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Discuss how your thesis relates to ALL NINE of the AACN MSN Essentials, using correct scholarly writing in APA style.

Solution

MSN Essentials

The anticipated outcome of pregnancy and childbirth is that both the baby and the mother are released from the maternity unit without obstetric complications. To exacerbate the adverse health and patient outcomes, over 300 000 maternal fatalities happen where more than 99% of them occur in developing countries (WHO, 2019). Postpartum hemorrhage (PPH) is the number one leading cause of maternal death, whether it is in developing or developed countries. This continues to happen against a backdrop of the steady decline of maternal mortality rates in developed countries even though PPH remains a significant cause of maternal morbidity and mortality within the US. Statistics indicate that as high as 8% of maternal deaths in the US were attributable to PPH. In contrast, the globally maternal death rate is directly related to pregnancy, and the delivery unit process is approximately 7 -10 women per 100 000 live births. The WHO (2019) is quick to point out that 5% of all deliveries are affected globally, yet more than half of the PPH related can be prevented. Most importantly, the majority of the PPH related fatalities happen within four hours after delivery, implying that they mainly occur due to mismanaged third stage labor. To prevent PPH, timely diagnosis, and adequate management of third stage labor are paramount. Therefore, this essay explores how simulation teaching of PPH and quantitative blood loss measures on quality of service in level three nursing students relates to all nine AACN MSN essentials since nursing education plays a crucial role in prevention measures.

The Nine AACN MSN Essentials

Nursing scholars acknowledge the fact that the Essentials of Masters Education in Nursing mirror the nursing profession’s call for the nurse of the 2020s and beyond to be equipped with graduate educate education that is imaginative, transformative, and evolutionary in its thinking approach. The MSN prepared nurse must have a solid background for practice from either sciences or humanities in the wake of an unprecedented explosion of knowledge, increasing diversity, and ever-expanding technologies in health and medical practice (Bastable, 2017). The nurse with a Master’s education displays flexible organizational and systems leadership. They endeavor to continuously improve quality and patient safety as the three leading essentials of MSN education. As the MSN-prepared nurses continue to lead change and promote health, they create a synergy within all the nine essentials, including the three includes mentioned above. However, they are not limited to translating and integrating nursing scholarship evidence into clinical practice to embrace Master’s level Nursing practice to the current and those aspiring to join nursing in the future. The subsections that follow examine how each of the nine AACN Essentials enhances PPH’s prevention and management.

Essential I: Background for Practice from Sciences and Humanities

Those aspiring to be advanced practice nurses have a background in sciences and humanities because nursing is fundamentally based on scientific principles that need to be utilized using a humane approach. For example, PPH described as the loss of more than 500ml after a vaginal delivery or 1000 ml in a caesarian delivery case, has been found challenging in the primary care setting where the obstetric physician usually underestimates the quantity of blood lost. While this definition rhymes with the set PPH WHO guidelines, the science-focused nurse will include the related signs and symptoms like low oxygen saturation, hypotension, tachycardia, and oliguria, all being signs that point towards hypovolemia. The nurse in the specific context would then be on the lookout for primary PPH within 24 hours after delivery or delayed/ secondary PPH from day 1 of the delivery up to 12 weeks. Solid background in the Humanities means the nurse will be equipped with the appropriate knowledge and skills to meet the specific patient needs, thus improving the patient and health outcomes. The nurse practitioner who is conversant with the two will find it easy to employ transformative leadership skills that come in handy in line with the second essential, focusing on organizational and systems leadership.

