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A Statewide Program to Teach Nurses the Use of Fetal Monitors
innovations
A Statewide Program to Teach Nurses the Use of Fetal Monitors MARY F . HAZRE, R N , BSN, and F R A N K H . B O E H M , MD, F A C O G The regionalization concept in perinatal medicine has opened many new areas of information and practice for obstetrical nurses. One of these areas is in electronic fetal monitoring. Since the technique i s relatively new to most nurses, the need for inhospital training is tremendous. This article describes the first steps taken in establishing such an educational program, the expansion of that program to statewide coverage, and the incorpmation and expansion of such a program to meet the needs of the area in the regionalization of perinatal health care.
Since electronic fetal monitoring has assumed the teaching methods established in the previous such a widespread role in the practice of obstetrics, program, and continuing under the previous directhe need for education of medical and nursing per- tor, the idea was outlined and offered to all hospitals sonnel in the use of equipment and interpretation of in Tennessee who had obstetric services. Letters information has assumed major proportions. were sent to the Directors of Nursing explaining the In August of 1974 the Department of Obstetrics availability (free of charge) of the program. Sessions and Gynecology of the School of Medicine, Van- were offered on an all-day basis, to be scheduled at derbilt University, began the establishment of a the convenience of the head nurse on each unit. network of hospitals for the purpose of offering The response from the hospitals was indicative of educational and consultative services in fetal mon- the need for such a program and of the high level of itoiing.' Funding for the original program was interest in continuing education on the part of provided by the Middle Tennessee Regional Medi- nurses in the state. cal Project. Twelve hospitals in middle and upper Twenty-nine hospitals wrote to indicate an intereast Tennessee were assisted in purchasing fetal est in participating. Seven hospitals have since been monitors. Monthly rental of a Xerox 400 Telecopier added. Due to the expertise of both physicians and to provide the necessary %-hour consultation serv- nurses and to the total number of hospitals inice on interpretation of the fetal monitor records volved, 12 of those first 29 participants received was secured.' To provide the necessary educational only two visits before being dropped from the proservices, workshops were offered to both physicians gram to allow greater concentration on less experiand nurses at various locations throughout the state. enced hospitals. After the first two visits, particiIn addition, a nurse trained in the use and care of pants at each hospital were asked to respond to a the machine, in the interpretation of tracings, and questionnaire designed to evaluate the sessions and in the treatment of the various deceleration patterns allow suggestions from attending nurses about the was employed to travel to the various hospitals to content of future sessions. Responses to these queswork with the nurses in their own units. tionnaires were overwhelmingly favorable (see This first program was so successful, and the need Table 1).Suggestions were used to establish further so great, that plans were made to expand to a state- programs and to improve the earlier lectures. The wide program. A grant from the Middle Tennessee only negative responses came from personnel outChapter of the National Foundation-March of side the labor area who felt (understandably) the Dimes enabled Vanderbilt University to employ a sessions were of no value to them in treating their nurse through the Department of Obstetrics and pa tien ts. Teaching methods included 1) practical demonGynecology to expand the existing program. Using May/June 1978 JOCN Nursing 0090-0311/78/0523-0029$0100
29
Table 1. Quoetionnain R . @ p o ~ . r From 110 Participant@in a Statewid. Program d Education on tho Uw of k t a l Monltortng Equipment Response Question Was the information clearly presented? Was the information applicable to your situation? Were the suggestions for treatment practical? Were the sessions a learning experiencefor you?
