Reflective Learning from a Maternal-Child Simulation: Enhancing Postpartum Nursing Practice

QUESTION

Maternal-child assignment.

The client is a 23-year-old female, G1P1T1A0L1, Who delivered a healthy baby 4 hours ago.  Delivered a female, at 3650 grams- spontaneous vaginal delivery with forceps, due to shoulder dystocia requiring vacuum and forceps.  The patient had a midline episiotomy with 1st-degree tear. Labour lasted 13 hours.  Morphine 2.5 mg was given 5 hours ago. EBL less than 250ml, PV loss moderate rubra – wearing pad.  The patient has ambulated to the bathroom once for 200cc of urine.  Breastfeeding initiated. Her partner just went home to shower and change.  The client has been transferred from labour and delivery to the postpartum unit.  You are the assigned nurse who needs to complete the initial patient assessment.  The newborn is in the nursery for assessment and the first bath at the mother’s request.

Target Learner: Nursing students enrolled in a maternal-child course.

Post debriefing questions

1. Were there any initial decisions made that have changed due to your experience with this simulation? Does this change or impact your nursing practice?
2. Imagine you have returned to check on mom post-breastfeeding the newborn. Mom discloses that she uses cannabis to reduce anxiety and asks “will this affect my baby?” What nursing intervention(s) would you use to address this concern?
3. Reflecting on different acronyms for example, BUBBLE-HE; the four T’s (tone, trauma, tissue, thrombin); rule of 30 (30% fall in hematocrit, a 30 mmHg fall in systolic blood pressure, an increase by 30 beats/min of pulse rate, a 30% fall of hemoglobin (approximately 3 g/dl), and an approximate blood loss of 30% of normal). Which acronym do you believe best supports your nursing practice to help ensure accurate and timely assessment of postpartum bleeding.

Post Simulation Reflection

Reflecting on the post simulation debriefing questions, describe the      relevance of the experience and learnings for your professional nursing practice. Learners will identify areas of learning, utilize literature (if relevant), and show critical thinking related to the simulation.

1. Each individual student will need to submit their own reflection.

Reflective Questions

• 1      How did you feel as you assumed the nurse’s role during the simulation?

2        How does this simulation compare to any other clinical experiences you have had? 3

3        What was similar or different about this client’s situation?

4        What did you take away from the incorrect decisions you made in the scenario?

5      List 2 things you will take back to your clinical practice from this scenario.

6      How would you describe the process or steps taken to conduct a post-partum assessment?7

7       How would you achieve a firm fundus in the event of atony?

Use a course textbook on maternity nursing and read the material regarding post-partum health assessment. The following 3 texts could be used by your nursing faculty as a course resource, only 1 of the 3 is required:

• Evans, Robin, et al., (2021). Canadian maternity, Newborn and Women’s Health Nursing: Comprehensive Care Across the Lifespan. Wolters Kluwer
• Leifer, Gloria & Keenan-Lindsay, Lisa. (2019). Liefer’s Introduction to Maternity and Pediatric Nursing in Canada. Elsevier
• Webster, Jessica et al., (2019). Canadian Maternity and Pediatric Nursing, 2nd edition. Wolter Kluwer

ANSWER

Reflective Learning from a Maternal-Child Simulation: Enhancing Postpartum Nursing Practice

Introduction

Participating in the maternal-child simulation allowed me, a nursing student, to assume the role of a postpartum nurse and complete an initial assessment for a 23-year-old female who had recently delivered a healthy baby. The simulation provided a unique opportunity to apply theoretical knowledge from maternity nursing textbooks and previous clinical experiences in a realistic scenario. This reflective essay will discuss my feelings during the simulation, compare it to previous clinical experiences, and explore the relevance of the learnings to my professional nursing practice.

Simulation Experience

During the simulation, I initially felt a mixture of excitement and nervousness as I took on the role of the postpartum nurse. The responsibility of providing care to a new mother and her baby added to the challenge, but I was eager to apply my knowledge and skills. As the scenario progressed, I felt more confident in my ability to perform the postpartum assessment and address the mother’s needs.

Comparison to Previous Clinical Experiences

The maternal-child simulation offered a more focused and comprehensive experience compared to some of my previous clinical rotations. While other clinical experiences were beneficial in providing a broader understanding of nursing practice, this simulation was highly specialized in the postpartum setting. It allowed me to hone my assessment and communication skills specific to maternal and neonatal care.

Client Situation Comparison

The client’s situation in the simulation was quite similar to some of the postpartum patients I encountered during previous clinical rotations. The case of a young mother who underwent a vaginal delivery with episiotomy and had initiated breastfeeding resonated with real-life scenarios I had encountered. However, the simulation allowed me to explore different aspects of postpartum care, such as addressing the mother’s concerns about cannabis use.

Learnings from Incorrect Decisions

The simulation exposed me to the importance of timely and accurate decision-making in the postpartum setting. When reflecting on incorrect decisions made during the scenario, I realized the significance of paying attention to detail and conducting thorough assessments to identify potential complications. It reinforced the need for staying updated on evidence-based practices to provide optimal care to postpartum patients.

Takeaways for Clinical Practice

Two key takeaways from this simulation that I will apply to my clinical practice are:

Communication: Effective communication is essential in the postpartum setting to address concerns, educate new mothers about self-care, and foster a supportive environment for breastfeeding.

Postpartum Hemorrhage Assessment: The rule of 30 acronym stands out as a useful tool for assessing postpartum bleeding and promptly identifying potential hemorrhage risks.

Process of Conducting a Postpartum Assessment

The process of conducting a postpartum assessment involves the following steps:

Greeting and establishing rapport with the mother
Obtaining a comprehensive health history, including the details of the labor and delivery process
Assessing vital signs, fundal height, and lochia
Evaluating perineal and episiotomy wounds
Supporting breastfeeding initiation and monitoring the baby’s latch and suckling pattern
Educating the mother on self-care, infant care, and postpartum recovery

Achieving a Firm Fundus in the Event of Atony

In the event of atony, the nurse must massage the uterus firmly until it contracts and feels firm. Additionally, administering uterotonics, such as oxytocin or misoprostol, can help promote uterine contractions and prevent excessive bleeding.

Relevance to Professional Nursing Practice

The maternal-child simulation provided valuable insights into the specialized care required for postpartum patients and their newborns. It deepened my understanding of postpartum assessments, breastfeeding support, and addressing maternal concerns. By applying the knowledge gained from this simulation, I aim to enhance the care I provide to postpartum patients in my clinical practice. Effective communication, thorough assessments, and timely interventions will be key priorities in my future nursing practice, contributing to improved patient outcomes and overall maternal-child healthcare.

Conclusion

The maternal-child simulation experience has been instrumental in consolidating my knowledge and skills related to postpartum nursing care. By reflecting on my feelings during the simulation, comparing it to previous clinical experiences, and identifying key learnings, I recognize the importance of incorporating evidence-based practices in postpartum care. This reflective process will inform my nursing practice, enabling me to provide comprehensive and compassionate care to postpartum patients and their newborns, ultimately contributing to positive healthcare outcomes.