This article provides a Complete Capstone Project Example.
Postpartum Hemorrhage Education to Nursing Students
Submitted as partial fulfillment of the requirements for
Master of Science in Nursing with specialization in XXXXXXXXXXXXX
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- Chapter 1: Introduction and Purpose. 4
- Chapter 2: Literature Review.. 8
- Chapter 3: Method. 18
- Chapter 4: Findings and Recommendations. 23
- Chapter 5: Conclusion. 27
- References. 29
- Appendix A.. 33
- Appendix B.. 35
Chapter 1: Introduction and Purpose
The capstone investigates how training student nurses on identification, treatment and management of PPH, would help improve their capability in addressing PPH. This chapter presents the background of the capstone, covering the incidence, prevalence and challenges of PPH. The chapter also addresses the significance and purpose of the interventions in clinical settings and within the nursing education continuum.
Post-partum hemorrhage (PPH) occurs in almost 1% to 6% of all childbirths (World Health Organization, 2019). This makes PPH the leading cause of morbidity and mortality in childbirth. Under the effective health care program, the Agency for Healthcare Research and Quality (AHRQ) highlights that mortality associated with PPH could be prevented through prompt recognition and more timely and adequate treatment. Since the occurrence of PPH is rarely associated with identifiable risk factors, preparation, patient education, and management of PPH is critical to the outcomes. A wide range of guidelines provides frameworks on PPH prevention and management that facilitate the identification of PPH, determining the cause, and implementing appropriate interventions based on the etiology (MacDorman, Declercq, Cabral, & Morton, 2016). Reducing the occurrence of PPH is a public health and clinical health issue as it helps improve clinical outcomes while also assisting in mitigating maternal mortality and morbidity.
PPH severity and varied etiology is a significant challenge in treatment and management. Due to the relative infrequency of PPH, student nurses may miss opportunities to practice critical skills and gain knowledge in a supervised learning environment. It is imperative to develop frameworks that improve the competence of nursing students on the management and treatment of PPH (Wormer et al., 2020). The nurses may face a wide range of challenges in managing PPH due to lack of consistent terminology, which delays time diagnosis and the appropriate intervention. Karoshi (2009) noted that the treatment and management of PPH partially relies on having a prepared mind, a complement of trained coworkers, and full access to modern therapies. Moreover, ARHQ also acknowledges that there is a limited understanding of optimal assessment methods to determine the cause of PPH, and in the administration of medications, especially first-line medication(s), and the order in which multiple medications are administered (Sentilhes et al., 2016). The capstone investigated how training student nurses on identification, treatment and management of PPH, would help improve their capability in addressing PPH.
In nursing education, simulation is founded on the cognitive learning theory (CLT), which actively engages students in the learning process. Since each PPH incidence presents diverse challenges, the theoretical model presupposes that the learners maintain flexibility, thinking, organizing, and understanding to facilitate the better provision of care. Hence, the theoretical framework focuses on changing the capacity and capability of the nurses in delivering care and managing PPH. CLT makes learning an inductive process that progresses from the understanding of general concepts to the gradual engagement with complicated and specific details (Farber et al., 2017). The CLT provides a comprehensive framework to guide the simulation-based education on PPH and a rationale for its effective implementation.
The capstone improves the capacity of nursing students to illustrate and reiterate the sequence of care and set up a care plan for women experiencing a PPH. Through the project, the students set up a treatment and care plan that utilizes the unit standard, the stage-oriented management plan for obstetric hemorrhage emergency with accompanying checklists for optimum care (Aliakbari, 2015). The capstone project also ensured that student nurses can approve and justify the list of pharmacological interventions used to treat PPH and specifying the follow-up care the women who experience PPH need (Wormer et al., 2020). Suffice it to say that these implications contribute to knowledge development, inculcation of the relevant skills, and nurturing the right attitudes in this nursing specialty area of practice.
Besides, the capstone also ensured that nursing students can define what post-partum hemorrhage (PPH) is besides cataloging the PPH risk factors. This contributes to developing the clinical ability to assess the risk that every woman in labor and giving birth has the potential risk of experiencing a PPH (Peterson et al., 2019). Through the intervention, the clinical nurses will learn how best to improve the outcomes of at-risk populations at birth. Hence the investigation contributes to better integration of nursing education and community-level health. With the increasing focus on interlinked integrations in different models of care, the capstone equips nurses with the knowledge they require to address community issues.
