Problem Statement (PICOT)
In healthcare sciences, a problem statement is a simple explanation of a health issue with the help of specially assembled keywords that explicitly target the issue under consideration and provide information regarding possible strategies planned to resolve the issue. The problem statement of a health issue comprises five components: intended population, goals, objectives for improvement, comparison, outcomes, and a particular time frame.
This paper discusses the healthcare issue related to preeclampsia in pregnant African American women during and after pregnancy. The goal is to educate women about the complications of preeclampsia. The targeted outcome is to improve the management of preeclampsia in African American women within 4 weeks. We can present our problem statement in keywords as given below:
P: African-American women during and after pregnancy is the target population
I: Patient education is the intended intervention plan
C: Comparison of data with patients who did not seek medical help to prevent or manage preeclampsia.
O: The intended outcome is improved patient education regarding the management of preeclampsia.
T: Time duration of 4 weeks.
Rational for Problem Statement
The rationale for this project is the complications in delivery, such as preterm birth, mortality risk to premature babies, and poor health outcomes among the pregnant and postpartum African American women population. Preeclampsia is a serious maternal health issue that is characterized by the incident of high blood pressure and hypertension during and after the pregnancy period. It can be diagnosed by regularly monitoring blood pressure. Urine tests having high protein content in urine also indicate the patient has preeclampsia. Due to the high-risk complications associated with preeclampsia, it is highly needed to conduct this project. This project is needed for health promotion among the intended population with the help of improved patient education and management of preeclampsia.
According to the article published in USA Today, more than 50,000 pregnant women suffer complications while giving birth and about 700 women die per year while giving birth (Kelly, 2018, para. 7). These statistical figures support the need for conducting this project that focuses on improving the health status of the intended population with the help of patient education.
Target population and Research Setting
For this project, I have selected African American women during and after pregnancy. I have selected this population because I belong to this population and experienced preeclampsia during one of my pregnancies. African-American pregnant women are three times more vulnerable compared to white pregnant women due to unequal distribution of health resources and racial discrimination in society (CDC, 2021, para. 2).
In addition, I spoke to a pregnant teacher at my workplace and collected information on a local clinic where the teacher receives prenatal care from.
On average, ten to fourteen patients visit this clinic daily for prenatal care consultations. They are scheduled to follow up every month for the first two trimesters. Later they are asked to visit the clinic every fortnight or as per need. They are called every week for assessment in the ninth month of pregnancy. Preeclampsia often occurs in the last trimester. Patients on prenatal care are provided with better management plans; however, those patients who only visit the clinic near delivery may have poor health outcomes if diagnosed with preeclampsia.
Overview of Intervention Plan
The intervention plan practiced with this teacher includes patient education and counseling regarding the management of preeclampsia. At the patient’s first visit, a proper examination and lab diagnosis was made, and the patient was scheduled for a counseling appointment. In the counseling session, patients have explained the changes they need to make in their diet plan and daily routine. They are educated about the nutritional value of various ingredients in their diet and prescribed to take a supplement if required. Patients are asked to provide their medical history and any unusual symptoms experienced regarding swelling around the face, headache, and weakness in vision. These clinical presentations’ assessment helps identify if the patient requires low-risk or high-risk care. If the patient is assessed to have a high probability of preeclampsia, she advised a lab test for hypertension and other labs for a prenatal care plan. Based on lab reports, a treatment plan is designed to prevent and manage preeclampsia in pregnancy and postpartum.
Comparison of Interventional Approaches
For the effective implementation of the intervention plan, an alternative approach is formulated by reorganizing the patient’s appointment schedule. In comparison to the initial intervention, prenatal care labs and labs for hypertension are advised before attending the counseling session. This change in plan is made to avoid delays in between appointments. This way patient visiting a clinic for a counseling session will have her required lab reports, and a quicker assessment of the patient can be made regarding the risk of having preeclampsia. If the patient is diagnosed with preeclampsia, she is better counseled from the very first visit and provided education for altering her diet pattern and daily routine accordingly. It will help gain better patient compliance with the follow-up appointments. Meanwhile, gynecologists, patient counselors, and other healthcare staff will be on the same page regarding the effective care management of patients having a high risk of preeclampsia.
