https://doi.org/10.33698/NRF0237-Preety Sharma, Avinash Kaur Rana,V.Venkadalakshmi, Rashmi Bagga
ABSTRACT : Introduction: Postnatal period is a crucial period for mothers and their neonates. Mothers and their neonates are observed for various health conditions (i.e. postpartum haemorrhage, sepsis and poor thermoregulation) during postnatal period by health professionals which can make them alert for prompt management of arising complications. Nurses play very important role in preventing and detecting the complications and managing them before they become life threading. The care of pregnant mother does not stop after the delivery but she need more focused care. Objectives: To assess the barrier and suggested facilitators for care of postnatal mothers and their neonates. Material and Methods: Focus group discussions (FGD’s) was conducted with bed side nurses of Obstetrics and gynaecological department, Nehru Hospital, PGIMER, Chandigarh on barriers and facilitators while providing postnatal care to mother and their neonates. Total 12 FGD’s were conducted till the data became saturated. Each FGD group included 3-6 nurses. Results: Results revealed that there are many barriers related to care of postnatal mothers and their neonates like lack of space and time, lack of standard teaching programmes for nurses, Lack of articles, insufcient nurse patient ratio. Some common suggestions were including increasing the nurse patient ratio, providing more space to labor room, single patient on single bed etc. Conclusion: Nurses suggested various barriers and facilitators regarding care of postnatal mother and their neonates. It was found useful for the researcher to develop the standard protocols for nurses on care of postnatal mother and their neonates.
Keywords : Focus group discussion; postnatal care; Bed side nurses; postnatal mother; neonates
Correspondence at
Avinash Kaur Rana Lecturer
National Institute of Nursing Education PGIMER, Chandigarh
Introduction
Postnatal period starts after separation and expulsion of placenta and its membranes and continues till 6 weeks post- delivery. This is the crucial period which demands monitoring of mothers and their neonates to ensure normal condition, so that complications can be prevented and managed. The major goals of post natal care are to provide comprehensive care to support mother’s recovery, identication of risk and maintenance of physical, psychological, social and emotional health of mother and their neonates to start new phase of life.1
Pregnancy is not a disease condition but comprises signicant physiological and psychological changes which take place during pregnancy and continues even after birth, which may lead to major health problems and risk the life of postnatal mothers and their neonates. The great demand of this period is to cope and adapt physically and emotionally. The other factors which kept women on great risk are biological factors, lack of access to information and health services, economic vulnerability and unequal powers. Nurses should be very vigilant in assessing signs of arising complications like bleeding and other signs of PPH, checking placenta for completeness, maintaining Input/ Output records and assessing vital signs. Nurses should provide psychological support, administration of medications as prescribed, arranging blood products, keeping operation theatre ready for any k i n d o f e m e r g e n c y a n d p r o p e r documentation related to all events and procedures.2,3
After delivery, postnatal mothers need continuous care till discharge from Hospital. Though nurses provide postnatal care, but there was no written standardized protocol to provide immediate and subsequent care to postnatal mothers and neonates. It was observed that the mothers and their neonates were not getting adequate postnatal care. So, need was felt to assess the barriers and facilitators for care of postnatal mother and their neonates.
Objectives:- To assess the barrier and suggested facilitators for care of postnatal mother and their neonates
Method and material:- Study was conducted in all units of Obstetrics and gynaecological i.e. Clean labor room, Clean labor room extension Septic labor room, maternity ward and Gynaecological ward. Sample was selected by purposive sampling technique. Sample population was 39 bed side nurses working in all units of Obstetrics and gynaecology. Tool was focus group discussion guide which have 12 guiding questions. All bed side nurses were informed about the study and written informed consent was taken. The main focus was on the problems and barriers faced by nurses while caring the postnatal mother and their neonates. The nurses were asked the suggestion to solve the problems and barriers. Focus group discussions (FGDs) were conducted in the group of 3-6 nurses. Each FGD was conducted for around 30 minutes and audio recording was done for each FGD as well as important points were noted down on paper. The data was saturated after 12 FGDs. Problem faced by nurses and their suggestions of those problems given by them were presented in form of table. After nishing FGDs, all natal mothers should be kept in maternity and Extension of CLR ward instead of transferring them to Gynae ward. “More space should be provided to the labor verbatim were inscribed. All problems and room”. “More than one staff should be suggestions discussed by nurses depict in form of Table. The theme were generated and validated by experts from the eld of psychiatry.