The project’s outcomes are geared towards enhancing knowledge, understanding, and clinical judgment of nursing students. This will be indicated by the nursing students’ ability to prioritize care during a simulated PPH, promote nursing program learning outcomes of therapeutic intervention, intellectual inquiry and analysis, communication, and collaborative caring (Pacheco, Saade & Hankins, 2019). The capstone provided a higher fidelity simulation experience, utilizing currently owned simulation manikins, with minimal financial impact to ensure practical know-how on managing PPH. Through this, the study develops a framework that can be implemented to improve the capacity of nursing students as well as staff nurses. With the continued focus on quality improvement, the study builds systematic frameworks that ensure PPH is addressed in a standardized approach. The capacity building capstone also facilitates effective prevention of maternal morbidity and mortality caused by post-partum hemorrhage (Gingrey 2020). In particular, the capstone contributes to the interventions on PPH by focusing on unit readiness, recognition and prevention, response, and systems teaching (Wormer et al., 2020). By contributing to the improved competence of student nurses, the project provides a platform to implement current teaching frameworks to facilitate improved quality of maternal care. (Complete Capstone Project Example)
Structured to improve competence of student nurses, the project provides a platform to implement current teaching frameworks to facilitate improved quality of maternal care. The capstone combined training of nursing students on current interventions on PPH with simulation training to enhance the competency of nursing students in handling PPH. The initial training involved a presentation geared to the attainment of set learning outcomes. Simulation allows students to practice low-frequency, high-stakes events such as PPH within an environment of safety. The capstone presupposes that by the end of the detailed presentation, the nursing students can define what postpartum hemorrhage (PPH) is besides cataloging the PPH risk factors. The achievement of this objective will equip the learners with the ability to assess the risk that every woman in labor and giving birth has the potential risk of experiencing a PPH. Secondly, the project illustrated and reiterated the sequence of care and set up a care plan for women experiencing a PPH (Wormer et al., 2020). The student nurses were trained on implementing treatment and care plans that utilized the unit standard, a stage-oriented management plan for obstetric hemorrhage emergency with accompanying checklists for optimum care (Pacheco, Saade, & Hankins, 2019). Furthermore, the project will ensure the student nurses can approve and justify the list of pharmacological interventions used to treat PPH in addition to specifying the follow-up care the women who experience PPH need. Upon completion, the student nurses were tested on their ability to organize a plan, implement, and evaluate measures that prevent postpartum hemorrhage. (Complete Capstone Project Example)
The goal of any birth is to have an outcome that is healthy for both the mother and the child. However, the maternal mortality rate continues to increase not just in the US but worldwide (World Health Organization, 2019). PPH has been identified as a leading cause of maternal morbidity and mortality. Through timely treatment and management of PPH, healthcare professionals can contribute to the reduction of maternal morbidity and mortality (Besaina et al., 2018). The project aimed at decreasing the rate of maternal mortality and morbidity by promoting optimal management and prevention of PPH. The research’s purpose is to investigate the impact of evidence-based training simulation and the use of QBL has on PPH prevention and diagnosis compared to the conventional method of estimate blood loss (EBL). The project is guided by the clinical question: To what degree does simulation education intervention and application of QBL measures influence nurses’ understanding and handling of PPH compared to current knowledge and practices at WMC over four weeks?
In conclusion, the purpose of the capstone project is to equip nursing student with knowledge and evidence on PPH and enhance their ability to develop and implement interventions that reduce maternal mortality and morbidity. Chapter 2 reviews theoretical literature on postpartum hemorrhage to establish a general understanding of the condition and prevalence. Likewise, scholarly data about the various challenges faced in dealing with PPH are reviewed.
Chapter 2: Literature Review
Chapter 2 reviews literature material on postpartum hemorrhage (PPH) was identified and reviewed. The literature reviews section takes a detailed analysis of the different works and studies that have been conducted on postpartum hemorrhage. The purpose of the section is to review theoretical literature on postpartum hemorrhage to establish a general understanding of the condition and prevalence. Likewise, scholarly data about the various challenges faced in dealing with PPH are reviewed. Educating health care workers on PPH preventive and management measures has been highlighted as one of the critical solutions to ending maternal mortality and morbidity associated with the disease. Therefore, the section reviews the cognitive learning theory as the theoretical approach to impart knowledge on learners and the role of education in combating PPH.
The materials were accessed from both online and library databases. In particular, the information was retrieved from nursing databases such as MEDLINE, the Excerpta Medica Database, Nursing Reference Center Plus, Health and Psychosocial Instruments, and ERIC on EBSCOhost. The sources were arrived at using the Boolean search process. The search method uses a logical approach to finding data based on certain keywords and accepted conjunctions such as AND NOT, AND, NOT, and OR. The method was quite effective in lowering the search duration as it provided hints of what was required for the review. The scholarly sources used in this review were selected based on their relevance to postpartum hemorrhage as the issue of interest, regency, reliability, credibility, and impact they have on the understanding of PPH and training outcomes. The literature review’s significance is highlighted in PPH’s discussion, thereby shedding more light on the ideal ways to manage and prevent the condition. Likewise, the review provides a good background on the role of the cognitive learning teaching model and the impact of education on lowering PPH cases in the society. The keywords used in the search included Postpartum hemorrhage, PPH, Cognitive Learning Theory, childbirth complications, postpartum hemorrhage risk factors, postpartum hemorrhage studies, postpartum hemorrhage learning studies, Uterine contraction, Simulation learning and PPH.