Draft of Improved Patient Outcomes
This project focuses on improving patient care outcomes among pregnant and postpartum African-American women having preeclampsia. For this purpose, patient education is given prime importance. With the help of counseling sessions at healthcare centers, the pregnant woman is educated to keep a proper check and balance on her physical symptoms and daily routine. She is counseled to adapt to the changes required to make in her meal plan and living style to help reduce the probability of preeclampsia in the last trimester and the postpartum period. She is educated to attend all the follow-up appointments for better management of preeclampsia and better healthcare outcomes. Patient education help meet the outcomes planned for this project and serve the selected population to deal with the complications of preeclampsia in a better way.
Time Frame
For this project, a four-week time frame will be implemented. This period would include prenatal care in pregnancy and the postpartum duration of preeclampsia. This time frame I will perform will be over 4 weeks which will include my planned interventions and record the assessment. This assessment over the selected time frame will help me support the need to conduct this project with the help of evidence-based data. Some of the challenges I may encounter include skipping patient follow-up visits. Other than that, the patient is visiting the clinic for follow-up appointments but not showing compliance with the recommended care plan. Moreover, delayed diagnosis due to the patient’s negligence also complicates the implementation of planned care interventions and often results in poor patient outcomes.
Review of Literature
Improper care plans, ineffective interventions, and negligence on the part of patients often result in poor patient outcomes for pregnant and postpartum women having preeclampsia. In the USA, high blood pressure due to preeclampsia in pregnant women is a common cause of death during labor that can easily be prevented using effective healthcare resources (Kelly, 2018, para. 1). Complications of preeclampsia other than the death of pregnant women include preterm delivery, survival risks of premature baby, organ dysfunction, and breathing difficulties in the newborn baby.
Preeclampsia can be diagnosed by the signs and symptoms of hypertension experienced by pregnant women. The onset of preeclampsia is expected in the last trimester of pregnancy, and postpartum preeclampsia can occur six to twelve weeks after birth. However, in certain cases, preeclampsia develops in pregnant women without showing any major characteristics; therefore, hypertension lab tests should be advised by healthcare providers and regular prenatal lab tests as mandatory. Delay diagnosis often results in high-risk complications during delivery (Mayo Foundation, 2020, para(s). 1, 3, 5).
Preeclampsia is a rare healthcare issue that is experienced by only 8% of women during pregnancy all over the world. However, complications associated with preeclampsia are life-threatening, so this health issue must be handled with serious concerns. The preterm birth of babies due to preeclampsia before completing thirty-seven weeks in the womb poses serious life threats to both the mother and the child (Preeclampsia, 2020, para. 3).
Preeclampsia diagnoses include regularly monitoring blood pressure and preparing a chart for showing follow-up visits in prenatal care. If the blood pressure of pregnant women is repeatedly recorded, equal to or higher than 140/90 patient should be advised to get repeated lab tests for hypertension. Moreover, an ultrasound is also repeated on each follow-up visit to keep a check on the growth of the baby. Hypertension labs can also be advised if the patient experiences unusual headaches, blurred vision, swelling in body parts, and unhealthy weight gain. A strict check on signs and symptoms helps formulate an early diagnosis and better preventive approach to deal with the medical condition (Herndon, 2021, para(s). 8, 9).
African-American population encounter racial discrimination in the availability of healthcare services. African-Americans experience health disparity during the recent pandemic of COVID-19. The unavailability of healthcare equity adversely affects maternal health and results in undernourished infants. In the USA, the mortality rate of women during labor is far higher than their comparable developed economies. This alarming situation demands the practice of health equity and the availability of healthcare facilities for all without discrimination based on color, race, or ethnicity (Artiga et al., 2020, para. 1).
Over recent years, racial discrimination has increased in the USA, contributing to an increased mortality rate during childbirth among African-American women. According to recent statistics, the death ration among African-American women is about five times higher compared to white pregnant women. The incidence of late maternal deaths is also 3.5 times higher among African-American women compared to the dominant race in the USA. Research suggests that more health equity should be followed during healthcare policy formation for states. Efforts should be made to protect the right to equal health for Black pregnant women in the USA. A holistic care plan should be assembled to provide medical assistance during prenatal and postpartum periods (Black Women, 2020, para(s). 1, 7, 10).
