Postpartum Nurses Research Articles

Improving Patient Safety by Increasing Patient Access to Blood Pressure Monitoring Kits and a Follow-Up Guide for Postpartum Patients

During a review of data regarding obstetric readmissions, it was noted that approximately half of the postpartum readmissions were because of elevations in blood pressures. Postpartum hypertension is observed in as many as 20% of women within 6 weeks of birth. For many patients who are discharged, the next blood pressure check would be at their 6-week postpartum check-up, unless noted with symptoms of high blood pressure, such as severe headache, visual changes, and/or epigastric pain. To provide blood pressure kits and a standardized blood pressure monitoring guidance grid for all patients who were noted with some type of hypertensive issue, on discharge from the hospital (chronic hypertension, gestational hypertension, or preeclampsia). A blood pressure monitoring kit was selected. A standardized home guidance grid was created for postpartum patients, with input from obstetric physicians regarding parameters for follow up. E-mails were sent to all obstetric physicians to alert them of the purpose of and availability of the program. Training was provided for all the obstetric and postpartum nurses on how to educate the patient in regard to use of the blood pressure kit and the guidance grid. Some patients were readmitted earlier. Several patients were able to start on blood pressure medication or have medication adjustments made in the outpatient setting. Verbal feedback from the patients who received the blood pressure kit has been positive. Some patients have stated that it would have been difficult to go and purchase a new blood pressure cuff for monitoring with a newborn. Programs such as this for home blood pressure monitoring and increases in patient education regarding postbirth warning signs will lead to an increased awareness about issues that can occur in the postpartum period. These programs and the actions to remove barriers for patients will likely lead to an increase in patient safety.

An Innovative Gestational Diabetes Follow-Up Program

To eliminate barriers for women who have gestational diabetes (GD), to follow up with a glucose tolerance test between 4 and 12 weeks after delivery, to identify and provide a primary care provider (PCP) for yearly follow up, to provide fellowship with other postpartum women who experienced the challenges of GD, and to provide strategies to decrease the conversion to type 2 diabetes. To increase the amount of glucose tolerance tests between 4 and 12 weeks after birth with women who have GD. A multidisciplinary team was formed to address the challenges of providing a free innovative program to address the lack of adherence of women with GD to follow-up with a glucose tolerance test. The “check and chat” program was implemented in January of 2018. Women are identified during pregnancy, provided diabetes education, and given an appointment for a follow-up glucose tolerance test. The women are contacted before the appointment. On arrival, a serum glucose level is obtained, women drink the glucola, and are encouraged to join discussions facilitated by a board-certified lactation consultant nurse specializing in infant care. Return to prepregnancy weight within 3 months, diet, exercise, and lactation are emphasized to prevent conversion to type 2 diabetes. After 2 hours, another serum glucose test is performed, and a free lunch is provided. The sessions are provided bimonthly. Women can bring their infants, their other children, and family members. The environment is comfortable, with big swivel chairs and stools for the women to relax and put their feet up. As of September 2019, 107 women have attended, 2 women have been identified with type 2 diabetes, and 32 women were referred to a PCP. Postpartum women complete a feedback form. Some comments from participants were, “Very helpful to meet other mothers,” “Speaking and relating with others helped decreased the stress,” “Learned a lot about lactation and newborn care,” and “Lunch was a nice thing. Thank you!” Nurses are instrumental in educating and encouraging health promotion. Postpartum nurses can promote follow-up glucose tolerance tests.

The application of nursing cooperation between parturient and postpartum nurses in the management of micturition after vaginal delivery

Objective To observe the effect of nursing cooperation between parturient and postpartum nurses in the management of micturition after vaginal delivery. Methods A total of 100 cases of pregnant women who were produced by vaginal delivery in the Second People's Hospital of Zhanjiang City, Guangdong Province (the Second Affiliated Hospital of Guangdong Medical University) (January to March 2018) and a total of 100 cases of pregnant women after the implementation (April to June 2018) were divided into the control group and the test group.The control group received routine post-natal urine discharge management, and the test group received the intervention of nursing management in post-natal and post-natal urination in the area of maternity ward and postpartum zone.The observation indexes of the two groups after intervention were compared. Results The first time of spontaneous excretion of urine and the incidence of postpartum urinary retention in the trial group were significantly lower than those in the control group, and the score of nursing satisfaction after puerperal urination was significantly higher than that in the control group, and the differences were satistically significant (P<0.05). Conclusions Using the collaboration between the delivery room and the post natal nurses to develop the nursing mode to carry out the urination management after vaginal delivery can help the parturient to successfully grasp the period of postpartum urination window, reduce the risk of postpartum urinary retention and improve the satisfaction of postpartum urination nursing. Key words: Crucial care; Vaginal delivery; Postpartum urination; Urinary retention

Delaying the First Newborn Bath and Exclusive Breastfeeding.