The topic of Postpartum hemorrhage (PPT) has slowly gained significance in the medical world. Even though perceived as a less occurring situation, it is the effects associated with the disease that has raised a lot of concern amongst medical practitioners. There is no conclusive definition of PPH as broader aspects are considered to form part of the health complication. Borovac et al. (2018) point out that as of 2015, PPH’s definition failed to include critical components of the disease. He points out that the definition should consist of cardiovascular changes and blood loss in women during childbirth. Newstone (2017) also links PPH with uterine bleeding. However, he states that such bleeding is not familiar with diseases such as fibroids of the uterine walls. Newton specifically focuses on pregnancy-related complications as one of the critical factors that lead to bleeding of the uterine walls.
According to Rong et al. (2017), postpartum hemorrhage refers to excessive bleeding after birth. The definition is further supported by Ononge et al. (2016), who associates PPH with the excessive loss of blood that occurs in women immediately after giving birth. The condition often starts a day after delivery and can continue up to 12 days. While it is common for women to lose blood during childbirth, PPH is signified by an excessive loss that places the mother’s life at risk (Ononge et al. 2016). Women are projected to lose about 500 milliliters of blood during vaginal birth. The quantity of blood lost again increases to 1000 ml in the case of cesarean delivery. PPH is thus said to occur when women continue losing blood beyond the accepted levels. Excessive loss of blood is associated with several health risks. A drop in blood pressure levels is likely to result, thereby leading to shock hence death. Likewise, lack of adequate blood deprives body organs of the much-needed oxygen for respiratory functioning. Excessive loss of blood for long durations thus causes death. (Complete Capstone Project Example)
Postpartum hemorrhage is identified by several symptoms that differentiate it from normal bleeding after birth. Failure for the bleeding to be controlled is one of the clear indications of PPH. Difficulties in controlling the bleeding indicate that mothers are heading towards the excessive loss of blood phase that is the crucial symptom and effect of PPH. Likewise, excessive bleeding is considered as physical evidence in PPH cases. Women suffering from PPH also experience an increase in heart rates. Low blood pressure due to excessive blood loss increases the heart’s intensity to supply blood to the oxygen-deprived organs. Apart from the bleeding, a person might also realize swelling around the vagina. Belfort et al. (2016) point out that apart from the bleeding, it is somehow difficult to identify PPT’s existence accurately. Visits to health care institutions are thus necessary for identifying other internal symptoms, for instance, loss of red blood cell count.
PPH diagnosis entails an investigation of the different symptoms associated with the disease. The diagnosis involves carrying out various measures to determine an individual’s state of health. A person’s blood level is recorded to estimate the quantity lost. Other medical tests for PPOH diagnosis include red cell blood count and blood pressure tests (Snegovskikh et al. 2018).
PPH is linked to different causes. Unusual contraction of the uterus after birth is the primary cause of PPH. It is usual for the uterus to contract after a woman delivers a baby. The uterus’ contraction pushes out the placenta, placing adequate pressure on the blood vessels where it had been attached. However, uterine contractions complications may lead to a lack of inadequate pressure leading to bleeding of the vessels. Likewise, failure to fully eliminate the placenta makes them attached to the uterine walls leading to bleeding at the contact points. Likewise, tears in the uterine blood vessels and the cervix due to birth complications result in bleeding. There are also cases of hidden bleeding in the hematoma. Moreover, PPH can result from placenta and blood clotting complications (Ngwenya, 2016).
