Single Room Maternity Care, Capstone Project Example

Literature Review

Hospitals have continually replaced the traditional models of maternity care with models that are centered on family. The introduction of single room maternity care (SRMC) in the health care system was aimed at satisfaction of the nurses’ and families’ needs and demands. Many researchers have supported SRMC due to the merits it possesses over the traditional models. Some however believe that the traditional models are better suited for maternity care. Arguably, a nurse dealing with all the operations of an SRMC can be overwhelmed. The traditional models are perceived to offer better chances of specialization which increases the effectiveness and efficiency of the nurses while providing maternal care. The SRMC model is believed to offer better satisfaction to the nurses through development of good relationships with the mother and the baby throughout the birthing process. Weighing the merits and demerits of SRMC would help in determination of which model suits the modern maternity care better.

Traditional Maternity Care Models

The traditional maternity care models consist of different rooms for labor, delivery, recovery, and postpartum (Lowdermilk, Perry, & Cashion, 2014). The labor-delivery-recovery rooms (LDRs) model was designed and implemented for the accommodation of the birthing process from labor stage to recovery stage of the baby and mother, through delivery stage. The model required installation of equipment capable to handle many birth complications except the cesarean sections. The LDRs are well equipped for uncomplicated deliveries for mother and baby and high-risk and preterm vaginal deliveries (Phillips, 2003). An LDR can accommodate the use of forceps during deliveries and the repair of lacerations. The nursing personnel involved in this model have to be separated for the different rooms provided for the birthing process. The mother and the baby are handled by different nurses present in the rooms. The conventional delivery room is lit using portable or installed lighting and adequate space is provided for infant resuscitation. Administration of regional anesthesia can be done in an LDR but not general anesthesia. The equipment used for the care of mother and baby are prepared and stored in the central area, which is different from the patient’s room. The movement of the equipment to and from the central area to the patient’s room brings fatigue for the nurses providing maternal care.

Some health facilities have eliminated post-anesthesia care units and specialty recovery rooms through direct transfer of mother and baby from the delivery rooms to the postpartum rooms (Basavanthappa, 2006). Provision of the initial care for the infant is done in the LDR, after which transfer of the mother and baby occurs from the LDR to integrated mother-baby units or nursery areas (Korte & Scaer, 2000). The improvement of LDR model into labor-delivery-recovery-postpartum rooms (LDPRs) model saw the addition of postpartum and newborn care. LDPRs are flexible enough to provide areas for infant care while the family members are provided with sleeping areas. The family members are allowed to stay with the mother to teach her more regarding infant care and assist with the infant care itself. This model eliminated the movement to nursery and postpartum after the delivery and recovery stages.

Single Room Maternity Care (SRMC)

The SRMC model used family-centered care principles in the improvement from the LDRPs model. Provision of postpartum, intrapartum, and newborn care is done in one room (Janssen, et al., 2000). Families receive comprehensive perinatal care from the nurses attending to mother and baby during the entire birth experience. This model eliminates all movements of the mother and baby since the labor, delivery, recovery, and postpartum stages occur in the same room, with one nurse provides family-centered care consistently. Nurses offering maternity care in the SRMC model need to be well trained in order to expand their range of competencies and knowledge depth (Gerrits, et al. 2013). The model helps nurses gain clinical experience and competency in all the aspects of child birth as opposed to the traditional model which expose nurses to one or two aspects of childbirth. Studies on the SRMC model show that the model has increased clients’ satisfaction through the avoidance of transfer from one room to another, respect for privacy, provision of assistance in infant feeding, development of good relationships between the nurses and the clients, and provision of support and information to the clients and their families.

