Scoping Review of Postpartum Discharge Education Provided by Nurses.

OBJECTIVE: To determine what is known about postpartum education provided by nurses to women before discharge from the hospital after birth and whether current nursing practices are effective to prepare women to identify warning signs of complications, perform self-care (physical and emotional), prepare for parenting a newborn, and establish infant feeding. DATA SOURCES: We conducted a systematic search of CINAHL Plus and MEDLINE for relevant sources, including peer-reviewed articles, conference presentations, and guidelines from professional organizations, that were published in English from January 2010 through November 30, 2020. STUDY SELECTION: We included sources if participants were women who had given birth to a healthy, liveborn, term infant and were receiving education in whole or in part by a nurse during the maternity hospitalization. We excluded sources with samples of high-risk women or those who gave birth to high-risk infants (preterm, congenital anomalies, neonatal abstinence syndrome). Forty-six of the sources met the inclusion criteria. DATA EXTRACTION: We extracted citation, type of document, country of origin, context (prenatal/postpartum or both and inpatient/outpatient or both), aim, participants (mother/father or both, sample characteristics), content of education and who provided it, outcomes or key themes, and main results. DATA SYNTHESIS: Infant topics included breastfeeding and safe sleep, and maternal topics included breastfeeding, postpartum mood, and self-care after birth. Nurses prioritized safety, including safe sleep; preventing infant falls; decreasing infection; screening for postpartum depression; and avoiding adverse outcomes after discharge. Women focused on self-care, pain management, infant care, and parenting. Women and nurses prioritized breastfeeding. Authors of the included sources measured effectiveness by patient satisfaction, chart audit, pre- and posttests of nurses' knowledge, and breastfeeding duration. Women reported barriers to postpartum education such as limited nursing time or conflicting information. CONCLUSION: Postpartum education is a priority, but its effectiveness is not well studied. Few maternal or infant health-centered outcomes have been measured beyond breastfeeding duration. Nursing care and nurse expertise are not easily quantified or measured. Research is needed to inform best practices for postpartum education.

What Do Women Want? Looking Beyond Patient Satisfaction.

OBJECTIVE: To hear the voices of women, their partners, and nurses about expectations and priorities during the postpartum hospitalization. DESIGN: Focus groups using semistructured interview questions. SETTING: A 12-bed labor-delivery-recovery-postpartum unit at a small urban hospital in the U.S. Northeast. PARTICIPANTS: Women who planned to or had given birth, their partners, and the maternity nurses who cared for them. MEASUREMENTS: Qualitative thematic analysis of focus group transcripts. RESULTS: Thematic analysis produced the following themes for women's priorities: Need for individualized attention to maternal physical and emotional care; Fear of providing inadequate care for the newborn, including establishing infant feeding; and Transitioning to parenting as a new mother versus as an experienced mother. Themes for nurses' priorities included Safety issues around sleep and breastfeeding, Transitioning to parenting with an emphasis on maternal self-care, and Addressing barriers to effective discharge education. Response comparisons between the women/partners and nurses suggest that there is a disconnection between women's and nurses' priorities and expectations for care during the postpartum period. CONCLUSION: Women and nurses identified unmet needs in the postpartum period, consistent with the current literature. Providing standardized education during the transitional period around discharge from the hospital to home may not be optimal and may even detract from meeting the needs for rest and connection with family and the health care team. Nursing care that extends beyond the maternity hospitalization may be needed to individualize care and meet previously unmet needs.

Technology-assisted nursing for postpartum support: A randomized controlled trial.

AIM: To determine if an electronic nursing intervention during the first 6 months postpartum was effective in improving mood and decreasing stress. BACKGROUND: Unmet needs postpartum can have a negative impact on mood and parenting stress. Technology-assisted nursing care may provide needed support and reduce risk. DESIGN: Randomized controlled trial (RCT) with three conditions. METHODS: Enrollment began on 11 May 2017. Participants were randomized into one of three groups after completion of the baseline survey. Intervention I participants received standardized electronic messages four times/week for 6 months postpartum. Intervention II participants additionally received the option for nurse contact. Depression and parenting stress as measured using the Edinburgh Postnatal Depression Scale (EPDS) and Parenting Stress Index-Short form (PSI-SF) was obtained at 3 weeks, 3 months and 6 months postpartum and results compared with a usual care group. Patient satisfaction and nursing factors were measured. RESULTS: Significantly higher satisfaction scores were found in both intervention groups as compared with control, but there were no significant changes in EPDS or PSI-SF. CONCLUSION: The interventions were perceived as helpful and not burdensome. Better nurse-sensitive outcome measures are needed to adequately assess effectiveness. IMPACT: Postpartum women report unmet needs for support and education. The interventions were perceived as being helpful but did not significantly reduce depressive symptoms or parenting stress. Nurses can use this research to inform development of innovative approaches to support postpartum women. TRIAL REGISTRATION NUMBER: ClinicalTrials.gov NCT02843022.

Measuring outcomes of digital technology-assisted nursing postpartum: A randomized controlled trial.

AIM: To determine if delivering electronic messages from nurses during the first 6 months postpartum is feasible, acceptable and effective in improving mood and decreasing parenting stress. BACKGROUND: Competing demands during the postpartum hospitalization make focused time for nurses to provide education and support difficult. Unmet needs following discharge may increase the incidence of postpartum depression. Untreated depression negatively affects families, especially for vulnerable women with limited access to health care. DESIGN: This is a longitudinal cohort study in three phases. Feasibility and acceptability were assessed during Phases 1 & 2. Phase 3 is a randomized controlled trial (RCT) with three conditions. METHODS: This protocol was approved by the Institutional Review Board of the maternity hospital on 12 May 2015 and reviewed annually. Women are enrolled during the maternity hospitalization, after which randomization occurs. The control group receives usual care. Intervention I participants receive a standardized electronic message four times/week for 6 months postpartum. Intervention II participants receive the messages and the option to request a call from a nurse. Electronic surveys at 3 weeks, 3 months and 6 months postpartum measure depressive symptoms using the Edinburgh Postnatal Depression Scale and parenting stress using the Parenting Stress Index-Short form. Patient satisfaction, nursing time and expertise required are also measured. DISCUSSION: Phase 1 and 2 have demonstrated the intervention is feasible and acceptable to women. Phase 3 enrolment is completed, and the last follow-up surveys were emailed to participants in February 2018. Results will help inform efforts to continue nursing care after hospital discharge.