Scholars and medical experts have also linked PPH to several risk factors. Women with certain conditions are thus highlighted as having higher chances of suffering from PPH compared to others. Understanding the PPH risk factors is perceived as a positive step in the management and prevention of PPH (Nyfløt, et al. 2017). Women with uterine complications such as uterine atony are depicted as having higher probabilities of PPH suffering during childbirth. Uterine atony is considered the leading cause of PPH (Gill et al., 2020). It occurs when the uterus experiences excess stretching during childbirth, therefore interfering with normal contractions. Abnormal uterine contractions lead to bleeding. Other uterine conditions that pose as PPH risk factors are inversion and rupture. While inversion is the uterus’s inside-out turning, rupture occurs when part of the uterine wall tears during labor (Gilmandyar & Thornburg, 2019). Women with different placenta complications are also at high risk of contracting PPH. Placental abruption, for instance, causes PPH due to the early separation of the placenta from the walls of the uterus. Placenta previa is caused by a low-lying placenta that ends up covering the cervix leading to birth complications. Moreover, women with issues of retained placenta have higher chances of experiencing PPH. The situation occurs when the placenta is not flushed out of the uterus within 30 to 60 minutes after child delivery. The retained portions of the placenta cause bleeding of the uterus. Likewise, the occurrence of different conditions during childbirth increases the chances of suffering from PPH. A C-section and cases of augmented labor are linked to PPH (Claroni et al. 2018). (Complete Capstone Project Example)
Recently, postpartum hemorrhage has attracted a lot of attention due to the increasing number of casualties. According to Borovac et al. (2018), the condition was responsible for the death of slightly above 80,000 women globally in 2015. Likewise, the occurrence of the condition does not affect particular groups. PPH affects both developed and developing nations in equal measures, as seen in its categorization into the top five leading causes of maternal deaths for low and high-income countries. However, the rate of death from PPH is lower in the developed nations (Belfort). The World Health Organization projects that PPH occurs in 1% to 6% of global childbirths. Thus, the high percentage makes PPH the leading cause of maternal deaths globally (Andrikopoulou & D’jAlton, 2019). This is highlighted by PPH accounting for a quarter of global maternal deaths. Closer, PPH is responsible for about 12% of maternal deaths in the United States (Evensen at al. 2017).
The critical intervention to postpartum hemorrhage is the early detection and management of the condition. PPH cases can be minimized through preventive mechanisms. According to Evensen et al. (2017), incidences of PPH occurring can be minimized by active management of pregnancy during the third stage. Active management of the third stage of Labor (AMTSL) is considered the right initiative to lower PPH instances in women at the risk of suffering from PPH. Likewise, efficient diagnosis of the condition and the right treatment procedures are required to prevent it from worsening. Administration of oxytocin after delivery helps in treating uterine atony, thus managing the condition. Management of the state also involves the use of the four mnemonic T’s associated with PPH that is Trauma Tone uterine walls, Tissue of placenta invasion, and Thrombin coagulopathy (Evensen et al. 2017).
The Agency supports the argument that preventive mechanisms best manage postpartum hemorrhage for Health Research and Quality (AHRQ). The agency agrees that early diagnosis and treatment are vital in curbing mortalities associated with the condition. While certain women may showcase risk factors of contracting PPH, health care institutions should be prepared to handle the situation in any case. Part of the reason as to why PPH mortalities occur is because health care workers are less ready to handle such situations. The rare occurrence of PPH complications thus catches them unprepared. Therefore, the adequate intervention of the PPH condition involves having advanced plans to handle the difficulties if they occur. The preparations do not just focus on those who indicate risk factors but on women looking forward to delivering. This is because 20% of PPH cases are linked to people without risk factors (Sentilhes et al. 2016).
Lack of adequate knowledge and preparation is illustrated as a critical challenge to fighting and preventing PPH (Cooper et al. 2019). Healthcare practitioners, such as nurses, have little knowledge of handling PPH cases. The lack of knowledge is caused by the low rate of interaction with the condition. Health care practitioners still grapple with handling PPH cases despite the existence of clear medical procedures on diagnosing and treating the condition. The challenge would continue if health care workers are not enlightened on PPH and how to handle it. The Agency for Health care Research and Quality points out that the management of PPH cases depends on the preparation and education levels that patients and health care staff regarding the condition. Lowering PPH cases is a public health issue that will lead to better health outcomes and a reduction in maternal mortality and morbidity. Extensive education on PPH and its management among nursing staff are one of the critical ways to lower its occurrence, thus boosting public health (Sentilhes et al. 2016).
