Digital Repository Masters Projects Spring 2023 Improving Access to Healthcare: Creation of an Online Prenatal Education Program Charlotte Andrus Weber State University Follow this and additional works at: https://dc.weber.edu/collection/ATDSON Andrus, C. 2023. Improving access to healthcare: Creation of an online prenatal education program. Weber State University Masters Projects. https://dc.weber.edu/collection/ATDSON This Project is brought to you for free and open access by the Weber State University Archives Digital Repository. For more information, please contact scua@weber.edu. 1 4/5/23 05/25/2023 2 Improving Access to Healthcare: Creation of an Online Prenatal Education Program Charlotte Andrus, BSN, RN, MSN Student Weber State University Annie Taylor Dee School of Nursing NRSG 6801: Integrating Scholarship into Practice Tamara Berghout, RN, EdD 3 Abstract Prenatal education is vital to a person’s journey into pregnancy and parenthood. Prenatal education is an excellent tool for providing important information about pregnancy, postpartum, and newborn care. Evidence indicates that prenatal education can be delivered in a variety of formats. This project aims at developing a prenatal education class that is easily accessible to all patients. This project includes resources for staff members about the prenatal education course and information on how the project will improve patient care in the labor and delivery unit. Resources for the patients will also be provided in the form of a patient handout. This project aims to improve knowledge about pregnancy complications, information about labor and delivery, postpartum care and complications, and caring for the newborn. Patients who participate in the education may benefit through decreased hospital stays, lower c-section rates, and increased confidence in caring for themselves and their newborn babies. Staff members can benefit because the time they typically use to educate patients at admission can instead be used to focus on direct patient care. Keywords: prenatal, prenatal education, prenatal class, online prenatal education, pregnancy, newborn care 4 Improving Access to Healthcare: Creation of an Online Prenatal Education Program Pregnancy and delivery can be an overwhelming journey for expectant parents. As a result, parents can feel anxious and unsure of what to expect during labor and delivery. Anxiety during pregnancy can stem from multiple issues, including knowing when to call the provider, when is the right time to go to the hospital, and what will happen when they arrive. Other causes of anxiety for expectant parents stem from worries about potential pregnancy complications, questions about what foods and medications are safe during pregnancy, and a lack of understanding of general precautions that must be taken during pregnancy (Lockwood & Magriples, 2022). Prenatal education plays a significant role in expectant parents' journey through pregnancy, delivery, and care of their newborn baby. Different forms of prenatal education must be offered to expectant parents, as different people learn from different teaching methods (Wright et al., 2021). Some examples of prenatal education include information given by the provider, in-person group prenatal classes, smartphone-based prenatal education books, and online prenatal classes. These different forms of education help fulfill parents' needs and establish expectations during pregnancy and delivery (Cutajar & Cyna, 2018). Fortunately, prenatal education can help reduce the stress associated with the expectant parent's lack of knowledge (Hong et al., 2021). Statement of Problem Prenatal education can be an effective way to prepare expectant parents (Mukhondya et al., 2020). However, some expectant parents need more resources to obtain prenatal education and often rely on information from friends or other sources that may not be accurate (Balasoiu et al., 2021). Current literature indicates that some people cannot afford reliable transportation and 5 are unable to afford a professional prenatal class (Bellerose et al., 2022). In addition, many of these expectant parents dismiss the importance of prenatal classes because of the cost. (Balasoiu et al., 2021). Many Women look for information online or via smartphone regarding prenatal education because of its convenience and low cost (Wright et al., 2021). One way to help families that have not been able to obtain prenatal education is to offer them a nurse-created, evidence-based online education. Therefore, the purpose of this MSN project is to implement a free or low-cost, easily accessible online prenatal education program. This innovative form of education could be vital for many individuals because it would help them to receive the knowledge necessary for a healthy pregnancy, delivery, and postpartum period. Online prenatal education will be able to deliver topics to these individuals about birth, breastfeeding, pregnancy, and parenthood. In addition, more specific education on pregnancy complications and exercise will also be available. Ways Project Contributes to Intended Recipients This MSN project will benefit expectant parents because it can help to increase knowledge about pregnancy, birth, and newborn care. Offering a low-cost online prenatal class could allow expectant parents to become more confident in their information regarding their pregnancy (Prabhakar et al., 2019). Another benefit is that prenatal education on breastfeeding can help those who cannot afford formula to learn how to breastfeed their babies successfully (CDC, n.d.). This project also benefits nurses because offering a low-cost prenatal class decreases the need for nurses to spend time providing in-depth education upon admission to the hospital for labor and delivery. In addition, online prenatal education can decrease unnecessary hospital trips if parents understand what to expect (Lockwood & Magriples, 2022). 