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Patient satisfaction with intrapartum and postpartum nursing care

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par Ngwingmechi MBEINKONG Chwinui
University of Buea, Cameroon - Bachelor in Nursing Sciences (BNS) 2009
  

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C. Nursing role during the postpartum period

After delivery, both the mother and the baby will have health concerns that need to be addressed attentively. Although pregnancy is considered to be wellness oriented, the nurse needs critical thinking skills to provide safe, high quality nursing care [31].

C.1. Immediate postpartum care [23]

The first four hours after delivery is a critical period. Postpartum haemorrhage is most likely to occur. Thus the following should be done [25].

1. Check blood pressure every 15 minutes for 1-2 hours until it is stable, then every 4- 12hours.

2. Check uterine fundus, lochia and episiotomy alongside vital signs.

3. Check signs of haemorrhage.

4. Monitor for bladder distention and record first voiding.

5. Monitor interaction with infant. If signs of bonding are not present, determine possible aetiology: pain, complication, or psychological instability.

6. Relieve discomfort in an oedematous perineum, distended bladder, perineal lacerations, vaginal haematoma, and engorged breasts.

7. Avoid leaving patient alone.

C.2. Subsequent Care [31]

· Provide a quiet and comfortable environment for the mother.

· Check breast, fundus, lochia, stitches if present, bladder, bowels and legs at least once every shift .

C.2.1. Perineal care.

· Teach patient perineal care using a Sitz bath .

· Teach patient how to use perineal pads, anaesthetic sprays or ointments for relief of pain.

· Teach patient how to contract her buttocks when sitting to prevent complications [26]. C.2.2. Voiding

· Check voiding patterns if patient's urethra or bladder is traumatized may be by a fistula, catheterization should be done.

· Teach patient how to void every several hours to keep her bladder empty. C.3. Breast care .

· Assess conditions of patient's breast and nipples for redness, ulcerations and firmness.

· Teach patient how to wash her breasts and nipples with warm water and avoid removing the protective skin oil.

· Teach patient how to wear brassieres or breast binders that provide good support day and night .

· Lactation suppressants may be given to non-breastfeeding mothers.

· Check breasts for signs of engorgement, (swollen, tender, shiny breast tissue) for engorged breasts, use hot compress to improve comfort, express some milk, a mild analgesic to improve comfort.

· Teach patient ideal positioning for breastfeeding.

· Teach patient the importance of breastfeeding, making sure she knows the advantages of effective breastfeeding:

v' It is costless in monetary terms.

v' It is always available.

v' It is rich in immunoglobulins A and hence prevents infections.

v' It contains nutrients in their correct proportions.

v' It is being stored under ideal temperatures.

C.4. Care of baby.

Complete clinical examination of the mother is important in order to know her state.

C.5. Newborn care.

· A newborn physical assessment is done at least three times within the first 12 hours of life.

· Verify notification of baby.

· Thermoregulation may be maintained by skin to skin contact, using a warm blanket and radiant warmer.

· Teach mother about infant stimulation techniques, signs and symptoms in the infant that indicate possible problems, baby's bath and cord care [25].

· The mother's wellbeing is inter-dependent with that of her baby as they adjust to
multiple physical cognitive and psychosocial changes during the puerperium period.

2.2. PATIENT'S PERCEPTION OF NURSING CARE (PATIENT SATISFACTION)

There exist scientific ways of measuring health care quality [34].

These tools have mostly been used by health professionals to review and improve the quality of care they provide.

A reliable indicator is by means of information gotten from the patients or an operational process that is converted into a rate, percentage or time that shows how well providers are taking care of their patients. Quality measures give information about how well providers care for some but not all of their patients. Quality care enhances patient's satisfaction and their use of services.

It is known that the nursing profession has only recently began to look at what the term caring really means [5]. In current care environments, the measurement of patients satisfaction defined by some investigators as patient's perception of quality of care has become important as hospitals compete for patients and struggle to control cost.

Nursing care has been found to be the most important variable influencing overall patient satisfaction. Caring is now viewed as a central component of nursing intervention necessary for cure to take place, the moral and ethical basis of nursing and the essence of nursing [26].

Majority of studies shows that nurses place more emphasis on task dimensions than the affective dimensions. Patients value the affective dimension and want nurses to be kind, friendly, considerate, careful and gentle as well as provide proficient and timely technical skills [33]. Several patient characteristics influence perception of care: age, gender and degree of pain. Male patients focus on physical aspects of care and female patient focus on emotional aspects. Patients in pain need more care [5].

The determination of nursing care effectiveness in improving client outcomes is accompanied through outcome measures [26]. Health care consumers are well able to define the quality of care they receive. The increased emphases on quality improvement in health care agencies bring with it the recognitions that quality is a dynamic costumer perception. Dissatisfaction results when customer expectations are not met.

It is known that patients perceived different levels in terms of quality of care [34]. The quality depends on certain contextual intervening conditions pertaining to the broader environments, perception may thus be considered from four dimensions:

v' The medical technical competence of the caregiver,

v' The physical-technical conditions of the care organizations,

v' The degree of identity-orientation in attitudes and

v' Actions of the caregiver and the socio-cultural atmosphere of the care organization. The nurse-patient relationship according to research sets the tone of care experience and has a powerful impact on patient satisfaction. The patients see how the nurses interact based on their observations. In addition, nurses' attitudes towards their work, co-workers and organizations affect patient and family judgment

If we want to improve quality of care we provide, we must be able to measure the performance; nevertheless health care providers have limited ability to obtain feedback regarding performance in their daily work due to:

? a lack of information system and lack of agreement on how to measure the quality of care.

v' resistance to raise service standards is understandable when nurses perceive leaders as doing too little to remove obstacles to provide excellent health care services. Broken equipment, linen shortages, short staffing, inadequate support in the phase of disrespectful doctors, all of these and more obstacles cause nurses to say «don't pin patient satisfaction on us, we don't have enough support we need to provide the care we want to provide» [8].

 

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