The cognitive learning model has been highlighted as a critical theory in imparting health care workers with the educational skills necessary to prevent and manage PPH. The theory posits that learners become familiar with different exercises due to their brains’ ability to process the information they encounter during training. Knowledge is considered as something that is continuously constructed from learner’s cognitive structures. Moreover, the cognitive approach to learning focuses on the mental processes that take place in learners. The brain is responsible for taking in information in terms of stimulus, interpreting it, storing, and retrieving when needed. Interaction of the mental processes with learning stimulus eventually leads to knowledge acquisition (Tennyson & Rasch, 1988). Knowledge acquisition thus depends on the mental processes of observation, attention, perception, interpretation, information storage, and retrieval, data classification, and ability to make generalizations from different stimuli. The Cognitive Learning Theory (CLT) effectively facilitates knowledge acquisition due to its inductive nature and understanding of complex concepts and specific details (Farber et al., 2017). Simulation training, a key feature of CLT, allows nursing students to familiarize themselves with PPH situations, thus getting the necessary knowledge to help them handle patients with the complication. Likewise, simulation is considered to raise the confidence level of health care workers when dealing with PPH. The confidence arises from trainees’ belief that they are capable of solving the different PPH complications that they once had little knowledge on before the training (Abisogun, 2019). (Complete Capstone Project Example)
Assessing the existence of PPH is one of the challenges nurses face. A timely diagnosis of PPH is required to help nurses determine the ideal treatment. Measuring the quantity of blood lost by women is considered a perfect option to diagnose PPH (Coviello et al. 2019). Traditionally, healthcare practitioners have relied on the EBL measurement approach, where a visual estimation of the quantity of lost blood is used to determine PPH’s existence. EBL has been linked with diverse inaccuracies making it an effective practice regarding diagnosing PPH (Rothermel & Lipman, 2016). The QBL approach is depicted as the correct approach to assessing blood loss among PPH patients. QBL relies on actual weighing to determine the quantity of blood lost during delivery. QBL requires the integration of different healthcare departments to ensure the administration of quality service care. The multidisciplinary team tasked with using the QBL approach for blood loss assessment put several methods that will aid in the measurement of lost blood. The QBL procedures for measuring the quantity of lost blood are different for vaginal and cesarean births. However, both vaginal and cesarean deliveries rely on the calculation of wet and dry weight. While the dry weight refers to weighing soaking materials such as drapes, the wet measurement is based on the results attained after blood. The equipment is soaked with blood. Differences between the wet and dry weights are then converted into milliliters, where one gram represents a millimeter of lost blood (Daniels, 2020).
Different studies have portrayed QBL as a more effective way of measuring blood loss in PPH patients; established EBL has many blood loss measurement disparities. Compared to QBL, using EBL resulted in underestimating blood loss when the actual volumes were high. Also, EBL was depicted as likely to overestimate the quantity of lost blood in situations that involved high volume (Powell et al. 2020). Better assessment of the PPH condition results in quality outcomes. Obstetric student nurses can effectively determine a patient’s condition through an efficient manner of calculating blood loss. The measures result in better treatment outcomes for PPH patients. Likewise, a study conducted by Hire et al. (2020) illustrated that the use of the EBL approach would have lowered 50% of PPH cases. The findings, therefore, makes it necessary for QBL to be adopted as the ideal assessment measure for PPH cases. While QBL has been portrayed as a more effective way of assessing and determining PPH’s existence, not much exists about its actual effect in reducing maternal deaths. For instance, (Hamm et al. (2017) argue that not many studies have been done to illustrate the effectiveness of the QB and EBL methods in identifying PPH. (Complete Capstone Project Example)
The lack of qualified health care workers in terms of skills required to handle PPH cases is a detrimental factor to the fight against the condition, as pointed out by (Nellisen et al. 2017). In their study, Nellisen et al. (2017) sought to determine the effect of simulation training on PPH in medical practitioners. It was hypothesized that simulation training on obstetric PPH cases would instill health care workers with knowledge on the condition leading to improvement in service delivery and management of PPH. The entailed PPH treatments such as uterine massage after birth, removal of the placenta and oxytocin administration. Likewise, the educational program involved examination of the uterine wall and birth canal to detect any symptoms of PPH conditions. The research findings illustrated significant improvement in the understanding and handling of PPH cases after the training. Simulation-based training on PPH is thus depicted as an ideal method to lower its occurrence.
Improvement in knowledge about PPH was also mirrored in a 2018 study by Powell. The research investigated the role of educational based interventions on lowering PPH cases. The study was guided by frequent inconsistencies in PPH diagnosis methods, thus leading to untimely treatment. Adult learning theory was perceived as crucial in instilling the participants with knowledge about PPH management. A pretest and posttest design was adopted to test participants’ level of understanding after the project. The findings illustrated that educating health care practitioners on PPH results in early diagnosis of the condition by lowering the numerous cases of inconsistencies (Powell, 2018).
In conclusion, training is also illustrated to enhance teamwork among nurses, thus enhancing quality care for PPH patients. Lack of knowledge in PPH exposes nurses to a lot of stress when dealing with the condition. The general effect of working under stress is reduced, thus depicting improvement in the quality of treatment and care for PPH patients. Training nurses on PPH is, therefore, crucial in enlightening them on handling such patients. Likewise, training nurses on PHH informs them of the need for teamwork when handling the cases. Enhanced cooperation while dealing with PHH complications lowers health care perceptions regarding the procedures being stressful. Training nurses on PPH is, therefore, an avenue to make them offer skilled services to mothers during and after childbirth.
Chapter 3: Method
The purpose of the practicum was to equip the student with knowledge and evidence on postpartum hemorrhage and enhance their ability to develop and implement interventions that reduce maternal mortality and morbidity. The project aimed at decreasing the rate of maternal mortality and morbidity by promoting optimal management and prevention of postpartum hemorrhage. This chapter explains the method used to deliver the capstone and the rationale for selecting the methods used. The chapter focuses on the activity used to deliver the capstone, and explores the approaches used to develop and implement the simulation activity. The chapter also explores the test-retest approach used in measuring the effect of the activity.