6 The Rationale for the Importance of the Project This project is valuable because the literature shows that many expectant parents cannot afford professional prenatal classes (Bellerose et al., 2022). Developing a nurse lead online prenatal education program is essential for many expectant parents and staff who work in the labor and delivery unit. This project can improve patient safety and limit unwanted complications by increasing expectant parents' knowledge. Implementing this online education program can also decrease expectant parents' anxiety about pregnancy, labor and delivery, and newborn care (Hong et al., 2021). In addition, free patient education can decrease costs related to unnecessary hospital visits (Lockwood & Magriples, 2022). Most importantly, this project will be able to provide prenatal education to those who otherwise would not receive professional prenatal education. Literature Review and Framework This section of the paper will discuss the process used to identify evidence to substantiate the problem, examine the impact of prenatal education on patient outcomes, and identify evidence-based solutions to help resolve the problem. The literature review identified an evidence-based framework to guide the implementation of this MSN project. Framework The model selected to guide this project is the Iowa Model Revised (IMR). The Iowa model begins when a patient-based issue is identified. Then, working with an interdisciplinary team, questions can be asked, research can be conducted, and evidence can be used to fix the problem (University of Iowa, 2017). The IMR also helps to prioritize projects within the healthcare system and allows small-scale planning and piloting before implementing a change system-wide (Klingbeil & Gibson, 2018). This model provides a process for changing healthcare 7 practice using evidence to improve nursing practice and patient outcomes (Hanrahan et al., 2019). Providing this online prenatal class for those in need can help improve patient outcomes. Therefore, this model will apply to this project. The IMR consists of 7 steps that can be used to make an evidence-based change. They are: 1. Identify where a change is needed 2. Determine if the problem is for a specific unit, department, practice, or organization 3. Form a team responsible for developing, evaluating, and implementing the change 4. Gather and analyze the research applicable to the change and formulate a research question in a PICO(T) format 5. Synthesize current knowledge 6. Decide if there is sufficient research to implement a change in practice; if there is not enough evidence, continue to search for evidence or determine if there is an actual need to conduct a research study. 7. Implement a small-scale pilot program 8. Evaluate the results, change the implementation as needed, then introduce the program across the unit/department/organization (Cabarrus College of Health Sciences, 2022). The steps of the IMR will be used to identify a need for an online prenatal education program in this MSN project. Evidence has shown that prenatal education can help increase the knowledge of expectant parents. However, many pregnant women and partners have reported that they cannot attend prenatal classes due to cost or accessibility. A PICOT question has been developed for this needed change, and research has been identified in a literature review to determine whether a change can be implemented. The next step will be to develop an affordable 8 and accessible prenatal education program for expectant parents. The change will then be evaluated by expectant parents who participate in the class, as well as staff members, to determine the effectiveness of the change. Strengths and Limitations One reason for using the IMR is that it allows the change to undergo a pilot process, which allows the change agent to make modifications based on the initial results. For example, in this project, the pilot's initial results can help identify issues that can be addressed before the change is fully implemented. This step is essential to ensure that the change will succeed. The IMR also allows for continuous project improvement. One possible limitation is that the IMR is a detailed, comprehensive, evidence-based practice model; therefore, implementing a project could take some time. (Arsalan, 2022). This complication could be a disadvantage to those organizations who want to implement change fast, but for those not impacted by time, having a detailed model will allow for a more successful implementation. Analysis of Literature By reviewing current literature, three primary themes regarding the benefits of offering a free or reduced cost online prenatal class for pregnant women and partners were identified. These themes will help plan how to implement an online prenatal class. The first theme identified in the literature emphasizes the importance of prenatal education. The second theme is the different prenatal education delivery programs besides in-person classes. The last theme is that a lack of prenatal education has been identified. Search Strategies 9 A literature search was conducted to identify current evidence using Google Scholar, Weber State University's Stewart Library's OneSearch, Advanced Search (which spans multiple databases), CINAHL, and Medline Plus. The following keywords were utilized in the search, prenatal, prenatal classes, prenatal education, online prenatal classes, online prenatal education, alternative, application, and smartphone. Various Boolean combinations were created with the keywords mentioned above to create a broad search. Only articles from 2017 through 2022 were included in this literature review to keep the information current. Both non-research and research-based evidence was appraised. After evaluating the evidence, 18 sources were identified as applicable to this project. Lack of Prenatal Education The literature review helped to substantiate that many pregnant women do not receive adequate prenatal education. Those most affected by a lack of prenatal education included those who reside in rural areas and those in lower socioeconomic groups (Milcent & Zbiri, 2018). The literature helps support that there is a lack of prenatal education. Milcent & Zbiri (2018), states