Abstract

Introduction

Theoretical Framework

Literature Review

Research Purpose and Questions

Methods

Result

Discussion

References

Acknowledgement

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Women’s Judgments And Attitudes
About The Quality And Quantity Of Postpartum Teaching

Melanie Martin
University of Arizona College of Nursing


Abstract

Purpose:  The purpose of this study was to describe women’s judgments and attitudes about the quality and quantity of postpartum teaching they received after recently giving birth in a hospital setting.  

Method:  A descriptive study of 27 women who participated in a telephone survey designed to examine women’s judgments regarding the quantity, usefulness and satisfaction of the postpartum education they received in the hospital setting.  

Results:  All the women in the study reported watching an educational video prior to discharge, yet 14.8% of the women did not recall receiving any discharge teaching.  The majority of them (95.6%) reported that postpartum teaching was useful.  Most women (77.8%) were satisfied with the discharge teaching, however women who stayed in the hospital for longer periods of time were less likely to be satisfied.  Women reported that they would have liked to learn more about self- and infant-care, with 46.1% reporting an interest in learning more about self-care and 38.5% wanting to learn more about infant/child-care. 

Introduction

The postpartum period is a time of great change for women both physically and psychologically.  During the postpartum period, women have much to learn about taking care of themselves and their new infants, but short postpartum hospital stays limit the amount of time available for instruction that postpartum women receive regarding self- and infant-care (Thilo, Townsend & Merenstein, 1998).

Currently, nurses provide large amounts of information about self- and infant-care to women prior to their hospital discharge. In order for nurses to provide pertinent and sufficient postpartum teaching, it is crucial that the knowledge needs and priorities of postpartum women be identified so they can be addressed properly.  The purpose of this study is to describe judgments regarding postpartum teaching among women who have recently given birth in a hospital setting. 

Theoretical Framework

The theoretical framework for the study was based on Rubin’s Theory of Puerperal Change (1984) and incorporated the findings of Ament’s (1990) research that suggest that shorter hospital stays accelerate women’s progression through the postpartum stages.  During the first few hours after giving birth, women experience the “taking-in” period, being primarily concerned with taking care of their own bodily needs and are not yet ready to assume all the responsibilities of being a mother (Bondas-Salonen, 1998).  By the second day, women enter the “taking-hold” period by being more assertive with their own self-care and easing into the maternal role (Ladewig, London, Moberly & Olds, 2002).  From around the tenth day after delivery until the baby is a few months old, women “bind in” to the maternal role by developing techniques that improve their mothering skills (Ladwig et al., 2002). 

Literature Review

Postpartal women experience physical discomforts and psychosocial change following the delivery of their infants (Ladewig et al., 2002).  Recent studies show that during the first 48 hours after delivery, women today follow Rubin’s steps at an accelerated pace (Ament, 1990), and as a more continuous process (Martell, 2001).  

DeNatale and Kroeber (1998) found that parents indicated that they highly valued the postpartum information they were taught, but 44% of the participants reported that there were areas where more teaching would have been appreciated.   Moran, Holt and Martin (1997) conducted a survey to identify the topics postpartum women wanted to learn more about and reported that that 77% of their respondents felt that they did not receive enough information about self-care and 73% wanted more information about infant-care.

Ruchala (2000) compared the educational priorities of postpartum nurses and postpartum patients.  The results of that study showed that postpartum nurses believed that women wanted to learn primarily about infant care; but postpartum women were primarily concerned with their own needs during the first 24 hours, although their concern for their infants' needs increased over the next few days.  

Little research has addressed women’s judgments about the postpartum education that hospitals provide.  Previous research shows that postpartum women value discharge information (DeNatale and Kroeber, 1998), they would appreciate more discharge education (Moran, Holt & Martin, 1997), and that educational priorities of nurses and those of postpartum women are incongruous (Ruchala, 2000).

Research Purpose and Questions

The purpose of this study was to describe women’s judgments and attitudes about the quality and quantity of postpartum teaching they received after recently giving birth in a hospital setting. 

The study addresses the following research questions:  1) Do postpartal women indicate that they received teaching about self- and infant-care during the post-delivery hospitalization?   2) Do postpartal women indicate that the teaching about self- and infant-care that they received while hospitalized was useful to them?  3) Do postpartal women indicate that they were satisfied that the teaching that they received in the hospital was sufficient to meet their needs?  4) What content areas do new mothers indicate were not adequately addressed in the teaching they received in the hospital during the post-delivery period?

