Digital Repository Masters Projects Spring 2023 Nurse Education on Postpartum Complications Chelsie Boyce Weber State University Follow this and additional works at: https://dc.weber.edu/collection/ATDSON Boyce, C. 2023. Nurse education on postpartum complications. 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 Amber Fowler 3/30/2023 05/25/2023 2 Nurse Education on Postpartum Complications Chelsie Boyce, BSN, RN, MSN Student Weber State University Annie Taylor Dee School of Nursing 3 Abstract Maternal death rates are rising in the United States, yet many nurses are unaware of the leading cause of death of postpartum patients. Nurses are overwhelmed by the amount of education they must provide patients. Nurses spend limited time teaching patients about high-risk complications that can lead to death. This project aims to promote patient safety by first increasing nurse knowledge about high-risk complications postpartum patients can experience and secondly by providing nurses the tools to improve skills in teaching postpartum education. This project will include resources to help standardize postpartum discharge education. Education will benefit postpartum nurses by improving their knowledge and skills to help increase their confidence in providing effective patient education. Nurses will ensure patients correctly understand the education received through the teach-back method. Postpartum patients will also benefit from this project through an increased understanding of postpartum complications to reduce hospital readmissions and improve patient outcomes. Keywords: postpartum education, maternal death, teach-back method, standardized education 4 Nurse Education on Postpartum Complications Nurses are responsible for performing many tasks to provide quality patient care. Providing patient education is one of the most critical responsibilities of a nurse (Suplee et al., 2016b). To improve health outcomes and promote independence, providing thorough, understandable information to a patient regarding their care is essential to help prevent complications and readmissions following the patient's discharge from the hospital (Suplee et al., 2017). Empowering patients to improve their health through informed decision-making and selfcare involves patient education (Yeh et al., 2018). Nurses must provide patients with the knowledge and skills required to continue safe care at home. Maternal mortality rates during the postpartum period are increasing in the United States from cardiovascular disease, hemorrhages, hypertension, and infection (Centers for Disease Control and Prevention [CDC], 2019). While many women do not experience postpartum complications, all women have the potential to face severe postpartum complications that can lead to death. Nurses can help patients recognize these complications and encourage them to seek early intervention, which can help reduce maternal death rates (Suplee et al., 2016b). Improving nurses' understanding of postpartum complications, utilizing standardized discharge teaching in the hospital setting with educational bursts to manage time restraints, and assessing patient understanding with the teach-back method can help increase nurses' confidence in their ability to empower patients through high-quality patient education Statement of Problem In the United States, mortality rates for mothers during the postpartum period are increasing (CDC, 2019). Mothers may face severe complications during the postpartum period that can be life-threatening, such as cardiac failure, hemorrhages, and hypertension. Many nurses 5 are unaware of postpartum complications contributing to this crisis; up to 93% of nurses inaccurately identified the leading cause of death in postpartum patients (Suplee et al., 2017). Hemorrhages, high blood pressure, and infection are common complications in the first week of the postpartum period. However, the leading cause of death for postpartum mothers is cardiomyopathy from heart disease or stroke (CDC, 2019). Nurses provide postpartum education to new mothers at the time of discharge, which is vital in educating patients on the risks of postpartum complications. While there are mandates in place by regulatory agencies requiring specific education for patients, there needs to be a standardized education plan to help nurses cover essential information during the patient's hospital stay (Buchko et al., 2012). Without a standardized education plan, discharge teaching may vary depending on what the nurse taught, and the amount of information provided can overwhelm the patient. Nurses must be willing to adapt their teaching and implement changes to help reduce variations in discharge teaching and seek patient feedback to ensure correct understanding (Fidyk et al., 2014). Nurses face time restraints with increased staffing shortages across the United States, which can affect their teaching (Greenwood, 2021). Nurses caring for new mothers also have limited time to provide quality education for patients distracted by pain, fatigue, and caring for a newborn; this can impact the patient's understanding of symptoms related to postpartum complications. As many as 67% of nurses stated they spent less than ten minutes teaching patients about warning signs of severe postpartum complications at discharge (Suplee et al., 2017). These restraints limit effective patient education, demonstrating the need for change in nurse teaching to improve patient understanding. 