In the USA, Blacks are considered second-ranked citizens compared to the dominant class of Whites. This racial discrimination, along with the low socioeconomic condition of African-Americans, has raised health concerns for pregnant Black women. In health care centers, Black patients are not treated with equal attention compared to White patients. This cultural incompetency practiced among healthcare providers poses serious threats to the health of pregnant Black women in the USA (AHA, 2019, para(s). 5-7).
There is a high probability of having preeclampsia among African-American pregnant women compared to White pregnant women in the USA. Other than ethnicity, the risk factors that should be considered by prenatal care providers include the history of the patient having hypertension, the age of pregnant women more than 40 years, women having kidney disease, repeated conceiving, high body fat content, and being overweight and family history of having preeclampsia (NICHD, n.d., para. 2).
An effective treatment plan for managing preeclampsia depends on the time of diagnosis and the intensity of the preeclampsia episode. In the case of early diagnosis, it is easy to manage with modification in diet and medication therapy. However, if it is diagnosed in the last month of pregnancy, the patient undergoes complicated delivery, and it is difficult to meet the protocols and proper intervention plan. Moreover, if the delayed diagnosis of preeclampsia appears to have a mild influence, it is manageable with good care of the patient near delivery and extra care measures during delivery. If the delayed diagnosis appears severe, preterm delivery is advised to avoid risk to maternal life and infant survival (Jacobson & Zieve, 2020, para(s). 3, 4).
Patient education helps in the nonpharmacological management of preeclampsia causes. Patients can be counseled regarding their dietary habits and sleeping pattern. To lower the risk of high blood pressure, prenatal care providers advise taking low salt and fat and drinking more water daily. Regular daily walks and light exercise may also be recommended. However, pharmacological intervention may include prescribing baby aspirin to lower blood pressure (APA, 2021, para. 15).
This literature review validates the project needs and the importance of patient outcomes planned for pregnant African American women with preeclampsia. The research-based literature provided above supports the intervention plan focusing primarily on patient education for achieving the desired outcomes.
Established Healthcare Policies
American College of Obstetricians and Gynecologists (ACOG) has initiated a program to ensure health equity in public health sectors. This program, Council on Patient Safety in Women’s Health Care, has formulated healthcare policies that demand the availability of healthcare services for all without any racial discrimination. The high mortality rate among African-American pregnant women due to preeclampsia is easily preventable with conscious efforts to implement improved health care policies.
With the help of my project, I intend to foster the need to recognize the healthcare policy gap impacting safe child delivery among African American women. Health for all must be practiced by the healthcare centers to ensure the availability of healthcare resources and serve the purpose of health equity in the community (Preeclampsia Foundation, n.d., para(s). 1-3).
Conclusion
This paper highlights the need to educate patients for better management of the rare medical condition preeclampsia among the more vulnerable population of pregnant African-American women. It further provides research-based literature to support the need for this project and the intervention plan formulated to achieve the desired improved patient healthcare outcomes.
References
American Heart Association. (2019, February 20). Why are black women at such high risk of dying from pregnancy complications? www.heart.org. Retrieved September 8th, 2022, from https://www.heart.org/en/news/2019/02/20/why-are-black-women-at-such-high-risk-ofdying-from-pregnancy-complications
Artiga, S., Pham, O., Orgera, K., & Ranji, U. (2020, November 10). Racial Disparities in Maternal and Infant Health: An Overview. KFF. Retrieved September 8th, 2022, from https://www.kff.org/report-section/racial-disparities-in-maternal-and-infant-health-anoverview-issue-brief/
Black Women Over Three Times More Likely to Die in Pregnancy, Postpartum Than White Women, New Research Finds. PRB. (n.d.). Retrieved September 8th, 2022, from https://www.prb.org/resources/black-women-over-three-times-more-likely-to-die-inpregnancy-postpartum-than-white-women-new-research-finds/
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Jacobson, J., & Zieve, D. (2020, October 5). Preeclampsia – self-care. MedlinePlus. Retrieved September 8th, 2022, from https://medlineplus.gov/ency/patientinstructions/000606.htm10
Kelly, C. (2018, July 27). What is preeclampsia? and does it still kill women in the US? USA Today. Retrieved September 8th, 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 September 8th, 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 September 8th, 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 September 8th, 2022, from https://americanpregnancy.org/healthypregnancy/pregnancycomplications/preeclampsia/
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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 September 8th, 2022, from https://www.nichd.nih.gov/health/topics/preeclampsia/conditioninfo/risk
