Patients' and nurses' perceptions of patient problems during the immediate postpartum period

Abstract

A COLLABORATIVE project between a university-based researcher and four agencybased clinicians was developed to identify healthrelated concerns as perceived by postpartum women, to identify the nursing diagnoses used by their nurses, and to examine congruence between patient-identified concerns and their nursing diagnoses. This study involved four postpartum units in a large northwestern city from which the convenience sample of 236 nurse-patient pairs was recruited. These four hospitals (3 urban, 1 suburban) differed in patient populations and acuity levels. Patient subjects were stratified according to parity and type of delivery so that the sample consisted of similar numbers of primiparous and multiparous women and women who had experienced vaginal and cesarean births. Data were collected via questionnaires completed independently by each nurse and patient. Four instruments were used: patient and nurse demographic forms, a patient problem questionnaire filled out by patient subjects, and a nursing diagnosis questionnaire filled out by nurse subjects. The patient problem and nursing diagnosis questionnaires contained identical lists of 34 patient problems/nursing diagnoses. Subjects were asked to identify whether or not each problem was a concern for them or their patient and to identify the five most problems. Data were analyzed using descriptive statistics, chi-square, and measures of interrater re'liability. The most frequent diagnoses (median = 8 diagnoses per patient) identified by nurses were alteration in comfort and potential for growth, followed by knowledge deficit, alterations in bowel elimination and body fluids, sleep pattern disturbance, and anxiety. The most frequently identified patient concerns (median = 9 per patient) were alteration in comfort and potential for growth followed by alteration in body fluids, impaired mobility, sleep pattern disturbance, alteration in bowel elimination, anxiety, and alterations in urinsaion and nutrition (Tribotti, Lyons, Blackburn, Stein, & Withers, in press). The majority of the problems identified by this group of patients focused on the physical discomforts and physiological changes inherent in the immediate postpartum period. The most frequently identified problems/ diagnoses tended to be those that both nurse and patient subjects indicated were their m o s t important problems. Although there were significant differences between the four hospitals in patient age, education, and socioeconomic status, as well as in the educational background of the nursing staff, the most frequent problems identified by both patients and nurses were similar across hospitals. Women who experienced cesarean births were significantly more likely to identify alteration in comfort, impaired mobility, sleep pattern disturbance, alteration in bowel elimination, self-care deficit, anxiety, and fear than women who experienced vaginal births; primiparas were significantly more likely than multiparas to identify knowledge deficit as a problem. Even so, fewer than half of the primiparas identified knowledge deficit as a problem. Multiparas were more likely to identify social isolation and ineffective family coping (Tribotti et al., in press). Although the problems identified most frequently by patient subjects and nurse subjects were similar, there was a significant lack of congruence between individual nurse-patient pairs for many of the problems/diagnoses. Congruence was identified as agreement between a nurse-patient pair that