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    Desa Research Proposal Idea Paper

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    Primary cesarean section rate for obstetrical delivery has been on the rise. As the rate of cesarean deliveries increases, so does maternal mortality. When nurses act as patient advocates, positive patient outcomes can be seen.

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    Desa Research Proposal Idea Paper

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    145 views7 pages
    Primary cesarean section rate for obstetrical delivery has been on the rise. As the rate of cesarean deliveries increases, so does maternal mortality. When nurses act as patient advocates, positive patient outcomes can be seen.

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    Primary cesarean section rate for obstetrical delivery has been on the rise. As the rate of cesarean deliveries increases, so does maternal mortality. When nurses act as patient advocates, positive patient outcomes can be seen.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    145 views7 pages

    Desa Research Proposal Idea Paper

    Uploaded by

    api-302310876
    Primary cesarean section rate for obstetrical delivery has been on the rise. As the rate of cesarean deliveries increases, so does maternal mortality. When nurses act as patient advocates, positive patient outcomes can be seen.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    of 7

    Running head: DECREASING PRIMARY CESAREANS

    Nursings Contribution to Decreasing Primary Cesarean Rates:


    Research Proposal Idea Paper
    Katherine deS
    SUNY Institute of Technology

    DECREASING PRIMARY CESAREANS

    Nursings Contribution to Decreasing Primary Cesarean Rates:


    Research Proposal Idea Paper

    Background
    The primary cesarean section rate for obstetrical delivery, along with its associated
    complications and expense, has been on the rise at an astronomical rate (Caughey, 2009). Citing
    MacDorman, Menacker, & Declercq (2008), Caughey (2009) states although we have seen the
    cesarean rate rise 50% since 1995, there has been no concomitant reduction in neonatal
    morbidity and mortality (p. 717). More and more women are choosing, or steered, toward
    primary cesareans for delivery for a myriad of reasons, but newborns are not ending up healthier
    for it. In fact, as the rate of cesarean deliveries increases, so does the rate of maternal mortality
    (Caughey, 2009). In the US healthcare culture, free will and medical technology are highly
    valued, leading to increased numbers of c-sections on demand (Alnaif & Beydon, 2012) as well
    as paternalistic practices on the part of healthcare providers (Deline et al., 2012). When
    combined with the highly litigious environment that medicine is practiced in, it has been difficult
    to reverse this trend because attempts to deter c-sections are often viewed as an attack on
    personal choice or the primacy of the doctor/patient relationship (Deline et al., 2012). However,
    when nurses act as patient advocates, positive patient outcomes can be seen (Lyndon et al.,
    2011).
    Problem statement
    The increasing rate of cesarean sections, coupled with the declining rate of attempted
    vaginal births after cesarean (VBAC), is leading to higher rates of complications for mothers
    (Caughey, 2009), inflated costs for healthcare (DSouza & Arulkumaran, 2013), and delayed
    breastfeeding (Zanardo et al., 2010) without any measurable decrease in infant morbidity and
    mortality (Caughey, 2009).

    DECREASING PRIMARY CESAREANS

    Purpose of the Research


    In order to decrease the rate of primary cesareans, we need to address the problem from a
    number of angles. For this research, the impact that nursing can have on the cesarean rate is
    explored. Lyndon et al. (2011) established that nurses can affect positive change in patient
    outcomes by acting as vocal patient advocates. Berard (2008) and Goldberg (2009) discuss how
    educating patients can lead to more informed choices. The purpose of this research is to answer
    the question, What self-described personality characteristics, if any, of labor & delivery nurses
    lead to lower rates of primary non-scheduled cesarean sections? I specify non-scheduled at this
    time because nurses have very little opportunity to effect change on patients who come to the
    hospital on the day of a scheduled surgery.
    Applicable Theories
    Gadows Existential Advocacy
    This theory espouses the idea that the freedom of self-determination is a primary
    fundamental right (Bishop & Scudder, 2003). It is, therefore, the distinct role of nurses to
    advocate for those choices the patient would make for herself (Bishop & Scudder, 2003).
    Existential advocacy focuses on treating the body objectively without reducing the patient to an
    object (Bishop & Scudder, 2003, p. 108). For my research, nurses personality characteristics
    that encourage patient advocacy might have some bearing on the cesarean rate. Bu & Wu (2008)
    designed a tool for measuring nurses likelihood for engaging in patient advocacy activities
    which could be useful for my research.
    Game Theory
    According to Tarrant, Dixon-Woods, Colman, & Stokes (2010), game theory suggests
    that social norms, awareness of others reputations, and signals of trustworthiness from verbal
    and nonverbal communication influence decisions about trust and cooperation, alongside the
    structural and dynamic aspects of the situations within which individuals interact (p. 441). I am

