Lynn J Cook

A regionalized perinatal continuing education programme: successful adaptation to a foreign health care system and language

Much of the decline in perinatal mortality over the past two decades in the United States has been attributed to regionalization of perinatal care. Outreach education from regional medical centres to community hospitals is an essential component of regionalization. The Perinatal Continuing Education Program (PCEP) has been successfully used for outreach education in more than 30 states since 1979. This project tested the efficacy of implementing the PCEP strategy in Poland.

52 CURRENT STATUS AND GOALS OF THE COMMUNITY HOSPITAL PERINATAL SERVICE AS DETERMINED BY A SELF - INVENTORY

Regional perinatal care is often criticized because local personnel are uninvolved in determining their “level” category. To intensify local input, we developed a self-assessment inventory of desired care practices and existing resources. The inventory includes a list of 48 high-risk conditions to be classified as requiring local care or referral and a list of 179 items for hospital equipment and staffing. 21 obstetricians (O), 16 pediatricians (P), 16 family physicians, and 84 perinatal nurses from 8 rural hospitals completed the inventories. The results of the inventory were compared with data obtained from 3-day site visits to the hospitals.O and P consistently felt that over 80% of Level II and III prenatal conditions should be managed locally, but they disagreed about referring neonatal conditions (O=46% refer; P=76% refer). 10.6% of the resources required for desired level of care were stated as not present in the hospitals. These results were 96% consistent with site visit observations. There were conflicting responses on 17.1% of the 179 items (i.e., some responders did not know many of their own resources).We conclude that 1) patient care goals frequently are not consistent with available resources and 2) the self inventory can replace site visits, identify discrepent patient care goals, accurately assess hospital facilities, and identify existing hospital resources not being utilized.

495 SELF-INSTRUCTIONAL PROGRAM FOR PERINATAL EDUCATION

Perinatal regionalization encourages regional centers (RC) to provide educational programs for community hospitals (CH). We have developed a program with the following novel approaches: (1) Each hospital defines its own equipment and personnel needs by completing an inventory; (2) The same self-instructional program is completed by all perinatal nurses and physicians, thus facilitating uniformity of care and improving nurse-physician communication; (3) The RC trains 2 nurses from the CH who subsequently direct an intensive 4 month program entirely in their hospital and with minimum intervention by the RC. The program consists of 5 self-instructional books (575 pages) covering 17 perinatal subjects and 17 skills. The program was revised through 3 field trials and critiqued by 7 national experts. 55 physicians, 173 nurses and 107 supporting personnel representing 81% of the perinatal professionals from 9 CH participated in the program.For the units completed by all hospitals to date, pre vs. post test scores increased from a mean of 70% to 87% respectively (p<.001). Critical incident data suggested that the program resulted in improved patient care and staff morale. Pre-transport conditions of referral babies showed a 34% increase in quantity of stabilizing activities. Chart reviews are now underway to evaluate care practice changes.We conclude that a self-instructional, locally-based and coor-dinated program of this type is an effective, well accepted, and efficient means of training personnel in the CH.

494 ATTITUDES TOWARD PERINATAL CARE IN COMMUNITY HOSPITALS

At the time of on-site observations of the perinatal services of 9 community hospitals, interviews and discussions were held with nursing personnel. Unexpectedly, these interviews suggested that hospital personnel held fatalistic attitudes that could potentially interfere with optimal perinatal care.From these interviews, 51 statements regarding perinatal attitudes were written. The items were condensed to 32 statements through a pilot study and the resulting attitude survey was administered to 435 perinatal physicians, nurses, and support personnel from community hospitals. The data from the survey were subjected to a principle components factor analysis with squared multiple correlations in the diagonal and a Varimax rotation. The factors to be rotated were selected by Kaisers criterion and the following were identified as general attitudes: (1) it does little good to anticipate perinatal problems; (2) some babies are predestined to be unhealthy; (3) some sick babies survive only because they have a “will to live”. These respective attitudes were expressed by 12.1%, 9.4% and 38.2% of the individuals. The survey was readministered after a 4 month educational program. Preliminary results show a statistically significant shift toward less fatalistic attitudes following the program.We conclude that (1) non-facilitating attitudes toward perinatal care exist in community hospitals and (2) these attitudes can be favorably influenced by an educational program.