The purpose of this study was to determine if changing the timing of the initial newborn bath would have an impact on exclusive breastfeeding during hospitalization. The first newborn bath had been routinely done within 2 hours of age; practice was changed to the first bath being delayed until at least 12 hours of age. A secondary purpose was to examine the nurses' perceived benefits and challenges to such a change. Through a retrospective design, exclusive breastfeeding rates among mother-infant couplets prepractice change (cohort A) were compared with two postchange cohorts (B and C). Cohorts B and C were from the first 5 months and second 5 months, respectively after the practice change. Demographic information, birth type, bath timing, and feeding data were collected. Comparative statistics were applied to the three cohorts to examine differences in exclusive breastfeeding rates. Postpartum nurses were asked two open-ended questions on concerns and benefits of this change via an anonymous survey. Content analysis was completed on responses. There were 1,463 mother-infant couplets included in three cohorts (A: n = 564; B: n = 468; C: n = 431). There were no significant increases in the exclusive breastfeeding rates (baseline 74.1%) in both the first postimplementation delayed bath cohort (70.1%, p = .207) and the second "sustainability" cohort (79.4%, p = .060). Fifteen of the 60 postpartum nurses completed the survey, for a response rate of 25%. Themes generated from survey responses included concerns (infection control, work distribution), as well as benefits (perceived breastfeeding success, decreased workload) with delaying the first newborn bath. Delaying the first newborn bath may be one factor that can influence exclusive breastfeeding rates during postpartum hospitalization. Results have been mixed based on recent literature. In our study, the exclusive breastfeeding rate was already above average, as would be expected in a Baby-Friendly designated hospital and may be a reason we did not see a significant change in the rate among mother-infant couplets in our study. Randomized trials are needed for a rigorous evaluation of timing of the newborn bath and possible link to exclusive breastfeeding in the hospital and beyond.

Investigation of Anxiety and Its Influencing Factors in Postpartum Nurses Returning to Work from Giving Birth to a Second Child

<i>Objective:</i> We attempt to investigate the anxiety and its influencing factors in postpartum nurses returning to work from second childbirth so as to provide reference basis for making intervening measures to promote physical and psychological health of the postpartum nurses. <i>Methods:</i> We conducted a network questionnaire survey. Firstly, convenience sampling was used to select postpartum nurses who return to work from giving birth to a second child in public hospitals affiliated to Jiangmen City from September 1^st 2018 to December 31^st 2018. Then we adopted Self-Rating Anxiety Scale (SAS) to conduct a cross-sectional study of the anxiety of postpartum nurses returning to work from giving birth to a second child. We later used Logistics regression analysis to analyze the influencing factors of anxiety of the postpartum nurses. <i>Results:</i> the average score of 702 postpartum nurses on anxiety was (48.64±11.57), and the incidence of anxiety was 42.1%, among which the incidence of mild anxiety was 25.7%, moderate anxiety was 11% and severe anxiety was 5.4%. The Logistics regression analysis showed that duty, coping style, family function and social support were the factors that influenced anxiety of the postpartum nurses (R²=59.41%). <i>Conclusions:</i> The situation of anxiety of postpartum nurses returning to work after giving birth to a second child is severe, and family function is a major influencing factor of their anxiety. Nursing managers can help reduce the influence of family function on anxiety of postpartum nurses through providing psychological adjustment for them, help for their family and support for their work.

Current Resources for Evidence-Based Practice, January/February 2020.

Current Resources for Evidence-Based Practice, January/February 2020.

Postpartum hormonal contraception in breastfeeding women.