that cesarean section rates are higher in areas where there is a lack of prenatal education. A pilot program was launched in areas where a lack of prenatal education was identified, and cesarean section rates were subsequently lower than before (Milcent & Zbiri, 2018). Prenatal and postpartum depression rates are continually rising, and a lack of prenatal education can contribute to this problem (Zhang et al., 2021). Pregnancy is a vulnerable time for many women, and the emotions and fears can stem from questions left unanswered that could typically be answered in a prenatal educational setting (McAlister, 2019). Many healthcare providers assume that expectant parents have their questions answered without having supplemental prenatal education outside of scheduled appointments (McAlister, 2019) and do not 10 encourage enough patients to have supplemental prenatal education outside of their appointments, or there is a lack of prenatal education that is accessible to the patient. The literature clearly emphasizes that a lack of prenatal education exists. In addition, the importance of prenatal education has also been identified. Importance of Prenatal Education The literature indicated that prenatal education is successfully delivered in several ways. While in-person prenatal classes have been the traditional way to educate expectant parents, other ways are beginning to be utilized. For example, prenatal classes have recently been taught in various ways, including online, hybrid, small groups, and even smartphone applications. Many educational delivery formats have been implemented and tested with pregnant women and their partners. Some examples in the literature include a text-messaging-based program (Munro et al., 2017) and a smartphone application-based education (Wang et al., 2019). Offering these programs allows for more easily accessible prenatal education for those who cannot attend inperson classes. For example, Munro et al. (2017) piloted a text-messaging program called SmartMom, as an alternative to face-to-face prenatal education. Those who participated reported that the information provided was relevant and felt well-educated about prenatal topics (Munro et al., 2017). This text-messaging program proved to be an effective way to educate expectant women. Having accessible education is essential. Many expectant parents use smartphones, which makes it an ideal way to deliver prenatal education. Applications on smartphones can be an excellent resource for prenatal education. Applications geared toward prenatal education can deliver general and specialized prenatal education for high-risk pregnancies. With Smartphones being standard in today’s world, smartphone-based prenatal education has proven effective. 11 Parents at risk for preterm birth were involved in a pilot test of an application called Preemie prep for Parents. The results showed that the application was practical and helped increase their knowledge of preterm birth (Kim et al., 2018). Applications that deliver prenatal education have also provided information about nutrition and diet during pregnancy, and many women have reported the usefulness of applications during pregnancy (Want et al., 2019). Another way to provide education that is accessible is to offer free or reduced-cost online prenatal education. However, there is much debate on whether the online format is plausible and cost-effective. At the beginning of the COVID pandemic, face-to-face conversations and education programs were limited due to the precautions brought on by the pandemic (Chen et al., 2022). Many online educational formats were developed during COVID due to quarantine requirements extended by different governments worldwide. Some online education formats were produced well before the pandemic but became popular due to the uncertain times the world was facing (Grussu et al., 2020). Online prenatal education and smartphone applications have become increasingly popular and more effective in recent years. Summary of Literature Prenatal education is essential for expectant parents to gain information about pregnancy, labor, delivery, and care of the newborn. Various prenatal education formats exist, including text-messaging-based, smartphone applications, hybrid, and online programs. Although many formats of prenatal education are available, a need for more formats of prenatal education was identified in the literature. With the importance of prenatal education, the lack of prenatal education, and the possibility of providing prenatal education in an online format, the literature supports the implementation of an easily accessible, affordable online prenatal education course. 12 Project Methodology This MSN project will provide prenatal education that is easily accessible at no cost to the patient through the creation of education and support documents that will be given to patients and caregivers in the hospital’s labor and delivery unit. Four deliverables have been created to promote the introduction and implementation of this project. The deliverables include (a) a PowerPoint, which will be used to educate staff members on the importance of prenatal education, (b) a handout for providers to give to patients in the office; registered nurses (RNs) will also give the handout to patients who come through triage, the third item is (c) an assessment tool to determine eligibility for the program, and the fourth item is (d) a timeline for the implementation of the project. The fifth item is (e) the education that will be provided to patients in PowerPoint format. Description and Development of Project Deliverables Five deliverables were created to assist in the implementation of this project. These deliverables are described in detail in this section, and the importance of each deliverable has been explained below. Importance of Providing Prenatal Education PowerPoint The first deliverable is an educational PowerPoint presentation (see Appendix A). This presentation will educate and prepare the nurses on the unit on the importance of prenatal education, and provide a brief introduction