Making the Most of Bed Rest: Weekly Support Group and Education for Hospitalized Antepartum Patients

Abstract

Purpose for the Program Psychological sequelae associated with bed rest during pregnancy have been well documented with more pronounced reactions in hospitalized women. Women quickly develop feelings of separation and isolation from their normal routines and connections with others. As a result, anxiety, loneliness, boredom, powerlessness, stress, dysphoria, and depression may complicate an already high-risk pregnancy. Hospitalization provides an opportunity to offer support as well as pregnancy-related education to these women. At this community hospital with a large high-risk obstetric population and more than 3,500 deliveries per year, a support group for hospitalized antepartum patients is used for socialization, to lessen anxiety, improve mood, and provide patient education. Proposed Change To develop and initiate weekly support group sessions on an 18-bed antepartum unit to address commonly identified concerns with evidence-based education and support. To develop a data collection tool identifying successful group topics and patient's moods before and after group participation. Implementation, Outcomes, and Evaluation The perinatal clinical nurse specialist (CNS) identifies antepartum patients able to attend the group, requests a physician's order, and then invites patients to attend. A multidisciplinary team within perinatal services is used to provide education for each 1-hour “Mom's In Waiting” group session, where the CNS or the perinatal social worker is also present. A structured activity or discussion occurs for part of the hour, with time being specifically left for socialization among the group members. At the end of group session, a short Likert scale survey is administered to each participant. Survey results for the first 18 months provide an overwhelmingly positive response to the group by attendees with 98% noting enhanced mood perception after attending the group and 100% stating they looked forward to attending the group. Group participants frequently dress and apply make-up before the sessions and the conversations in the sessions flow easily. Popular session topics, chosen by participants’ suggestions, include breastfeeding, infant massage, guided imagery, and neonatal intensive care (NICU) preparation. The postgroup survey is currently being amended to include additional markers for improved mood. Implications for Nursing Practice Survey documentation should promote development of support groups in other antepartum settings. Currently at this hospital, antepartum patients as well as postpartum NICU mothers are screened with the Edinburgh Postnatal Depression Scale (EPDS). As perinatal mood disorders have been shown to correlate with poor maternal and neonatal outcomes, long-term goals include evaluating EPDS scores and mood disorders related to group attendance. Psychological sequelae associated with bed rest during pregnancy have been well documented with more pronounced reactions in hospitalized women. Women quickly develop feelings of separation and isolation from their normal routines and connections with others. As a result, anxiety, loneliness, boredom, powerlessness, stress, dysphoria, and depression may complicate an already high-risk pregnancy. Hospitalization provides an opportunity to offer support as well as pregnancy-related education to these women. At this community hospital with a large high-risk obstetric population and more than 3,500 deliveries per year, a support group for hospitalized antepartum patients is used for socialization, to lessen anxiety, improve mood, and provide patient education. To develop and initiate weekly support group sessions on an 18-bed antepartum unit to address commonly identified concerns with evidence-based education and support. To develop a data collection tool identifying successful group topics and patient's moods before and after group participation. The perinatal clinical nurse specialist (CNS) identifies antepartum patients able to attend the group, requests a physician's order, and then invites patients to attend. A multidisciplinary team within perinatal services is used to provide education for each 1-hour “Mom's In Waiting” group session, where the CNS or the perinatal social worker is also present. A structured activity or discussion occurs for part of the hour, with time being specifically left for socialization among the group members. At the end of group session, a short Likert scale survey is administered to each participant. Survey results for the first 18 months provide an overwhelmingly positive response to the group by attendees with 98% noting enhanced mood perception after attending the group and 100% stating they looked forward to attending the group. Group participants frequently dress and apply make-up before the sessions and the conversations in the sessions flow easily. Popular session topics, chosen by participants’ suggestions, include breastfeeding, infant massage, guided imagery, and neonatal intensive care (NICU) preparation. The postgroup survey is currently being amended to include additional markers for improved mood. Survey documentation should promote development of support groups in other antepartum settings. Currently at this hospital, antepartum patients as well as postpartum NICU mothers are screened with the Edinburgh Postnatal Depression Scale (EPDS). As perinatal mood disorders have been shown to correlate with poor maternal and neonatal outcomes, long-term goals include evaluating EPDS scores and mood disorders related to group attendance.