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Essential II: Organizational and Systems Leadership

Since expectant and delivering mothers visit all levels of healthcare from home-based care that excludes any form of midwifery intervention where the dominating cadre of healthcare providers are the community reproductive healthcare workers referral hospitals where obstetricians are required to manage the arising complications, leadership holds the key(De Young & De Young, 2009). At the lowest level, the community reproductive health workers do impart reproductive health education, promote health, and point out the danger signs that call for immediate referrals. Organizational and systems leadership is also needed for community midwives who attend to home-based management of uncomplicated pregnancies, childbirth together with postnatal care. Though home-based, it embraces effective leadership is needed at this level of primary care for prompt identification and referrals of the mothers and the newborns together with family planning options. The third cadre is midwives who require competencies to manage uncomplicated pregnancies at the primary health care facility and attend to the woman’s needs at childbirth and postnatal care, which addresses the emerging issues. Above the midwives are the qualified obstetricians who are mainly found in secondary and tertiary levels of care whose organizational and system leadership competencies are equal to address complicated issues surrounding the child delivery process. Effective leadership is instrumental in preventing and managing PPH through policy and planning, education, training, and staff development in order for the nurses involved to be able to deploy and utilize their skill mix and competencies.

The critical product of leadership at the organization and healthcare system level is that healthcare professionals adhere to the laid down regulations and make appropriate evidence-based decisions. It may suffice to say that organizational and system leadership essential seamlessly ties to the third one, which is quality improvement and safety in promoting measures and strategies whose implementation would result in decreased maternal mortality attributed to PPH through prevention and proper management.

Essential III: Quality Improvement and Safety

With a background in sciences and humanities coupled with effective organizational and systems leadership enhancing PPH prevention and management, a nurse who promotes a safety culture ensures that each team member of the healthcare team speaks up in safety concerns. Traditional midwifery was laden with a power hierarchy, which inhibited some healthcare team members and contributed to the inexperienced nurses from speaking up about the safety concerns they recognized. According to Keating & DeBoor (2017), nursing education evaluation would demonstrate these improvements’ trends. Be that as it may, the MSN-prepared nurse is currently equipped with adequate skills to articulate using various methods, tools, and performance measures specific to their organization and the working environment in which they operate in. Most importantly, utilizing a quality improvement approach guided by the best available evidence helps the nurse develop a plan to collect PPH data while simultaneously evaluating the plan’s efficacy solely on the process and outcome information. AS such initiatives in quality improvement and their implementation the=rough effective team effort result in imminent recognition of PPH where prompt interventions are operationalized to reduce PPH and its associated complications, some of which lead to death.

Essential IV: Translating and Integrating Scholarship into Practice

The fourth essential means the MSN prepared nurse is at a vantage point in applying research outcomes within their respective practice settings to resolve the attendant practice problems, act as change changes, and disseminate results to the nursing fraternity. One the obstetric nurse, translation, and integration of nursing scholarship into nursing practice implies the nurse is equipped with the right skills whose critical and creative application means the patient gets customized care according to their distinct and unique needs. Literature indicates insufficient implementation of the recommended guidelines for labor management in nursing (Than et al., 2017). Subsequently, it is essential to note that once obstetric nurses adopt and implement the recommended PPH guidelines, this leads to its prevention and management, leading to decreased rates and incidence.

Essential V: Informatics and Healthcare Technologies

Even in low resources care settings like in the remote parts of rural America and the urban neighborhoods inhabited by low-income individuals, these and other measures should be given top priority in developing curriculum in nursing education (Iwasiw & Goldenberg, 2014). The use of promising innovations offers a credible solution to the challenge of PPH for mothers who need them most. Health informatics and emerging cutting edge technologies are rapidly transforming health care where robotic arms are used to perform surgery and Nanorobots that deliver drugs through the bloodstream. Likewise, the use of Tranexamic acid (TXA) has become an emergency obstetric care mainstay. Being an antifibrinolytic agent which differs from conventional PPH drugs that are mainly uterotonics. Unlike oxytocin, which works by helping the uterine contract, TXA works by decreasing blood clots’ breakdown, making it an ideal medication to be used within three hours of birth.

Another health care technology that has proven effective in lowering PPH is the uterine balloon tamponade (UBT). The said medical device manages PPH cases that do not respond to uterotonics and other primary management approaches or, better still, where other treatments are unavailable. In UBT, a professional inserts a balloon into the uterine cavity that, upon inflation, achieves a tamponade effect, thus putting pressure on the uterine wall to stem the bleeding. The device, though, does not come cheap with a price of $400 or more, necessitating researchers to come with more cost-effective devices. The initial responsibility towards this path begins with the nurse educator (Bradshaw & Hultquist, 2016). Nursing competencies in health informatics and health technologies means that the MSN prepared can identify the primary PPH causes like atonic uterus, birth canal trauma, defects in clotting, and uterine inversion. Intrapartum risk factors predisposing a woman to PPH include but are not limited to induction of labor augmentation by oxytocin, rapid or extended labor, instrumental labor, and caesarian section delivery. Health informatics empowers the obstetric nurse to bear in mind that even without\t those risk factors can develop or even more dangerously conceal their bleeding internally. This rationale is what guides the MSN –prepared nurse to regard every woman to be at risk.

