PubMed · 7991398
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L Warner. Changing ideas.. https://pubmed.ncbi.nlm.nih.gov/7991398/
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OBJECTIVE: Our purpose was to compare an early postpartum discharge program versus standard postpartum care. STUDY DESIGN: A randomized controlled trial in a 637-bed university hospital included 175 healthy women recruited at 32 to 38 weeks gestation from physicians' offices and sonograms. Experimental intervention consisted of discharge 6 to 36 hours post partum with nursing care available by telephone or at home at 34 to 38 weeks' gestation and at < or = 48 hours and at 3, 5, and 10 days post partum. The control included a postpartum stay of 48 to 72 hours and standard follow-up. RESULTS: At 1 month no significant differences were seen in perceived maternal competence (Experimental-Control = 4.3 points [95% confidence interval-7.7 to 16.3]), infant weight gain (1.2 gm/ day [-2.8 to 5.2]); identification of significant neonatal hyperbilirubinemia (rate ratio 0.50 [0.10 to 2.51]), infant utilization of health services (rate ratio 0.88 [0.45 to 1.73]), or predominant breast-feeding (adjusted odds ratio 1.25 [0.88 to 1.75]). Program participants did have significantly less frequent infant bilirubin testing (rate ratio 0.39 [0.17 to 0.94]). The program also enhanced perceived maternal competence in recent immigrants (26.9 points [2.7 to 51.5]). CONCLUSIONS: Early postpartum discharge coupled with prenatal, postnatal, and home contacts leads to no apparent disadvantage and may yield benefits for some mothers and infants.
The use of an illuminative approach to the national evaluation of the first 18 months of Project 2000 nurse and pre-registration midwifery education in Scotland has facilitated the generation of data about the contexts in which the new programmes function. The aim of this paper is to present some of the data generated from programme participants about the conditions students experience in practice-based learning experiences. The reported issues are direct or indirect effects of policy initiatives and service reforms. The current climate of change in health care provision has fostered a limited number of developments which are consistent with the aspirations of the new programmes and which offer highly valued learning experiences to students. More often however the reforms have served to frustrate the intent of the programmes to offer students experiences which are patient-centred, holistic-care and health oriented.