to the project. Staff members will also be given resources that can be used to supplement the education provided to the patients. Patient Handout Another deliverable is a handout for patients (see Appendix B); both providers and nurses will be able to give the handout to patients. This item will also serve to educate caregivers about 13 the project. This handout will be used to educate patients about the importance of receiving prenatal education and the benefits that it can provide Resources for educational material will be provided. Eligibility Screening An eligibility screening tool (Appendix C) was also created for this project. This tool will be an evidence-based form that can be used by caregivers to assess the need for the patient to receive prenatal education that is accessible to them. Timeline The next deliverable will be a visual timeline (Appendix D), outlining the implementation of this MSN project. Patient Education PowerPoint The last deliverable will be a PowerPoint of the education to be provided to the patients in the program (Appendix D). This PowerPoint will include information about pregnancy, labor and delivery, postpartum, and newborn care. Plan and Implementation Process The implementation process of this MSN project will begin after approval has been granted by the Nurse Manager. Afterward, it is crucial to gain the support of the staff members on the unit. A formal educational process will begin after approval is received. A meeting with staff members will be established and will occur in the education center after coordinating with the scheduler. In this meeting, the educator will use the PowerPoint to cover the implementation of the change and stress the importance of prenatal education in the patient population the hospital serves. The deliverables will be presented to the staff members during this meeting. The RNs will be instructed on the evaluation process and how to pr the referral to the patient. Staff 14 members will then be able to ask questions after the information and deliverables have been presented. Interdisciplinary Teamwork Working in an interdisciplinary team allows multiple healthcare professionals in different fields to work together to positively impact the community (Taberna et al., 2020) and the labor and delivery unit. With this collaboration, the team members will achieve success with the implementation of a readily accessible prenatal education program. This implementation can lead to improved patient outcomes. Nurse Manager. The nurse manager for this unit is a master’s prepared RN. The manager must approve the plan for change before it is implemented on the unit. The nurse manager will also need to approve time for the unit staff members to receive education on the implementation. The nurse manager will also have to allocate a budget for the education and implementation of the project. The nurse manager will also encourage team members to promote and refer patients to this program. Unit Educator: The unit educator will need to approve and distribute the education for staff members on the implementation of this project. The unit educator will help obtain education for staff members and patients about the project. Social Worker: The social worker will need to be involved in the implementation of this project, as they will be helping to provide information to patients about this program. In most situations, the social worker will interact with the patients most in need of this program. The social worker will be able to refer patients to the program as they see fit. 15 Registered Nurse: The registered nurse will be responsible for evaluating patients for eligibility in triage, as well as referring patients to this program. The RN will also provide education to patients and their family members about the program. OB Medical Director: The OB medical director should know and understand the implications of this MSN project. The OB medical director has the main communication line to all other providers who have privileges at the hospital. The medical director will be able to help field any questions that the providers may have about the implementation. Timeline Developing a timeline sets clear directions and priorities for the implementation of this project (Appendix D). The total time for implementation will be six months to one year. The implementation will require coordination between members of the interdisciplinary team, including the nurse manager and the unit educator. Once the nurse manager has approved the implementation, a meeting will be organized within 2 weeks to present the implementation.. The meeting will probably take about 90 minutes. After the meeting has concluded and the deliverables have been presented, staff members and providers may start referring patients to the project. To begin, a small pilot group will be used to initiate the start of the easily accessible prenatal classes. After the pilot group has delivered their babies and completed a post-knowledge assessment, the project will be evaluated and any changes will be made. Then, a full implementation of easily accessible prenatal classes will begin. Plan for Evaluation of Project The participants of the project will be asked to complete a pre- and post-course knowledge assessment to determine the success of the project. A higher score on the post-course assessment compared to the pre-course assessment will indicate a successful implementation. The post- 16 course assessment will be evaluated after the patient delivers their baby. Both assessments will assess knowledge, but the post-course assessment will also ask if they felt that the prenatal education program helped with their labor and delivery experience, and it will help to determine if they would recommend the program to friends and family. Staff members will also receive a survey asking them to provide feedback on their perceptions of what they found useful. A chart check will also be performed to determine how many patients received the new resources and how many people were referred to the program. The post-course assessment and