MSN Essentials Related to Simulation Teaching Post-Partum Hemorrhage (PPH)

Similarly, active management of third stage labor goes a long way in preventing PPH. These measures include actions to deliver the placenta, use uterotonic medication within sixty seconds of delivery, and controlled cord traction. Studies indicate that these measures can prevent maternal blood loss by up to 66% when juxtaposed to expectant or physiological management (Nsangamay & Mash, 2019). Besides the savings in healthcare costs, the increased shared knowledge and enhanced use of patient care technologies enhance communication, and care coordination is where the transition from one care setting to another happens.

Essential VI: Health Policy and Advocacy

Like the other five essentials, the essential on health policy and advocacy acknowledges that the advanced practice nurse, regardless of their speciality area, should have the ability to intervene at the healthcare system level by engaging in health policy formulation and advocacy. In playing their role as advocates, nurses have to engage in advocacy, which is passing information or influencing leadership, making health policies, and prioritizing issues. As the advocate nurses marshal their strong, compelling, and evidence-based messages, they seek to persuade the decision-makers to adopt specific interventions over others to prevent and manage PPH. For example, in an advocacy campaign promoting the use of Misoprostol to prevent PPH, the critical advocacy messages would begin by underpinning the fact that PPH is the leading cause of death that is both treatable and preventable. The second message would be that every woman needs to access a uterotonic to prevent and treat PPH, followed by another that Misoprostol is as safe as it is effective besides being a practical use at home and healthcare facilities. The MSN prepared nurse should engage in advocacy premised on scientific evidence. Considering a significant segment of the US population lives in resource-poor- settings, the local, state, and federal governments should opt for cost-effective interventions that have been proven to reduce PPH rates and incidences.

Essential VII: Interprofessional Collaboration for Improving Patient and Population Health Outcomes

According to Fogenberg et al. (2017), inequity within the context of access to skilled birth healthcare services is a global issue where more than three-quarters of pregnant women globally have access to about 42% of the world’s midwives, nurses, and doctors. In low socio-economic neighborhoods in the US, this is likely to be replicated, thus underscoring why interprofessional collaboration is paramount. The US obstetricians should implement measures proven in third world countries, like multi-professional simulation training on PPH that have proved effective in managing PPH. Since healthcare professional receives training on different aspects of healthcare in their respective disciplines training in teams, skills training and real-life repeated scenarios offer a reflective approach to managing human error (Egenberg et al., 2017). It is essential to acknowledge that the MSN prepared nurse can appropriately and effectively lead an interprofessional team and, in consultation with other healthcare professionals, offer coordinated care to reduce the PPH rates in US healthcare facilities significantly. Successful interprofessional collaboration would further reinforce the eighth essential, which focuses on clinical prevention and population health for improving health. The subsection that follows delves into elaborate details on how this becomes manifest in the MSN prepared nurse.

Essential VIII: Clinical Prevention and Population Health for Improving Health

Successful completion of the MSN degree means that nurses who specialize in obstetrics and postpartum issues are urged to immediately call for clinical and medical assistance when they realize a clinical complication like PPH, their position within the unit notwithstanding (Finlayson et al., 2019). This is because a nurse’s brief in the maternity wing is that each one should take clinical responsibility for every postpartum patient in a timely way. Once every nurse accepts this professional mandate, the MSN level graduate will impart their clinical knowledge and the best practices to improve health among women at childbirth and their newborns. Having acquired advanced knowledge, these nurses skilled in obstetrics and postpartum issues devise clinical interventions that significantly reduce PPH rates.

