Posted: September 8th, 2022

1 Problem Statement
A problem statement is a short, simple explanation of an issue or problem that needs to be fixed. A problem statement is an important communication tool that tells everyone what has been done or is being done to fix the problem. It also describes the project’s goals and expected results. The needs of a certain group of people will be met by the problem statement in this assessment. Several pieces of literature will back up the evidence.
P – The target patients are African American women who are pregnant or have just given birth.
I. The plan is to teach patients early on about preeclampsia, including signs and symptoms, recommended lifestyle changes, and when they should see a doctor.
C – An alternative to the plan is to compare the data to patients who don’t actively work with their providers to prevent or treat preeclampsia as early as possible.
O – I want more people to know about the complications of preeclampsia so that people don’t have to go to the hospital and have bad outcomes.
T – The time frame needed is twelve months, because that’s how long it takes to do assessments during pregnancy and the first twelve weeks after giving birth.
Need Statement
Preeclampsia is a rare but serious medical condition. It is diagnosed when you have very high blood pressure and proteinuria, which means you have a lot of protein in your urine, before and after giving birth, and sometimes for up to six weeks after. After thinking about the problem, I came up with more than one need for my project: health promotion, education, prevention, and management, with patient education as the main focus. Taking care of these needs is very important because preeclampsia can cause the mother to die if it is misdiagnosed or not treated. A USA TODAY article says, “Every year, more than 50,000 women suffer serious injuries or complications related to childbirth, and about 700 of them die.” This is a key piece of evidence that shows how important this need is. About half of those caused by high blood pressure and bleeding could have been avoided, say experts (Kelly, 2018, para. 7).
Location and Number of People
African American women who are pregnant or have just given birth will be the focus of my project. Because I am African American and have read several alarming articles about racial differences in maternal health, it is important for me to address the needs I have found in this group. “Black women are three times more likely than white women to die from something related to pregnancy. “These differences are caused by a number of things, including differences in the quality of health care, underlying chronic conditions, structural racism, and implicit bias” (CDC, 2021, p. 2)
The place where my project will take place is the OB/GYN clinic where I work. Ninety percent of our patients aren’t getting the care they need, so it’s important that my needs are met in this setting. These women need someone to speak up for them, raise awareness, and fight for their safety and equality in healthcare. Depending on when they find out they are pregnant and start prenatal care, the average number of prenatal appointments is between 12 and 14. For the first six months, they have appointments every month, then every two weeks for months seven and eight, and every week from month nine until they give birth. Most of the time, preeclampsia is found in the third trimester. However, some women don’t get prenatal care until the third trimester, which could change how often they go or cause them to have the baby as soon as possible.
3 Summary of the Intervention
The OB/GYN clinic is very focused on the goal of a healthy pregnancy and a safe birth.
There are many ways to help the large number of people they work with. The first appointment a patient has is an education appointment, where they are asked about their whole medical history. At the end of the appointment, it is decided if they need to see a low-risk nurse practitioner or MD or a high-risk one. If they have had high blood pressure or preeclampsia in a previous pregnancy, they are given hypertension labs in addition to the standard prenatal labs. This intervention meets the identified need for prevention and management because ordering these labs makes it more likely that people with high blood pressure will be caught early and treated with medicine and changes to their diet. At their education appointment, they are also taught and given information about nutrition. This intervention meets the needs for education and management that have been identified. At the patient’s education appointment, depending on how far along she is, she is asked if she is having headaches, swelling in her face or extremities, or trouble seeing. These are all signs of preeclampsia. This intervention meets the needs for education and management that have been identified.
A Comparison of Methods
A possible interprofessional alternative to the initial intervention overview is scheduling and ordering the standard prenatal labs and the hypertension labs for everyone before their first appointment, then combining the prenatal education and initial prenatal appointment into one visit instead of doing the education appointment and labs, then scheduling the initial prenatal appointment, which sometimes isn’t available for two weeks. The OB/GYN clinic where I work sees a lot of African American women, and a lot of them get preeclampsia. This alternative would work for them. If you draw the labs first, they will be ready for the doctor to look at before the first appointment. This will also make sure that they get the right information about their pregnancy, like if they are at a high risk of getting preeclampsia or just found out they are pregnant. The clinic uses MyChart to tell patients about their lab results. However, many of them do not have active accounts, so if their provider sends them a message about their labs, they may not see the results or message.
If the prenatal labs are ordered first, the patient, the educator, and the provider will all be on the same page at the first appointment.
