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Strengthen the Evidence for Maternal and Child Health Programs

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Evidence Tools
MCHbest. Postpartum Visit.

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Strategy. Provider Training and Education

Approach. Train perinatal nurses to educate patients on potential postpartum complications that may require treatment after discharge

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Overview. Perinatal nurses can be trained to provide postpartum patient education on the potential complications and warning signs that may require treatment after hospital discharge.[1,2,3] Training courses about postpartum depression and other leading causes of maternal mortality and morbidity can help nurses provide patient education on signs and symptoms that may require immediate medical attention during the postpartum period.[2,3,4] However, continued research focusing on best practices for providing postpartum education and methods to disseminate this information is warranted.[5,6]

Evidence. Emerging Evidence. Strategies with this rating typically trend positive and have good potential to work. They often have a growing body of recent, but limited research that documents effects. However, further study is needed to confirm effects, determine which types of health behaviors and conditions these interventions address, and gauge effectiveness across different population groups. (Clarifying Note: The WWFH database calls this "mixed evidence").

Access the peer-reviewed evidence through the MCH Digital Library or related evidence source. (Read more about understanding evidence ratings).

Source. Peer-Reviewed Literature

Outcome Components. This strategy has shown to have impact on the following outcomes (Read more about these categories):

  • Quality of Care. This strategy promotes the degree to which healthcare services meet established standards aimed at achieving optimal health outcomes.

Detailed Outcomes. For specific outcomes related to each study supporting this strategy, access the peer-reviewed evidence and read the Intervention Results for each study.

Intervention Type. Health Teaching (Education and Promotion) (Read more about intervention types and levels as defined by the Public Health Intervention Wheel).

Intervention Level. Individual/Family-Focused

Examples from the Field. There are currently no ESMs that use this strategy. As Title V agencies begin to incorporate this strategy into ESMs, examples will be available here. Until then, you can search for ESMs that have similar intervention components in the ESM database.

Sample ESMs. Here are sample ESMs to use as models for your own measures using the Results-Based Accountability framework (for suggestions on how to develop programs to support this strategy, see The Role of Title V in Adapting Strategies).

Quadrant 1:
Measuring Quantity of Effort ("What/how much did we do?")

PROCESS MEASURES:

  • Number of perinatal nurses who complete training on educating patients about potential postpartum complications and warning signs that may require treatment after discharge. (Measures the reach and scale of the workforce development strategy)
  • Number of healthcare systems, hospitals, and professional organizations that adopt and integrate postpartum complication education training for perinatal nurses into their standard protocols and curricula. (Assesses the uptake and institutionalization of the strategy)

OUTCOME MEASURES:

  • Number of postpartum patients who demonstrate increased knowledge, awareness, and self-efficacy in recognizing and responding to potential complications after receiving education from trained perinatal nurses. (Measures the learning and support outcomes of the patient education intervention)
  • Number of perinatal nurses who report increased confidence, competence, and job satisfaction in providing postpartum complication education and supporting patients' safe transitions from hospital to home. (Assesses the workforce capacity and engagement outcomes of the training intervention)

Quadrant 2:
Measuring Quality of Effort ("How well did we do it?")

PROCESS MEASURES:

  • Percent of perinatal nurse training programs on postpartum complication education that adhere to evidence-based content, adult learning principles, and cultural humility practices. (Measures the quality and fidelity of the workforce development intervention)
  • Percent of healthcare systems, hospitals, and professional organizations that adopt and integrate postpartum complication education training for perinatal nurses into their standard protocols and curricula. (Assesses the uptake and institutionalization of the strategy)

OUTCOME MEASURES:

  • Percent of postpartum patients who report feeling informed, supported, and prepared to identify and respond to potential complications after receiving education from trained perinatal nurses. (Measures the patient experience and care quality impact of the intervention)
  • Percent of postpartum patients who seek timely medical attention for suspected complications based on the education received from perinatal nurses, leading to earlier diagnosis and treatment. (Measures the patient activation and health-seeking behavior outcomes of the education)

Quadrant 3:
Measuring Quantity of Effect ("Is anyone better off?")