The capstone project utilized a pre-test, intervention, and post-test design. The pre-test and post-test approach facilitated effective assessment of the participants before and after the implementation of the intervention. The repeated measures approach is adequate in the assessment of change in perspective and attitudes of participants in a study. As such, a positive increase is evident on the better scoring on the post-test compared to the pre-test scores. The capstone’s pretest and posttest (Appendix A) had ten questioned and was structured as a multi-choice survey. The questions ranged from the common cause of PPH, risk factors of PPH, first-line medications for PPH, to the normal blood loss after a CS, the volume of blood loss after a vaginal delivery is considered a PPH and the first nursing intervention for treating a PPH.
The pre-test and posttest approach was paired with purposive sampling where the participants were selected purposefully. The dependent variable was knowledge on the interventions used to identify, treat, and manage PPH, while the independent variable was the simulation training session. By utilizing the design to guide the implementation of the capstone, the project was able to assess specific representatives of the population, who are students, and the immediate assessments of the impact of the intervention on the student’s knowledge and perspective. Furthermore, the selection of the measurement approach was based on the basis that it provided a means for rapid refinement of the instructor teaching or simulation technique. In addition to being a convenient research method, pre-test and post-test design allowed for statistical analysis of data using established statistical methods. (Complete Capstone Project Example)
Simulation Education Training
The pre-test was first administered to the participants, followed by a 20-minute presentation given to 6 groups of 5 students, and finally, a post-test was administered. The intervention used in the capstone was simulation-based education coupled with an instructor led PowerPoint presentation. The simulation approach was selected for its ability to provide real-time scenarios and improve the engagement of the students. The student nurses were able to feel a firm fundus in the simulation lab as well as weigh different chux with bloody substances on them to calculate and quantify blood loss. The simulation education training involved care for a client experiencing post-partum hemorrhage (r/t Uterine Atony), performing nursing interventions for the patient experiencing PPH, providing emotional support to a patient experiencing PPH, and professional communication a PPH.
The participants were expected to complete post-partum assessment, assess if the patient has a PPH, call a code for PPH (Code PPH), perform fundal massage, and perform NI. During a PPH (insert a foley catheter / administer IVF), and provide emotional support. The capstone relied on the facility simulation-lab equipped with all resources to simulate a PPH clinical scenario effectively. Pre-test and the intervention, plus post-intervention for each of the groups, will be achieved over one week. Simulation-based training will follow through the following week, covering all the highlighted areas and coordinated by the nurse educator. The post-test evaluation will be administered at the end of the simulation.
Evaluation played a critical role in determining the effectiveness of the project in attaining its intended objectives. A pre and post-test was developed to evaluate the impact of the education activity. Both tests consisted of the same test items, with the pre-test administered to determine the knowledge of participants on the clinical issue, and the post-test after the education intervention to determine the participant’s knowledge on the same topic. Besides measuring the amount of learning the student nurses got on the specific clinical area, PPH, pre, and post-tests allow for numerical scoring, which provides a quantitative measure for the change. Pre and post-tests also provide comparison data that highlight the areas that were well understood and those that need improvement. The method also assessed the impact of the intervention design and content, necessitating improvements depending on the outcomes of the pre and post-tests.
Working with other nurses helped improve and align the education intervention to attain its intended objectives. Health professionals in the maternal unit informed the intervention of the additional clinical issues related to PPH and on the literature on different interventions addressing PPH. The collaborations ensured that the education intervention effectively addressed PPH and would improve the competence of students in maternal health. Besides, working with staff nurses helped identify and incorporate their perspectives on maternal health, and the areas need emphasis. Besides, two staff nurses were beneficial in the simulation lab as they helped guide the students on the appropriate actions to take when assessing PPH. The contribution of the staff nurses and maternal health professionals was integral to the project. (Complete Capstone Project Example)
In the preparation and development of the education intervention, literature search was conducted on peer-reviewed articles that documented evidence-based practices that addressed PPH. The databases searched include CINAHL, PubMed, MEDLINE, and PsychINFO. The search included seminal, primary, and secondary sources, enabling an extensive understanding of PPH and the clinical issues attributed to maternal mortality and morbidity. I also examined the latest policies on maternal safety and government interventions. The sources underlined the recent advancements in policy and clinical interventions within the maternal continuum and with a specific focus on PPH and maternal safety.
