N301: Nursing Research and Evidence-Based Practice

Pregnancy refers to the period between fertilization (i.e., when a woman conceives) and birth. It is a sensitive period of time-bearing in mind the fact that a woman carries a fetus in her womb for nine months. Pregnancy necessitates that a high level of vigilance be observed throughout the entire period in order for a woman to successfully deliver a healthy baby at the end of the gestation period. Otherwise, if there is inadequate prenatal care as far as pregnancy is concerned, a woman becomes susceptible to high-risk pregnancies (Virginia, 2012).

High-risk pregnancy, in this case, refers to a condition that puts both the lives of the mother and the fetus at risk during the gestation period. Several factors put the pregnancy of a woman at risk. Among the factors affecting pregnancy are health conditions. In this case, the existing health conditions can complicate pregnancy. Example of these health conditions includes high blood pressure, depression, sexually transmitted infections, and chronic infections such as HIV, to mention but a few. Overweight and obesity are also found to contribute to high-risk pregnancies outcome. The two conditions are dangerous during pregnancy as they act as predisposing factors to high-risk pregnancy conditions such as gestational diabetes, preeclampsia, as well as caesarian delivery (Virginia, 2012). 

Lastly, this paper outlines a summary of the findings upon reviewing the five articles. A research problem is then stated, followed by a PICO question, project proposal, project implementation, project obstacles, and finally, a conclusion is drawn based on the findings of the research study. Thus, in a recap, the primary goal of this paper is to establish whether better nursing care determines the outcomes of high-risk pregnancies. Better nursing care will, therefore, act as a project to be implemented-aimed at solving high-risk pregnancies problem.

Literature Review

In order to impeccably well understand the topic under study, five articles are thoroughly reviewed in the literature review. Each article has valuable information regarding how better nursing care plays a vital role in determining the outcome of high-risk pregnancies. These articles bared both similarities and differences. To begin with similarities, a majority of the articles recognizes the fact that prenatal care is crucial in countering high-risk pregnancies. For instance, Virginia (2012) claims that preterm labor incidents among pregnant women are attributed to lack of sufficient knowledge concerning pregnancy. That is, women’s reluctance to timely responding to preterm birth symptoms is lack of knowledge regarding the same. Some women are not aware of the preterm symptoms and hence will tend to be a bit reluctant while responding to such situations (Virginia, 2012). The author, in other words, implies that most of the pregnant women are not aware of preterm labor. Thus, as such, because of their lack of knowledge, they are more likely to give birth before the due date and hence being exposed to high-risk pregnancies outcomes. Thus, it typically implies that there is need to give pregnant women enough education on pregnancy, including preterm labor. Hence, prenatal care is, in this case, essential.

Similarly, Novick et al. (2013) further reinforce the argument that prenatal care is essential in mitigating high-risk pregnancies. The author claims that prenatal care has a positive impact on high-risk pregnancies, giving the CenteringPregnancy group as an example (Novick et al., 2013). Also, Lathrop (2013) is also of the same views regarding the impact of prenatal care on high-risk pregnancies. Just like the authors mentioned above, Lathrop (2013) too argues that prenatal care has positively impacted on high-risk pregnancies.

However, Lathrop (2013) has showcased a slight difference from the other authors in that he divides prenatal care into two; the traditional and the group prenatal care. The author further claims that group prenatal care is more effective than traditional prenatal care in as far as a positive impact on high-risk pregnancies outcome is concerned. For instance, it increases breastfeeding while reducing low birth weight cases (Lathrop, 2013). Byerley et al. (2017), just like the other authors, also supports the notion that prenatal care is positively impacting high-risk pregnancies outcomes. The author claims that increasing prenatal care popularity is attributed to its reduction of high-risk pregnancies outcomes (Byerley et al., 2017). Finally, Brooten et al. (2007) have got too similar views on the impact of prenatal care on high-risk pregnancies outcomes. In his article, the author claims that both the advanced practice nurse knowledge and skills are essential in as far as the high-risk pregnancies outcomes improvement is concerned (Brooten et al., 2007). 