6 Ways Project Contributes to Intended Recipients Developing a standardized education plan for nurses can improve their confidence and ability to teach new mothers effectively (Buchko et al., 2012). Improved education for patients can help them better recognize symptoms of severe complications during the postpartum period and what to do if they experience these symptoms. Improved recognition leading to earlier interventions can reduce maternal mortality rates in the United States (Suplee et al., 2016b). Standardized patient teaching and learning outcomes can improve understanding between nurses and patients. Improving patient outcomes by implementing changes to discharge teaching requires postpartum units to collaborate as a team. As the unit educator and manager work together to implement a postpartum teaching plan for nurses to utilize during patient discharges, they can foster an environment for nurses to change, allowing patients to collaborate with their caregivers and improve their health (Fidyk et al., 2014). The Rationale for Importance of Project Postpartum nurses face unique challenges in patient education since many of their patients are healthy and independent yet can experience serious life-threatening complications quickly (CDC, 2019). Limited studies are available regarding improving discharge education, specifically for postpartum units; this increases disparities in discharge teaching when consistency is needed to provide accurate information on postpartum complications. Without standardized patient teaching, nurses decide what information to relay to patients leading to variations in discharge education (Suplee et al., 2016b). Initiating standardized education plans and strengthening teaching skills can improve patient understanding and increase patient empowerment (Yeh et al., 2018). 7 This project will help nurses learn how to provide practical education to new mothers about life-threatening complications that can occur during the postpartum period. Ensuring nurses understand the severe complications postpartum mothers can experience can help reinforce the importance of practical education for patients (Suplee et al., 2017). When nurses better understand the postpartum risks facing new mothers, they can educate their patients more thoroughly at discharge to prepare them for continuing care at home. Effective patient education begins at admission (St. John & Englund, 2020). Nurses should utilize time with patients by communicating at ideal times when mothers are alert and able to comprehend. Many nurses learn an effective patient education tool known as the teach-back method. This method works by having the patient relay to the nurse what was taught to them; this allows the nurse to evaluate and determine if the patient learned the information correctly and thoroughly (Fidyk et al., 2014). The amount of education nurses are required to provide may be overwhelming for patients (Buchko et al., 2012); however, using educational "bursts" throughout the day can help introduce educational topics and prepare new mothers for discharge education. Teaching patients 10 to 15 minutes daily starting upon admission and reinforcing education throughout the hospital stay improves their comprehension and confidence to take care of themselves adequately at home (St. John & Englund, 2020). Combining educational bursts with the teach-back method can help improve patient education and increase understanding. Literature Review and Framework Disparities in patient education that nurses provide lead to confusion and poor outcomes, including patient death (Suplee et al., 2017). Poor outcomes demonstrate the need for change in patient education to improve patient understanding and health outcomes following hospital 8 discharges by increasing nurses' ability and confidence in providing proper education. The literature analyzed demonstrates how to improve patient education through standardized teaching plans and patient outcomes. Implementing changes in discharge education can be applied through the Iowa Model Revised framework. Framework The framework selected for this project implementation is the Iowa Model Revised (IMR). The IMR is a multi-step process that assists healthcare teams in evaluating the need for change, presenting evidence, applying the change, and gathering feedback (Buckwalter et al., 2017). Gathering feedback between each step of the IMR process ensures the application of evidence-based practice to the proposed change for improvement. Applying evidence-based practice change through the IMR model includes (a) identifying the issue in practice, (b) stating the purpose, (c) forming a team, (d) gathering and evaluating evidence, (e) designing and implementing change, (f) maintaining the change, (g) and dissemination of results (Cullen et al., 2022). For this project, the IMR model helps apply the change by utilizing a team approach with feedback loops. Applying the model for this project will include a postpartum unit at a local hospital in the mountain west region; nurses identified a need for change due to differences in patient discharge education. This project aims to improve patient education by increasing nurses' ability and confidence in teaching about severe postpartum complications. Team collaboration between nurses, the unit educator, and the manager will help implement change to improve patient education. Receiving feedback from nurses and patients will help evaluate the areas of miscommunication in discharge teaching and determine verities in nurses' teachings. Design