The capstone project utilized a pretest-posttest methodology approach coupled with simulation-lab education training with an instructor led power-point presentation. The participants were selected through purposeful sampling and included student nurses. The capstone offered student nurses an opportunity to have increased knowledge in identifying, treating and managing postpartum hemorrhage. The project significantly improved their practice as it provided insightful information on PPH. Using a pre and post-test approach, the capstone was able to conduct assessments and evaluations on the impact of the project. The findings and recommendations drawn from the implementation and evaluation of the project are discusses comprehensively in chapter four. The chapter offers an in-depth analysis of the results and offers approaches to utilize its significance in practice.
Chapter 4: Findings and Recommendations
Chapter 4 presents the results of the feedback from the evaluation of the intervention’s effect. The chapter examines the intervention’s ability to meet the study’s purpose, which was to equip the learners with the ability to assess the risk that every woman in labor and giving birth has the potential risk of experiencing a PPH as well as illustrate and reiterate the sequence of care and set up a care plan for women experiencing a PPH in a simulation-lab. The chapter analyzes the findings of the capstone project and provides insights and recommendations attained from the project.
The pre-test average was 68%, and the average of the post-test was 86%, a clear indication of the significant impact of the project. The capstone project’s findings illustrate that the nurses became more aware of PPH interventions. The realization is seen in the growth of numbers of participants who pointed out that they had become familiar with PPH interventions after undergoing simulation education. This aligns with the results of Powell’s (2018) findings that simulation education is the right avenue to create awareness on nurses’ PPH best practices. Likewise, the number of participants who strongly agreed to have more understanding of PPH interventions after the simulation exercise from the pre-test score of 68% to 86% in the post-test reveals that the project was successful. The findings reveal that the project met its objective of enhancing an understanding of PPH identification, treatment, and management.
In particular, the simulation education intervention’s impact was seen in the number of people who gained more awareness on using the QBL assessment approach from the pre-test score of 10% to 50% in the post-test. The results reveal the project’s ability to enhance service quality for PPH patients using accurate assessment methods. Besides, the nursing students acknowledged that the simulation exercise imparted them to handle PPH cases, as highlighted by increased knowledge of PPH interventions, understanding, and knowledge. Individual feedback from the participants indicated that they strongly agreed that simulation education had improved the provision of quality services to PPH patients after the training. The findings agree with those of de Melo et al. (2017), who pointed out that simulation education is critical in enhancing healthcare facilities’ quality. Moreover, the findings support the research’s significant quest to improve service delivery by educating the general healthcare practitioners on the profession’s best practices.
Better handling of PPH cases was highlighted by improved knowledge on PPH risk factors, complications, and interventions. During the simulation education training, the student nurses’ understanding of how to conduct QBL also significantly improved their ability to treat and manage PPH on occurrence effectively. While only 54% of the participants could identify the risk factors, first-line medications, and nursing intervention for PPH in the pre-test, the 88% of the student nurses correctly identified PPH treatment and management’s critical indicators post-test. This indicated confidence in handling PPH incidence due to the implementation of the intervention as measured in pre-test and post-test, respectively. The results support Egenberg (2017) findings that revealed quality care in handling PPH patients would improve if healthcare practitioners no longer felt stressed when dealing with the condition. (Complete Capstone Project Example)
Besides, the findings reveal that most of the participants gained knowledge in assessing PPH cases using QBL. A rise in the number of people who strongly agreed to have the capability of using the QBL method to diagnose PPH from 64% in the pre-test to 94% in the post-test supports the project’s objective of enhancing the use of better PPH interventions, especially on the estimation of blood loss methods. The results agree with Coviello et al. (2019) that QBL is a more accurate method of assessing PPH. The findings also indicate that with the knowledge of QBL, the participants could select quantification as the most accurate and useful way of estimating the quantity of blood loss during cases involving colossal blood loss.
The capstone project has proved that educating student nurses on PPH interventions is ideal for improving the competence and utilization of best practices. Using simulation education, the capstone improved the students’ understanding of the use of best quantification practices in PPH, identification of risk factors, knowledge of first-line medication, diagnostic criteria for PPH, and effective treatment and management of PPH. The capstone indicates that presenting QBL has been depicted as a better approach to assess PPH, thereby enhancing the timely diagnosis of the condition and enacting the right procedures to facilitate effective care delivery for pregnant women. Similarly, the findings are crucial in lowering maternal mortality cases that arise for poor handling of PPH cases.
The current project relied on descriptive data from the nurses. Therefore, the student nurses can give biased answers regarding their perceptions of the education intervention and use of the simulation-lab intervention. Therefore, future studies should embrace a design that does not solely rely on participants’ views for data collection. Also, future studies should use a random sampling approach to lower bias. The likelihood of participants being selected in this particular research was high, as seen in 30 student nurses being considered for the sample participants from a population of 50. A random sampling technique will further reduce any instances of bias from the study.