    Secondly, on the other hand, with regards to the differences, there is a disparity among the authors' views on high-risk pregnancies outcomes. Virginia (2012), for example, argues that high-risk pregnancies are attributed to women's reluctance to respond to preterm labor (PTL). Preterm labor typically refers to as a condition in which a pregnant woman starts experiencing labor pain, implying that they are ready to give birth before their due date. PTL can lead to premature birth incidents or miscarriages. It is recommended that women should alert/inform either the doctors or midwives about PTL whenever they start experiencing symptoms to swiftly halt the symptoms and pave the way for the growth of the fetus until the delivering date is due. The PTL symptoms include vaginal discharge, contractions, and lower backache. Women are found to be reluctant in responding to these PTL symptoms for various reasons. Among them include depression. Depression is very dangerous during pregnancy as it can make the women not to respond to preterm labor symptoms. Besides, denial is another factor that has been found to contribute to women reluctance to responding to preterm birth symptoms on time. Women, in this case, do not take the symptoms seriously as they think it is just the normal pain experienced, perhaps when the fetus is moving in the womb (Virginia, 2012). Novick et al. (2013) on the other hand argues that even though CenteringPregnancy group-which has been showcased as having potential in contributing towards pregnancy improvement, has established that there are different prenatal efficacies in different clinics. This difference is attributed to fidelity. That is, fidelity affects both the process as well as CenteringPregnancy’s content. While the fidelity of the process was found to significantly reduce both the preterm birth incidents as well as the intensity of prenatal care needed, the fidelity of content, on the other hand, was found only to reduce the intensity of prenatal care needed during pregnancy.

Besides, the study established that facilitative leadership is crucial in group prenatal care. Hence, the need to train the clinicians to develop facilitative leadership skill (Novick et al., 2013). Byerley et al. (2017) have his views on high-risk pregnancies.  For instance, the author claims that low-income earners, as well as the African Americans, were found to have a lower percentage of preterm birth incidents. Most of the women who were being attended to at the group prenatal cares were found to either opioid addicts, earning a low income, or were at their adolescence stage. Both the African Americans and the adolescents were found to respond well to weight compliance for pregnant women. The two also exhibited an upward trend of breastfeeding as well as expressing their satisfaction with the group prenatal care. Additionally, both the income earners and adolescents psychologically responded well to the group prenatal care. 

Based on the research study, it was found that those women who were subjected to group prenatal care services did not require medicines in order to treat diabetes while pregnant (Byerley et al., 2017). Lastly, Brooten et al. (2007) claim that physiological cases were found to dominate with 59.2% in antenatal problems while other health associated problems to be 33.3%.  Postpartum was found to be associated with health-related problems. While 44% of postpartum had psychological issues, 31% of the postpartum had psychosocial issues. Advanced practice nurse interventions concerning antenatal problems included counseling the high-risk pregnancies women, teaching as well as guiding them on health matters while they are pregnant. Other interventions were physiologically assessing the state of both the fetus and the woman on time.   High-risk pregnancies outcome is attributed to women's reluctance to respond to preterm birth symptoms. 

Summary of Findings

High-risk pregnancies outcome is attributed to women’s reluctance to respond to preterm birth symptoms on time (Virginia, 2012). Fidelity plays a vital role in both the process as well as the content of prenatal care clinical practices. Facilitative leadership is fundamental in group prenatal care (Novick et al., 2013). Besides, group prenatal care has reduced the high-risk pregnancy outcomes over the past years and as a result gaining proportionate popularity in return (Byerley et al., 2017). Brooten et al. (2007) claim, on the other hand, that advanced practice nurse knowledge and skills are essential for improving high-risk pregnancies outcomes. Last but not least, group prenatal care is more effective as compared to traditional prenatal care (Lathrop, 2013).   

The Research

Research Problem

Based on the fact high-risk pregnancy outcomes threatens both the health and life of the fetus as well as that of the mother during the gestational period. The women’s reluctance to responding to preterm birth symptoms on time is a significant cause. There is a need to put in place robust measures that will help improve the outcomes of high-risk pregnancies. Thus, the research project proposal therein is, in particular, meant to find out as to whether better nursing care plays a crucial role in determining the high-risk pregnancies outcomes.

PICO Question

 Does the implementation of better nursing care determine the outcomes of high-risk pregnancies outcomes among various women as opposed to when there are no better nursing care interventions, during the gestational period? 

Project

 To establish whether the implementation of better nursing care determines the outcomes of high-risk pregnancies outcomes among various women as opposed to when there are no better nursing care interventions, and the necessity to make use of the prenatal nursing care properly. Prenatal nursing care will entail the act of preventing high-risk pregnancies outcomes through regular medical check-ups throughout the gestational period every month. Individualized Prenatal nursing services apart from the regular check-up with doctors will be given to assess if additional services and education indeed helps to determine outcomes of high-risk pregnancies. Therefore, the medical team will have assignments to follow up with pregnant women to ensure their pregnancy is going as planned. These pregnant women, too, will have an obligation to be committed to the nursing services and interventions offered. How they respond to additional services will be assessed individually. As opposed to a group of pregnant women who receives little to no extra prenatal, nursing services will be instrumental in determining high-risk pregnancies.