    DECREASING PRIMARY CESAREANS

    exploring how this theory could relate to my question on a number of levels, particularly in
    patient interpretations of nonverbal cues of trustworthiness both from the nurse and the
    obstetrician. I would hypothesize that maternity nurses who give verbal and nonverbal cues of
    trustworthiness would be able to elicit more cooperation with techniques and interventions
    designed to reduce the odds of cesarean rate, such as anesthesia free delivery and mobility during
    labor.
    Orems Self Care Deficit Theory
    In Orems theory, patients seek nursing care when they have a need that they are
    incapable of addressing on their own and require teaching and guidance to do so (Orem, 2001).
    Orem (1991) believes that within the theory of self-care, person and environment are identified
    as a unity characterized by human-environmental interchanges and by the impact of one on the
    other (p. 143). It is nursings responsibility to teach patients coping skills in order to fill the
    self-care void (Orem, 2001). Orems theory is applicable to my research study because it forms
    part of the basis for my hypothesis that nurses who educate, advocate, and coach women
    adequately through childbirth can remove the fear and stress responses that contribute to
    increased cesarean deliveries.
    Conclusion
    The steady increase in cesarean sections for obstetrical delivery is leading to undue
    increases in healthcare costs and rising complication rates for mothers with little to no benefit for
    newborns. To address this problem, it needs to be combatted from multiple angles. Due to the
    intimate, personal relationship between the labor & delivery nurse and the mother, the nurse may
    have an impact on her ultimate mode of delivery. This research study, therefore, would address
    the following research question: What characteristics, if any, of labor & delivery nurses lead to
    lower rates of primary non-scheduled cesarean sections? Utilizing existential advocacy, self-care
    deficit, and game theory to form a hypothesis, I would predict that nurses who highly identified

    DECREASING PRIMARY CESAREANS

    themselves as trustworthy and outspoken would have a lower primary cesarean rate than those
    who identified themselves and inexperienced, softspoken, or patriarchal.

    DECREASING PRIMARY CESAREANS

    References
    Alnaif, B. & Beydon, H. (2012). Practice of primary elective cesarean upon maternal request in
    the commonwealth of Virginia. JOGNN: Journal of Obstetric, Gynecologic & Neonatal
    Nursing, 41(6), 738-746. doi: 10.1111/j.1552-6909.2012.01387.x
    Berard, V. (2008). Restoring balance in maternity care... "Combating coercion: breech birth,
    parturient choice, and the evolution of evidence-based maternity care" (Birth
    2007;34(2):176-180). Birth: Issues In Perinatal Care, 35(1), 86-87.
    Bishop, A., & Scudder, J. R. (2003). Gadow's contribution to our philosophical interpretation of
    nursing. Nursing Philosophy, 4(2), 104-110. doi: 10.1046/j.1466-769X.2003.00125.x
    Bu, X., & Wu, Y. (2008). Development and psychometric evaluation of the instrument: attitude
    toward patient advocacy. Research in Nursing & Health, 31(1), 63-75. doi:
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    Caughey, A. (2009). Reducing primary cesarean delivery: can we prevent current and future
    morbidity and mortality? Journal of Perinatology, 29(11), 717-718.
    doi: 10.1038/jp.2009.132
    Deline, J., Varnes-Epstein, L., Dresang, L.T., Gideonsen, M., Lynch, L., & Frey, J.F. (2012).
    Low primary cesarean rate and high VBAC rate with good outcomes in an Amish
    birthing center. Annals of Family Medicine, 10(6), 530-537. doi:10.1370/afm.1403
    D'souza, R., & Arulkumaran, S. (2013). To 'C' or not to 'C'?/Caesarean delivery upon maternal
    request: a review of facts, figures and guidelines. Journal Of Perinatal Medicine, 41(1),
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    Goldberg, H. (2009). Informed decision making in maternity care. Journal of Perinatal
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    Gould, D. (2008). Professional dominance and subversion in maternity services. British Journal
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    DECREASING PRIMARY CESAREANS

    Lothian, J. (2009). Ethics and maternity care: from principles to practice. Journal of Perinatal
    Education, 18(1), 1-3.
    Lyndon, A., Sexton, J., Simpson, K., Rosenstein, A. H., Lee, K., & Wachter, R. M. (2011).
    Predicting likelihood of speaking up in labor & delivery. JOGNN: Journal of Obstetric,
    Gynecologic & Neonatal Nursing, 40(S), 117-8. doi: 10.1111/j.1552-6909.2011.01243
    MacDorman, M., Menacker, F., & Declercq, E. (2008). Cesarean birth in the United States:
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    Orem, D. E. (1991). Nursing: Concepts of Practice (4th ed.). St Louis: Mosby.
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    Schmidt, N. (2008). Guided imagery as internally oriented self-care: a nursing case. Self-Care,
    Dependent-Care & Nursing, 16(1), 41-48.
    Tarrant, C., Dixon-Woods, M., Colman, A., & Stokes, T. (2010). Continuity and trust in primary
    care: a qualitative study informed by game theory. Annals of Family Medicine, 8(5), 440446. doi: 10.1370/afm.1160
    Walker, H. (2008). The balance of power. Nursing Standard, 22(27), 64.
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    Zanardo, V., Svegliado, G., Cavallin, F., Giustardi, A., Cosmi, E., Litta, P., & Trevisanuto, D.
    (2010). Elective cesarean delivery: does it have a negative effect on breastfeeding? Birth:
    Issues In Perinatal Care, 37(4), 275-279. doi: 10.1111/j.1523-536X.2010.00421.x

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