Methods

A descriptive study was used to explore women’s perceptions regarding the postpartum teaching they received in the hospital setting. Both qualitative and quantitative methods were used to answer the research questions.

The convenience sample included 27 women who recently delivered their babies in a hospital in Southern Arizona.  Approval was obtained from the Institutional Review Board and all subjects read a disclaimer prior to participation.  Each of these women was required to watch a 45-minute video that focused on breastfeeding and infant care called, “Home Before You Know It.”  To be included in this study, subjects had to be: 1) between the ages of 18-45 years old, 2) 1-2 weeks postpartum at the time of data collection and 3) English speaking. Women who met these criteria participated in a brief, investigator-developed telephone survey one to two weeks following delivery.  The survey examined their judgments regarding the quantity, adequacy and usefulness of the postpartum education they received from health care providers in the hospital where they delivered, as well as information about level of satisfaction, type of provider and demographic characteristics. 

Results

Descriptive statistics were used to describe demographic characteristics of the sample.  Frequencies and percentages were calculated. 

Sample Characteristics

See Table 1.

Table 1:  Demographic Characteristics (N=27)

 Maternal Characteristics Results

Mean Age

27.6 years

   

Parity

14
13 

(52%)
(48%)
primiparous
multiparous

Ethnicity

Caucasian
Hispanic American
African American
Asian American

15
8
3
1
 

Education Level

Less than High School Diploma
High School Diploma
Vocational/ Technical Degree
Some College
Bachelor’s Degree
Graduate Degree 

5
5
2
8
5
2

(18.5%)
(18.5%)
(7%)
(30%)
(18.5%)
(7%)

Research Questions

The research questions were analyzed using frequencies, percentages, cross tabulation and logistic regression.   See Table 2 for all research questions and results. 

Table 2:  Postpartum Discharge Teaching Evaluation

 Variable  Results

Reported that postpartum education was provided

None
Self-care
Infant-care
Watched informational video

4
18
19
27
(14.8%)
(66.7%)
(70.4%)
(100%)

Felt that postpartum teaching was useful (N=23)

                                                       

22  (95.6%)
 

Information considered most useful

   (29 comments total)

Breastfeeding
Infant-care (e.g. bathing)
Self-care (e.g. vaginal bleeding) General comments
          (e.g. “everything”)
Negative comments                            

8
11
3

3
4
(27.6%)
(37.9%)
(10.3%)

(10.3%)
(14%)

Discharge teaching satisfaction levels

Very satisfied
Somewhat satisfied
Somewhat dissatisfied
Very dissatisfied

16
5
5
1
(95.3%)
(18.5%)
(18.5%)
(3.7%)

Comments about satisfaction
       (19 comments total)

Positive comments
     Helpfulness of staff
     General positive comments

Negative Comments
     Not receiving enough information
     Requesting more verbal instruction

9
3
6

9
6
2
(47.4%)
(33.3%)
(66.6%)

(47.4%)
(66.6%)
(22.2%)

Areas where new mothers wanted more information (N=13)

Self-care
Infant/child-care
General comments

6
5
2
(46.1%)
(38.5%)
(15%)

                                                                                                                       

Research Question One

Research question 1 assessed the extent to which postpartum women indicated that they received teaching about self- and infant-care during the post delivery hospitalization.  A curious finding was that although all 27 women (100%) reported watching a discharge video provided by the postpartum unit in the hospital, four women (14.8%) did not recall receiving any discharge information on either self- or infant-care.   This was congruent with findings from previous studies that indicated that women were not highly receptive to teaching the first few days following childbirth (Ament, 1990; Ladewig et al., 2002; Martell, 2001).   Also, women may have only considered face-to-face interaction as a form of education and may not have considered watching the video as a means of education.  A third explanation of why some women did not recall receiving discharge information was because they may have been distracted when the video was playing and may not have paid much attention to the video. 

Research Question Two

Research question two measured the extent to which postpartal women indicated that the teaching about self- and infant-care that they received while hospitalized was useful to them.  Twenty-two (95.6%) of the 23 people responded that the information presented was useful, which concurred with the findings of DeNatale and Kroeber (1998).  This indicates that postpartum teaching is helpful, and it is important to do even though the circumstances may not be ideal for learning due to lack of receptivity. 

