RUA

5

Impact of Nursing Care on the Quality of Health among Postpartum Haemorrhaging Mothers

Student Name

University name

Class name

Professor.

03-22-2024

Impact Of Nursing Care on The Quality of Health Among Postpartum Haemorrhaging Mothers

Postpartum haemorrhage is the excessive vaginal bleeding that occurs after childbirth. It is a serious condition that contributes to maternal illness and mortality all over the world. Postpartum haemorrhage (PPH) mostly occurs 24 hours after childbirth and up to 12 weeks. It can occur both in Caesarean section and normal delivery (Alves et al., 2020). PPH is caused when uterus contractions are not strong enough to cease the bleeding after placental discharge. This leads to excessive bleeding, which can cause hypovolemic shock and even death (Alves et al., 2020). This, therefore, creates the need to monitor postpartum hemorrhaging to improve the mother’s quality of care.

Clinical Question

During childbirth, mothers are prone to many complications that threaten both their lives and the neonates’ lives as well. Therefore, health facilities have developed systems to reduce this threat and improve the health and well-being of their patients. This study focuses on the quality of life for postpartum women experiencing haemorrhage as an effect of an extended hospital stay.

After a baby is delivered, the muscles in the uterus continue to contract. This is essential for placental discharge. After the placenta has been discharged, these contractions facilitate compression to stop bleeding where the placenta was attached. Postpartum haemorrhage occurs when the uterine muscle contractions are not strong enough to contain the bleeding, hence causing a haemorrhage (Castiblanco Montañez et al., 2022). This results in increased heart rate and decreased blood pressure, which can cause hypovolemic shock, posing a huge risk. Other symptoms of Postpartum haemorrhage include dizziness, fainting, and a decrease in red blood cell count, also known as hematocrit (Alimjanovich et al., 2021).

Postpartum haemorrhage often occurs 24 hours after childbirth and up to 12 weeks. Early detection is critical in preventing excessive blood loss since a higher percentage of blood loss occurs from 24 hours to 6 weeks; >500 ml of blood compared to > 150 ml of blood during the first 2 hours. According to research done in Latin America, 8.5% of maternal births are likely to show signs of severe PPH, while in Colombia, PPH is ranked as the second cause of death among pregnant women between 24 and 34 years of age, occurring at a rate of 6.9 cases per 1000 childbirths (Castiblanco Montañez et al., 2022). The World Health Organization, through the implementation of sustainable development goals, has managed to reduce the maternal mortality rate in Africa from 510 per 100,000 live births to 265 cases in 100,000 live births, proving that PPH is highly preventable (Nsangamay & Mash, 2019).

This paper addresses the PICOT question: In postpartum hemorrhaging mothers, does an extended hospital stay improve monitoring and overall quality of care in patient satisfaction? Therefore, the purpose of this paper is to study whether extended nursing care for postpartum mothers suffering from haemorrhage can result in monitoring and improved health and well-being. The paper will also seek to investigate patient satisfaction in the monitoring of PPH.

Levels of Evidence

The question being evaluated in this study is whether an extended hospital stay improves monitoring and overall quality of care in patient satisfaction for mothers suffering from postpartum haemorrhage. This question can be classified as a clinical question of prognosis. A question of prognosis seeks to explore the probability of particular results for patients with certain conditions (Cooper et al., 2019). Thus, this question evaluates the probability of improved quality care for postpartum haemorrhage patients due to monitoring during an extended hospital stay.

The most appropriate type of evidence to tackle this question would be the use of prospective cohort studies. One can monitor the decreasing rate of morbidity during childbirth by examining the quality of life for postpartum haemorrhage mothers under nursing care. This is because the services provided during prenatal visits, child delivery, and the puerperium are vital in the prevention of PPH among young mothers (Alimjanovich et al., 2021). Therefore, nurses can monitor patient’s vitals easily to reduce the risk of haemorrhage during childbirth.

Search Strategy

When choosing a search strategy, one needs to consider the type of clinical research question being addressed. The researcher can thereby use a systematic hierarchy of evidence according to the type of research question. Additionally, an efficient search strategy requires eloquence in the question’s terminologies. These search terms should be precise to narrow down one’s field of research but not too narrow to miss important articles and journals crucial to evidence. In this study, some of the search terms that were used include:

a) Postpartum haemorrhage, which is the excessive bleeding after childbirth,

b) Uterine atony- occurs when uterine muscle contractions fail to constrict bleeding after placental discharge.

c) Placental discharge – the process by which the uterus releases the placenta after delivery.

d) Types of Clinical PICOT questions- There are four categories of clinical questions: Therapy, prognosis, diagnosis, and economic/decision analysis questions (Cooper et al., 2019).

