- Email: [email protected]
Hospital-Based Community Initiative to Reduce Pertussis in Mothers
INNOVATIVE PROGRAMS Proceedings of the 2011 AWHONN Convention
Tackling Maternal Mortality in the Sierra Tarahumara, Mexico: A Community Based Intervention Poster Presentation Purpose for the Program n 2008, Mexico had a maternal mortality rate (MMR) of 62.6/100,000 live births. However, the Tarahumara, the indigenous group who live in caves and small dwellings in the mountains of Northern Mexico, have a staggering MMR of roughly 998/100,000 live births. They have more than 10 times the burden of disease, representing only 3% of the population but 38% of the maternal deaths in the state of Chihuahua. Many geographic, cultural, and socio-economical barriers exist, limiting the access to appropriate health care for the Tarahumara. The majority of Tarahumara women still give birth at home, unattended. One HEART Worldwide (OHW) is a U.S. based nongovernmental organization that works to decrease maternal mortality one birth at time through using a communitybased pregnancy education model.
I
Proposed Change OHW has established an e¡ective, replicable, and sustainable model to reduce preventable deaths related to pregnancy and childbirth among vulnerable populations. Essential to the OHW model are integration of local resources, collaboration with local communities and providers, and respect for cultural norms and practices. OHW trains local health care providers to work within their communi-
ties to raise awareness, teach best practices, and distribute prenatal vitamins and birth kits. The use of misoprostol is an integral component of the OHW model. OHW implemented its Pregnancy and Village OutreachTraining Program (PAVOT) in the pilot area of the Urique Municipality in the Sierra Madre, Chihuahua, Mexico in January 2010. Implementation, Outcomes, and Evaluation We recruited 12 volunteers from the project’s 8 pilot communities in a population of 3,100. We revised the PAVOT curriculum complete with culturally appropriate picture-based handouts and £ipcharts. Volunteers attended a 3 day training which covered half of the curriculum and are now delivering PAVOT messages, prenatal vitamins, and birth kits in their communities. Follow-up testing showed 90% retention of knowledge. The next training is scheduled for October. Birth kits were delivered to all pregnant women in the pilot area. The project is now managed by local indigenous sta¡ and expansion beyond the pilot area is planned for 2011.
Susan Messer, RN, MPH, Labor and Delivery, The Cambridge Hospital, Cambridge, MA
Keywords three-delays maternal mortality indigenous community-based education barriers
Childbearing
Implications for Nursing Practice The leading causes of maternal death are the same around the worldçhemorrhage and preeclampsia. Be it in an acute care setting or a cave on a mountainside when a woman dies a maternal death, it was because there was a delay that occurred.
Hospital-Based Community Initiative to Reduce Pertussis in Mothers Poster Presentation
tussis immunization before discharge from the hospital.
Dale M. Monnier, BSN, RNCOB, C-EFM, IBCLC, Labor and Delivery, The Christ
Purpose for the Program ertussis is a highly contagious bacterial disease that can be fatal for infants. In recent years there has been a signi¢cant increase in cases due to waning of immunization with inadequate numbers receiving boosters. This is problematic for the vulnerable newborn, who does not have adequate immunity until 6 months. The purpose of this project was to develop a program to provide maternal per-
P
S10
Proposed Change Childhood immunity for pertussis wanes over time. Most adults are not fully immunized despite the strong recommendations from the Centers for Disease Prevention, the recent epidemic or near epidemic rates of infant pertussis in some states, and the relative ease of preventing infant infection through parental vaccination. It would be advantageous to provide the vaccine while the mother is
JOGNN, 40, S2-S84; 2011. DOI: 10.1111/j.1552-6909.2011.01242.x
Hospital, Cincinnati, OH
Keywords pertussis immunization vaccination
Childbearing
http://jognn.awhonn.org
INNOVATIVE PROGRAMS
Schafer, D. J. and Allen, M.
