postpartum newborn teaching record and reflection Lisa Tripp

Running head: POSTPARTUM/NEWBORN TEACHING 1

Postpartum/Newborn Teaching Record and Reflection

Lisa Tripp

California Baptist University

Author’s Note

This paper is presented to Professor Hutchinson in partial fulfillment for the

requirements of Childbearing Famil Practicum, NURS 533B on April 22, 2016.

Postpartum/Newborn Teaching 2

Teaching Record 30 points – make sure that evaluation of learning is measurable. Patient states they understand are not measurable.

Content Assessed/Taught

1.5 points each

(Describe in detail what you taught)

Teaching Methods Used

1/2 point each

Evaluation of Learning

1 point each

(Explain how you know patient understands).

1. During the newborn assessment, the postpartum patient was taught about the newborn’s fontanels. The postpartum patient was taught that the newborn has two openings in the skull called fontanels, that exist because the bones of the skull have not yet fused to allow for the newborn’ skull to fit through the vaginal canal and to allow for brain growth. The postpartum patient was taught that the newborn has a posterior fontanel that closes any time between birth and 2 months, and an anterior fontanel that closes between 12 and 18 months. The postpartum patient was taught that the newborn’s fontanels are a good representation of the newborn’s level of hydration. The postpartum was taught how to feel the newborn’s fontanels (with a flat hand), and that sunken fontanels indicate dehydration, and bulging

1. The postpartum patient was familiarized with the concept of fontanels by using conversational teaching. The postpartum patient was familiarized with the technique used to assess the newborn’s fontanels using demonstration (flat handed touch).

1. The postpartum patient demonstrated understanding by stating that she has been taught about the baby’s “soft spots” at a previous time, but that she felt more comfortable with the concept since teaching had been reinforced. The patient stated that she had not been taught about the danger signs that the fontanels can indicate, and that she would monitor for any changes and report to the HCP if they occurred.


fontanels indicate possible increased intracranial pressure. The postpartum patient was taught that both of these assessments require immediate notification of the health care provider.

2. During the newborn assessment, the postpartum patient was taught about breastfeeding the newborn. The postpartum patient was taught that the newborn needs to be fed at least every 2-3 hours, and upon demand. The postpartum patient was taught signs/cues the newborn would demonstrate indicating demand. The postpartum patient was taught that the newborn may demonstrate the rooting reflex, sucking reflex, and become irritable when ready to feed. The postpartum patient was taught that she can assess whether or not the baby is being fed often enough and an adequate quantity by noting the number of diapers the baby soils. The postpartum patient was taught that he newborn should produce at least 1 diaper on the first day of life, 2 diapers on the second day of life, 3 diapers on the third day of life, etc. up

2. The postpartum patient was familiarized with breastfeeding frequency, feeding cues, newborn feeding assessment using conversational teaching. The postpartum patient was familiarized with the technique used to assess the newborn’s cues through demonstration both by the nursing student and by eliciting the sucking and rooting reflex on the newborn.

2. The postpartum patient demonstrated understanding by stating that she understood the newborn needed to be breastfed on demand, and at least every 2-3 hours. The postpartum verbalized understanding of newborn feeding cues. The postpartum patient verbalized the correct newborn diaper count expectations according to days since birth.


until the sixth day of life, when the number of diapers should be 6-8 per day, indicating that the newborn is being adequately fed.

3. During the newborn assessment, the postpartum patient was taught about umbilical cord care for the newborn. The postpartum patient was familiarized with the newborn’s umbilical cord and taught to fold the diaper down below the umbilical cord to prevent pressure and wetting of the cord. The postpartum patient was taught to refrain from wetting the cord during bathing until the umbilical stump falls off, and not to apply alcohol to the stump. The postpartum patient was taught that the stump should fall off in approximately one week from the date of birth. The postpartum patient was taught that warning signs that should be reported to the healthcare provider include bleeding from the site and any drainage.

4. During the postpartum assessment, the postpartum patient was taught about expected emotional changes post-delivery. The

3. During the umbilical cord teaching, verbalization was used to educate the patient about cord care and warning signs that need to be reported to the health care provider. Demonstration was used to teach the patient about diaper folding and placement below the umbilical cord.

4. The postpartum patient was taught about expected emotions post-delivery, postpartum

3. The patient demonstrated understanding by verbalizing that she understood how to how to care for the cord by keeping it clean and dry. The patient verbalized that she had planned on putting alcohol on the stump to facilitate drying and sloughing, but she stated that she no longer planned on applying alcohol after reinforcement.