To provide an overview of recent research and guidelines regarding contraception and breastfeeding. Recent studies assessed lactogenesis, breastfeeding rates, and milk supply concerns in patients starting postpartum hormonal contraception. One study showed a small but statistically significant increase in milk supply concerns between users and nonusers of postpartum hormonal contraception. Mean time to lactogenesis and breastfeeding rates were similar between patients with immediate and delayed insertion of the levonorgestrel (LNG) implant in one study and the LNG intrauterine device (IUD) in another study. Two studies assessed nursing knowledge and attitudes toward postpartum contraception in breastfeeding women, showing that postpartum nurses had incorrect knowledge of contraceptive safety in this patient population. Both studies demonstrated persistent erroneous beliefs that depot medroxyprogesterone acetate (DMPA) adversely affects breastfeeding. In postpartum patients intending to breastfeed, more than half intended to initiate contraception within 6 weeks postpartum and few indicated effect on breastfeeding as a factor in their decision. There are no significant differences in lactogenesis, breastfeeding, and infant growth parameters between immediate postpartum (IPP) and delayed insertion of LNG implants and IUDs. Labor and delivery and postpartum nurses have persistent erroneous beliefs that DMPA negatively affects breastfeeding. Patients desire to use contraception postpartum but prenatal counseling rates and practices are of variable content and quality.

Informing New Mothers about Newborn Screening Bloodspot Repositories during Postpartum Hospitalization.

The primary goals of the study were to assess maternal knowledge and attitudes about the newborn screening bloodspot repository program in Texas and to evaluate the effect of a video about the bloodspot repository on the rate of parental permission to store infant bloodspots. This descriptive, comparative study used descriptive statistics, nonparametric tests, and multivariable analyses to describe the sample, compare groups, and determine associations between factors that influenced parents' decisions to permit state storage of infant bloodspots. There were 465 mothers in the study. Maternal knowledge about basic genetics and risks of genetic testing was poor, but mothers reported strong trust in the state to make good decisions about using genetic material for research. Race, ethnicity, and attitude toward research significantly influenced decisions to opt-in to the bloodspot storage program. Postpartum nurses provided the bulk of information about newborn screening and dried bloodspots, although 2/3 of respondents would have preferred to obtain this information prior to birth. Although postpartum nurses are the most common source of information about newborn screening, genuine informed consent for bloodspot storage is questionable. Information about newborn screening and bloodspot storage needs to be addressed in community venues prior to birth.

Standardizing Postpartum Discharge Instructions With an Educational Video: A Quality Improvement Project

Background The World Health Organization (WHO) estimates that, in the United States, 1200 women annually experience perinatal events that prove fatal and 60,000 suffer complications that are near-fatal. Postpartum morbidity and mortality may be decreased by explicit patient education. At our institution, the maternal discharge education process was varied among providers. Of the available literature, most focus on maternal knowledge of pediatric concerns with a limited amount of studies looking at maternal postpartum health. Objective The objective of this quality improvement project is to standardize postpartum education with the use of a postpartum education video available on a bedside tablet in order to improve maternal perception and knowledge of postpartum warning signs. Methods This prospective cohort study was designed using a patient survey which was administered to evaluate the effectiveness of the maternal discharge education procedures in our institution. The baseline results were reviewed by a team of physicians and nurses. A 10-question survey was provided to patients following the birth of their first baby about maternal warning signs and complications after discharge from the hospital. A standardized discharge education video was created using information from ACOG and AWHONN. The video was made accessible on bedside tablet devices. Patients were able to indicate understanding or request clarification on the devices after review of the materials, and this was communicated from the tablets to the electronic health record. All postpartum nurses were trained on the video content and how to operate the tablets. Survey responses were collected via bedside tablets following implementation of the video and were compared with the baseline results. Educational information was available to patients after discharge from the hospital via a patient portal. Results Twenty-nine women were surveyed prior to implementation of the standardized educational video available on bedside tablets. After implementation, 50 women were surveyed. Comparison of the survey responses showed there was an increase in patient-reported knowledge and understanding in all 10 questions on the survey. Of those, 4 areas were statistically significant with P values &lt;.05: when to call 911 (82.8% before and 98% after), when to call your doctor (75.9% before and 98.0% after), heavy vaginal bleeding (62.1% before and 87.8% after), and symptoms of acute blood loss (51.7% before and 83.7% after). Conclusions The implementation of a postpartum education video available to patients on bedside tablets improved and standardized workflow for routine postpartum care and discharge processes. Survey questions regarding patient knowledge and perception of when to call 911, when to call your doctor, heavy bleeding, and signs of acute blood loss were all noted to be statistically significant. The improved perception of postpartum warning signs after the educational video appears to be beneficial in patient education at this high volume OB institution. The establishment of this platform for education became a model for education in other hospital units using bedside tablets. The use of a multidisciplinary team to review, revise, and standardize the postpartum education program at our institution was well received and supported by nurses, providers, and ultimately patients.

