SIVB Learning Sessin 1 Patient and Family Perspectives and their cnnectin t Increasing the Vaginal Birth Rate The Assignment: Patients cme t ur units t deliver their babies with a range f needs, expectatins, knwledge, desires, and fears. Explre hw yu d and shuld respnd t patients wh cme t yu with expectatins that may nt fit the culture f an L&D unit, specifically in terms f the fllwing tpics: Dulas Requests fr Primary Elective C/S (prir t r during labr) Patient Cannt Speak English Birth Plans Nrmal Culture Infrmed cnsent Family invlvement n Labr & Delivery Patients frm cultures different frm yur wn Cnsider the fllwing: Hw can yu incrprate the patient s perspective int yur services? Why is this an imprtant cnsideratin? Hw des it relate t increasing the rate f vaginal birth? Think in terms f these questins: Knwing what yu knw abut hspitals, what wuld yu want if yu were the patient? What wuld yu change abut the way care is prvided n yur unit? Brief summary f grup discussins fllws: Page 1
Dulas: Hw can yur team incrprate the patient s perspective int yur services? We have a ntebk in Labr and Delivery that includes the names and infrmatin (credentials cntact infrmatin) fr all the dulas wh wrk in this area. If a patient shuld request a dula when she cmes t L&D we can give the patient the ntebk and they can cntact a dula t wrk with them. We have a nurse liaisn wh wrks with the dulas. Each dula named in the ntebk has gne thrugh an rientatin with the nurse liaisn which includes the rientatin t the unit (physical layut, rutines, plicies regarding visitatin, FHR mnitring, etc.) The dulas and the nurse liaisn als have grup meetings as needed. When a dula cmes t wrk with a patient n the unit she must register (ntebk at the unit desk), must wear a name tag with name and identifying her as a dula and the DONA dulas wear purple vests. S frm the patient s perspective dulas are available even if they have nt made arrangements prir t birth and they are riented t the unit and knw the rutines. The Patient des feel that a dula is a real supprt t them and can assist them thrugh a shrter, less traumatic labr. Evidence shuld that the dula assistance can decrease pain, length f labr and cesarean sectin rate. Knwing what yu knw abut hspitals, what wuld yu want if yu were a patient?: I wuld want t knw: That dulas are welcmed and their wrk is supprted by the hspital. Hw many supprt persns are allwed fr labr, delivery, c/sectins ne n ne supprt is available frm a nurse r dula- and they are knwledgeable abut and will encurage me t use technique that will help t reduce my pain, will supprt my wishes and advcate frm my birth plan The midwife r MD is pen t fllwing my birth and will discuss plan with me What is availability f epidurals and what is % patients that get epidurals What is hspital % f Cesarean births/vbacs/epidurals Childbirth educatin classes available What are plices n FHR mnitring, IVs, ambulatin, availability f water birth, birth balls, ther equipment Dulas need t knw the answers t all the abve in their rientatin and culd answer these questins prir t delivery. Page 2
What wuld yu change abut the way care is prvided n yur unit? Dulas wuld want t be allwed t accmpany the patient where she is receiving care: OP, C/S prenatal tests. Dulas d nt want t be lked at/cunted as a supprt persn in the visitr number Figure ut a way t individualize number if supprt persns fr labring/delivering patients- prblem patients d nt always knw hw many they want can change mind when in labr and d nt knw hw t cnvey that change. Requests fr Primary Elective C/S (prir t r during labr) One way t incrprate the patient s perspective int ur services is t talk t the patient. When they are admitted, r when they cme t triage (which wuld be even better), we shuld discuss their birth plan with them. Even if they dn t have a frmal birth plan written, all patients have sme idea f what they expect their labr and delivery experience t be like. I think it wuld help t make a pint f talking t them abut this and knw ahead f time what they wuld like r let them knw what is available t them (walking, tubs, birthing ball etc.) If a patient feels mre in cntrl f the situatin and knw they have ther ptins, they may nt be as quick t decide upn an elective C/S. I als think it is imprtant t make sure the patient is making an educated decisin and nt just a decisin. Ideally, this infrmatin and educatin wuld begin in the ffice. Or, at least when the patient is first seen at the hspital. If I were the patient, and culd change smething abut the way care was prvided, I wuld want the nurses and prviders t educate mre. I wuld want them t be mre at the bedside supprting labr and giving encuragement t the patient. Make sure that