Apart from focusing on future studies, the project’s findings can also improve the quality of service at healthcare facilities. The institutions are likely to enhance service delivery across all departments by using simulation to teach healthcare practitioners the best quality standards to improve service delivery and better patient outcomes. The findings also inform organizations dealing with obstetric patients on the best practices of handling PPH cases, thereby lowering maternal mortality rates as they inform healthcare institutions on training measures and adoption of technologies such as QBL to assess PPH conditions. Lastly, the research is significant to the reduction of PPH cases in medical institutions. It informs health practitioners of the diverse nature of the condition, assessment, and interventions. The knowledge is significant in enhancing nurses’ confidence, thus addressing PPH conditions using standard care services. (Complete Capstone Project Example)
The chapter has discussed the project’s methodology used to answer the clinical question. Likewise, results from the collected data have been analyzed, and their findings are presented. Discussions on the findings have revealed that simulation education is significant in enhancing nurses’ knowledge of PPH, thereby allowing assessment and treatment to manage PPH and lower maternal mortality. Lastly, the chapter has discussed the different recommendations that arise from the study.
Chapter 5: Conclusion
Postpartum hemorrhage (PPH) is considered the leading cause of maternal deaths. The complication is associated with excessive bleeding in women after giving birth. The critical challenge to combating PPH is highlighted to lie in healthcare practitioners and institutions. Despite a massive database on PPH, many healthcare practitioners are depicted as still lacking the skills required to handle the situation. The capstone project, therefore, focused on the impact of educating students on PPH interventions. The clinical question guided the research: “To what degree does simulation education intervention and application of QBL measures influence nurses understanding and handling of PPH compared to current knowledge and practices at WMC over four weeks?” The findings highlighted significant improvements in nurses’ perceptions of PPH. Contrary to the pre-test, the nurses showed a great understanding of PPH interventions, medications, risk factors, and best practices in the treatment and management. Furthermore, education intervention improved student nurses’ capacity, competence, and confidence in managing PPH complications. Positive results were also seen regarding simulation education’s role in imparting nurses with knowledge on managing PPH. Moreover, the nurses indicated that they can now use the QBL method to assess PPH in patients. The use of QBL was further enhanced by findings that portrayed it as more than EBL in measuring blood loss. The findings agree with previous studies that posit that simulation education is a fundamental approach to ending PPH. The intervention improved nurses’ knowledge of the best care standards to use when dealing with PPH patients. Quality in service delivery is seen in the healthcare providers on the use of effective treatment approaches, utilization of best practices in PPH treatment, and improved PPH outcomes. Moreover, quality treatment is seen in the timely assessment of PPH conditions using the QBL, thereby taking the right interventions. On the contrary, the findings are ideal for nursing students in maternal care as it enhances service quality delivery when dealing with PPH treatment, management, and complications. The project’s general significance is seen in its availing viable solutions to combating PPH, thereby lowering maternal mortality that arises from the condition. (Complete Capstone Project Example)
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(Complete Capstone Project Example)
PRE & POST-TEST
1. What is the most common cause of a PostPartum Hemorrhage? (PPH)
a. Cervical laceration
c. Uterine atony
d. Retained placenta
2. Which answer is not a risk factor for a PPH?
a. Over-distended uterus
c. Previous history of a PPH
d. Preterm delivery
3. What is the first line medication for treating a PPH?
4. What is normal blood loss after a cesarean section?
a. 1000 mL
b. 700 mL
c. 1200 mL
d. 900 mL
(Complete Capstone Project Example)
5. What is a symptom of uterine atony?
a. Firm uterus on palpation
b. An unrepaired laceration seen at the perineum
c. Boggy uterus on palpation
d. Retained placental tissue
6. Which item is not a risk factor for a laceration? (which can lead to hemorrhage)
b. Occiput Posterior position – (“sunny side up”)
c. Trial of labor after a cesarean section
d. Operative vaginal delivery
7. What volume of blood loss after a vaginal delivery is considered a PPH?
a. > 200 mL
b. > 300 mL
c. > 500 mL
d. > 450 mL
8. What is the most accurate way to estimate blood loss?
d. Heaviness when picking up pads/chux
9. What is the first nursing intervention for treating a PPH?
a. Pad count
b. Patient teaching
c. Uterine massage
d. Have patient empty their bladder
10. Identify the incorrect signs and symptoms of a patient experiencing a PPH
a. Light-headed, nausea, visual disturbances
b. Increasing pulse and respirations, BP same or lower
c. Unable to walk d. Anxiety, pale/ashen color, clammy skin, excessive bleeding
Capstone Outline is included as a file, Project must reflect Outline/Template completely.
Also included are previous papers written on the project.
The project is on Postpartum Hemorrhage and the importance of Qualitative Blood Loss.