Proceedings of the 2011 AWHONN Convention
still in the hospital after birth; however, most insurance will not reimburse for this service. We wanted to be able to provide this service but had to develop a proposal to adopt the practice without ¢nancial reimbursement and then develop a strategy to implement the inpatient maternal pertussis vaccination program. Implementation, Outcomes, and Evaluation The business plan for the pertussis immunization program provided a cost of the vaccine, equipment, and professional time. This cost (US$40.00) is low compared with the cost of caring for a sick newborn. Administration accepted this proposal as a service to the community aimed at improving public health. Educational brochures were created to help families learn the importance of vaccination and a video
was placed on the education channel for families to view. The sta¡ was educated on this initiative before starting the program. The obstetricians, pediatricians, nurses, and technical sta¡ were involved in creating a standing order in the electronic medical records for the vaccines. Monthly reporting of patient assessment for pertussis vaccination and booster administration can be obtained. Implications for Nursing Practice Providing vaccinations to enhance the health of mothers, newborns, and their families is an important intervention to decrease the incidence of pertussis in our community. While it is di⁄cult to assess community outcomes there has been an overall decrease of pertussis in our county.
One Size Does Not Fit All: Using Research to Improve the Postpartum Care of Women on Long-Term Antepartum Bed Rest Poster Presentation Deborah J. Schafer, MSN, RNC-OB, Women and Children Services, Pinnacle Health System, Harrisburg, PA
Marianne Allen, MN, RNCOB, Women and Children’s Services, Pinnacle Health System, Harrisburg, PA
Keywords long term bed rest knowledge translation improved quality of care postpartum high-risk pregnancy
Childbearing
D
emphasis on healing environment through genuine, compassionate, invested nursing, and demonstrating respect/validation for the patient’s journey, rounding by management team to evaluate patient experience, discharge instructions speci¢c to this population and postdischarge follow-up.
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 speci¢c to this population. Practice changes included nursing management guidelines, hando¡ tool to enhance communication of patient needs between departments, assignments based on synergy characteristics to promote e¡ective relationship building/trust between patient and nurse,
Implementation, Outcomes, and Evaluation All nursing and support sta¡s were educated about the study ¢ndings, unique needs of this population, and practice changes. Sta¡ 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, sta¡ have embraced that they are indeed caring for two separate populations with di¡erent 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 a¡ected the change process and nurse satisfaction.
Purpose for the Program espite a lack of proven e⁄cacy, bed rest continues to be prescribed for patients with complications of pregnancy. Physical, psychological, and social sequelae of bed rest on the highrisk 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.
JOGNN 2011; Vol. 40, Supplement 1
S11
Tackling Maternal Mortality in the Sierra Tarahumara, Mexico: A Community Based Intervention Poster Presentation Purpose for the Program n 2008, Mexico had a maternal mortality rate (MMR) of 62.6/100,000 live births. However, the Tarahumara, the indigenous group who live in caves and small dwellings in the mountains of Northern Mexico, have a staggering MMR of roughly 998/100,000 live births. They have more than 10 times the burden of disease, representing only 3% of the population but 38% of the maternal deaths in the state of Chihuahua. Many geographic, cultural, and socio-economical barriers exist, limiting the access to appropriate health care for the Tarahumara. The majority of Tarahumara women still give birth at home, unattended. One HEART Worldwide (OHW) is a U.S. based nongovernmental organization that works to decrease maternal mortality one birth at time through using a communitybased pregnancy education model.
I
Proposed Change OHW has established an e¡ective, replicable, and sustainable model to reduce preventable deaths related to pregnancy and childbirth among vulnerable populations. Essential to the OHW model are integration of local resources, collaboration with local communities and providers, and respect for cultural norms and practices. OHW trains local health care providers to work within their communi-
ties to raise awareness, teach best practices, and distribute prenatal vitamins and birth kits. The use of misoprostol is an integral component of the OHW model. OHW implemented its Pregnancy and Village OutreachTraining Program (PAVOT) in the pilot area of the Urique Municipality in the Sierra Madre, Chihuahua, Mexico in January 2010. Implementation, Outcomes, and Evaluation We recruited 12 volunteers from the project’s 8 pilot communities in a population of 3,100. We revised the PAVOT curriculum complete with culturally appropriate picture-based handouts and £ipcharts. Volunteers attended a 3 day training which covered half of the curriculum and are now delivering PAVOT messages, prenatal vitamins, and birth kits in their communities. Follow-up testing showed 90% retention of knowledge. The next training is scheduled for October. Birth kits were delivered to all pregnant women in the pilot area. The project is now managed by local indigenous sta¡ and expansion beyond the pilot area is planned for 2011.
