Postpartum hemorrhage as a healthcare issue
One of the primary causes of maternal deaths worldwide still involves bleeding during pregnancy and delivery. All trimesters of pregnancy, the first and second weeks after giving birth, as well as the early and late postpartum periods, may result in pregnancy-related blood loss in women. Postpartum hemorrhage (PPH) is often brought on by iatrogenic causes connected to "obstetric aggressiveness" during labor. These variables include unintentional labor stimulation and induction, the Christelle method's promotion of trauma, and amniotomies with "immature" cervixes, which raise the incidence of cesarean sections. A lot of these situations are often linked to the nurses' general lack of knowledge.
Clinical safety, which is regarded as a crucial element that determines and minimizes the risks faced by patients, is a component of healthcare quality. "Nurses and midwives are the essential clinicians in birth care," claim Nishimwe et al. (2021). (p. 1). Does educating nurses about postpartum hemorrhage prevention in medical facilities help to lessen its occurrences?
Pregnant women in their second and third trimesters make up the population that this intervention is aimed at. A standard Hemorrhage Risk Assessment (HRA) has improved the ability to identify all women at risk for complications and has decreased the incidence of PPH, according to Anca et al. (2020). (p. 1). To create a safe environment and lower risk factors, educational interventions must support laws and regulations. In their study published in 2019, Ghosh et al. looked into how "in the Indian state of Bihar, a multi-faceted quality improvement nurse-mentoring program was implemented to improve provider skills in normal and complicated deliveries" (p. 1). The studies demonstrate the need to encourage participation in technical aspects of removing potential hemorrhage hazards through the explanation of prevention strategies during the educational process. According to the findings of Ulfa et alstudy .'s from 2021, "the intervention group that received team-based learning showed a higher knowledge of PPH at 2 weeks, 6 weeks, and 12 weeks post-tests than the control group" (p. 6). The final aspect of nursing education should go into greater detail and focus on educating patients and communities about postpartum hemorrhage risk factors and prevention strategies.
The use of digital technology to aid evaluate the patient's status in real-time is one of the therapies that must be taken into consideration. However, it should be underlined that teaching programs should also be employed to ensure that the nurses are able to use these technology appropriately. Reductions in maternal mortality rates and PPH incidences in the Labor and Delivery department are the intended outcomes for the intervention suggested in this PICOT inquiry. Six months is the anticipated time frame for the intervention's first benefits, since this is the ideal amount of time for finishing at least one educational program.
Literature Search Strategy
Search engines were used to find pertinent publications from a variety of sources, including the GCU library, CINAHL, Google Scholar, Web of Science, and PubMed. The project's keywords, including postpartum hemorrhage prevention, nurses' education, patient safety, nursing knowledge and skills, and nurses' learning, were used in the search for these papers. Only papers published within the last five years were taken into account throughout the search.
The study by Anca et al. was the first publication to be used in this investigation (2020). The issue of postpartum hemorrhage and the function of nursing intervention in it are briefly discussed by the writers. According to Anca et al. (2020), the problem is caused by "inconsistencies in the nurse's communication practices who conducted interprofessional perioperative huddles" (p. 1). They stress that even when a patient had a nurse do a hemorrhage risk assessment, the patient was only informed during labor if there was a significant risk of postpartum hemorrhage.
According to the authors, a clinical expert in the labor and delivery department did literature study in conjunction with nursing personnel and graduate students as a manner of addressing the issue. Following the completion of the study, the expert delivered lectures on the best perioperative strategies to students and L&D Shared Governance Council members. The outcomes of the teaching exercise, according to Anca et al. (2020), "indicate 100% compliance for HRA scores communication during perioperative huddles, whereas activation of large transfusion procedures was lowered by 20%." (p. 1). This study demonstrates the critical role that nurse intervention plays in reducing the risk of maternal death and avoiding postpartum hemorrhage.
The second paper explores the nursing intervention's potential for reducing postpartum hemorrhage. The impact of a multifaceted nurse mentorship program is described by Gnosh et al. (2019). The mentors "engaged in a range of activities, including skill demonstrations and bedside mentoring during real patient care," according to the authors (2019), who state that "facilities received one week of mentoring monthly for 7-9 consecutive months" (p. 3). The training curriculum was also culturally specific, which contributed to addressing additional local contextual requirements associated with birthing.
Direct observation of deliveries (DOD) and the Facility Information System (FIS) were two data sources that CARE India gathered and maintained, according to the authors (2019). (p. 4). This demonstrates the validity and dependability of the study. Overall, the study's conclusions were encouraging: culturally relevant instructional strategies aided nursing staff in recognizing and treating postpartum hemorrhage. The nurse-mentoring program "appears to have strengthened clinicians' ability to recognize PPH; moreover, providers seem to be rather well placed to handle these problems," according to Gnosh et al. (2019). (p. 12). This research also demonstrates the urgent need for appropriate nursing education programs in order to adequately address the problem of postpartum hemorrhage and the accompanying mother mortality.