Results
The table 1 and 2 depicts the barriers and suggested facilitator for care of postnatal mother and neonates in deferent units of Obstetrics and Gynaecology.
Main problems faced by nurses while providing care to postnatal mothers and their neonates were “Inadequate nurse patient ratio in all units of obstetrics and Gynae ward, that’s why providing holistic care to each and every patient was difcult.”.“Admission of patients with different diagnosis in same unit makes it difcult to provide care as all patient’s needs were different.” “Lack of space for providing care to mothers and 2-3 mothers were admitted on a single bed”. “Stressful environment in labor room made it difcult for the nurses to assess postnatal mothers more vigilantly” and “Companion was not allowed in labor room because of congested infrastructure and privacy issues of other mothers”
Suggestions for improvement:
Nurses suggested facilitators for the posted in delivery room”. “One female relative should be allowed with mothers to provide basic care and in assisting the postnatal mothers”.
Discussion
Being a mother is the most beautiful emotion in whole world. This period has great potential for development of complications in both mother and baby, which can threaten their lives.According to World Health Organization, death during maternity period is the 2nd leading cause of death of women in reproductive age group. A vigilant care can help to decrease burden of country in terms of maternal and neonatal morbidity and mortality. Mother and baby need special care in their crucial phase of life which should be standardized based on national and international guidelines.4-7 Focus group discussion (FGD) is a process of discussion between groups from same background on a specic topic. This helps in gathering information related to concerned topic. It also provides nurse’s perspective related to the topic. It helps in seeking possible solution for the problem and issues faced by them. The number of FGD to be done depends upon saturation of information i.e. till no new information was gained.8,9 In present study, FGDs were barriers were “Maintaining adequate nurse patient ratio especially in labor room”. Post conducted among 3-6 members because in patient care setting nurses were not getting
Table 1 – Focus group discussion for assessing problems and seeking their suggestions while performing procedure of postnatal care of mothers and their neonates.
| Themes | Responses | Suggestions |
|
Stress full environment in labour room |
(The patients are shifted to delivery room in hurry. Though delivery set is prepared in advance but still there is pressure on us. We have to assist the delivery vigilantly because any time doctor can ask for outlet forceps or ventouse. So we have to rush for getting things ready. We don’t have time to stand with patient side and continuously monito the patient.) (CLR) Þvxj ge vital signs bruh ckj repeat djsaxs ;k uterine contractions psd djsaxs rks Dr. Hkh cksy nsaxs dh vki oxytocin nks] misoprostol nks] ;k betadine nks] vki ;s D;k dj jgs gks fdlh us cksyk vkils ckj ckj vitals check djus ds fy,]ß (If we check vital signs too frequently. Doctors will ask why you are taking vital signs so frequently or monitoring the uterine contractions if nobody asked. You just assist the delivery ) |
More than one staff should posted in delivery room |
| No attendant is allowed in labour room | Labor room ,d rks bruk congested gSa vkSj ij ls fj’rsnkj Hkh vk tkrs gSa] dke djus ds fy, txg gh ugÈ feyrhß
(There is no space to work effectively if we allowed relatives of the mother to stay with her as it is already very congested area.) (CLR, SLR)
Labor room esa tcrd dke u iM+s fj’rsnkj dks ugÈ cqykrs- gk¡ dksà patient sick gSa rks female attendant vk ldrs gSaAß (We never ask mother’s relatives to stay with her unless mother is very sick.(only female attendant) (CLR, SLR) Þfdlh fdlh islsaV ds lkFk rks dksà female attendant Hkh ugÈ gksrh rks husband ds lkFk vkà gqà gksrh gSa vkSj male dks rks vanj ugÈ vkus ns ldrs gSa׀ß (Sometimes mothers are accompanied with their husbands only. There is no female attendant. So we can not allow male attendants to come inside the labour room.) (CLR, SLR) |
One female relative should allowed with mothers |
free time to sit together. Initially nurses did not show interest in present study, so gathering 8-10 nurses at the same time became difcult for the researcher. The nurses showed interest and participated enthusiastically in FGD’s after repeated reinforcement by the researcher. Total 12 FGDs were conducted till the data became saturated.