the patient knws that it wuld be nrmal fr an inductin t take 3 days. I wuld want them t knw that yu have t be in labr befre yu can call it failure t prgress. I wuld want them t knw that pstdates are 41 weeks, nt 39+1. I wuld want the patient t knw that there are ptins fr labr, they dn t have t be induced, and they dn t have t have a C/S just because the physician mentins it. Hw can yur team incrprate the patient s perspective int yur service? Why is this an imprtant cnsideratin? Hw des it relate? Patient educatin in the prenatal setting is an imprtant element in understanding the patient s perspective and shaping her perspective n c-sectins. Giving clear criteria fr when a c-sectin is indicated prenatally, befre labr and during labr can help the patient knw what t expect and anticipate what will happen in the decisin making prcess. Ensuring that the patient understands that having a vaginal delivery is the safest and best fr her and her baby. Develpment f tls t enhance cmmunicatin f these cncepts, including cmplicatins related t a surgical delivery, impact n future pregnancies, and recvery issues can be very effective. Page 3
Nursing educatin n supprting labr and vaginal birth is als key t this issue. Nurses need t be trained n hw t best supprt the patient and family wh desires a surgical delivery befre and during the labr phase. Hw she reacts t and deals with this request will significantly effect hw successful the health care team is at supprting vaginal births. Custmer satisfactin is a fcus f all delivery services and must be cnsidered. A cllabrative team apprach alng with a strng educatinal apprach will allw fr bth the desired excellent patient experience and the intended supprt fr a vaginal delivery. Intrapartum techniques t ease frustratin and fatigue include evaluating pain management, plan f care, address their specific cncerns such as fear, pain, cncern fr pr utcmes, and infant care and bnding etc. Other techniques in apprpriate situatins culd be allwing fr time fr rest, ambulatin, shwer, meals, water therapy, massage, psitining, and ther alternative interventins. Knwing what yu knw abut hspitals, what wuld yu want if yu are a patient? We wuld want a cllabrative medical team f physicians and nurses that listened t ur cncerns and culd think utside the bx fr ways t meet ur desired plan f care while sharing the same gals. Keeping patient safety a pririty and a brad perspective f the impact that plan f care decisins have n the future. We wuld want t be well infrmed f all ptins f the plan f care including the decisin making prcess and reasns certain decisins are made such as when a c-sectin is r is nt necessary. Accessibility f ur care prviders such as anesthesia, primary MD, NICU team, nursing management is imprtant. What wuld yu change abut the way care is prvided n yur unit? We wuld like an enhanced cllabrative apprach t prcesses that already exist. Participate in mck situatinal training fr dealing with difficult patients and unusual requests. Prvide additinal tls and strategies fr educatin and labr care ptins. Prvide imprved prenatal teaching t better infrm ur patients n the impact that c- sectins have n their future health and future pregnancies. I. Patient perspective/intentins Clarify/listen t patient s reasns fr wanting c-sectin; educate abut risks and benefits f vaginal delivery vs. c-sectin; dispel myths. Educatin all thrugh pregnancy (r befre) Stress/clarify utcme desired Imprtant because patients talk t each ther; health f mm and baby may be adversely affected lng-term Hpefully mm chses vaginal birth Respect patient decisin regardless Page 4
II. Practice changes Early educatin t general public as well as patient/family Bargain with patient try this fr and then we ll reassess Educate all patients regardless f parity Tell the why s as well as the what s Educate that c-sectin is majr surgery with risks; may affect bnding, breastfeeding, future delivery ptins Get away frm Burger King baby syndrme all planned, scial event Cncern abut HCAPS if negative, it s OK t be different if yu have the patient s best interests/health care as gal Patient Cannt Speak English Be culturally sensitive t the patient s birth expectatins thrugh hspital apprved interpreter Include family/supprt peple in the plan f care With the interpreter, discuss gals f labr and birth With patient s preferred methd f learning give written materials in preferred language At this facility, an imprtant change wuld be an in-huse Spanish interpreter 24 hurs/7 days a week. Availability f ther language interpreters t cme t the hspital and be at the beside. T increase the rate f vaginal birth, these wuld increase the wman s understanding and participate in the birth prcess, i.e. ut f bed, mving, psitin change frequently. Hw changes culd impact supprt fr vaginal birth: Cmmunicatin! If we can effectively cmmunicate we can imprve pt educatin, we have large percent f nn-english speakers, wuld help us admit apprpriately and nt t early. We d have Hmng patients wh refuse c- sectins even with previa that is a nn English grup that is challenged in ther ways. Knwing what we knw abut hspitals what wuld we want: We wuld want translatrs, we wuld want family with us in labr, we wuld want cnsents in ur language. Page 5