4. The postpartum patient demonstrated understanding by verbalizing that she had heard about baby blues and postpartum


postpartum patient was taught that emotional changes are normal and expected during the first two weeks postpartum. The postpartum patient was taught that due to natural hormonal fluctuations that occur after delivery of the newborn, she may feel feelings of sadness and irritability referred to as “baby blues”. The postpartum patient was encouraged that this change is normal, and that the postpartum patient should not be alarmed. The postpartum patient was taught that if these feelings do not subside after the first two weeks, that the patient should seek help from the health care provider as postpartum depression may be occurring. The postpartum patient was encouraged to additionally seek support from her family.

5. The postpartum patient was taught about lochia. The postpartum patient was taught that lochia is the flow that occurs after birth any may last 2-4 weeks. The postpartum patent was taught about lochia rubra, serosa, and alba and the expected length of time

blues, and postpartum depression, and warning signs using one-on-one verbalization.

5. The postpartum patient was taught about what lochia is, the types of lochia, amount, consistency, color, and odor of lochia, and warning signs of report to the healthcare provider using verbalization and

depression, and that her previous teaching was reinforced. The postpartum demonstrated understanding about the need for support by verbalizing three people she can rely on for help including her mother, father, and the newborn’s father.

5. The patient demonstrated understanding bv verbalizing that she had never been taught about lochia, and that she would be sure to monitor her lochia for type, amount, consistency, color, and odor, and report any warning signs to her


each type of lochia would be present, the expected color, the expected consistency, the expected odor, and the expected amount. The postpartum patient was taught that the healthcare provider should be alerted if more than 1 pad per hour is being soaked, if clots greater than the size of a ping pong ball are produced, or if the odor of the lochia is foul. The patient was taught to empty the bladder, put the newborn to the breast, and perform fundal massage if these circumstances occur.

6. The postpartum patient was taught about her cesarean section surgical site. The patient was taught that the site is secured by staples, and that the doctor would perform the first dressing change. The patient was taught that the site may cause considerable pain, and that the site may be splinted during movement in order to reduce pain. The patient was taught about pharmacological pain management. The patient was taught to report any amount of significant bleeding to the healthcare provider. Additionally, the

demonstration showing the patient the amount of lochia currently on her pad and the size of clots to report to the healthcare provider.

6. The patient was taught about her cesarean section surgical site, site care, site assessment, and warning signs that should be reported to the healthcare provider using verbalization of instruction and demonstration, showing the patient her site and what warning signs might look like.

doctor immediately.

6. The patient demonstrated understanding of the surgical site teaching by verbalizing warning signs that should be reported and ways to reduce surgical site pain.


patient was taught that any redness, edema, drainage, and pulling of the wound apart from itself should be reported to the healthcare provider.

7. The postpartum patient was taught about the importance of ambulation after cesarean section. The postpartum patient was taught that since it had been 24 hours since her cesarean section, it was an appropriate time to begin ambulation. The postpartum patient was taught that ambulation after surgery is important because it is an important element of deep vein thrombosis prevention. The patient was taught that although many cesarean section patients would like to stay in bed due to pain and exhaustion, doing so may result in stasis of blood within the vessels of the legs which can cause clot formation, which is very dangerous. The patient was taught that early ambulation after surgery is essential in preventing clot formation. The patient was taught to request analgesics before ambulation if necessary.

8. The postpartum patient

7. The patient was taught about DVT prophylaxis and the importance of early ambulation after surgery using verbal teaching strategies and physical demonstration of the areas where clots may form.

7. The patient demonstrated understanding of teaching by agreeing to walk after the assessment was over after a morning of refusing to get out of bed due to pain.

8. The patient


was taught about breastmilk production. The patient was taught about the different types of breast milk including colostrum, foremilk, and hind milk. The patient was taught about colostrum, the time frame during which it is produced, the amount that is produced, the concentrated factors that colostrum contains, and the importance of the newborn being fed the colostrum. The patient was taught that her regular milk would come in approximately 48-72 hours after delivery. The patient was taught that milk letdown can be facilitated by feeding the newborn often and applying warm compresses. The patient was taught that a sign of milk letdown is engorgement.

9. The postpartum patient was taught about nipple care. The postpartum patient was taught that some nipple discomfort may occur during breastfeeding, especially considering that she is a first time mom. The patient was taught that should dryness and cracking occur, breastmilk can be expressed and applied to the areola as

8. The patient was taught about breastmilk production, the types, amount, and timing of breastmilk production, and how to facilitate milk letdown. The patient was taught about engorgement and how to palpate the breasts to detect engorgement using demonstration.

9. The postpartum patient was taught through verbalization about nipple changes due to breastfeeding, and about nipple care that can be done to prevent and treat discomfort. The patient was demonstrated how to express milk to apply to the areola and how to release the newborn’s

demonstrated understanding by verbalizing that she had never been taught what colostrum was, and about why it is so important for the baby, and that she would be sure to breastfeed the baby frequently to ensure the baby was able to receive it. The patient verbalized understanding that milk letdown would occur 48-72 hours after delivery and that feeding the baby frequently and applying warm compresses will facilitate letdown.

