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Neonatal Nurses Preventing Maternal Smoking
INNOVATIVE PROGRAMS Proceedings of the 2011 AWHONN Convention
solutions, marking the epidural bag in the pharmacy with a yellow label, and marking the epidural pole with yellow tape to facilitate a visual connection are a few changes that increase safety at the bedside. Implementation, Outcomes, and Evaluation Utilizing an assessment tool during a rapid team assessment period, a multidisciplinary team made more than four changes in an 6 week window to improve the safety of women undergoing epidural
procedures. Additional changes were made throughout the team assessment period that involved additional disciplines and coordination. Implications for Nursing Practice Improved patient safety is a goal every nurse lives; it is part of their scope of practice. Reviewing patient injuries and deaths of patients undergoing epidurals caused by medication error allows nurses to review their own practice and put safety guards in place to minimize the chance of future errors.
Keywords epidurals patient safety epidural-intravenous route mix-ups reducing risk maternal death
Professional Issues
Neonatal Nurses Preventing Maternal Smoking Poster Presentation Purpose for the Program ost women who quit smoking during pregnancy relapse within weeks of giving birth. Improvement in the integration of smoking prevention services along the continuum of care may help women quit smoking and remain abstinent. Postpartum and neonatal hospitalization provides an opportunity for neonatal nurses to coordinate services and bridge the gap between the obstetric and outpatient pediatric settings. However, many neonatal nurses lack the knowledge and con¢dence to provide smoking prevention interventions. A performance improvement program to educate neonatal nurses about e¡ective strategies for maternal smoking prevention during postpartum hospitalization was developed.
M
Proposed Change An educational program that focuses on skills for assessing and documenting maternal smoking status, providing advice to quit smoking or remain abstinent and making a referral to treatment will increase nurses’ knowledge related to smoking prevention strategies and nurses’ self-e⁄cacy for providing interventions. Implementation, Outcomes, and Evaluation Forty-one neonatal nurses from the newborn nursery and neonatal intensive care unit (NICU) participated in an educational program. Four live-instruction classes were held. The educational program was converted to an interactive computer-based training (CBT) format to increase sta¡ participation. A pre- and posttest design utilized a
S78
questionnaire with nine general knowledge questions and four self-e⁄cacy questions. Pre- and posttest results were compared for participants overall and for subgroups (CBT/Live and registered nurse/licensed practical nurse [RN/LPN]). A twoproportion test was used for data analysis. Overall posttest scores were higher than pretest scores after education: knowledge (30.4% vs. 96.8%; po.001), and self-e⁄cacy (53.7% vs. 85.9%; po.001). There were no di¡erences in posttest scores between RNs (n 5 32) and LPNs (n 5 9) for knowledge (96.9% vs. 96.3%; p 5 .804) or selfe⁄cacy (85.9% vs. 85.6%; p 5 .897). Posttest knowledge scores were higher with CBT compared with live-instruction (p 5 .01), while posttest selfe⁄cacy scores were higher with live-instruction compared with CBT (p 5 .41). Modi¢cations were made to the CBT format to incorporate strengths of the live-training format. Participants expressed satisfaction and acceptance of the educational program irrespective of mode of instruction.
Sharron R. Forest, DNP, APRN, NNP-BC, Neonatal Intensive Care Unit, Women & Children’s Hospital, Lake Charles, LA
Keywords postpartum relapse maternal smoking postpartum smoking prevention
Professional Issues
Implications for Nursing Practice The use of CBT increased participation rates by 128% and was found to be cost-e¡ective. Nurses currently employed and newly hired neonatal nurses are easily educated via CBT. Maternal smoking status, including quit attempt, is documented on the infant H&P; therefore, pediatric providers have information to continue interventions and support after hospital discharge. The program provides opportunities for additional research and for expanding the program across other settings.
