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Assignment: Doctor of Nursing Practice Prospectus Essay
Assignment Doctor of Nursing Practice Prospectus Essay
Excessive bleeding has been ranked as the leading cause of death among women post-pregnancy in the world (Smith, 2017). In the United States, a woman almost succumbs to pregnancy-related complications approximately every ten minutes with post-partum hemorrhage (PPH) being the leading cause of obstetric complications. Postpartum hemorrhage affects an estimated 2.9% of women who give birth in the U.S (Bingham, Scheich & Bateman, 2018), of which 125,000 women die annually. Creanga et al. (2017) also report that PPH is a major cause of deaths among mothers of childbearing age and is linked to 11.8% of maternal deaths.
In 2017, the rate of PPH deaths at a tertiary care facility in the South West United States was approximately 18% (Thorp, 2020). The figure was higher than the national level of 11.3%, although lower than the state level of 19% (Petersen et al., 2019). Due to the high rates of PPH deaths, the facility implemented measures to reduce the numbers. In June 2018, the hospital implemented the Modified Early Warning Scores and realized that nurses and physicians administered oxytocin inconsistently. In November 2018, the hospital introduced a PPH in situ simulation tool. The tool enhanced teamwork, communication, and technical skills among staff in the obstetric unit because they could practice using a sample scenario for labor and delivery. In March 2019, the unit adopted a policy of third stage labor oxytocin infusion since it reduces mean blood loss by 22% and lowers the frequencies of PPH by 40% (Zagorsk, 2017). In May 2019 the hospital initiated a quantitative blood loss and PPH risk assessment and stratification. The implementation of the American College of Obstetricians and Gynecologists (ACOG) PPH protocol concerning risk assessment tools by the hospital in December 2019 was expected to reduce the maternal deaths linked to PPH. It is unknown what the impact of the implemented protocol has on PPH, and thus, the project will evaluate the extent that the incidence of PPH has decreased.
Postpartum hemorrhage is considered a significant obstetrical emergency in the healthcare setting. It is ranked among the top five causes of maternal mortality, not only in low per capita income countries, but also in affluent nations (Smith, 2017). Research by Bros et al. (2015), Davies (2019) and Ngwenya (2016) report that the many fatalities linked to PPH can be prevented through prompt recognition, appropriate response and timely aggressive treatment. The ACOG provides an operation guideline to address cases of PPH in care facilities. The guideline includes identification of maternal age, risk factors to PPH, primary causes of bleeding, assessment of the severity of PPH and development of intervention strategies based on diagnosis. In the present health facility, care workers have already been trained on the PPH implementation matrix as contained in the ACOG PPH protocol. However, despite the availability of the protocol at the facility, PPH associated morbidity and mortality continue to be recorded in the maternity unity. The goal of the project is to determine the effectiveness of the PPH protocol in the facility and to ascertain practice variability aimed at improving the quality of care for postpartum women.
Hospitals have registered remarkable rates of PPH due to their intransigence on adopting recommended guidelines such as the ACOG PPH protocol (Shaylor et al., 2017). The reason for the intransigence is founded on the fact that further studies have not been conducted on the protocol to determine its effectiveness. Therefore, the project will focus on the following question, what is the effect of implementation of the ACOG PPH protocol on the incidence of PPH?
Based on the question, the project aims at investigating the rate of PPH before and after the implementation of the ACOG PPH protocol. The ACOG advises hospitals to develop organized, systematic processes to help coordinate the response to and management of PPH (ACOG, 2017). Following the advice, the California Maternal Quality Care Collaborative (CMQCC) project initiated new protocols and policies to prevent maternal deaths secondary to PPH (Guilliland, 2017). The project led to a reduction in maternal mortalities and morbidities, which prompted all States to review their policies. Therefore, the identified gap in practice entails the reluctance of the practice site to adopt the usage of the ACOG PPH guidelines to manage maternal deaths and morbidities. As such, determining the effect of the implementation of the ACOG PPH protocol on the rate of PPH prompts the adoption of the guidelines in the hospital of study.
The project will play an important role in impacting social change for consumers, organizations and the nursing profession. The project is expected to support the adoption of the ACOG PPH protocol in the reduction of PPH mortalities and morbidities through specific interventions. As such, maternal delivery will be safer, which will encourage more women to seek hospital delivery without fear. The confidence that consumers will have in hospital labor and delivery units will increase the uptake of maternal healthcare services even by skeptics of the same (Sudhof, Shainker & Einerson, 2019). Organizations may also be required to ensure that evidence-based practices as supported by the ACOG PPH protocol are instituted to ensure equity in the provision of services irrespective of the economic status of a patient. Lastly, the healthcare professionals will ensure the existence of social equity as regards maternal deaths through the adoption of the ACOG protocol (Alailfy et al., 2018). Thus, the project will produce profound social change impact across the continuum of care encompassing the consumers and professionals at the facility.