Yes
No Occasionally
144
0
6
126
9
15
133
2
15
140
3
7
stration of equipment, its care, and use; 2) slide presentations on the reasons for monitoring, vocabulary definitions, differences in internal and external monitoring, interpretation of data; 3) review of tracings from the hospital’s files; and 4 ) group discussion. In addition, the experiences of other hospitals in developing monitoring protocols, written procedures, patient information handouts, and storage of tracings were discussed at various times in an effort to facilitate the establishment of this new treatment and diagnostic service. Outlines of the sessions were made available on request. They included such areas as an introduction to fetal monitoring, obstetrical complications as seen on the monitor, contractions (terminology and possible effects), and compromised maternal-fetal exchange system. In addition, a bibliography of the sources used in preparing the sessions was made available. Slide illustrations were used to demonstrate the various responses being discussed. Our present program has been underway since January 1976. We are currently considering the necessary changes and improvements for following years if funding continues to be available. The major change anticipated would be in the geographical area to be covered. The fact that one nurse has been attempting to cover the entire state has been a definite drawback to the program. Under the present arrangement, it has been impossible to visit the hospitals more often than every 5 to 6 weeks, and this time interval is too large to adequately meet the needs of hospitals that are often completely unfamiliar with monitoring and are trying to learn to use the equipment, interpret the data, and provide necessary storage space, all at the same time. Follow-up sessions at the more experienced hospitals are also excluded, since so much time must be spent on basics in hospitals whose number of deliveries is too small to allow adequate experience during the learning phase. For this reason, we continue to 30
recommend the use of the Xerox Telecopier to aid the nursing and medical staff in interpreting data. Tennessee is currently studying the feasibility of regionalizing perinatal health care by the estab lishment of levels of care according to the capabilities of each institution. Under such a system, hospitals would be designated as Level I, Level 11, or Level 111, depending in part on the facilities at each institution. Under this system, the Level I11 Hospitals (often called tertiary care hospitals) would be located at medical centers where facilities would be made available for consultation and education on all levels of expertise. As such, these hospitals would serve as referral centers for surrounding areas. Under such a division of territory, the areas to be covered by educational programs would be considerably reduced, thereby allowing concentrated assistance as needed by the smaller institutions. For this reason, and because of the limitations previously discussed, it is recommended that educational programs such as this one be the responsibility of the Level 111 center for each geographic area. Such an arrangement would also increase the communication among the different levels, thereby increasing the possibility that the needs of each level will be better understood and adequately met. Our program will hopefully be expanded next year to include other areas of interest to obstetric-gynecologic nurses. As we gain experience in this type of educational endeavor, we hope to offer a wide variety of programs on a regular basis. Regionalization is still being studied, but the need for a system of continuing education for perinatal personnel is a present and pressing reality. Fetal monitoring is only one of the advances being made to improve the quality of care given the o b stetric patient and fetus. A nurse educator, covering a smaller area, could expand the program to include topics such as fetal maturity testing, stress testing for the antepartum diagnosis of fetal distress, care of the pregnant woman with complications, development of patient teaching programs, etc. The possibilities for continuing education in obstetrics alone are endless. Continuing education is increasingly being recognized as an important and necessary part of the services offered by the medical centers. Taking this education to the surrounding hospitals is the logical solution to a long-standing problem. We feel the program designed by our department and presently being implemented is meeting a tremendous need for continuing education for nurses and physicians in our area. In keeping with the regionalization ideas, we have presented three seminars at Vanderbilt for nurses and one for doctors, called “What’s New in Obstetrics?’ We hope to continue May/June 1978 JOCN Nursing
similar seminars on a regularly scheduled basis on a gency room, labor and delivey, postpartum, gynecological, and neonatal nursing. She has developed and taught, with variety of related topics. another nurse, a 12-week refresher course for RN’s and particiWe invite comments on the present program pated tn “What’s New in Obstetrics” seminars at Vanderbilt and offer our experiences as an example of one type University.A member of NAACOG and the Southern Perinatal of program designed to meet the expressed needs of Association, she is currently employed by Vanderbilt University as a s t d nurse in OblGyn, teaching high-risk obstetrics in a the perinatal health care system in this state. developing regionalization program, and has sewed as fetal monitor coordinator in the department.
References 1. Boehm, F., and D. Goss: “The Xerox 400 Telecopier and the Fetal Monitor.” Obstet GynecoZ52:475,1973 2. Boehm, F., and S. Hodge: “Regionalization of a Fetal Monitoring System,” J Tenn Med Assoc 68 (1): 13, 1975 Mary Haire is a graduate of Berea College, Berea, Kentucky. Experience since graduation includes medical-coronary, emer-
Frank H. Boehm graduated from Vanderbilt University, Nashville, Tennessee, and received -his MD frm the Vanderbilt University Medical School. His OblGyn residency was completed at Yale-New Haven Hospital, New Haven, Connecticut. He is now Associate Professor and Director of the Fetal Intensive Care Unit at Vanderbilt University Hospital. His major interests are high-risk obstetrics,fetal monitoring, and regionalization of perinatal health care.
CONTINUING EDUCATION SYMPOSIUM
The Colorado Nurses’ Association announces ‘‘Chautauqua ’78: Bavarian Holiday,” a national continuing education symposium for registered nurses. Held July 29-August 5 at Vail, Colorado, the symposium will offer 204 seminars, from two-hour blocks to all-day workshops, on topics of general and specialized professional interest. All seminars are approved for contact hours by CNA, which is accredited by the Mountain Regional Accrediting Committee of ANA. Cultural, social, and sporting activities are planned. Fees for the continuing education programs are $10 per 2 hours, or 20 hours for $90. Family and friends not attending seminars are welcomed. For a catalogue and registration materials contact Colorado Nurses’ Association, Chautauqua ’78,5453 East Evans Place, Denver, CO 80222; (303)757-7483.