standardized teaching plans by utilizing a uniform patient handout, organize onsite lectures 9 regarding postpartum risks to increase nurse awareness, and implement the teach-back method for discharge teaching. Evaluate the success of the proposed change as it is applied to maintain changes and share the results of improved postpartum education with other local postpartum units. Strengths and Limitations Strengths of the IMR model include the feedback loops between each step of the change process. The IMR model increases awareness of the need for improvement, which helps to promote action among nurses and other healthcare workers (Buckwalter et al., 2017). The IMR model is also generalizable, effectively adapting to unexpected variables. Teams implementing the IMR model can encourage patient engagement, leading to sustained change (Buckwalter et al., 2017). While the IMR model is broad and easy to adapt, the model serves as a guide and does not provide specific instructions for change; this can be limiting, but for this project, flexibility is an asset (Buckwalter et al., 2017). The most challenging step of the IMR model is to implement sustainable change; this step lacks instructions on how to make change sustainable over time. The IMR model suggests actively promoting the change and assessing the outcomes (Buckwalter et al., 2017). Analysis of Literature In reviewing the literature, three themes were identified to help improve nurse education on postpartum risk factors for patients at discharge—first, improving nurse awareness of postpartum risks. Improving patient education begins by strengthening teaching skills and nurses' understanding of patients' postpartum complications. Second standardized patient teaching; standardizing education can aid in minimizing disparities throughout discharge education and 10 empower patients with the knowledge to maintain health at home (Suplee et al., 2017). Lastly, successful nurse educators should include a patient assessment utilizing the teach-back method to ensure correct understanding and minimize miscommunication to improve patient learning outcomes (Fidyk et al., 2014). Search Strategies Databases utilized for this literary search included CINAHL, Medline, PubMed, and Google Scholar. Keywords used in database searches included postpartum, nurse education, postpartum risk factors, maternal mortality, and patient education. Qualitative and quantitative studies were reviewed, as well as peer-reviewed articles. There were three themes discovered after the literary review, which are: (a) improving nurse awareness of postpartum risks, (b) standardized patient teaching, and (c) patient learning plans. Improving Nurse Awareness of Postpartum Risks A mixed method study (N=372) surveyed postpartum nurses and found that only 54% of nurses were aware of the increasing mortality rates among postpartum women in the United States; also, in this study, up to 93% of nurses were unaware of the leading cause of maternal mortality (Suplee et al., 2017). While hemorrhages, high blood pressure, and infection are common maternal complications during the first week of postpartum, the leading cause of death for postpartum mothers is heart disease (CDC, 2019). Nurses must understand their patients' risks after discharge and be prepared to educate them to improve outcomes. Maternal mortality rates began to rise in the United States in the 1990s and are still increasing (Kozhimannil, 2018). Each year, about 700 women die from pregnancy-related complications; about 60% of these deaths could have been prevented (CDC, 2019). Of the 700 women dying yearly, 52% of maternal mortalities occur postpartum (Tikkanen et al., 2020). 11 One study explained that nurses felt underprepared to provide effective patient education; however, nurses who had participated in a simulated patient-teaching session had increased awareness of the importance of patient teaching, and 90% of the students (N=20) reported an excellent experience with their nurse providing education. This study demonstrated success in building nurses' confidence to provide patient education through simulation practices, allowing nurses to practice authentic interactions in a safe learning environment and receive feedback (Coleman & McLaughlin, 2019). For nurses to improve their teaching abilities, they must be willing to adapt their discharge routines and understand the value education provides to their patients (Fidyk et al., 2014). As nurses adapt and gain knowledge of postpartum mothers' severe complications, they can develop skills to improve their teaching, including assessing patient learning needs and implementing the teach-back method. Standardized Patient Teaching Patients have a legal right to ask questions and receive comprehensive education about their care. Nurses are responsible for creating time to provide patient education (Friberg et al., 2008). Most postpartum hospitalizations are 24 hours, limiting nurses' time to provide effective patient education. The lack of time combined with the amount of education required by regulatory agencies that nurses teach patients can be overwhelming for nurses and patients. In a qualitative study (N=52), a review showed that discharge education content was inconsistent and sometimes incorrect; 25% of the nurses providing discharge education to patients in this study could not list the top three causes of death in postpartum patients (Suplee et al., 2016a). Nurses must provide clear, consistent education to patients