الفهرس 
discharge planning processOnly 14 pages are availabe for public view
 |  | from | 112 |  |  |
| | | from | 112 | | |
Abstract
Discharge planning is a routine feature of health care system in many countries. However, the current medical literature provides little scientific evidence to guide discharge planning for most apparently well postpartum mothers. The high cost of hospitalizations, in addition to advancements in technology and medical sciences have abbreviated mothers’ hospitalization periods, thus leading to early discharges. Mother care should continue at the household, which would help to avoid rehospitalizations. This calls for systemized health care facility discharge planning, which would guarantee enhanced explanations for mothers or families.
The postpartum period is the six weeks following the birth of a baby or completion of pregnancy. Research indicates that the lack of effective rituals of reintegration may be a cause of postpartum disorders.
Egypt’s maternal mortality rate of 84 deaths per 100,000 births is relatively high. 49%of deaths occurred during delivery within 24 hrs. The discharge planner in any health care facility should be a nurse. Discharge planning requires a person who is skilled in accurate assessment, is very well organized, has good communication skills, and is aware of community resources. Nurses are well prepared for such roles.
The aim of the present study was to identify the nursing activities in discharge planning in maternity homes affiliated to MCH centers in Alexandria.
The study was conducted in five maternity homes affiliated to MCH centers in Alexandria namely Smouha, Moharam-Bey, El-Gomrok, El-Seouf, and Wadi-El-Kamar. The study included 300 mothers who have birth recently and ready to be discharged from these centers. It also included all nurses (47) working at the selected five maternity homes affiliated to the MCH centers.
Structured questionnaire interview sheet was applied for data collection from nurses working at maternity homes in the five MCH centers. Total nurses’ knowledge score regarding discharge planning process were 120 points from question No (10 to 20). While regarding postpartum discharge plan care were 210 points from question No (23 to 43).
A Structured interview questionnaire sheet for collecting data from women who were recently delivered and ready for discharge. Total mothers’ knowledge score regarding postpartum period were 110 points from questions No (23 to 33).
Regarding the instructions which should be given to the mothers and her family before discharge was counted to be 55 points. We count the instructions given to each mothers from the total instructions to determine the level of the instructions received before the discharge from MCH center.
The SPSS 11.0 statistical soft ware package was used for data entry and analysis.
The study revealed the following results:
A. For nurses sample
• The mean age of nurses was 27.15 years ± 7.67. More than the half (59.6%) of nurses were single and were from health technical institute.
• 46.8% of nurses had <-5 years of experience, (40,4%) of them had one training course in labor and postpartum care, (51.6%) of nurses had the last training course since 1<3 years ago, Nearly two thirds (64.5%) of nurses had their last training course for about 4 months.
Nurses knowledge regarding discharge planning process.
• Nearly two thirds (66%) of the nurses didn’t know the concept of discharge planning. In spite of the Most of them (85.1%) knew the importance of discharge planning for postpartum woman.
• About two thirds (65.9%) of nurses knew that the discharge planning process depends on all the members of health care team as the nurse, physician, and social worker. In addition the majority (95.8%) of them mentioned that the discharge planning team should involve the mother and her family or any other care giver.
• More than half (59.6%) knew the role of the nurse in postpartum discharge planning.
• More than the half (55.3%) of nurses mentioned all the benefits of planning for early discharge for the mothers and her family. A considerable percent (70.9%) of nurses knew the criteria of early discharge.
• Only 29.6% of nurses knew the suitable time of discharge after uncomplicated vaginal delivery.
• Small percent (14.9%) of nurses knew the ideal time for the beginning of discharge planning process.
• More than three fourths (78.7%) of nurses knew that the discharge planning is an individualized plan, formulated according to mothers’ needs.
• More than one third (34.1%) of nurses mentioned how to know the post discharge needs of postpartum mothers.
• 61.7% of nurses knew the barriers to implement discharge plan.
• 46.8% of nurses had high level of knowledge regarding discharge planning.
