An In-house Program of Continuing Education for Perinatal Nurses

A learning program implemented with motivation and peer-group teaching was combined with a program of learning through research on a topic and sharing this information with others. In using these two methods of learning, both inexperienced and highly skilled perinatal nurses have been able to continue effectively their education, using resources in their own institution.     

An Education Program for Nurses from Referring Hospitals in a Perinatal Regionalization System

Administering high-quality perinatal care at a regional center involves more than providing in-center services. An outreach education program was developed for nurses in referring hospitals. The authors believe that through the carefully phased development of un outreach education program, quality perinatal care on all levels can be realized.     

Hospital-Based Perinatal Home-Care Program

In recent years, hospitals have established home-care programs to provide care on a continuum, meeting needs in the hospital and home setting, whichever is most appropriate and efficient in response to defined patient needs. Hospital-based home-care programs with specialization in perinatal nursing have been established to meet the care needs of patients and their families during antepartum, postpartum, and neonatal periods. One of the greatest advantages of a hospital-based program is the internal availability of highly knowledgeable and skilled nursing staff. Physicians are more likely to refer patients to a program that is staffed with nurses they know and trust from the hospital setting. More cost-effective and coordinated care is achieved through the appropriate use of resources across the continuum.     

Effectiveness of a Pregnancy Smoking Cessation Program

OBJECTIVE: To evaluate two nursing approaches to promoting smoking cessation during initial antenatal visits. DESIGN: Experimental, with assignment to interventions using a random, alternate-day strategy and blind assessment of smoking at baseline, 1 month postintervention, 36 weeks' gestation, and 6 weeks postpartum. SETTING/PARTICIPANTS: 224 daily smokers, fewer than 31 weeks gestation, during first prenatal visit, at a teaching hospital antenatal clinic. INTERVENTIONS: An evening class providing guidance on a self-help program for 2 hours on a group basis or 20 minutes on an individual basis during the prenatal appointment. MAIN OUTCOME MEASURE: Smoking cessation, confirmed by urinary cotinine levels. RESULTS: All women assigned to the referral intervention received a referral, but none attended the classes. In contrast, 93% assigned to the immediate intervention received the intervention. The group receiving immediate intervention had two to three times higher rates of cessation at all follow-up periods, with significant differences at the 1-month follow-up. There were certain similarities between the groups. CONCLUSION: Cessation interventions should be administered during the first prenatal visit.     

A Perinatal Continuing Education Program: Its Effects on the Knowledge and Practices of Health Professionals

Objectives: To determine whether there was an increase in knowledge when an interdisciplinary group of health care providers participated in the same comprehensive perinatal continuing education program and to determine whether care practices followed before the program differed from those followed 1 year after its completion.
Design: Administration of a 100-item comprehensive pretest and a similar posttest measuring knowledge before the continuing education program and 1 year after taking it, as well as an ex post facto audit of medical records of newborns who were sick and at risk.
Setting: Hospitals throughout the state of Oklahoma that provide perinatal care. Test data were derived from health care providers in 24 hospitals; data on care practices were obtained from 12 hospitals.
Intervention: A comprehensive program of perinatal continuing education.
Participants: Physicians, nurses, and other providers of perinatal health care.
Main outcome measures: Scores on a 100-item test measuring knowledge of perinatal care and newborn care practices taught in the educational program.
Results: Pretest and posttest scores demonstrated an increase in scores at the p < 0.001 level for each group of providers studied. There was a statistically significant increase in use of two care practices and a definite trend toward an increase in the use of three others.
Conclusion: A continuing education program delivered to a multidisciplinary group of health care providers can increase knowledge and improve perinatal care to newborns who are sick and at risk.     

Development and Implementation of a Perinatal Education Consortium

The North Puget Sound Perinatal Education Consortium provides a collaborative framework for planning, implementing, and evaluating a basic orientation program for newly hired and cross-trained perinatal nurses. The program currently provides 9 days of prenatal, labor and delivery, mother-infant couplet, and neonatal didactic orientation at no cost to registrants from participating hospitals. Consortium hospitals supply instruction time and additional services to support this high-quality, regional, perinatal orientation program.     

Professional Bereavement Photographs: One Aspect of a Perinatal Bereavement Program

Although professionals can do little to cushion the emotional trauma for parents and family when an infant dies, many institutions have implemented bereavement programs to offer counseling, support, and assistance. Included In such programs are photographs of the deceased infant. The value of such photographs has been documented In the literature. Some institutions provide parents with instantly developed photos of the deceased infant. Unfortunately, instant prints may blur and often fade with time. To improve services to bereaved families at a hospital in Massachusetts, a program was implemented to use the skills of the hospitals professional biomedical photographers and the nursing team. The perinatal clinical nurse specialist or her designee takes a 35-mm black-and-white photograph of the infant. The biomedical photographers process the negatives and use hand coloring techniques and matting to produce professional-quality photographs. The response by parents and families to the improved photographs has been positive. As the number of photographs taken has increased, the staff have continued to improve the service.     

