August 23, 2017

This gap in nurse education may be putting new moms in danger

Daily Briefing

    Many nurses lack the education to inform new mothers about the symptoms of potentially life-threatening conditions, according to a new study in the American Journal of Maternal/Child Nursing.

    Background

    According to NPR/ProPublica, the United States has the highest maternal mortality rate among affluent countries. Between 700 and 900 women in the United States die each year from childbirth and pregnancy-related issues, according to CDC data, and another 65,000 women nearly die. The rates are highest for black women and women who live in rural areas.

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    Based on data from four states, the not-for-profit CDC Foundation in a recent study determined that about 60 percent of these maternal deaths were preventable, NPR/ProPublica reports.

    Study details

    For the latest study, researchers surveyed 372 postpartum nurses nationwide. According to the researchers, roughly one-third of respondents had a master's degree or a doctorate. All of them were members of the Association of Women's Health, Obstetric and Neonatal Nurses, which NPR/ProPublica characterized as the "leading professional organization for nurses specializing in maternal and infant care."

    According to NPR/ProPublica, the study was funded by Merck for Mothers as part of a 10-year, $500 million initiative to boost maternal health globally.

    Key findings

    The researchers found that 46 percent of respondents did not know that over the past few years, the rate of maternal mortality had increased in the United States, and 19 percent of respondents incorrectly thought the rate had decreased.

    Further, just 12 percent of responding nurses said they knew that most maternal deaths happen in the days and weeks following childbirth, and only 24 percent were able to correctly identify cardiovascular problems as the leading cause of maternal death.

    In fact, according to Patricia Suplee—an associate professor at Rutgers University School of Nursing, and the lead researcher on the study—cardiovascular disease and heart failure were "the area that the nurses felt the least confident in teaching about," despite the fact that cardiovascular-related problems account for more than 25 percent of maternal deaths in the United States.

    Survey respondents said they typically spent no more than 10 minutes explaining concerning postpartum symptoms with new mothers. Further, many respondents said they would only discuss the symptoms of certain life-threatening conditions—such as blood clots in the lungs, heart problems, or preeclampsia—"if relevant," even though, as the study mentions, "it is impossible to accurately predict which women will suffer from a post-birth complication."

    In fact, based on a previous study of two focus groups in New Jersey and Georgia, the researchers found that most nurses spend the majority of their time teaching new mothers how to care for infants—not how to identify their own health issues. Moreover, the focus group study found that when nurses did educate women about their own health risks, the information was typically inconsistent and occasionally incorrect, according to Debra Bingham, the head of the Institute for Perinatal Quality Improvement and a teacher at the University of Maryland School of Nursing. And the information that women took home with them after discharge was rarely of higher quality, Bingham added.

    Part of the problem, Bingham said, was nurses' reluctance to discuss potentially life-threatening complications during a time that is supposed to be more life-affirming. "We had some nurses come out and say, 'Well you know what, I don't want to scare the woman. This is supposed to be a happy time. I don't want to seem like all I want to talk about is death,'" Bingham said.

    Discussion

    According to Bingham, the fact that many nurses were unaware of the rising maternal mortality rates in the United States could be problematic. "If (nurses) aren't aware that there's been a rise in maternal mortality, then it makes it less urgent to explain to women what the warning signs are," she said.

    It's also crucial, NPR/ProPublica reports, that new mothers are educated about these conditions post-delivery, because they usually will not have a follow-up appointment with a physician for another four to six weeks, and many new mothers—up to 40 percent—will not make her follow-up appointment at all.

    Possible solution

    The researchers in the latest study did identify a potential solution, however, NPR/ProPublica reports. Based on feedback from the two focus groups, an expert panel developed a standardized checklist and script for nurses to use as an outline when talking with new mothers, as well as a one-page handout of the symptoms of concerning post-birth complications for new mothers to take home.

    The researchers tested the materials in four hospitals in 2015, Bingham said, and "very quickly, we started hearing from the nurses that women were coming back to the hospital with the handout, saying,'I have this symptom'" (Martin and Montagne, NPR/ProPublica, 8/17; Kuhrt, FierceHealthcare, 8/18).

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