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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