Discovery
The topic and the nursing practice issue related to this topic
Ann is a nurse, and she has identified obstetric fistula cases within her maternity department that she would like to address to ensure mothers’ well-being. Most of the issues are from her unit, which has triggered her to try and understand what was really happening. As a committed nurse in her profession, Ann decides to investigate what could be the cause of the rising cases.
The rationale for the topic selection and the scope of the issue or problem
Ann was not certain about the cause of the obstetric fistula, but she suspects it could be a result of the midwives’ negligence, prolonged labor, or the presence of a skilled birth attendant. She intends to go through the unit data and also consider any other relevant information within the unit.
Summary
The practice problem and the PICOT question
From the data, Ann found out that most of the mothers with obstetric fistula had prolonged labor, and they were not attended to on time. Ann thinks that the mothers were not closely monitored during the labor period and were not also attended to on time while giving birth. She decides to use the PICOT format to elaborate on what she intends to summarize and plan as follows:
- P= Mother who began labor and gave birth within the hospital’s maternity
- I= Develop and implement a strict policy about the attention that needs to be given to pregnant women in the maternity
- C= The Comparison between mothers who were closely monitored during labor and attended and immediately attended to while giving birth
- O= The anticipated outcome would be to reduce the number of new obstetric fistula cases
- T= The timeframe would be 12 months of the trial period
The systematic review chose from the CCN Library databases
A case–control study of the risk factors for obstetric fistula in Tigray, Ethiopia.
Lewis Wall, L., Belay, S., Haregot, T., Dukes, J., Berhan, E., & Abreha, M. (2017). A case–control study of the risk factors for obstetric fistula in Tigray, Ethiopia. International Urogynecology Journal, 28(12), 1817-1824.
Other sources used for data and information
The teenage pregnancy on obstetric fistula among women in fistula center at Malalai Hospital, Kabul Afghanistan: a cross-sectional study.
Mahbooba, S., Saiqal, O., & Salih, M. (2021). The teenage pregnancy on obstetric fistula among women in fistula center at Malalai Hospital, Kabul Afghanistan: A cross-sectional study. Technium Soc. Sci. J., 20, 953.
The main findings from the systematic review and the strength of the evidence
Obstetric fistula is a complication of childbirth due to labor obstruction and failure of prompt delivery. Most fistula cases, in general, are largely contributed by poor or no attendance at antenatal clinics; this is where expectant mothers miss vital information about healthy pregnancy and delivery. This complication also affects teenage mothers who either got married pregnant or married at a tender age. The complication happens due to a lack of attention from a skilled birth attendant or a visit to a health facility for delivery.
Evidence-based solutions for the trial project
The prevalence of and risk of developing obstetric fistula are highly associated with few or no antenatal visits, prolonged labor, delayed intervention during labor and delivery, and delay in accessing emergency obstetric care. Community health workers should be trained to facilitate the timely detection and referral of women with the potential risk of obstetric fistula (Swain et al., 2020). This will be a great boost to the fight against obstetric fistula. The age for marriage should be enshrined in the constitution to prevent early marriages and, thus pregnancies which put young women at potential risk of developing obstetric fistula (Amodu et al., 2018). Government should also develop policies that enable women to access quality maternal care services with a sufficient number of nurses and midwives.
Translation
Care standards, practice guidelines, or protocols to support the intervention planning
A maternity change process should be developed to provide proper but strict guidelines regarding the handling of pregnant women. This will ensure all women in labor are closely observed, and in case of any emergency, they should be attended to or referred immediately. The change process will also ensure that delivery women are attended to prevent any complications associated with delayed delivery promptly.
The stakeholders and their roles and responsibilities in the change process
- Unit Manager – The Unit Manager oversees the implementation of the new change process.
- Associate Unit Manager – The Associate Unit Manager assists and acts and steps in during the Unit Manager’s absence.
- Ann and other Enrolled Nurses – Implement the new change process and report any challenges arising to their seniors.
The nursing role in the change process
Since Ann initiated the whole change process and became instrumental in developing the new change process, she will be a consultant to her team and report back to her seniors besides her routine duties.
The stakeholders by position titles
Unit Manager, Pharmacist, Nutritionist, Gynecologist, Pediatricians, and Psychiatrists are very critical members of the term required to ensure the well-being of the mother and the baby.
Type of cost analysis needed prior to a trial
Cost-effectiveness analysis will be required to assess whether the new change process’s benefit is worth the cost incurred while developing and during implementation. The Unit Manager will be required to table the budget associated with the new change process in her department to the Chief of Finance in the hospital.
Implementation
The process for gaining permission to plan and begin a trial
Once the development of the change process is completed, it is handed over to the unit council for consideration. The chairperson will then forward it to the hospital’s Nursing Council for assessment, and upon approval, it will be forwarded over to the Quality Council for further evaluation. This will be the final authority to approve after checking the quality and viability.
The plan for educating the staff about the change process trial
For the change process to be effective, it requires participation and effort from every member of the maternity unit. Educating the team on what the change process entails and what is expected from them is important during the brief trial period. This will be an opportunity to define the roles and responsibilities of each individual.
The implementation timeline for the change process
The change process is subject to review every 12-months basis to ensure it remains effective and any shortcomings are addressed on time. Ann and the associate unit manager will develop a plan and data to be collected to help in the evaluation.
The measurable outcomes based on the PICOT
The measurable outcome will be reduced cases of obstetric fistula for mothers laboring and giving birth in Ann’s hospital. The outcome will be measured by comparing the number of cases in 12 months before the change process trial to those in 12 months of the trial.
Forms used for recording purposes during the pilot change process
The form should capture details about the duration of labor, giving birth, and respective complications, if any. The data can be used to classify sensitive cases and the average duration for delivery; these give a clue on appropriate actions to take.
Resources available to staff during the change pilot
They will be issued with data recording, assessment and recording materials, and allowance for extra effort during the pilot change process.
Meetings of certain stakeholders throughout the trial
There would be meetings between the Unit Manager and Unit Council regarding the pilot change process.
Evaluation
Reporting the outcomes of the trial
Ann will make a PowerPoint presentation to the Unit Council before handing them copies of the report. The Unit Council will then share copies with the Nursing and Quality Council for scrutiny.
The next steps for the use of the change process information
The information captured in the outcome report will be analyzed to check whether the change process is viable or not. If it is viable, it will be adopted, and if not, it will be disregarded.
References
Swain, D., Parida, S. P., Jena, S. K., Das, M., & Das, H. (2020). Prevalence and risk factors of obstetric fistula: Implementation of a need-based preventive action plan in a South-eastern rural community of India. BMC women’s health, 20(1), 1-10.
Amodu, O. C., Salami, B. O., & Richter, M. S. (2018). Obstetric fistula policy in Nigeria: A critical discourse analysis. BMC pregnancy and childbirth, 18(1), 1-9.