceptions of patients’ willingness to speak up about care and nurses’ role in this process.   

Setting:

Mid-Atlantic level three teaching hospital

Patients/Participants:  

Twenty- three postpartum mothers participated (mean age 25.8, 79% African American, 26% married, 63 % ≥ high school education).   Ten nurses (mean age 40.6, 80% ≥ 6 years experience, 8o % Caucasian) participated.

Methods:

Interviews continued until saturation was achieved.  Questions addressed definition of safe care, comfort in speaking up and how nurses can encourage patients to speak up. 

Focus group and interviews were recorded and transcribed.  Researchers reviewed transcripts for themes and completed a computerized theme analysis using Atlas.ti 5©.  Themes from interviews and focus group were compared and summarized.

 Results:  

Communication was the theme most frequently identified by patients and nurses.  One patient said, “…she just kept talking to me and you know, telling me what was gonna happen and what was going on…she was right there with me….”  Nurses reported that trust and communication ensure that patients feel comfortable voicing concerns.  One nurse encourages patients to use the words: concerned, uncomfortable or scared.   Lack of communication among the healthcare team was identified.

One nurse reported that patients see safety as a healthcare system responsibility and expectation.  This was consistent with one patient’s perspective,” if something goes wrong with me, there’s somebody right there that can attend to me...”  Patients reported that nurses asking if they have questions helps keep them safe. 

Some patients identified safety as a shared responsibility relating it is important to ‘not panic’, give all their health history, follow directions, and tell the nurse if something is wrong.

Conclusion/Implications for nursing practice:   

Visible communication among and between the healthcare team and a patient is critical to make a patient feel safe.  ‘Being there’ for a patient helps develop trust and comfort with speaking up.  Patients know by the nurse’s demeanor whether or not the nurse is there for them.   Additional research is needed to further explore these themes, including patients’ and nurses’ expectations for safe care.

Keywords:  

ADVOCACY, NURSE PATIENT RELATIONSHIP, SPEAKING UP

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