• The highest mean knowledge of nurses belonged to 25< -30 year old 72.41 ±13.22. There was statistically significant differences nurses mean knowledge score between age groups. (F=2.352, P= .058).
• The highest mean knowledge score of nurses belonged to El-Gomrok 73.87.83±11.7, those had health technical institute (71.13± 11.9), and also had <-1 year of experience in maternity homes (71.78±11.10). It was also for nurses without training (73.89±10.36). The greatest mean knowledge score was (74.26±14.13) for nurses who have been took 4 months training. There was no statistically significant difference among mean scores of all these groups.
Nurse’s knowledge regarding postpartum discharge plan care
• More than one tenth (10.6%) of nurses didn’t know any components of postpartum discharge plan care for continuity of care in postpartum.
• More than the half (59.5%) of nurses mentioned drink warm fluid when after pain occurs. Nearly two thirds (65.9%) of the nurses mentioned walking in home daily as instructions for postpartum activity.
• About two fifths (40.4%) of nurses mentioned sleep as much as possible following the birth as instructions for sleep and rest.
• Nearly the half (44.6%) of nurses didn’t know the normal breast changes, on the other hand (31.9%) of them mentioned the normal lochia changes.
• A considerable percent (80.8%) of nurses mentioned wash the nipples with warm water as instructions for breast care. While nearly one fourth (23.4%) of nurses gave correct complete answers about perineal hygiene, and (78.7%) of them mentioned taking shower daily as instructions for body hygiene.
• The nurses instructions regarding postpartum dangerous signs it were fever, followed by bleeding, foul vaginal discharge, difficulty in urination, and postpartum depression, constituted 82.9%, 78.7%, 44.6%, 6.3%, and 4.2% respectively. Nearly the half (48.9%) of nurses recommended going to the nearest hospital when danger signs occur.
• Nearly two thirds (65.9%) of nurses recommended to putting warm compresses to prevent and manage breast engorgement.
• More than two fifths (44.6%) of nurses mentioned walking daily to prevent thrombophlebitis.
• The most of nurses (89.3%) mentioned eating vegetables and fruit and (91.4%) of them mentioned adequate fluid intake (8-10 cup /day) to prevent constipation.
• 61.7% of nurses recommended avoiding constipation to reduce hemorrhoid.
• Nearly the half (46.8%) of nurses mentioned the healthy food for postpartum woman.
• More than the half (51%) of nurses recommended healthy types of fluids in postpartum period.
• The most (89.4%) of nurses didn’t know anything about pelvic floor exercises.
• Nearly one fourth (23.4%) of nurses didn’t know any information about the resuming of sexual activity after the birth.
• More than the half (57.4%) of nurses mentioned the time for the mothers to come back for check-up after discharge at the end of postpartum period.
• 19.1% of nurses mentioned going to family planning clinic in MCH to select suitable method with the physician, and explained family planning methods advantages and disadvantages.
• Nearly half (49%) of nurses had moderate level of knowledge regarding postpartum discharge plan care, and 15% of nurses had very poor level of knowledge.
• The highest mean affiliated in El-Seouf nurses (51.82±11.99), which their mean knowledge score belonged to secondary school + specialty nurses (52.14±7.07), who’s trained for one month or two weeks (47.86±16.9). However, there was no statistically significant difference between mean scores of all these groups.
• Highest mean knowledge score was (55.17±8.87) for 30- year old nurses. And for (56.24±10.51) nurses married without children. It also was for (50.31±7.88) nurses belonged to 5+ years of experience. On the other hand, there was a statistically significant difference between mean scores of nurses of all these groups.
For mothers’ sample:-
• The modal age group among mothers is 25<30 years old.
• Concerning the socioeconomic level of the mothers 38.7% of them belonged to low middle, followed by 29% belonged to the middle, while 22.7% belonged to high level and 9.7% belonged to low level.
• A considerable percent (71. %) of mothers belonged to fair level of knowledge regarding postpartum period. Only 11% belonged to a good level of knowledge.