9. The postpartum patient demonstrated understanding of the nipple care teaching by verbalizing that she had not been taught about using her own breastmilk as a moisturizer, and that she would contact the lactation specialist at any time she had concerns about breastfeeding.


a natural moisturizer. The mother was taught that if nipple discomfort occurs during breastfeeding, the baby might not be fully and correctly latched to the entire areola, and that a finger can be slipped into the side of the newborn’s mouth to break the baby’s latch for repositioning. The patient was taught to contact the lactation specialist with any specific breastfeeding concerns.

10. During the newborn assessment, The postpartum patient was taught about crib safety. The patient was taught that when the newborn is laid in the crib to sleep, the baby should always be laid on its back, and never on its stomach. The patient was educated that laying the newborn on its back poses a risk for suffocation. The patient was also taught that no items should be placed in the crib with the newborn including blankets, stuffed animals, and toys, and these items may also pose a suffocation risk. The patient was also taught to always keep all sides of the crib up at all times.

latch when discomfort is felt.

10. The postpartum patient was taught about crib safety using verbalization of teaching.

10. The postpartum patient verbalized understanding of the crib safety teaching by expressing that she would never place the newborn on its stomach in the crib and that all items in the crib would be removed in order to prevent suffocation.

Reflection Questions: 2 points each


1. Describe emotions you experienced while providing patient/family teaching.

While providing patient/family teaching, I felt a sense of being overwhelmed by

the lack of knowledge the patient had being a very young first time mom. I felt that I

sould have talked to the patient about the postpartum and newborn teaching that she

really needed to receive for over an hour. I felt that the patient had been disservice in

ways during her prenatal and antepartum care by not being taught some of the concepts

that I had familiarized her with. Ultimately, I felt a sense of accomplishment both in the

amount of knowledge that I had, how comfortable I felt providing teaching, and knowing

that my patient would be better able to safely care for herself and her child when

discharged home.

2. Describe specific ways you could improve upon how you provide patient teaching.

I can improve my patient teaching in many ways. First, I need to improve my

assessment of the patient’s health literacy in order to teach in a way that is at an

appropriate comprehension level for the patient. In doing this, I can improve by using

medical terms when appropriate, and more colloquial terms when necessary.

Additionally, I can improve by improving my speed of teaching, as I found myself

speaking very quickly, which may have decreased the patient’s level of comprehension. I

can also ask the patient to perform more teach back in order to more accurately assess

their level of understanding of the teaching that was given.

3. Describe what was difficult for you during the patient/family teaching sessions & why.

During the teaching sessions, it was difficult for me to control my level of

anxiety. I was very nervous going into the postpartum and newborn assessments, and I

think that my anxiety affected the way that I performed teaching. I spoke quickly and


mixed up my words occasionally, which may have impaired the patient’s ultimate

understanding of what was taught. In the future, I need to remember how long it took me

to learn the material that I now understand, and take that timing into account when

performing patient teaching. Additionally, I found it difficult at times to organize my

thoughts and keep all of the teaching specific to one area within the same section of

teaching given.

4. Describe something you learned about teaching patients/families by observing another member of the health care team as they provided teaching.

By observing the nurses that I have shadowed over the semester, I have learned a

lot about how to give effective patient teaching. First, I have observed that my nurses do

not give patient teaching all in one sitting, but spread teaching out over the course of the

patient stay in order to enhance comprehension and not to overwhelm the patient.

Secondly, my nurses taught their patients using a level of language that is very simplified

in order to be sensitive to the patient’s level of health literacy. Third, I have noticed that

my nurses have performed teaching in a conversational way in order to make to teaching

feel natural and to make the patient feel comfortable.

5. Describe how you implemented aspects of the Humanbecoming theory as you were engaged in teaching your patients or family members.

I was able to implement Parse’s Humanbecoming theory in a variety of ways

during patient teaching. First, I had to be sensitive to the patient’s current place in life,

and take that into account when providing teaching (Parse, 2014). I had to understand that

the patient was still creating meaning out of her new set of circumstances, and that I

could really help to facilitate meaning acquisition through my communication (Parse,

2014). I made sure to use open-ended questions and give the patient my true presence in


order to allow the patient to express herself and her feelings in order for her to create

meaning (Parse, 2014). Additionally, I had to consider the fact that this patient was

demonstrating the Humanbecoming principle of revealing-concealing, revealing her

vulnerabilities and concealing her fears about being a first time mom (Parse, 2014). The

patient was treated as an august presence, and I did my best to show her the love,

attention, and respect that she deserved as a child of God (Parse, 2014).

References


Parse, R. R. (2014). The humanbecoming paradigm: A transformational worldview. Pittsburgh,

Pennsylvania: A Discovery International Publication.

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postpartum newborn teaching record and reflection Lisa Tripp