MayfJune 1978 JOCN Nursing
31
A Statewide Program to Teach Nurses the Use of Fetal Monitors MARY F . HAZRE, R N , BSN, and F R A N K H . B O E H M , MD, F A C O G The regionalization concept in perinatal medicine has opened many new areas of information and practice for obstetrical nurses. One of these areas is in electronic fetal monitoring. Since the technique i s relatively new to most nurses, the need for inhospital training is tremendous. This article describes the first steps taken in establishing such an educational program, the expansion of that program to statewide coverage, and the incorpmation and expansion of such a program to meet the needs of the area in the regionalization of perinatal health care.
Since electronic fetal monitoring has assumed the teaching methods established in the previous such a widespread role in the practice of obstetrics, program, and continuing under the previous directhe need for education of medical and nursing per- tor, the idea was outlined and offered to all hospitals sonnel in the use of equipment and interpretation of in Tennessee who had obstetric services. Letters information has assumed major proportions. were sent to the Directors of Nursing explaining the In August of 1974 the Department of Obstetrics availability (free of charge) of the program. Sessions and Gynecology of the School of Medicine, Van- were offered on an all-day basis, to be scheduled at derbilt University, began the establishment of a the convenience of the head nurse on each unit. network of hospitals for the purpose of offering The response from the hospitals was indicative of educational and consultative services in fetal mon- the need for such a program and of the high level of itoiing.' Funding for the original program was interest in continuing education on the part of provided by the Middle Tennessee Regional Medi- nurses in the state. cal Project. Twelve hospitals in middle and upper Twenty-nine hospitals wrote to indicate an intereast Tennessee were assisted in purchasing fetal est in participating. Seven hospitals have since been monitors. Monthly rental of a Xerox 400 Telecopier added. Due to the expertise of both physicians and to provide the necessary %-hour consultation serv- nurses and to the total number of hospitals inice on interpretation of the fetal monitor records volved, 12 of those first 29 participants received was secured.' To provide the necessary educational only two visits before being dropped from the proservices, workshops were offered to both physicians gram to allow greater concentration on less experiand nurses at various locations throughout the state. enced hospitals. After the first two visits, particiIn addition, a nurse trained in the use and care of pants at each hospital were asked to respond to a the machine, in the interpretation of tracings, and questionnaire designed to evaluate the sessions and in the treatment of the various deceleration patterns allow suggestions from attending nurses about the was employed to travel to the various hospitals to content of future sessions. Responses to these queswork with the nurses in their own units. tionnaires were overwhelmingly favorable (see This first program was so successful, and the need Table 1).Suggestions were used to establish further so great, that plans were made to expand to a state- programs and to improve the earlier lectures. The wide program. A grant from the Middle Tennessee only negative responses came from personnel outChapter of the National Foundation-March of side the labor area who felt (understandably) the Dimes enabled Vanderbilt University to employ a sessions were of no value to them in treating their nurse through the Department of Obstetrics and pa tien ts. Teaching methods included 1) practical demonGynecology to expand the existing program. Using May/June 1978 JOCN Nursing 0090-0311/78/0523-0029$0100
29
Table 1. Quoetionnain R . @ p o ~ . r From 110 Participant@in a Statewid. Program d Education on tho Uw of k t a l Monltortng Equipment Response Question Was the information clearly presented? Was the information applicable to your situation? Were the suggestions for treatment practical? Were the sessions a learning experiencefor you?