Research Question Three

Research question three measured the degree to which postpartal women were satisfied that the teaching they received in the hospital was sufficient to meet their needs.  One point to note was a trend toward greater satisfaction with a higher number of previous births.  Ten (71%) of the primiparous women reported satisfaction with the education, eight (80%) of the women who had had one previous birth reported being satisfied, and three (100%) of the women who had given birth on two other occasions were satisfied. 

Logistic regression was used to analyze how the length of hospital stay influenced satisfaction level.  This test required combining the satisfaction levels into simply “satisfied” and “dissatisfied.”  Analysis revealed that regardless of any other factor, for every hour that a woman was in the hospital the odds of her being satisfied with postpartum education decreased by six percent. 

Research Question Four

Research question four identified content areas that new mothers felt were not adequately addressed in the discharge teaching they received in the hospital.  The results were consistent with findings from other studies that showed that postpartum women felt they did not receive enough information about self-care (Moran et al., 1997).  Likewise, in a study performed by Ruchala (2000), findings indicated that nurses were more likely to emphasize teaching infant-care to postpartum women, whereas postpartum women were more often concerned with how to take care of their own needs. 

Discussion

Implications for Nursing Practice

The findings from this study can guide nurses in their health education of postpartum women.  Results of this study indicate that women may not recall receiving postpartum education, or may not consider all means of instruction as a form of education.  Nearly all of the women thought that the information provided was useful. Most of the women were satisfied with the teaching they received, yet they indicated they would like more information, especially on self-care.  This study also revealed that women would prefer if more information were provided in person rather than by a handout or video. 

Postpartum education could be improved by asking what the patient would like to learn about self- and infant-care and by teaching the patient in person.   It would also benefit the patient to follow up with a phone call during the first week after being discharged, allowing them to develop questions that nurses could answer.  Although this takes additional time for the nursing staff, it could improve women’s satisfaction with postpartum education. 

References

Ament, L.(1990). Maternal tasks of the puerperium reidentified.  JOGNN:  Journal of Obstetric, Gynecologic, and Neonatal Nursing, 19, 330-335.
 

Bondas-Salonen, T. (1998). New mothers' experiences of postpartum care - a phenomenological follow-up study.  Journal of Clinical Nursing, 7, 165-174.
 

DeNatale, M.L., Kroeber, S.L. (1998).  Teaching on a mother-baby unit:  parents’ ratings of its value.  The Journal of Perinatal Education, 7, 1-10.
 

Kapp, M. (1998).  Mothers’ perception of confidence with self-care and infant care.  The Journal of Perinatal Education, 7(4), 17-25.
 

Ladewig, P., London, M., Moberly, S., Olds, S., (2002).  Contemporary maternal-newborn nursing care (5th ed.).  Redwood, California: Addison-Wesley Nursing.
 

Martell, L. (2001).  Heading toward the new normal:  a contemporary postpartum experience.  JOGNN:  Journal of Obstetric, Gynecologic, and Neonatal Nursing 30, 496-505.

Moran, C., Holt, V., Martin, D. (1997).  What do women want to know after childbirth?  Birth, 24(1), 27-34. 

Rubin, R. (1984).  Maternal identity and the maternal experience.  New York: Springer.

Ruchala, P. (2000).  Teaching new mothers:  priorities of nurses and postpartum women. JOGNN:  Journal of Obstetric, Gynecologic, and Neonatal Nursing, 29, 265-273.

Thilo, E., Townsend, S., Merenstein, G., (1998).  The history of policy and practice related to the perinatal hospital stay.  Clinics in Perinatology, 25, 257-268.

Acknowledgement

Special thanks to Melissa Goldsmith for the countless hours she spent guiding this project, offering suggestions and demonstrating the role of an excellent mentor.    Thanks, Trish and Jim Ranger-Moore, for sharing your expertise in public health and biostatistics.  Also, thanks to Beverly Rosenthal, Claire Parsons, Ki Moore, Terry Badger, Clinton Winner, Terri Martin, Philip Martin, the University of Arizona’s College of Nursing, the University of Arizona’s Honors College and the entire postpartum staff at University Medical Center in Tucson, AZ.

The funding for this project came from the University of Arizona’s Honors College Undergraduate Research Grant, and materials were funded by the University of Arizona’s College of Nursing.

The findings from study were presented at the University of Arizona’s 2003 Undergraduate Research Day, AzPHA Spring ’03 conference and to nurses working at University Medical Center’s postpartum unit.

 

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