When conducting research, one comes across various articles and journals that require an integrative literature review. Refinement decisions facilitate the breakdown of this literature. This study used a combination of search terms to narrow the search to several required articles. Additionally, using prospective cohort studies to answer the question helped select the most appropriate articles for the paper.

During the search, several databases were used. The Chamberlain University Nursing Library provided adequate information on PPH, its causes, and case studies worldwide. Articles such as Postpartum haemorrhage: Interventions and treatment of the nursing professional to prevent hypovolemic shock by Castiblanco Montanez et al. (2022) and Prevention and Treatment of Postpartum Hemorrhage by Alimjanovich et al. (2021) were obtained from PubMed and MEDLINE databases. This paper also used Clinical Queries, a search database that identifies clinical study categories and can narrow the search by question in hand. Consequently, the search focused on the role of nursing healthcare in improving the health and well-being of postpartum mothers, thus ensuring patient satisfaction. This includes prenatal and postnatal care as well as C-sections.

Conclusion

This paper aims to assess the quality of care and monitoring of postpartum mothers suffering from haemorrhage through extended hospital stays. The health implications of PPH and its role in maternal morbidity and mortality are discussed. The paper also derives the question into clinical study category and states that prospective cohort studies may be the most appropriate evidence to answer the question. The process of searching for appropriate articles for the literature review is also evaluated. The paper also identifies two recently published articles: Postpartum haemorrhage: interventions and treatment of the nursing professional to prevent hypovolemic shock by Castiblanco Montanez et al. (2022) and Prevention and Treatment of Postpartum Hemorrhage by Alimjanovich et. al (2021) obtained from PubMed and MEDLINE databases.

References

Alimjanovich, J. R., Agababyan, L. R., & Kamalov, A. I. (2021). Prevention and Treatment of Postpartum Hemorrhage. Central Asian Journal of Medical and Natural Science, 2(4), 204–209.

Alves, Á. L. L., Francisco, A. A., Osanan, G. C., & Vieira, L. B. (2020). Postpartum hemorrhage: Prevention, diagnosis and non-surgical management. Revista Brasileira de Ginecologia e Obstetrícia, 42, 776–784.

Castiblanco Montañez, R. A., Coronado Veloza, C. M., Morales Ballesteros, L. V., Polo González, T. V., & Saavedra Leyva, A. J. (2022). Postpartum hemorrhage: Nursing interventions and management to prevent hypovolemic shock. Revista Cuidarte, 13(1). http://www.scielo.org.co/scielo.php?pid=S2216-09732022000100009&script=sci_abstract&tlng=en

Cooper, N., O’Brien, S., & Siassakos, D. (2019). Training health workers to prevent and manage postpartum haemorrhage (PPH). Best Practice & Research Clinical Obstetrics & Gynaecology, 61, 121–129. https://doi.org/10.1016/j.bpobgyn.2019.05.008

Nsangamay, T., & Mash, R. (2019). How to improve the quality of care for women with postpartum haemorrhage at Onandjokwe Hospital, Namibia: Quality improvement study. BMC Pregnancy and Childbirth, 19, 489. https://doi.org/10.1186/s12884-019-2635-6

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Title of Your Paper in Upper and Lower Case (Centered, Bold)

This Template is a guide, please refer to your rubric for all criteria, and feel free to adjust the headings names. This is just an example of how to structure your paper using headings with some content from the rubric.

Type your introduction here. Although the first paragraph after the paper title is the introduction, no heading labeled “Introduction” is used. This is a great place to utilize a scholarly resource, to emphasize why the topic is important.

Clinical Question

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1. Describe the problem. What is the focus of your group’s work?

2. Explain the significance of the problem in terms of patient outcomes. What health outcomes result from your problem? Or what statistics document this is a problem? You may find support on websites for government or professional organizations.

3. PICOT question in support of the group topic.

4. State the purpose of your paper. What will your paper do or describe? This is similar

to a problem statement. “The purpose of this paper is to . . .”