• Regarding the source of mother’s knowledge for most of them (94.3%) it was one of family members (her mothers and relatives), for only 11% it was the nurse, and for 19% it was the doctors.
• Concerning the concept of postpartum period, 63% of mothers mentioned that the concept of postpartum period was return of reproductive organ to prepregnant status.
• More than three fourths (78.3%) of mothers considered the duration of the postpartum period ranged from 30 to 40 days.
• More than the half of mothers (51.3%) mentioned the normal changes of lochia were red to brown to yellow white color. While 32.7% mentioned no change, and 10% didn’t know any answer.
• A considerable percent (47.3%) of mothers didn’t know the cause of fever in the postpartum period.
• More than half (55.7%) of mothers didn’t know the cause of foul vaginal discharge, and 39.7% of them revealed the cause to the bad perennial hygiene.
• The most of mothers (90%) considered the participation in home activities after a week from labor as the main activities in postpartum period.
• The majority of mothers (90.3%) mentioned the best sleeping are naps while baby naps. A little percent (4.7%) mentioned sleep as much as possible.
• Regarding the start of sexual relation after labor, 78.3% of mothers mentioned it was after the use of contraceptive method. On the other hand 78% of them mentioned it was at the end of postpartum period, and 10% mentioned when lochia stopped.
• Concerning the taboo food and drinks in this period spicy food, onions and garlic, drinks as tea, coffee, and chocolate, and water were constituted 43.3%, 33.7%, 26.3%, and 6% respectively. About two fifths of mothers (40%) said nothing.
• The mothers mentioned that they received instructions about postpartum care, this are as the following: on physiological changes (33%), on breast care (47,4%), on perineal care (76%), on breast engorgement 31.3%. on prevent the constipation (13.7%), on danger signs (19%), on nutrition (37.3%), on exercises (9%), on sexuality (13.3%), and on family planning (64.7%)
• Only 29.7% of the mothers mentioned that the nurse planned with them about follow-up after discharge. 13.6% of them were advised by nurses’ home visits, 10.3% were advised by follow-up clinic card, and 7.6% were advised by telephone call.
• The highest mean knowledge score (61.30±12.85) belonged to the mothers who attended to Moharam-Bey MCH, On the other hand the lowest (58.04±11.69) one belonged to the mothers attended to Smouha MCH. However there was no statistically significant difference between mean score of the MCH centers. (F=.759, P=.553).
• The greatest mean knowledge score (63.47±11.2) was for 30- year old mothers, whose had university education (64.15±12.28) or mothers had secondary education (62.6±11.26) There was statistically significant mean difference between all these groups. Also it was for mothers belonged to who’s those husbands had university education (63.34±11.87) or had secondary education (60.7±12.65).
• The mean knowledge score of the working mother (64.73±13.3) is higher than not working one (58.78±12.65). There was statistically significant mean difference between mother’s knowledge score of working or not working groups. (T=-2.749, P=0 .006).
• However the mean knowledge score of mothers whose husbands were working (59.42±12.95) was less than those not working (62.86±11.1). There is no statistically significant difference between the mean score of husband working or not working groups. (T=.941, P=.348)
• The mean knowledge score of mothers decreased with the decrease of socioeconomic level, it was (63.30±11.19) for mothers in high socioeconomic level to reach to (52.72±15.21) for mothers in low socioeconomic level. There is a statistically significant mean difference between all the socioeconomic levels. (F=6.763, P=0.00). Post hoc clarified that there was a statistically significant mothers mean difference in between high level and under average or low level, moreover, also between average level and low level. (Post Hoc were P=.029, P= .003, P=.012).
