Nursing Research Paper
Nursing Impact in Prenatal and Infancy Care
Even though the rate of infant mortality has been on a steady global decline, the subject still needs to be deliberated upon to determine the cause of neonatal deaths. Expectant women are subjected to medical care before, during, and after giving birth while under the care of a variety of medical staff. One of the reasons attributed to the high mortality rate is negligence by nurses, as reviewed in this study. After conducting a field study, it was determined that one of the common causes of negligence leading to infant mortality is the shortage of staff in hospitals. The nurses working in these hospitals have to endure long working hours and play double roles to fulfill the demand for their service. The study establishes increasing the staff number through training and outsourcing from other departments as the immediate course of action to be taken.
Keywords: infant mortality, prenatal care, infancy care, nursing care
Infant mortality can be described as the number of infant deaths for every 1,000 live births (Janssen, 2014). The infant mortality rate of the world is 49.4 according to the United Nations statistics, while the World Factbook gives the number of 42.09 (UN, 2015). The maternity ward is one of the most delicate units in a hospital. Women are admitted to the hospital hours before giving birth, observed and monitored by doctors and nurses, and necessary steps are taken to prepare for the delivery method chosen. The medical staff has to be cautious because any mistake made can lead to the death of the unborn child, its mother or both. Negligence in maternal care is stated as one of the attributing factors leading to neonatal deaths in hospitals. Neonatal deaths make up 40% of deaths among children aged five years and below, with the majority of deaths occurring within the first week of life (Janssen, 2014). About 45% of the deaths occur within the first 24 hours, making it a crucial period for the staff tending to expectant mothers. Within the first 24 hours, newborn babies and their mothers are still placed under observation to monitor their vitals and detect any abnormalities. This requires round-the-clock supervision of the designated staff, especially nurses (Ellis, 2010).
Common cases of negligence are contributing factors to the increase in infancy death rates. According to the World Factbook, approximately 10% of deaths in the hospital occur in the maternity department, which is an increase from the previous year’s 6% (UN, 2015). Upon reviewing case studies, it was noted that the maternity ward has a limited staff resource. The total daily hours of nursing care per patient affected the overall service given in the maternity department in the hospital. This has a direct impact on the infant mortality before, during, or immediately after the birth.
The central purpose of conducting this research is to determine the impact of nursing in prenatal and infancy care. Others include:
To determine whether there is a correlation between infant mortality and nursing care;
To discover the main cause of negligence in maternal care leading to an increased infant mortality rate.
Marquis and Houston (2015) state that involvement of nurses in childbirth begins at the antepartum stage and goes till the postpartum stage. The authors mention that a total of six nurses should be available during the birthing process:
Antepartum nurse, who plays the role of providing care to patients who need hospitalization due to complications.
Labor and delivery nurse (L&D), who plays the role of providing care to patients in labor in both complicated and uncomplicated cases.
Circulating nurse, who plays the role of providing and managing care for patients undergoing cesarean delivery.
Scrub nurse, who assists the surgeon during cesarean delivery.
Postpartum nurse, who plays the role of provision of care to patients who have delivered.
Nursery nurse, who plays the role of provision of care to newborn babies.
Due to the high admission rate in hospitals and the shortage of nurses, most of the nursing staff in the maternity ward ultimately have to play more than one role. In extreme situations, one nurse substitutes all nurses involved during the childbirth to let other nurses attend to other expectant mothers. This practice, in turn, translates to poor patient care and the possibility of inadequate service. A case study was conducted in one of the hospitals in Boston experiencing a high infant mortality rate. According to the data provided, 45% of newborns are lost during the childbirth process, 20% die when in the nursery, and 35% die before making it to the delivery table (Kahn, 2007). Another case study, conducted by London (2011) in a different hospital, revealed that a hospital lost 350,000 dollars within the previous year in settling damages related to legal suits pursued by affected parties.
This section discusses all processes, strategies, and approaches used in data collection, analysis, and interpretation of results. The scope of the study was narrowed down to a maternity ward in one of the community hospitals as the basic unit for research.The Infant Death Prevention Unit (IDPU) team comprising of the researchers and some of the maternity ward staff was set to carry out the study to address this urgent nursing indicator. The core mission of the IDPU was to conduct a comprehensive research to determine the impact of nursing on neonatal deaths, to prevent further infancy death, and to generate short and long-term solutions for implementation. This goes in line with the hospital’s mission of provision of quality service to ensure the health and safety of all patients.
Data for the research was gathered through observation and review of the hospital records. Data presented for use was obtained from the National Maternity Collection (MAT) (Board, 2011). It integrates the data from the Lead Maternity Care (LMC) and National Minimum Dataset (NMD) (Board, 2011). MAT is the source of demographic, clinical, and statistical data on selected maternity service providers. This data, ranging from a period of nine months prior to and three months after the birth, is used for strategy, policy development and service evaluation.
In the course of work, the IDPU team came across two ethical dilemmas. The first one was the issue of direct access to the maternity ward to gather information. The area was restricted to a few people including close family members of patients, doctors and nursing staff. The obsticle was letting the team members access the area to gather information. Secondly, the nurses faced an ethical dilemma of sharing patient information which was confidential. They were required to keep personal information about patients private.
Results and Analysis
The findings of the research confirmed that nursing had an impact on neonatal deaths in hospitals. The major issue facing the hospital in the study was the shortage of staff. Some nurses were forced to take up longer shifts whereas others had to play roles outside their area of expertise. The nurses were demoralized due to the fatigue and the stress of workload put on them. Demoralization and fatigue, in turn, changed into mistakes and negligence in the maternity department, hence leading to an increase in infant mortality rate.
The IDPU team was charged with the responsibility of coming up with a solution to the critical problem. After using the six-sigma model to define measure, analyze, and control the problem, the team discovered that the most urgent situation was the provision of extra staff to support the maternity ward (Coppens, 2005). It was found that other units like the pediatrics, pharmacy, and the physical therapy departments of the hospital had been shut down, and the nurses were away on leave. The team saw this as an opportunity to source the extra staff to the maternity ward as a short-term solution. The pediatrics department was suggested because of the nurses’ expertise in child care. To curb the risk of errors due to lack of competence in child delivery, the team also suggested the immediate commencement of in-house training of the said nurses.
Nurses play a colossal role in prenatal and neonatal care in hospitals as a part of the medical staff responsible for providing care to patients. One of the leading causes of infant mortality is the negligence among staff, and the research conducted above indicated that the said negligence was a result of staff shortage. The available nurses had to work longer shifts and take on multiple roles, thus increasing the probability of negligence. The best course of action was to train nurses from other available departments in the hospital as the administration searched for a long-term solution.
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