Yes
No Occasionally
144
0
6
126
9
15
133
2
15
140
3
7
stration of equipment, its care, and use; 2) slide presentations on the reasons for monitoring, vocabulary definitions, differences in internal and external monitoring, interpretation of data; 3) review of tracings from the hospital’s files; and 4 ) group discussion. In addition, the experiences of other hospitals in developing monitoring protocols, written procedures, patient information handouts, and storage of tracings were discussed at various times in an effort to facilitate the establishment of this new treatment and diagnostic service. Outlines of the sessions were made available on request. They included such areas as an introduction to fetal monitoring, obstetrical complications as seen on the monitor, contractions (terminology and possible effects), and compromised maternal-fetal exchange system. In addition, a bibliography of the sources used in preparing the sessions was made available. Slide illustrations were used to demonstrate the various responses being discussed. Our present program has been underway since January 1976. We are currently considering the necessary changes and improvements for following years if funding continues to be available. The major change anticipated would be in the geographical area to be covered. The fact that one nurse has been attempting to cover the entire state has been a definite drawback to the program. Under the present arrangement, it has been impossible to visit the hospitals more often than every 5 to 6 weeks, and this time interval is too large to adequately meet the needs of hospitals that are often completely unfamiliar with monitoring and are trying to learn to use the equipment, interpret the data, and provide necessary storage space, all at the same time. Follow-up sessions at the more experienced hospitals are also excluded, since so much time must be spent on basics in hospitals whose number of deliveries is too small to allow adequate experience during the learning phase. For this reason, we continue to 30
recommend the use of the Xerox Telecopier to aid the nursing and medical staff in interpreting data. Tennessee is currently studying the feasibility of regionalizing perinatal health care by the estab lishment of levels of care according to the capabilities of each institution. Under such a system, hospitals would be designated as Level I, Level 11, or Level 111, depending in part on the facilities at each institution. Under this system, the Level I11 Hospitals (often called tertiary care hospitals) would be located at medical centers where facilities would be made available for consultation and education on all levels of expertise. As such, these hospitals would serve as referral centers for surrounding areas. Under such a division of territory, the areas to be covered by educational programs would be considerably reduced, thereby allowing concentrated assistance as needed by the smaller institutions. For this reason, and because of the limitations previously discussed, it is recommended that educational programs such as this one be the responsibility of the Level 111 center for each geographic area. Such an arrangement would also increase the communication among the different levels, thereby increasing the possibility that the needs of each level will be better understood and adequately met. Our program will hopefully be expanded next year to include other areas of interest to obstetric-gynecologic nurses. As we gain experience in this type of educational endeavor, we hope to offer a wide variety of programs on a regular basis. Regionalization is still being studied, but the need for a system of continuing education for perinatal personnel is a present and pressing reality. Fetal monitoring is only one of the advances being made to improve the quality of care given the o b stetric patient and fetus. A nurse educator, covering a smaller area, could expand the program to include topics such as fetal maturity testing, stress testing for the antepartum diagnosis of fetal distress, care of the pregnant woman with complications, development of patient teaching programs, etc. The possibilities for continuing education in obstetrics alone are endless. Continuing education is increasingly being recognized as an important and necessary part of the services offered by the medical centers. Taking this education to the surrounding hospitals is the logical solution to a long-standing problem. We feel the program designed by our department and presently being implemented is meeting a tremendous need for continuing education for nurses and physicians in our area. In keeping with the regionalization ideas, we have presented three seminars at Vanderbilt for nurses and one for doctors, called “What’s New in Obstetrics?’ We hope to continue May/June 1978 JOCN Nursing
similar seminars on a regularly scheduled basis on a gency room, labor and delivey, postpartum, gynecological, and neonatal nursing. She has developed and taught, with variety of related topics. another nurse, a 12-week refresher course for RN’s and particiWe invite comments on the present program pated tn “What’s New in Obstetrics” seminars at Vanderbilt and offer our experiences as an example of one type University.A member of NAACOG and the Southern Perinatal of program designed to meet the expressed needs of Association, she is currently employed by Vanderbilt University as a s t d nurse in OblGyn, teaching high-risk obstetrics in a the perinatal health care system in this state. developing regionalization program, and has sewed as fetal monitor coordinator in the department.
References 1. Boehm, F., and D. Goss: “The Xerox 400 Telecopier and the Fetal Monitor.” Obstet GynecoZ52:475,1973 2. Boehm, F., and S. Hodge: “Regionalization of a Fetal Monitoring System,” J Tenn Med Assoc 68 (1): 13, 1975 Mary Haire is a graduate of Berea College, Berea, Kentucky. Experience since graduation includes medical-coronary, emer-
Frank H. Boehm graduated from Vanderbilt University, Nashville, Tennessee, and received -his MD frm the Vanderbilt University Medical School. His OblGyn residency was completed at Yale-New Haven Hospital, New Haven, Connecticut. He is now Associate Professor and Director of the Fetal Intensive Care Unit at Vanderbilt University Hospital. His major interests are high-risk obstetrics,fetal monitoring, and regionalization of perinatal health care.
CONTINUING EDUCATION SYMPOSIUM
The Colorado Nurses’ Association announces ‘‘Chautauqua ’78: Bavarian Holiday,” a national continuing education symposium for registered nurses. Held July 29-August 5 at Vail, Colorado, the symposium will offer 204 seminars, from two-hour blocks to all-day workshops, on topics of general and specialized professional interest. All seminars are approved for contact hours by CNA, which is accredited by the Mountain Regional Accrediting Committee of ANA. Cultural, social, and sporting activities are planned. Fees for the continuing education programs are $10 per 2 hours, or 20 hours for $90. Family and friends not attending seminars are welcomed. For a catalogue and registration materials contact Colorado Nurses’ Association, Chautauqua ’78,5453 East Evans Place, Denver, CO 80222; (303)757-7483.
MayfJune 1978 JOCN Nursing
31