to help them be aware of postpartum complications that could lead to adverse outcomes, including death. Standardizing 12 teaching plans and resources can help nurses to provide consistent educational information. In a mixed method study (N=52), nurses found that utilizing one educational booklet to reduce the number of handouts helped ensure the teaching of vital topics during patient discharge education (Buchko et al., 2012). Another tool to help standardize discharge education and improve nurse confidence in providing patient teaching is implementing daily educational "bursts" (St. John & Englund, 2020). Patient education should begin upon admission to prevent information overload, and nurses should reinforce teaching throughout the patient stay. Providing patient education daily in 10–15-minute intervals with the teach-back method can improve patient confidence in providing self-care at home (St. John & Englund, 2020). Patient Learning Outcomes Discharge education aims to empower patients to manage their care at home to maintain their health; knowledge deficits can lead to patient harm and hospital readmissions (St. John & Englund, 2020). With a lack of time, nurses often teach skills and educate patients without evaluating that the patient understands what has been taught (Coleman & McLaughlin, 2019). One study demonstrated that only two percent of healthcare providers assess patient comprehension following education, which may explain the miscommunication between nurses and patients when nurses stated that their patients were adequately informed. In contrast, the patients felt they needed more education (Fidyk et al., 2014). Nurses can confirm comprehension by implementing the teach-back method with their patients. The teach-back process is when the nurse asks the patient to explain what they understood from the education provided (Fidyk et al., 2014). Collaboration between patients and their healthcare team can help them be empowered and take an active role in their health; one 13 qualitative critical discourse analysis stated that involving patients in care can help lower maternal mortality (Allen & Sovik Benedetti, 2019). Nurses must provide patients with the knowledge and skills, then assess for correct understanding for patients to take control of their health outcomes (Yeh et al., 2018). Even though time is limited, once nurses gain experience utilizing the teach-back method, it can be performed quickly and efficiently (Fidyk et al., 2014). The postpartum period extends from delivery to six weeks after birth (Hundal et al., 2021). Scheduled postpartum follow-up appointments in the United States occur around six weeks after a vaginal delivery; a quality improvement report showed that 40% of women do not attend postpartum follow-up appointments (Kuster et al., 2022). However, many needs remain unmet for patients who participate in postpartum follow-up visits (Tully et al., 2017). A quantitative case study (N=381) showed that after discharge from the hospital, patients seek care at emergency departments when care is needed before the six-week follow-up appointment, and up to five percent of new mothers seek emergent care within the first ten days after delivery (Hundal et al., 2021). Postpartum care is a process, and education should address patients' needs and encourage patients to continue care at postpartum follow-up appointments (American College of Obstetrics and Gynecologists, 2018). Summary of Literature Review Findings and Application to the Project As nurses become aware of the rising maternal mortality rate crisis in the United States, ensuring patient understanding of postpartum complications and their associated symptoms should be a top priority. Providing knowledge of steps to take if a new mother experiences one of these complications can help to reduce hospital readmissions and mortality (Hundal et al., 2021). Standardizing discharge education by implementing daily teaching intervals with one patient handout booklet to reinforce teaching can strengthen nurses' confidence in their skills to better 14 prepare patients for discharge (Fidyk et al., 2014). Improving teaching skills for nurses is only part of providing practical education; nurses must assess patient understanding to ensure successful learning, which will empower patients with knowledge and skills to improve health outcomes as they continue care at home. Patient education provided by nurses is the key to empowering patients to perform self-care at home successfully and improve patient outcomes (Yeh et al., 2018). Project Methodology This MSN project aims to prepare registered nurses in the postpartum unit to teach patients the symptoms of severe postpartum complications that can result in death; this will be accomplished by educating nurses. The effectiveness of the education provided will then be evaluated by assessing patient understanding of the teaching provided by the nurses. Included are deliverables to implement at the local hospital's postpartum unit to promote this project's introduction. The deliverables include (a) a PowerPoint presentation for nurse education regarding the most common complications their patients face during the postpartum period and the importance of the nurse's role in educating their patients, (b) a patient handout explaining symptoms associated with severe complications that can occur during the postpartum period and actions to take if complications occur, (c) and a patient survey to evaluate their understanding of postpartum