Susan Messer, RN, MPH, Labor and Delivery, The Cambridge Hospital, Cambridge, MA
Keywords three-delays maternal mortality indigenous community-based education barriers
Childbearing
Implications for Nursing Practice The leading causes of maternal death are the same around the worldçhemorrhage and preeclampsia. Be it in an acute care setting or a cave on a mountainside when a woman dies a maternal death, it was because there was a delay that occurred.
Hospital-Based Community Initiative to Reduce Pertussis in Mothers Poster Presentation
tussis immunization before discharge from the hospital.
Dale M. Monnier, BSN, RNCOB, C-EFM, IBCLC, Labor and Delivery, The Christ
Purpose for the Program ertussis is a highly contagious bacterial disease that can be fatal for infants. In recent years there has been a signi¢cant increase in cases due to waning of immunization with inadequate numbers receiving boosters. This is problematic for the vulnerable newborn, who does not have adequate immunity until 6 months. The purpose of this project was to develop a program to provide maternal per-
P
S10
Proposed Change Childhood immunity for pertussis wanes over time. Most adults are not fully immunized despite the strong recommendations from the Centers for Disease Prevention, the recent epidemic or near epidemic rates of infant pertussis in some states, and the relative ease of preventing infant infection through parental vaccination. It would be advantageous to provide the vaccine while the mother is
JOGNN, 40, S2-S84; 2011. DOI: 10.1111/j.1552-6909.2011.01242.x
Hospital, Cincinnati, OH
Keywords pertussis immunization vaccination
Childbearing
http://jognn.awhonn.org
INNOVATIVE PROGRAMS
Schafer, D. J. and Allen, M.
Proceedings of the 2011 AWHONN Convention
still in the hospital after birth; however, most insurance will not reimburse for this service. We wanted to be able to provide this service but had to develop a proposal to adopt the practice without ¢nancial reimbursement and then develop a strategy to implement the inpatient maternal pertussis vaccination program. Implementation, Outcomes, and Evaluation The business plan for the pertussis immunization program provided a cost of the vaccine, equipment, and professional time. This cost (US$40.00) is low compared with the cost of caring for a sick newborn. Administration accepted this proposal as a service to the community aimed at improving public health. Educational brochures were created to help families learn the importance of vaccination and a video
was placed on the education channel for families to view. The sta¡ was educated on this initiative before starting the program. The obstetricians, pediatricians, nurses, and technical sta¡ were involved in creating a standing order in the electronic medical records for the vaccines. Monthly reporting of patient assessment for pertussis vaccination and booster administration can be obtained. Implications for Nursing Practice Providing vaccinations to enhance the health of mothers, newborns, and their families is an important intervention to decrease the incidence of pertussis in our community. While it is di⁄cult to assess community outcomes there has been an overall decrease of pertussis in our county.
One Size Does Not Fit All: Using Research to Improve the Postpartum Care of Women on Long-Term Antepartum Bed Rest Poster Presentation Deborah J. Schafer, MSN, RNC-OB, Women and Children Services, Pinnacle Health System, Harrisburg, PA
Marianne Allen, MN, RNCOB, Women and Children’s Services, Pinnacle Health System, Harrisburg, PA
Keywords long term bed rest knowledge translation improved quality of care postpartum high-risk pregnancy
Childbearing
D
emphasis on healing environment through genuine, compassionate, invested nursing, and demonstrating respect/validation for the patient’s journey, rounding by management team to evaluate patient experience, discharge instructions speci¢c to this population and postdischarge follow-up.
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 speci¢c to this population. Practice changes included nursing management guidelines, hando¡ tool to enhance communication of patient needs between departments, assignments based on synergy characteristics to promote e¡ective relationship building/trust between patient and nurse,
Implementation, Outcomes, and Evaluation All nursing and support sta¡s were educated about the study ¢ndings, unique needs of this population, and practice changes. Sta¡ 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, sta¡ have embraced that they are indeed caring for two separate populations with di¡erent 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 a¡ected the change process and nurse satisfaction.
Purpose for the Program espite a lack of proven e⁄cacy, bed rest continues to be prescribed for patients with complications of pregnancy. Physical, psychological, and social sequelae of bed rest on the highrisk 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.
JOGNN 2011; Vol. 40, Supplement 1
S11