Effectiveness of an Obstetrics‐Based Advanced Cardiac Life Support Education Program

ObjectiveTo study the effectiveness of an obstetrics‐based advanced cardiac life support education (ACLS OB) program with pre‐ and postcourse maternal mock code drills and surveys evaluating satisfaction and self‐confidence in abilities of labor and delivery (L&D) nurses to perform ACLS algorithms.DesignQuasi‐experimental pretest/posttest study.SettingObstetric units in a community hospital system.ParticipantsLabor and delivery nurses (N = 96).MethodsNurses rotated through an ACLS OB course when their ACLS recertification was due. Two studies were done. Prior to the class, nurses participated in a maternal mock code drill during annual skills review, and performances were scored. One year later, nurses participated in maternal mock code drills. Results were compared with the previous year's scores. In the second study, pre‐ and postclass surveys were completed reflecting nurses’ satisfaction and self‐confidence with successfully completing elements of American Heart Association (AHA) algorithms following attendance at traditional ACLS classes versus ACLS OB.ResultsThe scores of nurses who completed the ACLS OB course were significantly greater overall when performing ACLS MegaCode algorithms (z = −6.08, p < .001) for 18 of 21 individual elements of the algorithm. Nurses reported statistically significant increases (p < .001) in all 13 elements of satisfaction and self‐confidence following completion of ACLS OB over traditional ACLS courses.ConclusionsEmphasizing changes in ACLS for obstetric patients during the precourse and using patient scenarios encountered in obstetric settings improved nurses’ performance in maternal MegaCode scenarios. The course also increased self‐satisfaction and self‐confidence of obstetric nurses in their ability to perform ACLS algorithms.     

A Perinatal Center Based Antepartum Homecare Program

Homecare for the high-risk antepartum client is a rapidly growing specialty of perinatal nursing. In a tertiary care center, a homecare component staffed by specially trained obstetric nurses with fetal monitoring expertise provides for comprehensive home visits. Home visits by nurses enable the client to remain safely in her own environment during the experience of a high-risk pregnancy. Nursing care for this population includes the provision of physical care, home fetal monitoring, education, and support throughout the pregnancy.     

Essential Program Components for Perinatal Home Care

Home care will continue to be a rapidly expanding area of health care. This growth will be evident in the perinatal nursing specialty. There are multiple models for delivery of perinatal home services. In each case, consideration needs to be given to licensing and other standards; to operational areas such as staffing, supplies, equipment, and reimbursement; and to quality issues, such as staff development, internal and external customer service, and a continuous quality improvement program. Successful marketing of the services requires recognition that the product is nursing care.     

Planning and Evaluating Evidence‐Based Perinatal Nurse Staffing

Nurse staffing decisions are high‐cost decisions. Having too few nurses may cause more mistakes or more episodes of missed care resulting in worse outcomes, increased pain, and additional suffering and health care costs. Having too many nurses increases health care costs. The Organizing Frameworks for Calculating Nurse Staffing and for Evaluating Nurse Staffing Decisions presented in this article build on the American Nurses’ Association's principle‐based staffing models and Donabedian's framework for evaluating the quality of health care.     

Infant Car Seat Usage Effectiveness of a Postpartum Educational Program

A study, based on the social learning theory model and designed to assess the effect of a postpartum educational program on mothers' use of infant car seats at the time of discharge was conducted. The control group consisted of data for 92 mothers obtained by recording their behavior at the time of discharge regarding their use of infant car seats and eight other related measures. The postpartum study group (90) was shown an educational slide/audio tape presentation followed by a question–and-answer period and demonstration of car seats. They were also given a shoppers' guide and a pamphlet of facts and pictures of car seats. Statistical significance was obtained on several measures.     

Perinatal contraceptive counselling: Effectiveness of a reinforcement intervention on top of standard clinical practice