risk factors and the teaching provided by their nurse. The implementation of this project will include educating nurses on severe complications that can occur during the postpartum period, how to promote patient teaching through educational bursts each day, and how to assess patient understanding with the teach-back method. The nurses will provide education to patients throughout their hospital stay, and patients 15 will be able to answer a survey assessing the teaching they received and their understanding of postpartum complications. Description and Development of Project Deliverables Three deliverables have been created to implement this project. This section will explain the deliverables and why each is important for this project. The deliverables are attached as appendixes and will assist with providing consistent patient education. Postpartum Education PowerPoint The first deliverable is a PowerPoint presentation to educate nurses on postpartum teaching for their patients (see Appendix A). This PowerPoint will be presented to each postpartum nurse to teach them about severe life-threatening complications, such as cardiomyopathy and postpartum hemorrhage, which patients can experience during the postpartum period. This presentation will also review effective ways to educate patients throughout their hospital stay, including education bursts and the teach-back method to assess their understanding. This deliverable is essential to ensure nurses understand the importance of postpartum education and how to provide it to their patients efficiently. Save Your Life Patient Handout The second deliverable is a patient handout (see Appendix B). This handout will be delivered to the patient with postpartum education. The nurses will use the handout to educate patients on severe complications that can occur during the postpartum period and the steps to take if they experience these complications. This handout is vital in helping nurses provide consistent education to all patients and ensuring all critical information is discussed in discharge teaching for the patient and their caregiver. The Save Your Life handout can also remind patients 16 of essential teaching points to refer to at home if they experience complications or have further questions (Association of Women's Health, Obstetric and Neonatal Nurses, 2021). Patient Assessment Survey The final deliverable for this project is a patient survey (see Appendix C) to assess the education they received from their nurse and the understanding they have of the risks they face during the postpartum period. The survey asks the patient how well their nurse taught and answered questions and whether they understood what they were taught. The survey also asks if the nurse utilized the Save Your Life handout during teaching. Evaluating patient understanding of education received is essential for this project to determine the successful implementation of changes and assess for knowledge gaps that need to be addressed and resolved to continue successful improvement. Plan and Implementation Process The implementation of this project will begin when the postpartum unit manager approves the plan. A meeting with the postpartum unit manager and unit educator will be scheduled to plan times for nurse training. The training for nurses will be offered at four different times to ensure that each nurse can attend. The training will be scheduled on two days, each with a morning and an evening option within one week to allow day and night nurses to attend. The PowerPoint deliverable will be presented along with the Save Your Life handout that nurses will implement in their patient teaching. A question and answer portion will be conducted before breaking the group into small teams to roleplay patient education. The roleplay practices will focus on performing education bursts and implementing the Save Your Life handout with discharge teaching. Nurses will also practice applying the teach-back method in this roleplay (Fidyk et al., 2014). 17 Once all nurses have attended the patient education training, the handouts will be immediately available to utilize in their teaching. The handouts will be printed and included with the patient's discharge teaching resources. The nurses will implement what they have learned following the training. Nurses will provide patients with the survey following their discharge education before the patient leaves the hospital to assess the success of this project implementation. Patient surveys will be reviewed at the end of each week to assess for any consistent knowledge gaps that must be addressed immediately. After three months, all surveys will be combined into a reviewable format and presented to the unit manager, educator, and nurses in a follow-up meeting. Knowledge gaps will be identified and corrected, and education changes will be made for continuous improvement. Interdisciplinary Teamwork Various team members will be included to help this project succeed and benefit patients. In selecting the team, attention was paid to the skills needed to plan, implement, and follow up on the project. While not all team members may be required for every step of the plan, each team member should assist with critical decisions and communicate between interprofessional team members. The team may change over time based on needs, but each team member needs to understand the importance of the project and support the implementation (Buckwalter et al., 2017). Hospital Director. The hospital director will assist with this project by overseeing its implementation. The hospital director will assist in implementing the project by supporting the postpartum unit manager. Offering a conference room for the Postpartum Education training will help complete the steps necessary to carry out the plan for this project. 