• The highest mean knowledge belonged to 2-3 children (61.82±12.84); on the other hand the lowest one belonged to 1 child (57.10±13.13). Moreover there was a statistically significant difference between mean score of mothers with 2-3 living children and 1 living child. (F=4.939, P=.008& Post Hoc P=.009)
• The highest mean of knowledge belonged to 1<-5 visits (62.49±12.6) versus the lowest one belonged to 10+ visits mothers (58.43±13.04). And who’s started the antenatal visits at the second trimester (62.7±12.55). There was no statistically significant difference between these groups.
• The means knowledge score followed in the following order private clinic, (MCH center + private hospital or private clinic), MCH and public hospital. Among (80.5±10.45, 77.18±9.64, 69.21±14.50, and 68.71±25.4) respectively. There was statistically significant difference between mean knowledge score of mothers in these groups. (F=10.361, P=.00)
• The highest mean knowledge score (65.15±4.71) belonged to the mothers who received 35%+ from all the instructions, on the other hand the lowest one (49.22±9.08) belonged to those who didn’t received any instructions. Moreover there was a statistically significant difference between mean scores of mother’s knowledge and all levels of these groups. (F=4.582, P=.004). There was significant mean difference between no instructions given versus 20% - from all the instruction, or 35%- from all the instructions. (Post hoc P=.011, P=.040).
Conclusions
• Nurse’s knowledge regarding discharge planning process was acceptable level of knowledge score. The majority of the nurses (85.1%) knew the importance of discharge planning for the postpartum mothers.
• Only the half or slightly more knew the role of the nurse in discharge planning process. About one third from the nurses mentioned correctly who to know the post discharge mother’s needs.
• On the other hand nearly two thirds from the nurses didn’t know the concept of discharge planning, and the beginning of discharge planning process.
• The highest mean knowledge of the nurses regarding discharge planning process belonged to health technical institute nurses. Whose had <1 year of experience and not have any training courses in the field of labor and postpartum care.
• Deficiency in knowledge of nurses regarding postpartum discharge plan care.
• About one tenth of nurses didn’t know any components of postpartum discharge plan care. While nearly one third of nurses mentioned the normal lochia changes, and nearly one fourth of the nurses only gave correct answer about perineal hygiene.
• Nurse’s knowledge was very week regarding after pain, breast care, normal breast changes, and prevention of thrombophilbites, pelvic floor exercises, and family planning.
• Nurses knowledge was acceptable regarding when danger sings occur, nutrition, fluids , time of postpartum check-up, resuming sexuality, and perineal hygiene.
• The highest mean knowledge of nurses regarding postpartum discharge plan care was for secondary school + specialty nurses, also belonged to the nurses whose had 5+ years of experiences in labor0 and postpartum care, and the nurses whose had the last training course since 5+ years ago.
• The role of the nurse in educating the mothers and her family is missing as 94.3% of mothers had their knowledge from one of family members mostly her mother; only 11% of mothers had their knowledge from the nurses.
• A considerable percent of mothers belonged to fair level of knowledge regarding postpartum care. While nearly two thirds knew the concept of postpartum period.
• The greatest mean knowledge of mothers was for 30- years old, also it was for the mothers whose had university or secondary education and worked.
• The mean knowledge score of the mothers increased by the increasing of the socioeconomic level, of number of bearing children, and also by the increasing of the instructions given to the mothers and her family before discharge.
Based on the pervious findings the study recommended the following:-
• Updating the nursing curriculums for the undergraduate and postgraduate student include subject of discharge planning.
• Provision of continues training programs for nurses who work in maternity homes in MCH centers about postpartum discharge planning, and postpartum discharge plan care. Job description to specify the role of nurses in discharge planning and their role as discharge planner. They should be well informed and trained about their job description.
• Encourage meetings and conferences among the health care team to enforce discharge planning process and strengthen good communication among them, mother, her family, and the other community resources.
• For proper applications of discharge plan care audiovisual aides and nurses should be well trained on their use.
• Ensure that the mother and her family well understand to all items of discharge plan care before discharge from MCH center. Give copy of discharge plan care to the mother and her family
• Further researches are necessary to guide the development of discharge planning programs and policies regarding postpartum discharge planner nurse.