Moreover, the results of the project will support positive social change as envisioned in the Walden University’s mission statement. The university fosters positive social change through undertakings such as research, projects and community engagements that result in deliberate action for such changes (Davies, 2019). The project seeks to demonstrate that the adoption of the ACOG PPH protocol can reduce mortality rates and bleedings associated with maternal births. Postpartum women will benefit in the sense that their risk of complications and mortalities related to birth will be reduced as a consequence of the project (Schirmer, Lockman & Schirmer, 2016). The reduction of complications will occur because healthcare practitioners will become proactive in managing complications associated with maternal births and during the postpartum period through the adoption of the various protocols recommended by the ACOG.
The information from the project will play a fundamental role in facilitating a positive social change. The fact that the objective of the project entails the reduction of maternal deaths caused by PPH implies that the uptake of maternal services will increase during labor and postpartum periods. Moreover, the expected results of the project will enhance safe delivery, which will positively impact the manner in which people view hospital deliveries (Sudhof, Shainker & Einerson, 2019). The existence of safe delivery and postpartum experience forms one of the foundational tenets of social equity in the society, which is an important aspect of social change.
Context for Doctoral Project
The practice site is a tertiary acute care hospital located in the South West United States. The hospital is a 350-bed capacity facility with the maternal/children’s area accounting for 200 of the beds. The hospital principally serves pregnant women as it provides maternity care services such as antenatal care, labor and delivery and postpartum care and nutrition clinics. Moreover, the hospital also offers pediatric care services such as child wellness clinics, immunizations, and pediatric consultations. Lastly, the healthcare facility similarly offers services such as gynecological consultations, family planning, minor surgical procedures, cervical cancer screening among others. In order to successfully manage pregnancies, the facility has employed general practitioners, neonatal nurses, obstetricians, and neonatologists/pediatricians.
The health care professionals at the facility are already trained on the implementation of the recommendations contained in the ACOG PPH protocol. The approach in practice improvement will involve analysis of health care guidelines used at the selected hospital. Please see the comment, and develop the paragraph to explain how you will carry out the project: Explain how this project can be accomplished in the identified setting or context. How is management going to open the doors for you to have access to deidentified patient data? Leadership wants to know if the guidelines have been effective…. Look at some of your colleagues’ papers to see how they developed this subsection
Sources of Evidence
Smith (2017) notes that the mortality rate associated with pregnancy was 17.3 deaths for every 1000 live births in the U.S. in 2013. The U.S. health statistics by Shaylor et al. (2017), indicates that 11.4% of maternal deaths are linked to PPH. The ACOG (2006), conducted a study that revealed that at least one out of four women dies from PPH in the United States of America. Smith (2017) discussed that annually, there are 400,000 maternal deaths in the U.S. linked to PPH. Measures are therefore necessary to reduce the startling figures.
The literature will be obtained from the Cochrane Central Register of Controlled Trials, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Google Scholar, PubMed, National Guideline Clearing House, Medline, Ovid and the Cochrane Database of Systematic Reviews. The search terms used were ….different Boolean operators which included post-partum hemorrhage, ACOG protocol, post natal care and pregnancy. Inclusion criteria was Exclusion criteria was. All literature included in the review were written in English and published within the last ten years.
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The ACOG guideline for recognition and treatment of PPH considers bleeding more than 500 milliliters (mL) after a vaginal delivery or 1000 mL following caesarian section delivery to constitute PPH. The guideline is vital for nursing practice as it enhances early
identification of the condition. Besides, evidence of the guidelines will enable nurses to develop a diagnosis for the pregnant women. The initial step in the protocol for PPH management commences with development of a differential diagnosis to examine the source of the bleeding. Early identification of PPH serves as the main goal of care of the facilities providing maternal services (Alailfy et al., 2018). The protocol also identifies risk factors that place the postpartum woman at risk for bleeding, and strongly suggests that perinatal nurses assess for any risk factors present at time of admission and found during antenatal visits. Even though PPH hemorrhage remains unpredictable, there are relatively common clinical circumstances that may predispose to it, such as prolonged labor and chorioamnionitis (Smith, 2017). The guideline also addresses the need for prevention and recommends active management of the third stage of labor as a way to reduce the risk of bleeding. Preventative practices include the administration of oxytocin and frequent uterine massage (Alailfy et al., 2018).
The Approach or Procedural Steps
A comparative approach will be used for the evaluation of the effectiveness of the guideline to prevent PPH. Retrospective data related to the incidence of PPH will be obtained from the Quality Improvement Department for the three months before the PPH protocol was implemented. The data will include the incidence of PPH as a result of obstetric trauma, and after vaginal and Caesarian delivery. Also, the number of deliveries, causes of PPH and case fatalities related to PPH will be collected. The period for the beginning and ending of the bleeding will be recorded in the first three days postpartum. The identified data will be kept on a password protected computer in a Microsoft Excel spreadsheet. The computer will be kept in a locked, private office.