the staff survey will also provide the opportunity to add comments or feedback. Ethical Considerations Patient information is confidential, and it is important to respect patient privacy, therefore the participants will be made aware of the anonymity of the project. Patients will also be able to choose whether they want to participate. In addition, the educational assessments and surveys will not have any identifiers or names associated with them to protect patient and staff confidentiality. No patient will be excluded from the screening process of the project. After eligibility has been determined, all patients who are eligible will have the opportunity to participate in the project. If a patient is determined eligible for participation but decides they no longer want to participate, they will be able to leave the program. Staff members’ rights are also an important consideration in the planning of this project. Although the staff members will be required to attend the education and provide patients with education, they are not required to participate in the surveys. In addition, staff members may feel vulnerable if they provide negative feedback on the survey they receive. To prevent this from 17 happening and to ease staff members’ minds, the surveys will be anonymous, and will not be compulsory. Discussion Prenatal education is essential for expectant parents. Many expectant parents have anxiety during pregnancy, and prenatal education helps resolve that anxiety (Lockwood & Magriples, 2022). Prenatal education plays a significant role in expectant parents’ journey. In addition, it is essential to offer education in different formats because people have different learning needs (Wright et al., 2021). This project aimed to create a process to offer patients who may not be able to access regular education an online option. Evidence-based Solutions for Dissemination After the initial four months of implementation, the project results will be disseminated. A PowerPoint showing the results of the pre and post-surveys of the participants and staff members will be presented during a scheduled staff meeting. The project's outcomes will also be discussed verbally with the staff members. In addition, a poster will be developed and posted on the staff breakroom education board for staff members to review. The board will also present information regarding the project outcomes at a corporate level. The poster will include the information gathered from the pre- and post-surveys of staff members and a summary of the information learned from the literature review. The information provided will be used to determine if the project will continue in the labor and delivery unit and be implemented at a broader level across the corporation. Finally, the project will also be presented among WSU peers and faculty in a poster and a scholarly paper. Significance to Advance Nursing Practice 18 This project can benefit nurses working in a hospital labor and delivery units. This project will allow nurses to provide prenatal education to those who cannot attend a traditional format of an in-person prenatal class. Results can be shared with other units, such as the postpartum unit and the NICU, as the results may benefit their patient population as well. This project can improve patient outcomes and decreased pregnancy-related hospital admissions. Implications This project prepares expectant parents to navigate pregnancy, postpartum, and newborn care by providing prenatal education that is easily accessible. This project provides tools for not only expectant parents but also for nurses to provide this education to patients. With these tools, nurses will gain confidence in their educational skills. Expectant parents will also be able to gain confidence in their pregnancy journey, postpartum, and newborn care. This project could contribute to lower pregnancy-related hospital admissions (Lockwood & Magriples, 2022), lower c-section rates (Milcent & Zbiri, 2018), and lower rates of postpartum depression and anxiety (Zhang et al., 2018). This project has some limitations within the implementation. The project is small because it was introduced in a single labor and delivery unit. However, after the project has been fully implemented and improved, it may be introduced in other labor and delivery units in the area. Another limitation is that some staff members and patients may not want to participate in the project or will not complete or be honest in the evaluations. It will be essential to educate staff and patients about the potential to improve patient outcomes to prevent this from happening. Recommendations The literature review focused on the need to provide prenatal classes in different formats and identified a need for an online program. More research may help to determine if providing 19 patients with transportation to more traditional courses may be another way to help improve patient outcomes. One additional finding in the literature was that some patients may not have internet access to access this program. Therefore, the interdisciplinary team members may need to identify those needing internet access and find ways to help them gain access in the future. Conclusions Many expectant parents only understand the importance of prenatal education once they present to the hospital for delivery. These parents would be more likely to succeed if they had access to structured prenatal education. Labor and delivery nurses can implement an easily accessible, structured prenatal education program to improve patient outcomes. Both nurses and patients will be able to build their knowledge and confidence when there are better educational options. This project will allow nurses to provide more direct patient care when a patient is admitted for a routine delivery instead of having to spend time educating the patient. This program aids expectant parents in gaining the education they need to be confident during pregnancy, postpartum, and caring for their newborn. 20 References Amanak K, Sevil U, Karacam Z. 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