PROCESS MEASURES:

  • Number of partnerships and collaborations established between healthcare systems, nursing schools, professional associations, and patient advocacy groups to develop, implement, and evaluate perinatal nurse training programs on postpartum complication education. (Measures the multi-partner engagement and collective action approach of the strategy)
  • Number of policies, guidelines, and recommendations developed by professional organizations and regulatory bodies to support the integration of postpartum complication education into perinatal nursing practice standards and competencies. (Measures the enabling environment and systems change efforts for the strategy)

OUTCOME MEASURES:

  • Number of healthcare systems and payers that demonstrate improved patient outcomes, care quality, and cost savings through the implementation of perinatal nurse training on postpartum complication education. (Measures the healthcare value and return on investment of the strategy)
  • Number of perinatal nurses who become recognized as leaders, champions, and educators in promoting patient safety, support, and care transitions in the postpartum period. (Assesses the professional development and advocacy outcomes of the training intervention)

Quadrant 4:
Measuring Quality of Effect ("How are they better off?")

PROCESS MEASURES:

  • Percent of perinatal nurse training program development and implementation process that meaningfully engage and incorporate the lived experiences, cultural perspectives, and priorities of diverse postpartum patient populations. (Measures the patient-centered and inclusive design approach of the strategy)
  • Percent of perinatal nurse training program resources and funding allocated to address health equity, social determinants, and systemic barriers that impact postpartum patients' ability to recognize and respond to potential complications. (Measures the health equity and social justice orientation of the strategy)

OUTCOME MEASURES:

  • Percent of postpartum patients, particularly those from historically marginalized and underserved communities, who report feeling heard, respected, and supported in their interactions with trained perinatal nurses around postpartum complication education and care planning. (Measures the cultural humility and patient dignity outcomes of the strategy)
  • Percent reduction in structural and systemic barriers, such as discrimination, economic instability, and lack of social support, that prevent postpartum patients from accessing timely and appropriate care for potential complications, as a result of the equity-focused training and education efforts of perinatal nurses. (Measures the social determinants of health and health equity impact of the strategy)

Note. When looking at your ESMs, SPMs, or other strategies:

  1. Move from measuring quantity to quality.
  2. Move from measuring effort to effect.
  3. Quadrant 1 strategies should be used sparingly, when no other data exists.
  4. The most effective measurement combines strategies in all levels, with most in Quadrants 2 and 4.

Learn More. Read how to create stronger ESMs and how to measure ESM impact more meaningfully through Results-Based Accountability.

References

[1] Suplee, P. D., Kleppel, L., & Bingham, D. (2016). Discharge Education on Maternal Morbidity and Mortality Provided by Nurses to Women in the Postpartum Period. Journal of obstetric, gynecologic, and neonatal nursing : JOGNN, 45(6), 894–904. https://doi.org/10.1016/j.jogn.2016.07.006. [2] Suplee, P. D., D'Oria, R., Larson, K., Kilday, D., Eymold, C., & Onokpise, B. (2023). An Initiative to Improve Postpartum Discharge Education. Nursing for women's health, 27(4), 270–282. https://doi.org/10.1016/j.nwh.2023.04.007.
[3] Lewis N. L. (2020). Developing a Hospital-Based Postpartum Depression Education Intervention for Perinatal Nurses. Journal for nurses in professional development, 36(1), 7–11. https://doi.org/10.1097/NND.0000000000000595.
[4] de Los Reyes, S., Al-Khaled, D., Brito, K., Kholmatov, M., Farley, B., Kuriloff, M., Stamos, G., Victorson, D., & Plunkett, B. (2022). AWHONN postpartum discharge education: patient knowledge and sustainability. BMJ open quality, 11(4), e001528. https://doi.org/10.1136/bmjoq-2021-001528].
[5] Suplee, P. D., Bingham, D., & Kleppel, L. (2017). Nurses' Knowledge and Teaching of Possible Postpartum Complications. MCN. The American journal of maternal child nursing, 42(6), 338–344. https://doi.org/10.1097/NMC.0000000000000371].
[6] McCarter, D., Law, A. A., Cabullo, H., & Pinto, K. (2022). Scoping Review of Postpartum Discharge Education Provided by Nurses. Journal of obstetric, gynecologic, and neonatal nursing : JOGNN, 51(4), 377–387. https://doi.org/10.1016/j.jogn.2022.03.002

This project is supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) under grant number U02MC31613, MCH Advanced Education Policy, $3.5 M. This information or content and conclusions are those of the author and should not be construed as the official position or policy of, nor should any endorsements be inferred by HRSA, HHS or the U.S. Government.