Nurses in the maternity unit will be reminded in an educational session about the implemented practice protocol regarding PPH. An education forum using a 10 minute Powerpoint presentation in the boardroom will be organized twice weekly for six months to address issues pertaining to the proposed protocol. The information will address the PPH management protocol at the facility and presentations will be made by the nurse coordinator at the facility’s maternity unit. Brochures to reinforce the use of the PPH management protocol will be given to the nurses for further reading. Questions from the participants will be responded to accordingly through the question and answer session to decrypt potential doubts that nurses might have about the PPH protocol.
I will obtain data related to the incidence of PPH from the Quality Improvement Department.. The data will include the incidence of PPH as a result of obstetric trauma and after vaginal and Caesarian deliverys. Because you are using a before and after approach, the information and the way it is presented in the prospective data collection needs to mirror that in the retrospective arm. I stopped reading here. You can look at your colleagues’ papers to see how they developed the section. Look at Amanda’s for example.
The project aims at using electronic health record data generated from a children’s hospital in Texas. The use of the data requires compliance with the Health Insurance Portability and Accountability Act. For the project, the IRB will have to approve the registries and a rigorous de-identification process will be used to handle the data (Myers & Stevens, 2016). Therefore, as much as the project will contain data from hospital sources, the identity of the persons whose data will be used will be blurred.
Secondly, the hospital management will have to authorize the use of the data. The author will have to gain permission to use the data, assess the availability of data for the research, identify the needed data for the population of interest, link data from different sources, assess the quality of the data, manage data for the specified period and share the data after the study. The research will utilize the hospitals’ electronic health record related to the mortalities and statistics associated with PPH. The sources of data will entail patients who will be admitted at the hospital with complications leading to PPH.
For the participants, consent to use their data will be a requirement and security measures will be put in place to lower the risks of impermissible access to the protected health information. However, this may lead to ethical issues as most of the participants may not be in a position to objectively evaluate the request for consent. Moreover, some data may be obtained on participants who may not be admitted at the hospital at the time of the project, which raises potential HIPA issues.
The numerous aspects of the project are aligned. The problem statement reveals that PPH occurrences have resulted in several mortalities and morbidities in women in the United States. However, the adoption of the ACOG PPH protocol has been demonstrated to reduce maternal deaths associated with PPH. Ngwenya (2016), Smith (2017), Agrawal (2015), and Alhazmi et al. (2018) support the usage of ACOG PPH protocol to reduce incidences of maternal deaths as caused by PPH. The practice focused question will facilitate gathering of data at the beginning of the project without ACOG PPH protocol and at the ending of the project after adopting the protocol. The analysis of the data at the two project points will then be used to deduce the effectiveness of the intervention. Therefore, the practice focused question will help in determining the effectiveness of the ACOG PPH protocol in reducing incidences of maternal deaths due to excessive bleeding.
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Important information for writing discussion questions and participation
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Your initial discussion post should be a minimum of 200 words and response posts should be a minimum of 150 words. Be advised that I grade based on quality and not necessarily the number of words you post. A minimum of TWO references should be used for your initial post. For your response post, you do not need references as personal experiences would count as response posts. If you however cite anything from the literature for your response post, it is required that you cite your reference. You should include a minimum of THREE references for papers in this course. Please note that references should be no more than 5 years old except recommended as a resource for the class. Furthermore, for each discussion board question, you need ONE initial substantive response and TWO substantive responses to either your classmates or your instructor for a total of THREE responses. There are TWO discussion questions each week, hence, you need a total minimum of SIX discussion posts for each week. I usually post a discussion question each week. You could also respond to these as it would count towards your required SIX discussion posts for the week.
I understand this is a lot of information to cover in 5 weeks, however, the Bible says in Philippians 4:13 that we can do all things through Christ that strengthens us. Even in times like this, we are encouraged by God’s word that we have that ability in us to succeed with His strength. I pray that each and every one of you receives strength for this course and life generally as we navigate through this pandemic that is shaking our world today. Relax and enjoy the course!
Please read through the following information on writing a Discussion question response and participation posts.
Contact me if you have any questions.
Important information on Writing a Discussion Question
- Your response needs to be a minimum of 150 words (not including your list of references)
- There needs to be at least TWO references with ONE being a peer reviewed professional journal article.
- Include in-text citations in your response
- Do not include quotes—instead summarize and paraphrase the information
- Follow APA-7th edition
- Points will be deducted if the above is not followed
Participation –replies to your classmates or instructor
- A minimum of 6 responses per week, on at least 3 days of the week.
- Each response needs at least ONE reference with citations—best if it is a peer reviewed journal article
- Each response needs to be at least 75 words in length (does not include your list of references)
- Responses need to be substantive by bringing information to the discussion or further enhance the discussion. Responses of “I agree” or “great post” does not count for the word count.
- Follow APA 7th edition
- Points will be deducted if the above is not followed
- Remember to use and follow APA-7th edition for all weekly assignments, discussion questions, and participation points.
- Here are some helpful links
- Student paper example
- Citing Sources
- The Writing Center is a great resource