literature review
This literature review assesses the environment and culture within a postpartum unit. This topic is vital in the nursing profession as it directly affects the quality of care, patient outcomes, nurse satisfaction, and turnover rates. The population affected are mothers and their newborns, as well as their spouses and the medical staff caring for these families.
A thorough understanding of the literature’s exhaustive search makes it impossible to miss the lack of current research examining the postpartum unit. The search for current articles was exhaustive. The search integrated a wide array of search words, which included: obstetric nursing and stress, obstetric nursing and interpersonal communication, obstetric nursing and interpersonal relations, obstetric nursing and interpersonal relationships, obstetric nursing and relationship, obstetric nursing and culture, mother-baby unit and experience, mother-baby unit and nursing care, mother-baby unit and nursing, mother-baby unit and environment, postpartum nursing unit, and depression, postpartum unit, and environment, nurse to nurse relationships, nurse unit culture. Four qualitative research studies, one quantitative study, one informative journal article, and a systematic review will be used in this literature review.
This literature review aims to explore any research conducted in the unit culture field, particularly as it pertains to the postpartum unit. The three themes that emerged from this literature review include organizational culture, unit culture, and, finally, care approach.
Organizational Culture
Organizational culture has a significant impact on the working healthcare staff. Gifford et al. (2002) describe organizational culture as the proper way to behave in an organization, which is the stimulus that shapes the environment of a unit to provide either effective or ineffective quality of healthcare services. Organizational culture is comprised of three critical factors:
- Teamwork
- Staff support
- Autonomy in the decision making of patient care (Gifford et al., 2002)
Qualitative research conducted by Gifford et al. (2002) used the competing values framework (CVF) to investigate organizational culture. This tool is specifically used to understand a unit’s culture. Labor and delivery units of seven hospitals in the united states were selected for this study. The participants of this study were asked to complete questionnaires, and their responses were incorporated into the CVF. Organizational culture directly impacts the level of commitment, power, morale, motivation, and job satisfaction among the staff.
Additionally, it has an impact on the quality of care, patient outcomes, and turnover rate. According to Striley and Field-Springer (2016), individual and organizational culture in a medical unit affects nurse autonomy and attitude towards risks since humans value safety, relationships, and ethics of themselves and others. For this reason, nurses may fail to act in the patient’s best interest for fear of social risk with doctors, other patients, and fellow nurses, which can either have a constraining or enabling effect (Striley& Field-Springer, 2016). A study by Striley & Field-Springer (2016) examined what nurses believed were patient safety risks using risk orders theory. One hundred thirty-one obstetric nurses were selected and asked to answer a preset of questions organized by the researchers (Striley & Field-Springer, 2016).
In contrast to the positive aspects of organizational culture, Cassata & Dallas’s (2005) research study concluded otherwise. Organizational culture can be a constraint as the nursing staff is required to work within its limitations. Within the postpartum unit, the culture will influence how nurses interact with their patients as their social views, personal experiences, political standing, professional ethics, and educational background often shape their attitude (Cassata & Dallas, 2005). Therefore, an excellent organizational culture will shape the nurses to offer standard healthcare services to patients, improving patient outcomes. Cassata & Dallas’ study is an exploratory descriptive study that asked their participants a series of questions regarding low-income child bearing adolescents (Cassata & Dallas, 2005). Hence, hospitals should be particularly careful in shaping their culture as it impacts the nurses’ creative potential, moral character, identity as a nurse, autonomy, commitment, and overall performance. It is by providing feedback mechanisms from the teens or their families regarding the efficiency of the nursing care so that their attempts to offer educational, physiological, spiritual, and psychological needs to the adolescents may be fruitful. Besides, they ought to provide nursing education that will encompass cultural knowledge to enable them to deal well with childbearing adolescents and their families (Cassata & Dallas, 2005).