Satisfaction of nurses in this model was achieved through the physical setting of the SRMC model, their level of competency, responsiveness to clients’ needs, nursing practice environment, opportunity for teaching families, and peer support. The lighting of the room is adequate for all the procedures to take place. Storage of equipment and supplies in the room increases the accessibility to the nurses thereby easing their work and reducing fatigue. The nurses are able to maintain privacy easily in the delivery rooms as compared to the traditional models of maternity care. Equipping of the SRMC rooms with bath tubs allows for provision of water therapy by the nurses (Janssen, et al., 2001). The nurses enhance participation of clients’ family members in the maternity care by allowing their presence in the rooms and assistance in some activities such as infant care. The spiritual, emotional, and physical needs of the clients and their families are better catered for by the nurses due to the close relationships developed.

The quality and continuity of care in the single rooms is better than in the traditional maternity care rooms due to the close contact one nurse has with a client. Decisions made in the single rooms by the nurses are usually independent, which makes them feel more accountable. The training offered to the SRMC model nurses increases the confidence in their competency allowing them to provide quality care to the clients and their families (Janssen, et al., 2005). The training equips them with knowledge that is disseminated to the families for continuity of maternity care. The SRMC working units provide increased communication which improves teamwork in the health personnel in charge of the single rooms. The nurses working in this model are comfortable with the lack of hierarchy, isolation of the units, and the small number of personnel involved in the provision of maternity care (Harris, et al., 2004).

Deductions

The SRMC model has been found to be more beneficial in the provision of maternity care than the traditional models. The nurses are more satisfied working in SRMC due to the ease with which they work, the inclusion of family in the care, the autonomy in the decisions made, and the training received to improve competency (Reime, Dennis, & Janssen, 2006). The opponents of the model argue that the traditional models offer better opportunities for specialization in the aspects of maternity and that one nurse can be overwhelmed by the large amount of responsibilities in the single room. However, the training offered to SRMC model nurses overrules that argument. The nurses are well equipped with the skills and knowledge to undertake all the responsibilities in the single rooms. Hospitals should embrace the SRMC model in order to satisfy the needs of the nurses, the clients, and the clients’ families. SRMC provides a holistic family-centered approach to maternity care which cannot be achieved by the traditional models.

References

Basavanthappa, B. T. (2006). Textbook of Midwifery and Reproductive Health Nursing. New Delhi: Jaypee Brothers Medical Publishers.

Gerrits, P., Hosson, M., Semmekrot, B. & Sporken, J. (2013). “Less hypoglycaemias in single room maternity care”. Open Journal of Pediatrics, 3, 183-185.

Harris, S.J., Farren, M.D., Janssen, P.A., Klein, M.C., and Lee, S.K. (2004). “Single room maternity care: Perinatal outcomes, economic costs and physician preferences”. Journal of Obstetrics and Gynaecology Canada, 26(7), 633-640.

Janssen, P. A., Harris, S. J., Soolsma, J., Klein, M. C., and Seymour, L. C. (2001). “Single room maternity care: The nursing response”. Birth, 28(3), 173-179.

Janssen, P. A., Keen, L., Soolsma, J., Seymour, L. C., Harris, S. J., Klein, M. C., & Reime, B. (2005). “Perinatal nursing education for single-room maternity care: an evaluation of a competency-based model”. Journal of Clinical Nursing, 14(1), 95-101.

Janssen, P. A., Klein, M. C., Harris, S. J., Soolsma, J., and Seymour, L. C. (2000). “Single room maternity care and client satisfaction”. Birth, 27(4), 235-243.

Korte, D., & Scaer, R. (2000). A Good Birth, a Safe Birth: Choosing and Having the Childbirth Experience You Want (4^thEdition). Boston: The Harvard Common Press.

Lowdermilk, D. L., Perry, S. E., & Cashion, M. C. (2014). Maternity Nursing (8^th Edition). Maryland Heights: Mosby Elsevier.

Phillips, C. R. (2003). Family-Centered Maternity Care. Sudbury: Jones and Bartlett Publishers.

Reime, B., Dennis, C., & Janssen, P. A. (2006). “Development and Psychometric Testing of the Care in Obstetrics: Measure for Testing Satisfaction (COMFORTS) Scale”. Research in Nursing & Health, 29, 51-60.