Incorporating a Resident-Driven Quality Improvement Process Change Through a Lean Transformation of Post-Partum Hemorrhage (PPH) Care

PURPOSE: To investigate a resident-driven quality improvement lean event to improve satisfaction in PPH management. BACKGROUND: Interdisciplinary PPH response strategies are recommended as standard of care. OBGYN resident perceptions regarding PPH management prompted an interprofessional quality improvement lean event to create a systems process change on the post-partum unit. METHODS: This was a pre-/post-intervention study evaluating the impact of a lean event that created new hemorrhage protocols (intervention) on postpartum units including: medication safety bundle, assigned/clarified roles for providers, and a streamlined communication process. The survey queried respondents regarding team communication, access to uterotonics and analgesia, and perception of overall patient safety during PPH. It was administered to resident physicians and post-partum nurses prior to the system changes and at 6 and 12-month intervals. These results were compared using nonparametric analyses. RESULTS: Participants included 15 residents and 16 nurses. Pre-intervention, there was a significant difference in the overall perception of safety when comparing resident and nurse response (p=0.0495) with residents perceiving a less safe environment. Post-intervention, overall satisfaction among the 2 groups was improved at the 6 & 12 month intervals (p<0.05) without discrepancy between the groups. Nurse results demonstrated significantly increased satisfaction with team communication and IV access protocols (p<0.05). DISCUSSION: Resident led quality improvement events can result in improved satisfaction of interprofessional team members in PPH care with improvements maintained over 12 months. Reaching a shared perception and mental model between nursing and residents in the care of PPH can further be studied from the patient’s perspective.

Correlation of nurses' comfort with touch, job stressors and job burnout in postpartum nurses with the second-child

Objective To explore the correlation among nurses' with touch, and in postpartum nurses with the second-child, and to provide evidence for nursing managers to formulate and implement humanized and scientific management plans. Methods By convenience sampling, postpartum nurses with the second-child back to in 6 Class Ⅲ Grade A hospitals in Wenzhou from February 2017 to July 2018 were selected as the research objects. Self-designed General Information Questionnaire, Nurses' Comfort with Touch Scale (NCTS) , Chinese Nurses' Work-Stressor Scale (CNSS) , Chinese version of Maslach Burnout Inventory General Survey (MBI-GS) were used in the study. Totally 125 questionnaires were distributed and 119 valid ones were retrieved, yielding an effective recovery rate of 95.2%. Results The 119 postpartum nurses back to achieved a total score of (43.56±6.09) in NCTS, (535.58±245.96) in CNSS, (25.87±10.43) in the job burnout dimension in Chinese version of MBI-GS, (8.96±6.03) in depersonalization and (30.12±8.67) in personal sense of achievement. Pearson correlation analysis indicated that, the returning postpartum second-child nurses' scores of depersonalization and work stressors were negatively correlated with the score of comfort with (P<0.05) , the personal sense of achievements was positively correlated with comfort with (P<0.01) . Multivariate regression analysis showed that emotional burnout, nurses' stressors, whether receive special care from departments, and income satisfaction were the influencing factors of nurses' touch comfort. Conclusions Touch is related to stress and in the postpartum second-child nurses back to work. Nursing managers should formulate and implement corresponding management training programs according to the characteristics of them, and give more care and support to improve their enthusiasm and efficiency. Key words: Nurses; Job burnout; Comfort with touch; Job

Postpartum Nurses’ Experience Caring for Infants With Neonatal Abstinence Syndrome

In previous years, otherwise healthy infants with neonatal abstinence syndrome (NAS) in our hospital were transferred to the NICU and frequently treated with medication. Currently, infants with NAS room-in with their mothers and rarely require medication. We sought to understand the lived experience of nurses on maternity and well-newborn units caring for infants with NAS. We conducted focus groups of registered nurses on postpartum units at 2 hospitals using qualitative methodology. Themes were identified through consensus, and the focus groups were stopped when no new themes were identified. Seventeen postpartum nurses participated in 5 focus groups. The following major themes emerged: (1) managing the expectations of parents of newborns with NAS, (2) current NAS protocol (positive aspects of rooming-in and challenges with withdrawal scoring tool), (3) inconsistencies in care and communication, (4) perceived increase in nursing workload on the postpartum unit, and (5) nurses' emotional response to the care of infants with NAS. We highlight the perspectives of nursing staff on the well-newborn unit who were previously unaccustomed to caring for infants with NAS. With increasing numbers of infants with NAS and longer stays on the well-newborn unit, hospitals must prepare to better support staff and implement protocols that offer consistency in practice.