ObjectiveTo assess the effectiveness of supplemental perinatal contraceptive counselling in addition to standard Spanish postpartum contraceptive counselling with regard to contraceptive use and use of effective contraception up to 1 year postpartum. Women's satisfaction with counselling and the method chosen was also assessed.DesignCommunity-randomized trial.Setting“Reproductive and Sexual Health Care” units of the National Health Care System at twenty public Primary Care facilities in Catalonia (Spain).Participants1,004 consecutive pregnant women (~week 30) receiving prenatal care between 1st October 2015 and 31st March 2016. Women were considered eligible for analysis if appropriate information was available.InterventionsAt half of the centres, midwives provided the standard Spanish postpartum contraceptive counselling (control group, CG). At the other half, supplemental perinatal contraceptive counselling was provided in addition to standard counselling (intervention group, IG) at different time points during pregnancy and postpartum. This consisted of a leaflet and a blog with practical information about all contraceptive options plus a short reminder message in the mobile phone during the third quarter of pregnancy and a face-to-face or a virtual meeting lasting 20 min in the first 15 days postpartum. Midwives used ad hoc questionnaires to collect information at week 30 of pregnancy (recruitment), and week 6, month 6 and month 12 postpartum.Measurements and findings975 women were eligible for analysis (482 in the CG and 493 in the IG). ~33% women had resumed sexual intercourse by week 6, and nearly all by months 6 and 12. Use and effectiveness of contraceptives was similar in both groups at week 6 and month 6. At month 12, more women in the IG used more effective contraception and less women used contraceptives considered somewhat effective vs. those of the CG (P = 0.006). When considering the place of origin, this was only true for Spanish women. Women of other origins had a much higher use of very effective contraceptives at month 12 also in the CG, with contraceptive counselling having scarce effect. On multivariate analysis, conducted only in Spanish women, the additional counselling resulted in a higher use of highly effective methods while having a university degree increased 3.6 times the OR for this behaviour. A bias towards fostering use of very effective contraceptives among women with low education was seen in standard clinical practice. Satisfaction with counselling and the type of contraception chosen was higher in the IG.Key conclusionsOur study has shown that the supplemental counselling tested has a moderate impact on contraceptive use and use of effective contraception in postpartum women. Results of this effort were seen after 6 months postpartum. A possible bias towards women who were more socially vulnerable was found in standard clinical practice, which reduced the effectiveness of the intervention in women who were otherwise the most needy.Implications for practiceDespite the benefits provided by supplemental support in perinatal contraceptive counselling, the existence of a possible bias affecting the effectiveness of these interventions should be investigated and addressed.     

A Perinatal Education Consortium: Improved Resource Utilization

Maternal Newborn Nurse Professionals of Southeastern Michigan is an organization of nurses from more than 30 hospitals. The organization formed a committee to provide a comprehensive, cost-effective educational program for new nurses or nurses who were being cross trained, which would improve resource utilization in the region. Twice a year the organization offers a 5-day educational program covering antepartum, fetal monitoring, intrapartum, postpartum, and neonatal issues. The development, implementation, and evaluation of the program are outlined.     

Perinatal Nursing Education in Tennessee A Regional Approach

The role of Professional continuing education in the development of regionalized perinatal health care systems is of primary importance to the success of these systems. Below is a report of the establishment of a Level III hospital-based program for providing professional education in a large, predominantly rural, urea. The program's emphasis IS on meeting educational needs of the region as defined by the practitioners themselves, rather than by outside observers.     

Men's Sexual Health: Evaluating the Effectiveness of Print- and PDA-based CME

IntroductionPersonal digital assistant (PDA)-based continuing medical education (CME) activities have become widely available.AimsTo evaluate the effectiveness of print- and PDA-based CME materials in erectile dysfunction (ED).MethodsCME materials describing links between ED and comorbid medical conditions, effects of certain lifestyle modifications on ED, and treatment of ED with phosphodiesterase 5 (PDE5) inhibitors were distributed as a print supplement and as electronic modules, viewed with PDAs. We evaluated how effectively these materials improved evidence-based clinical choices, using survey questions about case vignettes and comparing responses of CME participants (N = 85) and matched nonparticipants (N = 94).Main Outcome MeasuresEffect size, measuring the difference in evidence-based clinical scores between participants and nonparticipants.ResultsCME certificates were awarded to 3,557 participants (459 print, 3,098 PDA). Among survey respondents, significantly more CME participants recognized that ED was associated with greater risk for myocardial infarction (61% participants; 34% nonparticipants; P ≤ 0.001) and was a strong marker for diabetes mellitus (37% participants; 9% nonparticipants; P ≤ 0.001). In contrast, participants and nonparticipants both displayed a good understanding of the relationships of smoking, obesity, and sedentary lifestyle with ED and of using PDE5 inhibitors to treat ED in patients with prostate cancer or benign prostatic hyperplasia; this likely reflects a good baseline understanding of these topics. Participants and nonparticipants each displayed a poor understanding of the recommendations regarding nonarteritic anterior ischemic optic neuropathy and PDE5 inhibitor use. Patient reluctance to discuss sexual concerns was perceived as the most significant barrier to optimal ED management.Conclusions. Given patient reluctance to discuss sexual concerns, future CME activities should focus on educating health-care providers and patients that ED is a risk factor for cardiovascular disease and diabetes. Both print- and PDA-based CME on ED were effective; the large number of lesson completers suggests a trend toward on-demand, self-selected CME is positive. Broderick GA, and Abdolrasulnia M. Men's sexual health: Evaluating the effectiveness of print- and PDA-based CME. J Sex Med 2009;6:2417–2424.     

Strategies to Improve Management of Shoulder Dystocia Under the AHRQ Safety Program for Perinatal Care

Objective

To assess implementation of safety strategies to improve management of births complicated by shoulder dystocia in labor and delivery units.

Perinatal Patient Education: A Practical Guide With Education Handouts for Patients

New York: Berkley Publishing Group, 2002. 300 pages. $14.95, paperback. Reviewed by: Robyn Churchill, BA, BSN, MSN, CNM, WomenCare, Arlington, MA.