What we wuld change abut ur unit: We wuld have live translatrs rather than phne translatrs. We wuld have assignments changed t have bilingual nurses with patients wh need them Use language line, assessment what are their expectatins? It is imprtant t knw what the patient s expectatins are. It is respecting their rights. Yu knw what the patient s desires are and can advcate fr them, educate if yu knw their expectatins. An in-huse interpreter, care prviders that speak my language, material in my language, educatin prir t admissin Psitin fr emplyee fr secnd language fr interpretatin, increased resurces fr staff. Birth Plans Practively prvide the patients with birth plan templates. Try t accmmdate these plans as lng as safe care can be prvided. If we're nt able t meet certain needs, we must prvide a ratinale. If the prviders and the patient are n the same page regarding the patient's planned birth experience, then everyne is wrking tward the same gal. This will reduce the chance f a deviatin t the plan, i.e.. C/S in sme cases. A hme-like birth with the safety that a hspital birth prvides with yur wishes and desires met if at all pssible. Begin prviding the patients with the birth plan templates. Try t change the culture (nursing and medical) abut the stigma f having a birth plan. Clarify the patient s expectatins (Ex. mecnium spread n baby patient meant vernix spread n baby) Cmprmise n realistic and nn-realistic expectatins Try nt t refer t plicies Cme up with alternatives, dn t say specifically n Early discussin Gives patient sme cntrl, gain trust f prviders because they respect their wishes which in turn decreases sme anxiety Nursing culd be a strnger advcate due t list f patient s expectatins Relinquish sme cntrl frm nursing standard Website with drp-dwn bxes n the facility s webpage t help better facilitate desires fr birth plan at that institutin As the patient, wuld like t wrk in cnjunctin with the prvider n my birth experience Page 6
Encurage flexibility with patient Be respectful f the patient s wishes and be supprtive withut cmprmising care f mm and baby May increase rate f vaginal delivery by mm feeling she has sme cntrl f labr and nt just being treated by a set way f care As a patient, I wuld want educatin. I wuld want the nurse t explain any prs and cns and ffer medically sund advice using prfessinalism. Have all nurses be n the same page and all prviders wrk with the nurses having similar gals Nrmal Culture We will utilize a birth plan in a new way based n the answer t the questin being that ur patients d nt always knw what they want r may nt cmmunicate what they need. Infrmed cnsent Imprtant t understand patient s perspective and ur perspective Why d they have the perspective they have? If patients are better educated abut elective inductin f labr, c-sectin and Pitcin, they wuld be less likely t be induced We shuld have cnsent frms fr inductin f labr and Pitcin Infrmed cnsent shuld ALWAYS be a cnversatin, nt just giving papers t the patient Family invlvement n Labr & Delivery Incrprate patient perspective by asking patient what she prefers all her family r nly the ne she really wants. Smetimes families are supprtive fr vaginal births and smetimes they create dubt and tensin that can lead t a demand fr cesarean. Fr patient safety nly allw ne r tw supprt peple in the rm fr delivery. Better hygiene fr family members wh visit in Labr & Delivery Patients frm cultures different frm yur wn Assessing what cultural expectatins they have surrunding birth Give infrmatin/educatin while respecting cultural nrms Page 7
Increased patient educatin leads t increased patient satisfactin and decreased patient anxiety = better utcmes (fewer c-sectins) Turs t increase trust and build relatinships Increase nursing educatin abut different cultures Cmpetent in-huse interpreters fr predminant language Classes fr nurses Increase respect fr individualized differences, birth plans, etc. What wuld we want? Clear cmmunicatin in language we speak. Be able t have sme cntrl amunt f peple in rm, wh they are, adequate chices. Mre infrmatin and ptins leads t increased patient chice. Respect fr cultural chices incrprated int plan f care. Page 8