Levels of Evidence

In this section discuss your Clinical Question and the Evidence that would be used to answer this. Be sure to talk about these following rubric criteria below.

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2. What is the best type of evidence to answer that question (e.g., RCT, cohort study, qualitative study, etc.)?

Search Strategy

In this section you will discuss how you found two relevant articles to support your discussion on your groups clinical question. You do not need to discuss the articles, this will come in later assignments. This is a discussion on your search strategy. Be sure to talk about these following rubric criteria below.

1. List search terms and results.

2. Databases used (start with the CU library). Link your search with the PICOT question described above.

3. Refinement decisions. As you did your search, what decisions did you make in refinement to get your required articles down to a reasonable number for review? Were any limits used? If so, what?

Relevant Articles

4. Identification of two (2) most relevant articles (primary sources published within the last 5 years).

Conclusion

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5

Impact of Nursing Care on the Quality of Health among Postpartum Haemorrhaging Mothers

Student Name

University name

Class name

Professor.

03-22-2024

Impact Of Nursing Care on The Quality of Health Among Postpartum Haemorrhaging Mothers

Postpartum haemorrhage is the excessive vaginal bleeding that occurs after childbirth. It is a serious condition that contributes to maternal illness and mortality all over the world. Postpartum haemorrhage (PPH) mostly occurs 24 hours after childbirth and up to 12 weeks. It can occur both in Caesarean section and normal delivery (Alves et al., 2020). PPH is caused when uterus contractions are not strong enough to cease the bleeding after placental discharge. This leads to excessive bleeding, which can cause hypovolemic shock and even death (Alves et al., 2020). This, therefore, creates the need to monitor postpartum hemorrhaging to improve the mother’s quality of care.

Clinical Question

During childbirth, mothers are prone to many complications that threaten both their lives and the neonates’ lives as well. Therefore, health facilities have developed systems to reduce this threat and improve the health and well-being of their patients. This study focuses on the quality of life for postpartum women experiencing haemorrhage as an effect of an extended hospital stay.

After a baby is delivered, the muscles in the uterus continue to contract. This is essential for placental discharge. After the placenta has been discharged, these contractions facilitate compression to stop bleeding where the placenta was attached. Postpartum haemorrhage occurs when the uterine muscle contractions are not strong enough to contain the bleeding, hence causing a haemorrhage (Castiblanco Montañez et al., 2022). This results in increased heart rate and decreased blood pressure, which can cause hypovolemic shock, posing a huge risk. Other symptoms of Postpartum haemorrhage include dizziness, fainting, and a decrease in red blood cell count, also known as hematocrit (Alimjanovich et al., 2021).

Postpartum haemorrhage often occurs 24 hours after childbirth and up to 12 weeks. Early detection is critical in preventing excessive blood loss since a higher percentage of blood loss occurs from 24 hours to 6 weeks; >500 ml of blood compared to > 150 ml of blood during the first 2 hours. According to research done in Latin America, 8.5% of maternal births are likely to show signs of severe PPH, while in Colombia, PPH is ranked as the second cause of death among pregnant women between 24 and 34 years of age, occurring at a rate of 6.9 cases per 1000 childbirths (Castiblanco Montañez et al., 2022). The World Health Organization, through the implementation of sustainable development goals, has managed to reduce the maternal mortality rate in Africa from 510 per 100,000 live births to 265 cases in 100,000 live births, proving that PPH is highly preventable (Nsangamay & Mash, 2019).

This paper addresses the PICOT question: In postpartum hemorrhaging mothers, does an extended hospital stay improve monitoring and overall quality of care in patient satisfaction? Therefore, the purpose of this paper is to study whether extended nursing care for postpartum mothers suffering from haemorrhage can result in monitoring and improved health and well-being. The paper will also seek to investigate patient satisfaction in the monitoring of PPH.

Levels of Evidence

The question being evaluated in this study is whether an extended hospital stay improves monitoring and overall quality of care in patient satisfaction for mothers suffering from postpartum haemorrhage. This question can be classified as a clinical question of prognosis. A question of prognosis seeks to explore the probability of particular results for patients with certain conditions (Cooper et al., 2019). Thus, this question evaluates the probability of improved quality care for postpartum haemorrhage patients due to monitoring during an extended hospital stay.

