Improving postpartum patient satisfaction through communication and pain management

¶ … InterestInterview Coding & Reaction

There is little doubt that the experience, events and quality of care that surround expecting and new mothers is extremely important (Berrien, Olledorff & Menard, 2015). The reduction or mitigation of things like excessive pain before and after birth, any sort of disconnect between patient and providers in terms of communication and an explanation of what is and shall be going on and so forth are all important (Taavoni, Abdolahian, Neisani & Hamid, 2016). This research deigns to cover a number of things. First, it is asked of the interviewee what went well, what did not, what perhaps could or should be compared and contrasted between this or prior birthing experiences (and one did exist in the case of this research), what could have been done better, what was done well, whether proper and full options were made available and so on.

The setting and meeting of expectations is one linchpin of what shall be covered in this report (Moore, 2016). Indeed, is important that patients know what to expect, what can be done, what is a little more difficult and so forth (Daugherty & Martinez, 2016). When patients are expecting more presence and appearances by nursing staff and it does not happen, pain management is needed but is not offered and so forth, it can truly sour the experience of the new mother and this must be avoided if at all possible (Mondy, Fenwick, Leap & Foureur, 2016). The use of the word of "setting" expectations is also important because patients do need to know what everything means and how it's going to work. Knowing what a medical chart truly and fully says is a stretch but knowing what a whiteboard in a patient room says and what it means is a good starting point and making sure that rounds and patient follow-ups are done well and with regularity is another. As one can easily see in the rest of the report, there are providers that do not set and/or meet the proper expectations.

Theoretical Perspective

Postpartum patients experience a range of issues which can affect their satisfaction and ability to manage pain. The literature notes that postpartum rounds are often inefficient and require nurses to spend considerable time with each patient (Segel, et al., 2010). As a result of inefficiency, a relatively low number of patients is actually discharged by the goal time of 11:00 am (Segel, et al., 2010). Research on the use of whiteboards in patient communication plans has demonstrated that the use of these tools may provide significant communication benefits (Dublon, Spurdle, & Adefunke, 2016). The rationale behind the use of whiteboards in providing patient care is that they can lead to improved communication between nurse and client, which helps to support better care (Dublon, Spurdle, & Adefunke, 2016). Conversely, hourly rounding involves nurses rounding with patients every one-to-two hour to promote improved quality of care (Rondinelli, Ecker, Crawford, Seeliger, & Omery, 2012). Hourly rounding with postpartum patients, along with the use of whiteboards, has the potential to improve communication, along with patient satisfaction with pain management (Wershofen, Heitzmann, Beltermann & Fischer, 2016).

Sample Selection

I The author of this study selected an English-speaking postpartum patient after her normal delivery postpartum day two. I The patient was selected this particular patient because this was not her first pregnancy, and thus she would have a frame of reference to compare this experience to her prior experience. Also, by selecting a patient as my participant, instead of a staff member, can help me to understand how the patient feels about the initiation of hourly rounding and whiteboard use and her concerns of implementing these two interventions on a patient perspective. The combination of factors including a normal delivery, English-speaking patient, and prior pregnancy made this particular patient a good candidate for the proposed research.

Inclusion Criteria

The participant was recruited through a simple conversation in which it was discussed what would be covered. Included in that was the following inclusion criteria, proper notifications and other procedures:

• we spoke about tThe research and its goals, including its

• goals, aA desire to know about her s well as her postpartum experience.

• At least one prior birthing experience to compare to • Also, the pParticipant was informed that the interview will would be taped

• on my iPhone. A foFormal opening script at the onset of the interview was initiated before the interview began (see Appendix A).

• The patient was being treated within the's position in the postpartum unit

• Signed consent form

Exclusion Criteria

Items that did or could have come up that could have or did disqualify other people include the following:

• An unwillingness to be taped

• Unwillingness to sign the consent form

• Unwillingness to discuss important elements of personal experience

• No prior births to compare to • English not the primary language of patient made her an accessible candidate, as recruitment was limited to those patients currently occupying a place in the postpartum unit.

Data Collection Procedures

The Interview

Data were collected in Queens Hospital Center, Mother/Baby unit, through the use of a face-to-face qualitative interview format. I asked the patient a series of questions related to her postpartum experience in the past and during this hospital stay, hourly rounding, whiteboard use in her room, and patient care. A list of questions, prompts, and probes is shown in Appendix A. The patient's answers were recorded via the voice memos application on my iPhone. I used the voice memos recording to later transcribe a full transcription of interview (see Appendix B). The interview took place in the patient's room, with the participants being myself, the patient respondent, and her newborn in the crib at the bedside.

The interview lasted approximately 15 minutes, during which time I asked questions and the patient provided her answers. At the end of questioning, we had additional time for the her to ask any questions, as well as debrief about the interview process itself.

Confidentiality was maintained prior and during the interview by taking steps to ensure privacy. According to the Queens Hospital Center's protocol, a consent has to be signed by the patient in order to proceed. Before the patient signed the consent, I, as the interviewer, have to make sure she understands what this interview is about and whether she has any questions or concerns. The consent was witnessed by the head nurse on the postpartum unit. The consent (see Appendix D) was then sent down to Ms. Elizabeth Sulik, the Associate Director of the Department of External Affairs at Queens Hospital Center. During the interview, the room door was closed, TV in the room was turned off, and the room was free from other observers during the interview itself. I did not record the patient's name on my interview notes, instead opting for a suitable pseudonym.

Results

The themes, concepts and results to be seen in this report are clear and prevalent. There were some obvious things that stood out and quite a lot of them directly align with the context and theoretical framework covered in this report. They are as follows:

• Pain management, among a few other things like post-partum depression and the like are obviously one of the more prevalent things that should be covered and watched over (Dannenbring, Stevens & House, 1997). Unless one is to believe that the patient is exaggerating, it would seem that she went hours at a time without seeing anyone. This aligns with the theoretical perspective mentioned earlier in that it clearly goes against what should be happening, if indeed her assessment and summary is accurate (Ogbolu, Scrandis, Fitzpatrick & Newhouse, 2016). Except at night, that is almost certainly improper for "hours" to pass with no visits from a nurse or doctor. Even so, it is possible that her perspective or expectations are not aligned. She did admit that her pain level at the time of the interview was a two on a scale of ten, which is quite good given that she had just given birth. Thus, at least things were properly in place at that time. Regardless, what she expected and what actually happened were clearly not aligned and that is something the staff should be concerned about. It is certainly something the author of this study is concerned about (Hueston & Kasik-Miller, 1998).

• One of the conceptual and thematic items covered in the theoretical framework of this case is the whiteboard and how the patient should not be confused or underinformed about what is stated and present on that board. More complex charting information and such should be on something other than the whiteboard and whatever is ambiguous or nebulous to the patient should be explained, per the related research (Chaboyer, Wallen, Wallis & McMurray, 2009).

• The patient did interrupt a number of the questions. This has been mentioned in passing before but it should be mentioned as its own theme and presence in the interview, not to mention the coding of the same (Rabel, Cunningham & Stephenson, 2014).

• For whatever reason, the patient was very prone to laughing. It could be her nature or she might have been nervous (Elliott, 2017).