As a pregnancy specific multi-systemic disorder, preeclampsia is common in the United States. Over the last three decades, cases of preeclampsia have been on a steady increase making it a leading cause of maternal and fetal mortality and morbidity (Wang et.al., 2019). Pregnant women together with their offspring who have preeclampsia stand higher chances for risks of cardiovascular complications. Preeclampsia is characterized by high blood pressure and usually manifests after the 20 th week of gestation or regresses post-delivery. As such the development of care practices ensures that high cases of mortality or morbidity resulting from preeclampsia are reduced. This paper will rely on secondary sources to define a practice issue surrounding preeclampsia. The PICOT approach will be used, and sources of evidence that are applicable to the research question sought. The paper will also explain findings from articles and the relevance of information as applicable to the research question.
Use of the PICOT Approach when Caring for Pregnant Women with Preeclampsia
A practice issue that requires resolution is adequately training patients to effectively control and manage preeclampsia. The question to be explored states, “Is adequate educating of pregnant women an intervention approach, more effective than actual treatment in preventing and controlling complications among patients with preeclampsia?” Below is the breakdown of the PICOT question:
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P (Population) – The population under study is pregnant women with preeclampsia in the hospital ward.
I (Intervention)- The intervention approach is adequately training patients. At its core, the approach is centered on the patient to ensure that their needs are met as well as patient outcome improved. Castro et al., (2019) reveal that patient centered care approach encourages the partnering between health care professionals and patients, promoting and acknowledging the preferences and values of the patient.
C (Comparison) – The actual treatment of patients with preeclampsia who have insignificant knowledge about the condition.
O (Objective) – The objective of the study is to explore educating practices that address the issue related within and out of the health care center.
T (Timeline)- The time frame for the study is three months.
Identifying Sources of Evidence
CLIP Model
The CLIP (Community-Level Interventions for Preeclampsia), is a model that identifies intervention options for patients with Preeclampsia (Magee et al., 2018). The model was developed for use among pregnant women in the community who might or might not be aware of the symptoms of preeclampsia. The CLIP model consists of engagement of the community to whom pregnant women belong. These include mothers, mother in-laws, husbands, and anyone else that is a source of support to expectant mothers (Payne et al., 2018). The model is a notable PCC intervention because it is centered on the interests of the patient which is inclusive of her family, friends, and community members being educated on identifying preeclampsia and its onset.
Essentially, the model recommends that to improve the outcomes of patients with preeclampsia, the community has to be engaged, training and education of pregnant women has to be done both in and out of health care centers, and enhancing the facilities by general preeclampsia and gestational hypertension-related educational resources (Lama et al., 2020).
Individualized Intervention Model
At its core the individualized intervention model involves a myriad of activities carried out based on the needs and preferences of the patient with preeclampsia. Furthermore, the severity differs across patients. Wang, Xing & Zheng (2016) reveals that personalized or individualized care should be based on the psychological characteristics to carry out patient health education. Nurses in the antenatal and postnatal units should explain to the individual patients about pathogenesis, prevention and control measures, and appropriate diet and exercises to reduces symptoms and complications of preeclampsia.
Findings from Articles
The CLIP model is a common approach for intervention among patients with preeclampsia (Mol et al., 2016). Its effectiveness in numerous studies has been studied by making a comparative analysis to a study group of women that have not been trained on how to prevent, control, and manage preeclampsia. The implementation of a community-based care for women with hypertension disorders during the gestation period will result in improved maternal and neonatal outcome and sequentially reduced morbidity and mortality rates. This is based on the premise that one of the major reasons why the prevalence of gestational hypertension complications and deaths is high in the United States is due to the lack of adequate knowledge among women about the onset and seriousness of the condition (Coulter, Lew & Jenny, 2020). Often the use of medication to intervene has low chances of salvaging the situation.