First Draft of the Outcome
In the end, the goal and result of this project is to raise awareness of the complications of preeclampsia so that African American women don’t have to go to the hospital and don’t have bad patient outcomes. This result shows the goal of my intervention because I’m trying to help African American women, and if I can teach them about their health early on and they are willing and determined, there will be fewer diagnoses and problems.
This outcome shows what I hope to do with my intervention. I hope that by choosing my target population carefully, it will bring attention to the racial differences in maternal health.
This outcome sets up a framework that can be used to improve the quality of care because it could lead to all pregnant women having hypertension labs added to their standard prenatal labs. Also, I hope that women will be able to recognize the early signs of postpartum preeclampsia and get medical help as soon as possible.
Time Estimate
Developing my intervention will take about four months of studying women from the end of their third trimester until the end of their postpartum. This timeline is reasonable because it will give me the information I need to show that my project needs to be put into action. Women who took care of their symptoms well but didn’t want to take part in the study or women who didn’t take care of their signs and symptoms but still wanted to take part in the study could cause this time frame to change. The time frame needed to implement my intervention is twelve months. This would allow a continuous assessment from the beginning of the pregnancy until the end of the risk mark for postpartum preeclampsia. This time frame is reasonable because it gives enough time to study a patient who got prenatal care early, was at risk or was diagnosed early, knew about the risk after giving birth, and didn’t have to go back to the hospital. A woman who started prenatal care late and was diagnosed with a problem before she had much time to make a plan for how to handle it could be a problem.
Literature Review
One of the most preventable causes of death in childbirth in the U.S. is high blood pressure disorders like preeclampsia, which often happen because hospitals don’t have enough safety measures (Kelly, 2018, para. 1).
Most signs and symptoms of preeclampsia show up after the twenty week mark of pregnancy.
But some women get preeclampsia even though there are no signs or symptoms. High blood pressure, also called hypertension, can come on slowly or all of a sudden. If you are told you are going to have a baby too early, you and your baby are more likely to have problems (Mayo Foundation, 2020, paras. 1, 3, 5).
Two to eight percent of pregnancies all over the world are affected by preeclampsia. But in the U.S., it’s the cause of fifteen percent of births that happen too soon. When a baby is born before the 37th week of pregnancy, it is called preterm (Preeclampsia, 2020, para. 3).
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Preeclampsia shows up in a lot of different ways. At every prenatal visit, your blood pressure will be checked. If your blood pressure is 140/90 or higher and it stays that way, the doctor will order more blood pressure tests, a nonstress test, and an ultrasound just to be safe and check on the baby. Other common symptoms include headaches that don’t go away with medicine, swelling in the face, hands, and feet, weight gain (two to five pounds in a week), shortness of breath, and problems seeing (Herndon, 2021, paras. 8, 9).
The Covid-19 pandemic and the growing focus on racial justice are bringing to light differences in health care for people of color, especially when it comes to the health of mothers and babies. “Maternal and infant mortality rates in the U.S. are much higher than those in similarly large and wealthy countries, and people of color are more likely to have bad maternal and infant health outcomes” (Artiga et al., 2020, para. 1).
In the United States, the differences between black and white mothers who die may be bigger than what has been said in the past. For black women, preeclampsia and eclampsia were the main causes of death during pregnancy. The death rate for African American women is five times higher than that of white women, which is sad. Late maternal death, which can happen between six weeks and a year after giving birth, is 3.5 times more likely to happen to a black woman than to a white woman. Thoma says that more research into the experiences of people of color can help improve health care systems and, in turn, make giving birth better for everyone. “To fix these problems, we need new models of care before, during, and after birth.” (Black Women, 2020, pp.1, 7, and 10)
Many of the deaths of mothers could be stopped, so it is becoming a public health and human rights emergency. One of the main reasons for racial differences is that some people can’t get care or get care that isn’t very good. This is especially true for women with lower incomes.
In general, black women are not valued enough. They don’t get as much attention as white women do. When they do show signs, they are often brushed off. (AHA, 2019, para(s). 5-7).
Risk factors for preeclampsia include a history of high blood pressure or kidney disease before pregnancy, a history of high blood pressure or preeclampsia in a previous pregnancy, obesity, age > 40, multiple gestation, a family history of preeclampsia, and being African-American. White women are more likely to get preeclampsia again in their next pregnancy than women of other races (NICHD, n.d., para. 2).