The most appropriate type of evidence to tackle this question would be the use of prospective cohort studies. One can monitor the decreasing rate of morbidity during childbirth by examining the quality of life for postpartum haemorrhage mothers under nursing care. This is because the services provided during prenatal visits, child delivery, and the puerperium are vital in the prevention of PPH among young mothers (Alimjanovich et al., 2021). Therefore, nurses can monitor patient’s vitals easily to reduce the risk of haemorrhage during childbirth.

Search Strategy

When choosing a search strategy, one needs to consider the type of clinical research question being addressed. The researcher can thereby use a systematic hierarchy of evidence according to the type of research question. Additionally, an efficient search strategy requires eloquence in the question’s terminologies. These search terms should be precise to narrow down one’s field of research but not too narrow to miss important articles and journals crucial to evidence. In this study, some of the search terms that were used include:

a) Postpartum haemorrhage, which is the excessive bleeding after childbirth,

b) Uterine atony- occurs when uterine muscle contractions fail to constrict bleeding after placental discharge.

c) Placental discharge – the process by which the uterus releases the placenta after delivery.

d) Types of Clinical PICOT questions- There are four categories of clinical questions: Therapy, prognosis, diagnosis, and economic/decision analysis questions (Cooper et al., 2019).

When conducting research, one comes across various articles and journals that require an integrative literature review. Refinement decisions facilitate the breakdown of this literature. This study used a combination of search terms to narrow the search to several required articles. Additionally, using prospective cohort studies to answer the question helped select the most appropriate articles for the paper.

During the search, several databases were used. The Chamberlain University Nursing Library provided adequate information on PPH, its causes, and case studies worldwide. Articles such as Postpartum haemorrhage: Interventions and treatment of the nursing professional to prevent hypovolemic shock by Castiblanco Montanez et al. (2022) and Prevention and Treatment of Postpartum Hemorrhage by Alimjanovich et al. (2021) were obtained from PubMed and MEDLINE databases. This paper also used Clinical Queries, a search database that identifies clinical study categories and can narrow the search by question in hand. Consequently, the search focused on the role of nursing healthcare in improving the health and well-being of postpartum mothers, thus ensuring patient satisfaction. This includes prenatal and postnatal care as well as C-sections.

Conclusion

This paper aims to assess the quality of care and monitoring of postpartum mothers suffering from haemorrhage through extended hospital stays. The health implications of PPH and its role in maternal morbidity and mortality are discussed. The paper also derives the question into clinical study category and states that prospective cohort studies may be the most appropriate evidence to answer the question. The process of searching for appropriate articles for the literature review is also evaluated. The paper also identifies two recently published articles: Postpartum haemorrhage: interventions and treatment of the nursing professional to prevent hypovolemic shock by Castiblanco Montanez et al. (2022) and Prevention and Treatment of Postpartum Hemorrhage by Alimjanovich et. al (2021) obtained from PubMed and MEDLINE databases.

References

Alimjanovich, J. R., Agababyan, L. R., & Kamalov, A. I. (2021). Prevention and Treatment of Postpartum Hemorrhage. Central Asian Journal of Medical and Natural Science, 2(4), 204–209.

Alves, Á. L. L., Francisco, A. A., Osanan, G. C., & Vieira, L. B. (2020). Postpartum hemorrhage: Prevention, diagnosis and non-surgical management. Revista Brasileira de Ginecologia e Obstetrícia, 42, 776–784.

Castiblanco Montañez, R. A., Coronado Veloza, C. M., Morales Ballesteros, L. V., Polo González, T. V., & Saavedra Leyva, A. J. (2022). Postpartum hemorrhage: Nursing interventions and management to prevent hypovolemic shock. Revista Cuidarte, 13(1). http://www.scielo.org.co/scielo.php?pid=S2216-09732022000100009&script=sci_abstract&tlng=en

Cooper, N., O’Brien, S., & Siassakos, D. (2019). Training health workers to prevent and manage postpartum haemorrhage (PPH). Best Practice & Research Clinical Obstetrics & Gynaecology, 61, 121–129. https://doi.org/10.1016/j.bpobgyn.2019.05.008

Nsangamay, T., & Mash, R. (2019). How to improve the quality of care for women with postpartum haemorrhage at Onandjokwe Hospital, Namibia: Quality improvement study. BMC Pregnancy and Childbirth, 19, 489. https://doi.org/10.1186/s12884-019-2635-6