Morton et al. (2019) in their study reveal that when patients are taken to hospital for preeclampsia, in some cases there is delay in provision of treatment and interventions. Treatment interventions for preeclampsia include magnesium sulphate for mild and severe seizures and anti - hypersensitive medication that is administered to lower blood pressure and reduce the risk of getting a stroke. If the patient was knowledgeable about the condition, they would manage it from becoming severe prior to visiting the health care centers.
The findings of this research are heavily dependent on secondary sources of information for previously done research. As such there are varying time frames over which the specific studies were carried out. Some studies had low period of intervention around 42 days while others were prolonged ranging from six months, to nine months, to two years. Based on the PICOT framework that this study used to seek answers to the research question, it is evident that the framework has made significant contribution to the precise description of intervention practices that are helpful in improving health outcomes of patients with preeclampsia.
Relevance of Findings
The article by Magee et al. (2018) is relevant for this research because it comprehensively elaborates the CLIP model and draws an objective comparison with a non-educated study group. The study reveals that the model was developed upon the realization that regardless of improved maternal health, there was still high morbidity and mortality maternal and neonatal rates in both the developed countries such as the U.S. and developing nations. The strategies and CLIP tools formulated in the intervention approach suggest a strong evidence that could be helpful for intervention in health care centers (Von-Dadelszen & Magee, 2017). With the approach being evidence-informed, it is helpful for clinicians in diverse health care settings where preeclampsia is an issue in question.
Rationale for selecting Giannakou et al., (2019) is that it presents a systematic review and meta-analysis of randomized control trials for preeclampsia interventions. Of the articles reviewed 59 of them had significant findings. The study concluded that educational interventions in the form of diet, nutrition, and lifestyle could lower the risk of preeclampsia. In general, the findings of the study highlight the importance of patient education about diet, lifestyle, and awareness to prevent, control and manage the complications of preeclampsia.
Conclusion
The study reveals the need of care practices that are critical for managing, preventing, and controlling complications of preeclampsia. The PICOT approach was applied in the research to gauge the effectiveness of educating patients than actual treatment in managing preeclampsia. The articles used in the study provide information that is relevant for exploring the effectiveness of the approach. The findings of the paper are critical for clinical and community settings to help curb the preeclampsia morbidity and mortality rates prevalent across the U.S. and world at large.
References
Castro, E. M., Van Regenmortel, T., Vanhaecht, K., Sermeus, W., & Van Hecke, A. (2016). Patient empowerment, patient participation and patient-centeredness in hospital care: a concept analysis based on a literature review. Patient education and counseling , 99 (12), 1923-1939.
Coulter, S. A., Lew, J., & Jenny, B. (2020). Heart Disease in Pregnancy. In Valvular Heart Disease (pp. 237-283). Springer, London.
Giannakou, K., Evangelou, E., Yiallouros, P., Christophi, C. A., Middleton, N., Papatheodorou, E., & Papatheodorou, S. I. (2019). Risk factors for gestational diabetes: An umbrella review of meta-analyses of observational studies. PloS one , 14 (4).
Magee, L., Sharma, S., Nathan, H. L., Adetoro, O. O., Bellad, M., Goudar, S., ... & Qureshi, R. (2018). The Incidence of Pregnancy Hypertension in the Community Level Interventions for Pre-Eclampsia (CLIP) Trials-Population-Level Data from India, Pakistan, Mozambique, and Nigeria.
Morton, C. H., Seacrist, M. J., VanOtterloo, L. R., & Main, E. K. (2019). Quality improvement opportunities identified through case review of pregnancy-related deaths from preeclampsia/eclampsia. Journal of Obstetric, Gynecologic & Neonatal Nursing , 48 (3), 275-287.
Payne, B., von Dadelszen, P., Bhutta, Z., Magee, L., Adetoro, O., Sotunsa, J., ... & Bellad, M. B. (2018). Protocol 13PRT/9313: The Community Level Interventions for Pre-eclampsia (CLIP) Trials: four prospective cluster randomised controlled trials comparing a package of interventions directed towards improving maternal and perinatal outcomes related to pre-eclampsia with current standards of care (NCT01911494). Lancet. Expecting submission date January .
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