Care during Breastfeeding: Perceptions of Mothers and Health Professionals.

Purpose. To know the perceptions of mothers and health professionals in relation to the care provided and received during breastfeeding at primary health care level.Methods. A qualitative exploratory study was conducted with breastfeeding mothers (10) and primary health care professionals (24). Data was gathered through in-depth interviews and focus groups. Data analysis was performed through thematic content analysis. The rigor of the study was ensured by the Guba and Lincoln criteria for qualitative research. Ethical aspects were addressed through the informed consent process, confidentiality, and methodological rigor.Results. The experience of providing/receiving breastfeeding support was revealed as a dynamic, multidimensional care and support process, through three central themes: 1. Influence of previous care and support experiences during the breastfeeding process; 2. Importance of the context within which care is framed; and 3. Addressing emotions to establish trust between professionals and mothers.Conclusion. The study findings contribute to further understanding a complex phenomenon, such as breastfeeding support and care for mothers/families, from the experience of the actors involved, deepening the experiences of both in integrated manner. In addition, the relational, organizational, and contextual dimensions that influence support, and that should guide care, are also highlighted.

Preparation for a Malignant Hyperthermia Event for Labor, Delivery, and Postpartum Nurses

Preparation for a Malignant Hyperthermia Event for Labor, Delivery, and Postpartum Nurses

An exploratory study of the perception of contraceptive safety and impact on lactation among postpartum nurses at Women and Infants Hospital in 2017

ObjectiveTo describe contraceptive knowledge and counseling practices of postpartum nurses. MethodsWe surveyed postpartum nurses at the largest women's hospital in Rhode Island. ResultsWe distributed 117 anonymous questionnaires and received 58 responses (response rate=50%). Twenty-three of 51 nurses (45%) reported routinely offering contraceptive advice to new mothers. Only 5/55 (9%) responded correctly that combined hormonal contraceptives were an “unacceptable health risk” in the immediate postpartum period. A minority of respondents correctly classified the progestin-only pill, depot medroxyprogesterone acetate, the etonogestrel implant, the levonorgestrel intrauterine system and the copper intrauterine device as safe to use during lactation [14/56 (25%), 24/56 (43%), 27/56 (48%), 19/55 (35%) and 9/55 (16%), respectively]. Thirty-three of 51 nurses (65%) incorrectly responded that depot medroxyprogesterone acetate decreases milk supply if started immediately postpartum. ConclusionThere are opportunities to improve knowledge regarding contraceptive safety and impact on lactation among postpartum nurses at our institution.

Application effect for seven emotions theory of traditional Chinese medicine in postpartum depression nursing

Objective To explore the application effect for seven emotions theory of traditional Chinese medicine in postpartum depression nursing. Methods A total of 70 cases of postpartum depression patients admitted from April 2016 to May 2017 were selected and divided into the control group (receiving conventional nursing) and the observation group (receiving traditional Chinese medicine seven-emotion theory nursing) with the random number table method.The clinical efficacy and quality of life of the two groups were compared. Results After treatment, the Hamilton Depression Scale (HAMD)score of the observation group was significantly lower than that of the control group (P<0.05). After treatment, the RP, BP and SF of the two groups were significantly higher than before treatment(P<0.05). The levels of BP, GH, VT, SF, MH and HT in the observation group were significantly higher than those in the control group(P<0.05). Conclusions The nursing effect of seven emotions theory of traditional Chinese medicine on postpartum depression patients is satisfactory with high quality of life, which is worthy of clinical application. Key words: The seven human emotions; Postpartum depression; Nursing care

Simulation-Based Education to Train Learners to "Speak Up" in the Clinical Environment: Results of a Randomized Trial.