Treatment for preeclampsia depends on how far along in your pregnancy you are and how bad your preeclampsia is. If a woman has preeclampsia and has been pregnant for more than 37 weeks, she may be told to give birth early. If a woman is less than 37 weeks pregnant and has severe preeclampsia, her baby will be delivered. If it is mild, she may be able to stay in bed and have more prenatal visits (Jacobson & Zieve, 2020, paras. 3, 4).
Some of the causes of preeclampsia can be controlled. For example, the patient can be taught to eat foods with little or no added salt, to drink at least six to eight glasses of water a day, to avoid fried foods, to exercise, and to put their feet up several times a day. Some patients may also need to take a daily baby aspirin as a preventive measure (APA, 2021, para. 15).
The evidence from the literature review supports my identified needs of health promotion, education, prevention, and management because it talks about preeclampsia and how rare it is as a complication. It also teaches patients about the risk factors and other 8 complications they may face as a result of it, as well as how to lower your chances of getting it and how to deal with it if it is caught early.
Health policy as it stands
Hospitals are expected to follow a standard set of rules and procedures to make sure that all women get the same, safe care. The severe hypertension during pregnancy and the postpartum period bundle shows clinical practices that should be used in all women’s health settings. This standard outline was made by the Council on Patient Safety in Women’s Health Care, which is part of the American College of Obstetricians and Gynecologists (ACOG).
This healthcare policy will change how I meet my needs because it will give everyone a plan for how to manage and treat preeclampsia (Preeclampsia Foundation, n.d., paras. 1-3).
Conclusion
After a very thorough review of the literature, there is evidence that preeclampsia needs to be promoted for health, and African American women should be taught how to prevent and treat it because they are most likely to get it.
9 \sReferences
Americans for a Healthy Heart. (February 20th, 2019). Why do complications during pregnancy kill so many black women? www.heart.org. Retrieved January 23, 2022, from https://www.heart.org/en/news/2019/02/20/why-are-black-women-at-such-a-high-risk-of-dying-from-pregnancy-complications
Artiga, S., Pham, O., Orgera, K., & Ranji, U. (2020, November 10). A Look at Racial Differences in Maternal and Infant Health. KFF. Retrieved January 23, 2022, from http://www.kff.org/report-section/racial-disparities-in-maternal-and-infant-health-an-overview-issue-brief.
New research shows that black women are over three times more likely to die during pregnancy or after giving birth than white women. PRB (n.d.). New research shows that black women are more than three times more likely to die during pregnancy or after giving birth than white women.
Disease Control and Prevention Centers. (2021, April 9). Working together to lower the death rate of black mothers. Disease Control and Prevention Centers. You can get this information from https://www.cdc.gov/healthequity/features/maternal-mortality/index.html on January 22, 2022.
Herndon, J. (2021, October 27). What are the causes and symptoms of preeclampsia? Healthline.
Retrieved January 23, 2022, from https://www.healthline.com/health/preeclampsia
Jacobson, J., & Zieve, D. (2020, October 5). Preeclampsia – self-care. MedlinePlus. Retrieved January 23, 2022, from https://medlineplus.gov/ency/patientinstructions/000606.htm
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Kelly, C. (2018, July 27). What is preeclampsia? and does it still kill women in the US? USA Today. Retrieved January 22, 2022, from https://www.usatoday.com/story/life/allthemoms/2018/07/27/what-preeclampsia-anddoes-still-kill-women-u-s/795635002/
Mayo Foundation for Medical Education and Research. (2020, March 19). Preeclampsia. Mayo Clinic. Retrieved January 23, 2022, from https://www.mayoclinic.org/diseasesconditions/preeclampsia/symptoms-causes/syc-20355745
Preeclampsia Foundation . (n.d.). Hospital Guidelines And The Preeclampsia Patients’ Bill Of Rights. Preeclampsia Foundation – Saving mothers and babies from preeclampsia.
Retrieved January 23, 2022, from https://www.preeclampsia.org/the-news/communitysupport/hospital-guidelines-and-the-preeclampsia-patients-bill-of-rights
Preeclampsia. American Pregnancy Association. (2021, December 9). Retrieved January 23, 2022, from https://americanpregnancy.org/healthy-pregnancy/pregnancycomplications/preeclampsia/ Preeclampsia. Home. (2020, October). Retrieved January 23, 2022, from https://www.marchofdimes.org/complications/preeclampsia.aspx
U.S. Department of Health and Human Services. (n.d.). Who is at risk of preeclampsia? Eunice Kennedy Shriver National Institute of Child Health and Human Development. Retrieved January 23, 2022, from https://www.nichd.nih.gov/health/topics/preeclampsia/conditioninfo/risk