18 Postpartum Unit Manager. The manager plays an essential role in change by creating an environment that supports improvement. The manager will assist with the patient education training for nurses and enforce the requirement that each nurse attends and participate in the needed improvements for this project. Fostering an environment of patient safety will help the nurses to understand the need for improvement to help serve their patients. Postpartum Unit Educator. The unit educator will help teach nurses skills to improve their patient teaching at the Postpartum Education training. The educator will assist in answering questions as the project is initiated. They will encourage consistent patient education by enforcing changes and encouraging nurses to improve. Registered Nurse. Nurses are at the frontline of applying the project and improving patient education. Through the efforts of postpartum nurses, consistent education can be provided. This will improve patient safety after discharge. Nurses will help the project succeed by evaluating their need for improvement and supporting fellow nurses in implementing it. Nurses will also support the project by encouraging patient feedback on the teaching provided. Timeline In the initial meeting, the postpartum unit manager will approve the timeline (Appendix D) for implementing this project. Following approval, the unit manager and educator will schedule a meeting within that week to plan the nurse training. The nurse training will occur within one month. After the nurse training has been completed, the project will be implemented in patient care, and the project evaluation will occur after three months to review feedback. Plan for Evaluation of Project Evaluation for this project will be based on patient surveys following discharge education. The results of this survey will determine the project's success. Evaluating the patient's 19 experience and understanding of the education provided will guide needed improvements in patient teaching. Five survey questions include a ranking scale from one to five; the average for each question will be calculated over three months. For the initial project implementation, a goal has been established with the unit manager that patients rate these questions at a four or higher on 80% of the patient surveys. Four questions on the survey are yes or no answers; of those questions, the goal is for patients to answer yes 80% of the time. One question will assist in evaluating how the time a nurse spends providing education will impact patient satisfaction and understanding. Two open-ended questions allow for other patient feedback and suggestions. Following feedback and evaluation, corrections will be reviewed with the nurses and implemented, and the goals can be evaluated and raised over time to encourage continuous improvement. Ethical Considerations Ethical considerations in this project include patients recovering from a traumatic birth or fetal demise. Education is provided gently considering their experience. Patient feedback will be optional but not enforced in these situations. The project is still important and must be implemented to provide consistent education for these patients at risk for severe postpartum complications. Traumatic birth experiences or fetal demise can affect the patient's comprehension of the education provided. Nurses must recognize the need to adapt patient education while covering vital information (Suplee et al., 2017). Involving family members in patient care and discharge education will be essential to emphasize vital information for patient safety as long as the patient has consented to involve the family in their care. Another ethical consideration is patient privacy regarding follow-up surveys. It is necessary for patients to feel they can answer survey questions honestly to ensure the success of 20 this project. Nurses should encourage patients to provide honest feedback on their education, regardless of their appreciation for the care their nurse provided. Nurses should remind patients that their submissions will be kept anonymous and that their feedback can help improve patient safety. Discussion Maternal death rates in the United States are rising, and many nurses are unaware of the leading cause of death for postpartum patients. The education nurses provide to postpartum patients before discharge is not standardized and sometimes inaccurate (Suplee et al., 2017). Increasing nurse understanding and providing tools to improve patient education will assist patients in receiving standardized education to improve their outcomes (Suplee et al., 2017). Evidence-based Solutions for Dissemination The results will be disseminated to the postpartum unit nurses three months after implementing this project. The outcomes will be presented during a staff meeting revealing the results of the patient surveys. The information gathered from the patient surveys will be compiled into a report and presented to the hospital leaders, both local and corporate, to allow them to determine whether or not to implement this project throughout all the company's hospitals. This project will also be presented to Weber State University faculty