Assertiveness is essential for communication and/or speaking up. We performed a randomized trial to assess the effectiveness of assertiveness/advocacy/CUS/two-challenge rule (AACT) simulation-based education for labor and delivery, as well as postpartum nurses. We aimed to determine whether this training would improve labor and delivery and postpartum nurses speaking up in the clinical setting. We conducted a randomized controlled trial among nurses on labor and delivery and postpartum units. During the intervention, participants were trained on abnormal vital signs, underwent a baseline assertiveness self-assessment, and were block-randomized (by work location: labor and delivery or postpartum) to either simulation-based AACT (intervention) or I-PASS [Illness Severity, Patient Summary, Action List, Situational Awareness and Contingency Planning, Synthesis by Receiver hand-off tool education] (control) simulation-based education. The outcome part of the study consisted of an in situ simulated clinical encounter during which each individual learner's assertive behaviors were assessed as they found out about a patient's abnormal vital signs. Two raters, different from those that participated in the intervention part of the experiment, and who were blinded to whether the learner was in the control or intervention arm, scored participants. The learner (Registered Nurse) was not aware that this was an in situ simulation and perceived this as a real clinical encounter. The degree to which the learners spoke up was measured using a validated scale (Pian-Smith). Seventy nurses completed the study. There were 34 learners in the intervention and 36 in the control groups. Among those in the intervention group, there were 18 labor and delivery (LDI) nurses and 16 postpartum (PPI) nurses. Among the control group, there were 14 labor and delivery (LDC) nurses and 22 postpartum (PPC) nurses. Using a five-point Pian-Smith scale, we demonstrated that there was no difference in the likelihood of speaking up between the overall intervention and control groups (2.00 ± 1.00 and 1.65 ± 0.82, P = 0.10). Among controls, the likelihood of speaking up was higher for labor and delivery nurses than for postpartum nurses (P < 0.006). There was a significant interaction (P = 0.02) between treatment group and work location. Although the control and intervention groups from labor and delivery showed similar higher levels of speaking up (2.29 ± 0.89 and 2.06 ± 0.95, respectively, P = 0.49), postpartum nurses in the intervention arm were more likely to speak up than were postpartum nurses in the control arm (1.97 ± 1.07 vs. 1.25 ± 0.43, P = 0.007). Although there was no difference in speaking up scores between intervention and control groups overall, simulation-based AACT training among postpartum nurses was associated with a statistically significant increase in the likelihood of speaking up during a challenging simulated clinical encounter. The degree of change makes the clinical significance uncertain. There was no statistically significant difference in the likelihood of speaking up among labor and delivery nurses.

Correlation between family cohesion and adaptation and work adaptation in postpartum nurses with second child

Objective To explore the correlation between family cohesion and adaptation and work adaptation in postpartum nurses with second child. Methods There were 155 postpartum nurses with second child collected from 4 hospitals in Chengdu of Sichuan Province between October and December 2017, by convenience sampling. Family Adaptation and Cohesion Evaluation Scale Ⅱ and Questionnaire of Return Adaptation for Postpartum Nurse were used in the investigation. Results The family real cohesion, ideal cohesion and dissatisfaction of coherence were (66.95 ± 8.37), (71.68 ± 6.45), (7.87±5.13) points in this study, which were higher than norms: (63.90±8.00), (68.80±5.30), (6.40 ± 5.00) points, and there were significant differences (t=-3.086, -4.079, -2.403, all P 0.05). The dissatisfaction of adaptation was (9.36±5.22) points, which was higher than norms: (7.40 ± 5.30)points, and there was significant difference (t=-3.076, P<0.05). There were 24 (15.5%) nurses in extreme type family, 54 (34.8%) in intermediate type and 77 (49.7%) in balance type. The average score of work adaptation was (2.41±0.76) points. The scores of work adaptation in nurses of extreme type family were lowest. Time since working, dissatisfaction of adaptation, dissatisfaction of coherence and hospital level were the influencing factors of work adaptation. Conclusions Nursing managers should face up to the situation of work adaptation in postpartum nurses, humanize their management, pay attention to the emotional state, promptly dispel their bad negative emotions, take measurements to improve the understanding of nurses′ families and help them pass the adaptation period of returning to work. Key words: Nurses with second child; Family cohesion; Family adaptation; Postpartum return to work

Student TXT.