Also Read:  Literature Review Writing in Nursing

Implementation

 This project will have three categories of women. In the first group, all the women will be required to check with a midwife or doctor after every month for prenatal care classes. Women will be taught in simple, understandable language the preterm birth symptoms and on how to immediately respond to such incidents. Pregnant women will be provided with essential knowledge regarding pregnancy by attending prenatal care classes. The bodyweight of pregnant women will be kept on track and report on the same issue to each once every month, i.e., after attending the prenatal class. The fetus will also get assessed every month on both its health wellbeing as well as its growth progress, and feedback is given to the women.

Moreover, nurse midwives, as well as doctors, will have to keep in contact with all pregnant women and call them whenever they fail to turn up after every month for prenatal classes. All the pregnant women will also be required to contact the midwives/nurses/doctors at the hospital for assistance in case of an emergency or anything unusual. In so doing, the high-risk pregnancy outcomes to which pregnant women are subjected to will be mitigated.

    In the second group, women will just be coming for prenatal care classes, without necessarily having to make a follow up whenever they fail to attend. There will not be any communication between the nurses and the patients. Nurses will not attend to these pregnant women while at home. They will only provide prenatal nursing care when they come hospital once in a while. Women will not be coming to the hospital for prenatal care classes every month, but every three months instead. 

The third group of women will not be given much attention while pregnant. Attending prenatal care classes is optional for them. Nurses will not make a follow up during their gestational period. The pregnant women will not be given nurses’ contacts for purposes of reaching them in case of an emergency. In a recap, the level of nursing care provided to these three groups of pregnant women is different. They are not given equally prenatal nursing care services. The first group is given the best nursing services, followed by the second group and lastly, the third group receives poor nursing services as compared to the other groups mentioned above. 

    Finally, after the gestational period is over, data will be quantitatively collected from the three groups for purposes of analysis. Each group will be given a questionnaire form-with both open and closed-ended questions to fill in. The questions will mainly focus on assessing the extent to which women from each group were subjected to high-risk pregnancies outcomes. In other words, the questionnaire will guide the women in giving out their high-risk pregnancies’ outcomes throughout the entire period of pregnancy. The data collected will then statistically analyzed to determine as to whether better nursing cares improves the outcomes of high-risk pregnancies.

Obstacles

Financial constraint is one of the major obstacles to better nursing care. Both the medical staff and pregnant women can face financial challenges. For example, hospitals need sufficient funds to buy the essential obstetrical equipment, medicines, machines, as well as pay well the medical team. Some of the pregnant women also come from such humble backgrounds that they cannot afford to attend prenatal nursing care classes. They will not afford even a proper diet because of lack of funds. They can occasionally abscond prenatal classes because of the lack of fare. Thus, a proposal, if possible, there is a need for the United States of America government to intervene and made prenatal nursing care affordable by subsidizing it.  

Conclusion

     In conclusion, and based on the five therein thoroughly reviewed articles, high-risk pregnancy is indeed a significant threat to health and lives of both the fetus and the pregnant women. It has been established that age, previous/current health conditions, overweight, obesity, the reluctance of women to swiftly respond to preterm birth symptoms, as well as general lifestyle, are among the factors impacting pregnancy. Prenatal care has been found to impact on the outcomes of the high-risk pregnancy positively. However, group prenatal care is more effective as compared to tradition prenatal care. Besides, the research study further shows the importance of advanced practice nurse (APN) interventions in curbing high-risk pregnancies. Among the APN interventions identified in the study included counseling, teaching, as well as guiding pregnant women on health matters to do with high-risk pregnancies. Hence, the above better nursing care project proposal can be beneficial in mitigating high-risk pregnancies, i.e., if adequately implemented

References

Brooten, D., Youngblut, J. A. M., Donahue, D., Hamilton, M., Hannan, J., & Felber, N. D. (December 01, 2007). Women With High-Risk Pregnancies, Problems, and APN Interventions. Journal of Nursing Scholarship, 39, 4, 349-357. 

Byerley, B. M., & Haas, D. M. (January 01, 2017). eA systematic overview of the literature regarding group prenatal care for high-risk pregnant women. Bmc Pregnancy and Childbirth, 17, 1.) 

Lathrop, B. (April 01, 2013). A Systematic Review Comparing Group Prenatal Care to Traditional Prenatal Care. Nursing for Women’s Health, 17, 2, 118-130. 

Novick, G., Reid, A. E., Lewis, J., Kershaw, T. S., Rising, S. S., & Ickovics, J. R. (August 01, 2013). Group prenatal care: Model fidelity and outcomes. American Journal of Obstetrics and Gynecology, 209, 2.) 

Virginia C.S. (2012). The Reluctance of Women to Respond to Preterm Labor.