and staff through a presentation. Significance to Advance Nursing Practice This project can help nurses who work with postpartum patients. This project will educate nurses about postpartum risk factors that could lead to death in patients and standardize practices to disseminate education and information to patients about these risks. Providing nurses with tools to educate patients will improve confidence in the nurse's ability to teach effectively 21 (Buchko et al., 2012). This project will also benefit patients as they receive proper education about postpartum risks and what to do if they experience complications. Standardizing education for postpartum patients will reduce hospital readmissions and patient death rates, improving patient outcomes (Yeh et al., 2018). Implications This project teaches nurses about postpartum patients' risks that could lead to death. This project gives nurses the tools to properly educate patients about postpartum risks and what actions to take if they experience complications. Nurses are also trained in evaluating patient understanding by implementing the teach-back method. Teaching nurses about the most common high-risk complications facing postpartum patients and causing sentinel events will help nurses understand the importance of providing clear, accurate education to improve patient understanding and, ultimately, patient outcomes. The limitations of this project include the sample size. The hospital the project will be implemented in is a new, local hospital. However, once the project has been implemented, it may be implemented at other hospitals within the corporation. Success is dependent on nurse cooperation to implement the education correctly and consistently. Feedback from patients is also necessary to determine the success of the project. The unit manager and educator can help encourage nurses to implement the project, and nurses can encourage patients to participate in the follow-up survey to determine project success. Recommendations An extensive literature search was conducted on postpartum patient education. Few studies were found to determine how to regulate the postpartum education nurses provide to ensure that teaching is thorough and accurate. Many hospitals provide different educational 22 materials to patients; additional research should be conducted to determine the most effective presentation of handouts to facilitate patient understanding. Conclusions Maternal death rates in the United States are rising, and many nurses and patients are unaware of the leading cause of death from high-risk complications among postpartum patients (Suplee et al., 2017). Research has shown that while nurses think their patients have been adequately educated, patients feel the opposite (Fidyk et al., 2014). Providing nurses with information about postpartum complications and tools to educate their patients about these risk factors can improve patient understanding and retention (Fidyk et al., 2014). Improved patient understanding can reduce hospital readmissions and improve patient outcomes (Suplee et al., 2016b). This project aims to increase nurse confidence in educating patients about postpartum risk factors to improve understanding and outcomes. 23 References Allen, R., & Sovik Benedetti, M. (2019). Unravelling US maternal mortality through critical discourse analysis. Health Education Journal, 78(6), 681-691. https://doi.org/10.1177/0017896919857773 American College of Obstetrics and Gynecologists (2018). Optimizing postpartum care. ACOG. https://www.acog.org/clinical/clinical-guidance/committeeopinion/articles/2018/05/optimizing-postpartum-care Association of Women's Health, Obstetric and Neonatal Nurses. (2021). Save your life Handout]. https://www.awhonn.org/education/hospital-products/post-birth-warning-signseducation-program/ Buchko, B. L., Gutshall, C. H., & Jordan, E. T. (2012). Improving quality and efficiency of postpartum hospital education. 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Discharge education on maternal morbidity and mortality provided by nurses to women in the postpartum period. Journal of Obstetric, Gynecologic, and Neonatal Nursing. 45(6), 894-904. https://doi.org/10.1016/j.jogn.2016.07.006 Suplee, P. D., Kleppel, L., Santa-Donato, A., & Bingham, D. (2016b). Improving postpartum education about warning signs of maternal morbidity and mortality. Nursing for Women's Health, 20(6), 552-567. https://doi.org/10.1016/j.nwh.2016.10.009 Tikkanen, R., Gunja, M., FitzGerald, M., & Zephyrin, L. (2020). Maternal mortality and maternity care in the United States compared to 10 other developed countries [Issue Brief]. The Commonwealth Fund. https://doi.org/10.26099/411v-9255 Tully, K. P., Stuebe, A., Verbiest, S. (2017). The fourth trimester: A critical transition period with unmet maternal health needs. American Journal of Obstetrics and Gynecology, 217(1), 37-41. https://doi.org/10.1016/j.ajog.2017.03.032 Yeh, M., Wu, S., & Tung, T. (2018). The relation between patient education, patient empowerment and patient satisfaction: A cross-sectional-comparison study. Applied Nursing Research, 39, 11-17. https://doi.org/10.1016/j.apnr.2017.10.008 26 Appendix A Postpartum Education PowerPoint for Nurses 27 28 29 30 31 32 33 Appendix B Save Your Life Patient Handout (Association of Women's Health, Obstetric and Neonatal Nurses, 2021) 34 Appendix C Patient Teaching Survey This handout should be printed on a single page and distributed to patients before discharge. 35 Appendix D Timeline