Essential IX: Master’s-Level Nursing Practice

As the ninth and the last of the essentials to be discussed how it related to my thesis on PPH prevention and management, one should remember that each of the other eight essentials has a substantive element of the MSN – level nursing practice. According to NLNCGC (2005), the widening scope of nursing practice should hasten to incorporate the nurse educator’s emerging roles. Through this essential, nursing practice describes MSN level nursing practice as any intervention the impacts the healthcare outcomes of the individual, populations, or healthcare systems. Its specific component is that the nurse of MSN level extensively and intensively understands nursing and related sciences with a capacity to integrate the same knowledge into practice (Andrade et al., 2019). At the MSN level, the nurse considers maternal mortality as the death of a woman during her pregnancy within six weeks of the pregnancy’s termination regardless of its duration and that pregnancy’s site emanating from or aggravated by either the pregnancy or its management where PPH is recognized as a leading cause. Guided by this, the MSN nurse endeavors to meet all the nine essentials in promoting the mother’s health and her newborn through effective management and PPH prevention.

Conclusion

In conclusion, this essay has established that PPH-related maternal fatalities pose a significant healthcare challenge in the US and across the world. Therefore, nurses need to gain, practical skills and theoretical knowledge on how to prevent and manage PPH effectively. In the prevention and management of PPH, the nine essentials help the MSN understand its pathophysiology, the risk factors, and active or expectant management of PPH. The essay has also reiterated the pharmacological interventions available in treating, managing, and preventing PPH like oxytocin, TXA, and Misoprostol. Methylergonovine and carboprost, those not discussed, constitute these measures. As an MSN prepared nurse, the practitioner should focus on new areas of their capabilities even as one continues to reflect on the need to respond and adapt to the dynamic healthcare environment that defines the 2020s and beyond the nursing profession

References

Andrade, P. D. O. N., Oliveira, S. C. D., Morais, S. C. R. V., Guedes, T. G., Melo, G. P. D., & Linhares, F. M. P. (2019). Validation of a clinical simulation setting in the management of postpartum haemorrhage. Revista brasileira de enfermagem, 72(3), 624-631.

Bastable, S. B. (2017). Nurse as educator: Principles of teaching and learning for nursing practice. Jones & Bartlett Learning.

Billings, D. M., & Halstead, J. A. (2009). Teaching in nursing. A guide for faculty.

Bradshaw, M. J., & Hultquist, B. L. (2016). Innovative teaching strategies in nursing and related health professions. Jones & Bartlett Learning.

DeYoung, S., & DeYoung, S. (2009). Teaching strategies for nurse educators (pp. 151-155). New York, NY: Prentice-Hall.

Egenberg, S., Karlsen, B., Massay, D., Kimaro, H., & Bru, L. E. (2017). “No patient should die of PPH just for the lack of training!” Experiences from multi-professional simulation training on postpartum hemorrhage in northern Tanzania: a qualitative study. BMC medical education, 17(1), 119.

Finlayson, K., Downe, S., Vogel, J. P., & Oladapo, O. T. (2019). What matters to women and healthcare providers with interventions for preventing postpartum hemorrhage: a systematic qualitative review. PloS one, 14(5), e0215919.

Iwasiw, C. L., & Goldenberg, D. (2014). Curriculum development in nursing education. Jones & Bartlett Publishers.

Keating, S. B., & DeBoor, S. S. (Eds.). (2017). Curriculum development and evaluation in nursing education. Springer Publishing Company.

National League for Nursing Certification Governance Committee. (2005). The scope of practice for academic nurse educators. New York: National League for Nursing.

Than, K. K., Mohamed, Y., Oliver, V., Myint, T., La, T., Beeson, J. G., & Luchters, S. (2017). Prevention of postpartum haemorrhage by community-based auxiliary midwives in hard-to-reach areas of Myanmar: a qualitative inquiry into acceptability and feasibility of task shifting. BMC Pregnancy and Childbirth, 17(1), 1-10.

World Health Organization WHO (2019). Maternal Mortality. URL:https://www.who.int/news-room/fact-sheets/detail/maternal-mortality

Question – MSN Essentials