JOGNN, 40, S2-S84; 2011. DOI: 10.1111/j.1552-6909.2011.01242.x
http://jognn.awhonn.org
solutions, marking the epidural bag in the pharmacy with a yellow label, and marking the epidural pole with yellow tape to facilitate a visual connection are a few changes that increase safety at the bedside. Implementation, Outcomes, and Evaluation Utilizing an assessment tool during a rapid team assessment period, a multidisciplinary team made more than four changes in an 6 week window to improve the safety of women undergoing epidural
procedures. Additional changes were made throughout the team assessment period that involved additional disciplines and coordination. Implications for Nursing Practice Improved patient safety is a goal every nurse lives; it is part of their scope of practice. Reviewing patient injuries and deaths of patients undergoing epidurals caused by medication error allows nurses to review their own practice and put safety guards in place to minimize the chance of future errors.
Keywords epidurals patient safety epidural-intravenous route mix-ups reducing risk maternal death
Professional Issues
Neonatal Nurses Preventing Maternal Smoking Poster Presentation Purpose for the Program ost women who quit smoking during pregnancy relapse within weeks of giving birth. Improvement in the integration of smoking prevention services along the continuum of care may help women quit smoking and remain abstinent. Postpartum and neonatal hospitalization provides an opportunity for neonatal nurses to coordinate services and bridge the gap between the obstetric and outpatient pediatric settings. However, many neonatal nurses lack the knowledge and con¢dence to provide smoking prevention interventions. A performance improvement program to educate neonatal nurses about e¡ective strategies for maternal smoking prevention during postpartum hospitalization was developed.
M
Proposed Change An educational program that focuses on skills for assessing and documenting maternal smoking status, providing advice to quit smoking or remain abstinent and making a referral to treatment will increase nurses’ knowledge related to smoking prevention strategies and nurses’ self-e⁄cacy for providing interventions. Implementation, Outcomes, and Evaluation Forty-one neonatal nurses from the newborn nursery and neonatal intensive care unit (NICU) participated in an educational program. Four live-instruction classes were held. The educational program was converted to an interactive computer-based training (CBT) format to increase sta¡ participation. A pre- and posttest design utilized a
S78
questionnaire with nine general knowledge questions and four self-e⁄cacy questions. Pre- and posttest results were compared for participants overall and for subgroups (CBT/Live and registered nurse/licensed practical nurse [RN/LPN]). A twoproportion test was used for data analysis. Overall posttest scores were higher than pretest scores after education: knowledge (30.4% vs. 96.8%; po.001), and self-e⁄cacy (53.7% vs. 85.9%; po.001). There were no di¡erences in posttest scores between RNs (n 5 32) and LPNs (n 5 9) for knowledge (96.9% vs. 96.3%; p 5 .804) or selfe⁄cacy (85.9% vs. 85.6%; p 5 .897). Posttest knowledge scores were higher with CBT compared with live-instruction (p 5 .01), while posttest selfe⁄cacy scores were higher with live-instruction compared with CBT (p 5 .41). Modi¢cations were made to the CBT format to incorporate strengths of the live-training format. Participants expressed satisfaction and acceptance of the educational program irrespective of mode of instruction.
Sharron R. Forest, DNP, APRN, NNP-BC, Neonatal Intensive Care Unit, Women & Children’s Hospital, Lake Charles, LA
Keywords postpartum relapse maternal smoking postpartum smoking prevention
Professional Issues
Implications for Nursing Practice The use of CBT increased participation rates by 128% and was found to be cost-e¡ective. Nurses currently employed and newly hired neonatal nurses are easily educated via CBT. Maternal smoking status, including quit attempt, is documented on the infant H&P; therefore, pediatric providers have information to continue interventions and support after hospital discharge. The program provides opportunities for additional research and for expanding the program across other settings.
JOGNN, 40, S2-S84; 2011. DOI: 10.1111/j.1552-6909.2011.01242.x
http://jognn.awhonn.org