Plz help!What can nurses do to directly improve pt outcomes?

[obizyanka]

Hello fellow OB nurses. I'm and RN who is now doing a BSN program. I'm a bit stuck on my latest assignment. I'm new to OB (3months) and the assignment deals with the workplace. I'd love any advice that I can get and ASAP, thanks!

So my question will be the basis for a peer review article search and later research and a paper that I will write, but I need to be sent in the right direction to get me started.

THE QUESTION - ID a clinical problem in the workplace that would be under a nurses control. Develop an appropriate research Q. It should be something that improves pt outcomes.

What problems do you see in the workplace? Everything I can think of is not directly under the nurses control, such as shortages of lansinoh, or vaccine refusals, or moms that give up on breastfeeding.

I was leaning in the direction of breastfeeding - buuut no matter how persuasive I can be, if the mom wont do it, she wont do it, more walks or frequent fundus checks?....foleys, pericare, UTI seems so overdone .....perhaps something in the nursery? I was thinking sweeties (sugar syrup) but technically its a med and not really a nurse control issue. Stressing that they leave nothing in the crib/ dont sleep with baby (we have had 5 infants deaths by smothering so far this year in my county) - can stress ut cant control what they do at home .....

Please share your thoughts and help!!!!

[FLOBRN]

Truly labor your patient at the BEDSIDE. Don't chart at the desk. Palpate contractions. Be hands ON. The monitor is a guide not the be alll and end all. If you want to try and decrease the epidural rate, then use positioning, get the patient out of bed onto the ball, doing slow dancing etc.

I often think the Mom gets lost in the all consuming computer work. I read awhile back that computer charting does take longer.

[obizyanka]

Thanks for the suggestion. I have been working in the nursery mostly lately, so i went with a newborn topic. I have not been oriented to L&D yet, (wil after new year) but I completely agree with you. I like a more hands on and natural approach to laboring.

[llg, PhD, RN]

What kinds of outcomes does your unit measure? (Patient satisfaction, infection rate, baby temperatures, baby blood glucose levels, etc.) Sometimes, looking at what is currently being measured or recorded can help you identify something that could be improved. For example, could you improve your newborn thermoregulation measures ... or incidence of newborn hypoglycemia? Could you improve your patient satisfaction scores? etc.

[obizyanka]

The topic/ question for research that I finally decided on is (How) can nurses influence proper positioning of infants to decrease the infant mortality rate? This question was selected because I am an OB nurse. In the county were I work and live, there have been five newborn deaths since the start of the year. It is possible that these deaths could have been avoided if nurses were better role models and were more adamant about educating parents to position their newborns on their backs. All nurses that I work with are not as good of educators as others. Some have poor practice habits themselves, such as laying the infant on belly, side, or propping with blankets in the crib. New parents can observe and copy these deadly habits.

Do you guys think this question is phrased properly?

Thanks for your input!

[suern2b]

How about something dealing with skin to skin time at birth? We have started a skin to skin in the OR for sections and that has been very successful. I believe it was just presented at AWHONN.

[obizyanka]

Sue, that would be interesting to learn more about, sounds like a great idea....however for this post, i already submitted my assignment...but thank you anyway :)

[llg, PhD, RN]

That sounds like a good start. Identify a problem, then develop strategies to improve the outcomes.

Good luck to you.