Unit Culture
The second theme found in this literature review was unit culture. Unit culture refers to the practice norms, beliefs, and values that affect nurses’ quality of work-life and their job satisfaction, commitments to the organization, empowerment, and job involvement in a unit (Gifford et al., 2002). Unit culture is a long-term critical approach to curbing employee turnover. A systematic review conducted by Baik et al., 2018 reviewed interprofessional team-based care and its role in improving care delivery. Forty-one articles were selected and yielded results supporting the role of unit culture in a postpartum unit. Over the past years, researchers have emphasized the importance of effective interprofessional and interdisciplinary collaborations in enhancing care quality. As mentioned earlier, the collaboration is particularly essential as it has been found to reduce healthcare costs, improve patient outcomes and safety, and promote efficient care (Baik et al., 2018). An influential culture within the postpartum unit would foster effective communication, trusting relationships, shared understanding of roles and responsibilities, and mutual respect.
A qualitative research study conducted in Brazil examined obstetric nursing and the nurse’s view of natural childbirth care (Mendes et al. 2019). Although the 6 participants were chosen from a maternity school, their research did generate exciting results. In their research, Mendes et al. (2019) noted that despite the evidence supporting interdisciplinary practice in obstetric care, the practice remains underutilized. An interdisciplinary practice in nursing is a team-based approach to acquire a wide range of knowledge that enhances productivity and improves decision making. Besides, it enhances communication strategies since the nurses’ social support and self-esteem is boosted (Mendes et al., 2019). In the long run, the lack of this approach causes damage to interpersonal relationships and humanization during childbirth since there is an impediment that occurs at times in the multidisciplinary team (between obstetric nurses and medical experts). As Mendes et al. (2019) further note, the barrier often makes the medical professions deprive women of their right to participate actively in the birth of their kids while at the same time looking down upon the decisions made by the Nursing Team. Postpartum units should ensure that their culture fosters interdisciplinary team-based care since it provides quality and humanized care to the mother and her newborn. As such, the woman enjoys the space to develop her autonomy throughout the delivery process, becoming her historical champion. Furthermore, the interdisciplinary approach in obstetric nurses and medical experts is essential in recognizing the diverse cultural needs, values, expectations, and beliefs surrounding pregnancy and childbirth (Mendes et al., 2019).
Care Approach
Wallbank & Robertson’s study quantified the relationship between perinatal death and its effect on the medical staff. According to Wallbank & Robertson (2013), the care approach in nursing entails attention to the desires, objectives, and needs of a patient, which creates a close and personal bond between the patient and the caregiver, making staff more susceptible to distress from perinatal deaths. As such, these caregivers in obstetrics and gynecology require protection, self-encouragement, and encouragement from others so that they manage the stress of caring for patients with stillbirths, miscarriages, and neonatal deaths Wallbank & Robertson (2013). Postpartum units should review their culture and practices since staff working in these units experience significant subjective distress levels as formal training tends to be less protective. Yet, these nurses require supervision and support to mitigate distress following the occurrence of neonatal deaths.
A study conducted by Verbiest et al. (2018) selected 22 women to participate in a study where they met with the researches in person or through virtual meetings discussing unmet postpartum health needs (Verbiest et al., 2018). This study supports the concept that culture directly shapes the care approach used in a postpartum unit. Given that 4 million women are reported to give birth each year, the quality and type of care cannot be underplayed. Currently, most postpartum units provide infant-centric care. The effect of this is that quality woman-centric care is hardly provided. The objective of this unit is to prevent the incidence of maternal and infant mortality. In the American healthcare system, a mother is given just one postpartum visit six weeks after birth (Verbiest et al., 2018). On the other hand, the infant receives a series of pediatric visits. Consequently, as supported by Wallbank & Robertson, most maternal healthcare needs to go unmet, thus the need for postpartum units to adequately incorporate both woman-centered and infant-centered care (Wallbank & Robertson, 2013).
Conclusion
In conclusion, organizational culture, unit culture, and the care approach may affect patient quality of care and outcomes, nurse satisfaction, and turnover rates. Although mainly unrelated, the articles included in this literature did have three common themes: organizational culture, unit culture, and care approach. It has a significant impact on nurse autonomy and attitude towards risks. It should be designed to encourage interdisciplinary care and allow nurses to provide infant-centric and woman-centric care interchangeably and as required to meet emerging infant and mother health needs.