The care needed by mothers and their neonates is not only the health talk but the actual procedures. The very important aspects like post partum haemorrhage, vitals monitoring, establishment of breastfeeding, prevention of sepsis and psychological wellbeing need to be taken care by nurses. If nurses faces barriers while proving theses vitals care to postnatal mothers and their neonates. The morbidity cannot be prevented. So nurses should be focused and asked about the barriers and administration should facilitate them as much as possible.10
The main barrier expressed by nurses was nurse patient ratio which cause the lack of time to provide quality care to mothers and their neonates. The CLR setting was too congested and 2-3 mothers along with their neonates were kept for observation in postnatal room that was having 5-7 beds. Maintaining the standard care in such overcrowded setting was difcult. There were many other barriers verbalised by nurses which need attention of administration. If these barriers continue the quality care will become difcult and so the attitude of nurses regarding care to postnatal mothers and their neonates.
Barrier varies from area to area like in CLR the labor room was very congested and bed were not equal to admitted patient strength. In SLR, the patient belongs to different diagnosis and it was an emergency area so the specic care to postnatal mothers and neonates who were appearing stable was neglected. In Gynaecological ward, the nurse patient ratio was inadequate and patient with different diagnosis including antenatal, postnatal, septic and gyne cases. The main barrier was lack of time to provide health talk and other important nursing procedures. They were capable of providing care to only those mothers and neonates who ask for it several times.Regarding the facilitators the main suggestions were to improve nurse patient ratio, labor room should be more spacious, one attendant should always be there with mother and one type of patient should be admitted in one unit.
Many of the suggested facilitators that were reported by bed side nurses needs the attention of administrators like providing the separate and spacious area to the maternal and neonatal care units with adequate bed strength. The nurse patient ratio should be improved. The inservice education should be organised for nurses. The guidelines for assessing and managing obstetric and neonatal emergencies and care should be prepared and made available in all the obstetric units.
References
- The National Academic Press. Improving birth outcomes: meeting the challenges in the developing world: Reducing maternal mortality and morbidity. 2003. [Accessed on 22 March 2018]. Available from https://www.nap.edu/read/10841/chap ter/4#42
- MontgomeryA, Ram U, Kumar R, Jha Maternal Mortality in India: Causes and Healthcare Service Use Based on a Nationally Representative Survey. Plos One. 2014;9(1).[Accessed on 18 Aug 2017]Available at journals.plos.org/plosone/article?id=1 0.1371/journal.pone.0083331
- Dutta DC. Text book of Obstetrics. 7th edition. Kolkata: New center book agency (pvt.) Ltd; 2010.
- Larossa J. Reactions to Motherhood: The Role of Postnatal Care. Contemporary Sociology. 1988;17(2):[Accessed on 24 December 2016]Available from pediatricnursing.org/article/088 2-5963(90)90057-G/abstract)
- Sit D, Rothschild A, Wisner K. A Review of Postpartum Psychosis. Journal of Women’s Health [Internet]. 2006 [cited 7 February 2018];15(4):352-368.[ Accessed on 24 November 2017]Available from: https://www.ncbi.nlm.nih.gov/ pmc/articles/PMC3109493/
- Warning Signs After Giving Birth – The Postpartum Period Health Central [Internet]. Healthcentral.com. 2018 [Accessed on 29 March 2018]. Available from: https://www.healthcentral.com/article/postpartum-warning-signs.
- World Health Organization 2013 guidelines. Postnatal care for mothers and newborns. (Accessed on 16 Nov 2017) available on http://www.who.int/maternal_child_a dolescent/documents/postnatal- carerecommendations/en/.
- Kumar S, Saini S K, Kaur S, Verma
- A Methodological study to develop standard operational protocol (SOP) on drug administration for children.[unpublished thesis]NINE, PGIMER, Chandigarh;2016
- Kaur D, Rana AK, Kalyan G, Kumar
- A methodological study to develop a standard operational protocol for feeding preterm neonates with expressed breast milk.[Unpublished thesis]NINE, PGIMER, Chandigarh.
- WHO collaborating centre for training and research in new-born care, AIIMS. In: Newborn Nursing for facility based care.2015.3rd edition.