Improved Perinatal Knowledge and Care in the Community Hospital Through a Program of Self-Instruction

Abstract

Evaluation of the perinatal in-patient services of nine rural community hospitals (CH) revealed that equipment and cognitive knowledge were inadequate for the complexity of patients cared for. These deficiencies were present despite prior exposure to traditional continuing education programs. In response to these findings, a six-month perinatal educational program was developed. The program is unique in that it is: (1) initiated by a hospital self-inventory through which patient care goals and the corresponding equipment, services and personnel needs are identified; (2) entirely CH based except for a workshop held at the regional center for two CH staff nurses who subsequently coordinate the program in their hospital; (3) self-paced and self-instructional (five books covering 19 subjects and 20 skills); and (4) completed by nurses, physicians, and support personnel thus facilitating uniform patient care and nurse-physician communications. The program was delivered to 362 CH nurses, physicians, and support personnel, representing 77% of total available perinatal health care professionals from the nine CH. Test scores improved by 24 percentage points with perinatal professionals approaching or exceeding criterion level following the program. A review of 1,404 CH charts showed that 12/28 patient care practices improved significantly. Spontaneous performance of eight pretransport stabilizing activities improved from 44% to 86%. It is concluded that a self-study, community-based program of this type can markedly improve both the knowledge of CH perinatal professionals and the CH care for transported and locally-managed babies.