The Nativity: A Postpartum Nurse's PerspectiveFigureBy Marlynda Droogsma, MSN, RN. Marylynda works in a postpartum unit at a large metropolitan hospital in the Minneapolis-St. Paul, Minnesota area. Christmas is rapidly approaching. You probably have already viewed and heard commercials advertising Christmas sales. Maybe you have plans for Black Friday shopping. But perhaps, like me, you will have to work on Christmas Eve and Christmas Day. As a postpartum nurse, I feel especially blessed with this opportunity, even if it means I miss celebrating the day with my family. I have the incredible opportunity to care for babies on the holiday when we remember the best birth of all: that of our Savior. Following are some reflections on that nativity scene from a postpartum perspective. Joseph: Most first-time dads have a certain look—exhausted, dazed, and overwhelmed. These new fathers have watched and encouraged their wives during the birth. However, Joseph's experience of birth did not include the support of physicians and nurses. He probably had to help Mary a great deal. But I imagine Joseph had that same look I see on daddies' faces when the birth ordeal is over and that baby is quiet in their arms—a mixture of love, wonder, and satisfaction. God chose Joseph to fill the earthly father role for the Son of Man. Mary: Sweet, beloved Mary! Here is a shout-out to all the women before us who gave birth to babies with no medical help (especially no pain meds!). Thank goodness Mary did not hemorrhage to death in that stable. She might have birthed the Son of God onto a scratchy piece of fabric amid onlooking animals—we'll never know those details. Mary had been brave since Gabriel visited her and presented her with the unexpected role that would make her appear as a less virtuous woman in people's eyes. Sweaty, bloody, and tired after the delivery, Mary finally looked with awe at the child of the promise that she held in her arms. Jesus: Holy and helpless. Our Redeemer. Our King. He was a baby. A tiny bundle. No warmer or high-tech equipment was ready to keep him stable in the stable, just a mother's skin. Bloody, crying (hopefully within the first minutes of life) and hungry. He needed to be cared for—the peace of heaven that would grow up to care for the world. What a gift. When I recall in my mind the babies I have cared for, I picture Jesus as one. I am thankful for this perspective and continue to wait patiently until that baby, who became our Savior, comes again. Did you know? Saint Francis of Assisi is credited with staging the first re-creation of the nativity scene on Christmas Eve 1223, after he visited Israel. His biographer, St. Bonaventure, wrote that St. Francis wanted people to focus on the humble birth of Jesus, rather than the exchange of gifts. This live nativity was held in a cave in Italy and incorporated an empty manger with hay and an ox and a donkey (Filz, 2016). The correct way to set up a nativity scene is with the figures of Mary and Joseph on either side of the manger, with Mary closest to the manger. The shepherds should form the first circle outside the stable, whereas the wise men form the second circle because they arrived later. The star and the angel should hover above the stable, with barn animals scattered throughout the scene (Bell, 2016). The town where the Savior was born—Bethlehem—is translated from Hebrew to English as house of bread. This is no coincidence with the fact that the infant born there later told his disciples in John 6 that he is the Bread of Life, explaining, “For the bread of God is the bread that comes down from heaven and gives life to the world” (John 6:33, NIV).

Status of self-efficacy and related influencing factors of postpartum nurses in early stage after returning to work

Objective To investigate the status of self-efficacy and related influencing factors of postpartum nurses in early stage after returning to work. Methods From January 2017 to February 2018, 71 nurses in the early stage of postpartum return from Liu'an People's Hospital of Anhui Province were selected as the research subjects. The subjects were investigated by the general data questionnaire, the Chinese version of the General Self-Efficacy Scale, the Self rating Anxiety Scale, the Simple Coping Style Questionnaire and the Understanding Social Support Scale. Results The early general self-efficacy of postpartum nurses was (2.57±0.58) points, and the different levels of anxiety, family support, coping style, Department nature and working years had an impact on the early self-efficacy of postpartum return nurses (P < 0.05). Conclusions The self-efficacy of postpartum nurses at the early stage is at a lower level. The level of anxiety, family support, coping style, Department nature and working life are the main factors affecting the self-efficacy of postpartum return nurses, including the severe department, short work years, high anxiety level and low family support. The period of self-efficacy is low. Nursing managers should pay attention to this part of postpartum return to post nurses, formulate perfect postpartum return training to give scientific management of science, so that they can be better put into work and life. Key words: Nurses; Postpartum return to work; Early stage; Self-efficacy