Quality Patient Care in Labor and Delivery: A Call to Action | PDF Show
IntroductionPregnancy and birth are physiologic processes, unique for each woman, that usually proceed normally. Most women have normal conception, fetal growth, labor, and birth and require minimal-to-no intervention in the process. Women and their families hold different views about childbearing based on their knowledge, experiences, belief systems, culture, and social and family backgrounds. As representatives of professional societies whose members care for pregnant and laboring women, we agree that patient-centered and safe care of the mother and child enhance quality and is our primary priority. Optimal maternal health outcomes can best be achieved in an atmosphere of effective communication, shared decision-making, and teamwork, and data-driven quality improvement initiatives. “Patient-centered” means that health care providers, and the system they practice within, accept that the values, culture, choices, and preferences of a woman and her family are relevant within the context of promoting optimal health outcomes. The overarching principles involved include treating all childbearing women with kindness, respect, dignity, and cultural sensitivity, throughout their maternity care experiences. Patient-centered care is enhanced when women are provided supportive resources such as education and skilled attendants. Specifically, patient-centered care requires the balance between maternal-child safety and well being with the woman’s needs and desires. CommunicationThe childbirth experience is dynamic and includes not only the woman and her family, but a host of other members of the health care team. Effective communication between the caregiver and the laboring woman and her family, as well as among the members of the care team, is critical to ensuring safety. Each team member should possess the skills necessary to promote effective communication, and should be aware of the concepts and skills involved in leadership, situational awareness, and mutual support. Attention to language, communication, and care practices can create a climate of confidence as well as enhance the women’s child-bearing experience. Effective communication is patient-centered, timely, direct, and specific, and occurs between the woman, her family, and members of the care team. Body language, non-verbal cues, courtesy, and prior experiences with team members can all strongly affect the content and effectiveness of any communication. A number of factors influence communication:
Structured systems may help to optimize communication about and response to rapid changes in
Shared Decision-MakingPatient-centered care recognizes that each woman brings unique knowledge regarding herself and her body to pregnancy, labor, birth, and mothering. Shared decision making, a process by which a woman and her care team interact as partners to make decisions that are
fully informed, based on the best TeamworkHighly reliable teams reduce the number of clinical errors, improve outcomes, and enhance satisfaction. Interdisciplinary team training is one strategy for improving perinatal care since highly performing teams are better able to address patient-centered maternity care needs. A team of experts does not necessarily make an expert team. Since obstetric teams typically assemble using available personnel, forming teams with consistent membership is improbable; thus, it is important for all team members to clearly understand their roles and responsibilities even when an ad hoc team is formed. Perinatal care team training incorporates the important aspects of highly functioning teams: team leadership, mutual performance monitoring, mutual support, effective communication, respect for the input of all members, adaptability, and avoidance of hierarchy. Highly effective teams demonstrate the following behaviors:
Quality MeasurementMaternity care process and outcomes data should be tracked, benchmarked, and used for quality improvement purposes. Some maternity care performance measures have been endorsed by nationally recognized organizations. Additional performance measures may need to be developed and incorporated into ongoing quality improvement efforts that support patient safety goals. A culture of improvement requires a continuous process for measuring, improving, evaluating, and repeating the process as often as needed until the desired outcomes are achieved. Process and outcome measurement serve as the foundation to these improvement processes that enable organizations to assess their own performance, as well as compare it to those of other comparable facilities. Using evidence-based protocols, reminders, and checklists can facilitate standardized care processes that can improve outcomes. ConclusionWe believe that mutual respect, patient-centered care, and shared decision-making are essential for providing quality obstetric care. Improving safety also requires teamwork and effective communication at multiple levels within the organization. The goal is to improve outcomes and satisfaction by working together. The following are specific recommendations for health care providers and administrators are:
Statement Endorsed by: American Academy of Family Physicians December 1, 2011 What interventions does the nurse perform to provide emotional support?Starting a conversation, listening to patients and understanding their personal values assists the nurse in providing emotional support. Some topics and concerns that come up during discussions with patients and their friends and family will be outside the scope of your work.
What interventions does the nurse perform to provide a relaxed environment for labor?A relaxed environment for labor is created by controlling sensory stimuli (e.g., light, noise, temperature) and reducing interruptions. Nurses should remain calm and unhurried in their approach and sit rather than stand at the bedside whenever possible (Creehan, 2008).
Which effect can increased fear and anxiety during labor have on the patient?If there is fear, anxiety, lack of privacy or a feeling of being unsafe, the body can close or stall rather than opening and progressing.
What intervention does the nurse provide to prevent respiratory alkalosis in the patient with hyperventilation?During acute episodes of hyperventilation caused by panic or anxiety, instruct the patient to breathe into a paper bag. This simple yet effective strategy allows the patient to breathe the exhaled air back into the lungs and restore normal levels of carbon dioxide.
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