Debates and Challenges in Nursing

Question: Discuss about the Debates and Challenges in Nursing. Answer: Introduction: Depending upon the challenges and limitations that occur in course of the obstetric nursing or in case of prenatal care services, it is imperative to assess the factors that govern the efficacy of the services through considerations of the main hindrances to facilities within the healthcare framework. A specific searchable question to find out the highest level of evidence related to the area of obstetric nursing practice may thus be developed through utilization of the PICO format in order to make accurate response to the question developed (Bluhm 2016, p. 90). The PICO question in order to search for the highest level of evidence is as follows: What are the factors that influence the working of the obstetric nurses or midwives in rendering quality care services to the pregnant women or women during childbirth within the clinical setting in hospital? The PICO procedure refers to the technique utilized in evidence based practice by virtue of which framing and addressing of a clinical health related question occur (Hoffmann et al. 2013, p. 218). The components of PICO format that may be elucidated in the given question context consists of the following: P (Problem or Patient or Population): Pregnant women and women during childbirth I (Intervention): Skills and competencies related to Obstetric Nursing or Midwifery C (Comparison): Barriers or facilitators to provision of quality care in obstetric wards Outcome (O): Effective quality care Search Strategy: In order to answer to the specific research question, peer reviewed articles published in academic journals over the past 10 years encompassing the time frame between 2007 and 2017 will be selected. Electronic databases such as Google Scholar or Cochrane library will be utilized for reviewing and examining the articles suitable for the research. The key search terms that will be referred to for procuring the most pertinent articles include obstetric nursing, challenges in obstetric nursing, barriers to care in obstetric nursing and other similar terms. The levels of evidence for each of the retrieved article will be thoroughly investigated and explored to acquire the desired findings. Every step for analyzing the research article will be stringently followed to procure the best possible evidence. The evidences are essentially derived by means of systematic research review by taking into consideration the original research articles results (Melnyk Fineout-Overholt 20 05). The articles in which the outcomes relevant to specific interventions have been mentioned will not be evaluated. Review of highest level of evidence: The article authored by Hofmeyr et al. (2009, p. S39) analyzed and put an insight into the issue of obstetric care pertaining to the low resource settings and the methods to overcome the challenges encountered. Complications at childbirth are mostly attributed to the unavailability of effective care at birth or inaccessibility to prompt caesarean delivery. Risk of intrapartum related hypoxic injury as well as the feasibility of the available intervention options has been critically evaluated in the content of the article. Findings suggested that intrapartum interventions hardly relate to mitigate the intrapartum associated neonatal mortality or morbidity. Challenges encountered in this domain included the issues related to shoulder dystocia, hemorrahage, suspected fetal distress, severe hypertension, breech position, post term and intra-amniotic infections along with labor difficulties. For the low resource setting, the dearth of planned caesarean for breech presentation and post par tum induction thwart the health of the pregnant mothers thereby making the job tougher for the attending healthcare professionals. Innovative low cost equipments coupled with obstetric drills and checklists have been suggested as vital facilitators to aid in managing the potential hazards relevant to the specific condition in case of the provision of care to the pregnant mothers. The level of evidence falls under the level V category as evidences were procured from systematic reviews of qualitative and descriptive studies. The gaps in quality, coverage and equity with respect to the intrapartum care need to be revamped and attended to for proper address of the condition at birth in order to prevent incidences of still birth and save maternal lives to a large extent. The study conducted by Kozhimannil et al. (2015, p. 367) highlighted on the rural obstetric workforce operational in the US hospitals with reference to their definite challenges and associated opportunities. The job profile, employment status, the prospective link between the hospital birth volumes and hospital staffing models along with the staffing limitations encountered by the rural hospitals have been explicitly described in their research. The results revealed that the hospitals having lower birth volumes are most likely to recruit family physicians and general surgeons for attending deliveries. On the contrary those depicting higher hospital birth volumes, resort to obstetricians and midwives for attending deliveries. Factors affecting the staffing challenges in hospitals encompassed a multiple issues such as that of training, scheduling, recruitment and retention, census fluctuation in addition to intrahospital relationships. Thus the impediments to provision of effective car e in obstetrics have been found to undergo proper management through promotion of programs related to telehealth, interprofessional education and simulation training. This particular evidence comes under the level VI whereby evidences have been retrieved from a single descriptive qualitative study by means of undertaking telephonic surveys. The roles of the federal governments and policy makers apart from the regional authorities and collaborative strategies have been found to be particularly important in this regard to account for holistic solutions. The work by Eadie and Sheridan (2017, p. 4) brought to the forefront the experiences of the midwives who are associated to working in an obstetric high dependency unit (HDU). The obstetric high dependency unit consisted of a purpose built, two bed unit situated in the delivery suite of a large, urban tertiary teaching hospital. The major findings of the study showed that the competent and highly skilled midwives were engaged in providing holistic care to the women in need within an obstetric HDU. Matters relevant to obstetric high dependency care required additional skills and requisite knowledge on the part of the midwives apart from their core competencies and attributes. Training beyond the pre-registration midwifery education has thus been suggested for equipping these professionals to provide high dependency care appropriate for catering to the demands of both the mother and the infant. According to the levels of evidence, this study belong to level VI where qualitative research has been undertaken through recruitment of participants in three focus groups. The responsibilities lie with the hospital authorities and the associated working professional to impart definite technical knowledge and vocational training to the midwives to combat the challenges in obstetrics high dependency unit thereby fostering specialized care facilities for the clients. References Bluhm, R., 2016. Evidence-based nursing and the generalizability of research results.Exploring evidence-based practice: Debates and challenges in nursing, pp.88-98. Eadie, I.J. and Sheridan, N.F., 2017. Midwives experiences of working in an obstetric high dependency unit: A qualitative study.Midwifery,47, pp.1-7. Hoffmann, T., Baird, M., Bennett, J.W., Boyle, M., Coombes, J., Elkins, M.R., Nissen, L., Reilly, S., Rickard, C. and Sanders, S., 2013. Questions about prognosis: examples of appraisals from different health professionals. InEvidence Based Practice Across Health Professions [2nd Ed.](pp. 218-220). Elsevier. Hofmeyr, G.J., Haws, R.A., Bergstrm, S., Lee, A.C., Okong, P., Darmstadt, G.L., Mullany, L.C., Oo, E.K.S. and Lawn, J.E., 2009. Obstetric care in low?resource settings: What, who, and how to overcome challenges to scale up?.International Journal of Gynecology Obstetrics,107(Supplement), pp. S21-S45. Kozhimannil, K.B., Casey, M.M., Hung, P., Han, X., Prasad, S. and Moscovice, I.S., 2015. The rural obstetric workforce in US hospitals: challenges and opportunities.The Journal of Rural Health,31(4), pp.365-372. Melnyk, B.M. and Fineout-Overholt, E., Nursing Resources: Levels of Evidence (I-VII). 2005.