Aisha Kendrick, MSN, APN, CNS, RNC-OB
Monica Gonzalez, MS, APN, PCNS-BC, CCRN-K
Julia Snethen, PhD, RN, FAAN
Title:
Development of a Postpartum Preeclampsia Video to Promote Patient Education
Introduction/Background:
What is the problem:
Women’s postpartum health has had increasingly poor outcomes across the state in Illinois. Factors identified as contributing to negative postpartum health outcomes have included: poor communication, lack of coordinated care, inadequate provider skill and knowledge and limited public awareness about the importance of postpartum health.
Antepartum and intrapartum care has continued to improve statewide in Illinois, yet postpartum follow up care continues be an area for improvement. Statewide initiatives have therefore been sought to improve the early identification and treatment of hypertension disorders within the perinatal patient population.
Given the concerns expressed at the state level, an evaluation of postpartum follow up was initiated at a large level three perinatal teaching medical center located in an inner city. Within the facility, postpartum patients are discharged daily (n = 2 to 3) with a hypertension diagnosis. Patients are instructed to follow up with their care provider at the facility within 7-10 days post discharge. Unfortunately, only 30% of women with postpartum hypertension were returning to the healthcare facility for their follow-up appointments. During the discharge process, it was noted that nurses instructions to patient’s diagnosed with preeclampsia suggested that hypertension postpartum was no longer an issue, their hypertension was resolved. Additionally, no standardized discharge process or educational materials were available for the nurses to educate their patients. Therefore, every nurse used different resources to provide discharge education to their patients.
Aim/Goal/Purpose:
Both aims of the project focus on achieving the state objectives of increasing provider knowledge and increasing the public awareness of the importance of postpartum health.
1. The first aim of this project was to develop a postpartum preeclampsia education video to standardize the nursing staff’s language during education to patients.
2. The second aim was to enhance the knowledge base of the nursing staff.
Methods:
The Sigma Maternal Child Health Nurse Leadership Academy (MCHNLA) and Johnson and Johnson have been instrumental in identifying tool kits that would help to frame the approach to plan, implement, and evaluate organizational changes.
Identifying key stakeholders: The idea and aims for the projects was presented to the obstetric quality director and the nursing director of the women’s care department. It was important to secure buy-in from key stakeholders to align with unit initiatives and demonstrate the institutions commitment to achieving state recommendations. Through this meeting, it was noted that this project could potentially support another project being implemented concurrently. Other key stakeholders were identified which led to formulation of the project team.
Formulation of the team: There was another unit project that involved other aspects of improving the quality of care to postpartum preeclampsia patients from a physician aspect. The aims of this project were shared with an interdisciplinary team which included: a maternal fetal medicine physician, the obstetric unit’s pharmacist, an obstetric fellow, a medical student and the clinical nurse lead for labor and delivery. There was an appeal to the importance of the nursing perspective and contributions to improving postpartum preeclampsia education to patients.
After synthesizing the literature, a script for the video was developed with a focus on postpartum preeclampsia and the potential effects on long-term cardiovascular health. The video emphasized the importance of follow-up with a primary care provider and post-discharge blood pressure checks. Patients were educated on the potential long-term effects on health.
Production of the video through the institution required a budget of about $5,000.00. The idea of the video was presented to the women’s board of the department. A member of the women’s board introduced me to a professional videographer by the name of Justin Flocco whom was willing to produce the video pro bono.
The video involved the input of the team members as well as community involvement of a patient experience. The postpartum nursing staff received education and was able to view the new video. Emphasis was placed on how this video could potentially benefit patient’s understanding of the importance of postpartum follow up care. The video could also help the postpartum nurses practice, by enhancing their understanding of postpartum preeclampsia and standardizing verbiage when educating patients.
Results:
The video was integrated into the institution’s education streaming service as a “hard-stop” viewing option. Therefore, when patients are admitted to the postpartum unit, they are required to watch the postpartum preeclampsia video in order to watch the Television. The education streaming service was also integrated with the patient’s electronic medical record (EMR). Once the video was completed, it was documented in the EMR and gave the nurse an opportunity to follow up with the patient to address any questions or concerns. Because viewing the video occurred upon admission, this allowed patients to view prior to delivery on labor and delivery and again with admission to the postpartum unit. The goal of this approach is to introduce the concepts and revisit the topic twice during their hospitalization prior to discharge.
Conclusions:
The integration of the video into the hospital patient education system achieved the outcome for this project. Talking points were developed based on the teaching points in the video to help further assist the nurses in standardizing the language used during education to patients.