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Kim, Jeong, Kang, Moon, and Kim: A Survey on the Educational Needs and Competence of Nurses in Maternal Fetal Intensive Care Unit
Original Article

Korean J Women Health Nurs 2019;25(2):194-206.

Published online: 19 June 2019

DOI: https://doi.org/10.4069/kjwhn.2019.25.2.194

A Survey on the Educational Needs and Competence of Nurses in Maternal Fetal Intensive Care Unit

Jeung-Im Kim2, Geum Hee Jeong3, Hee Sun Kang4, So-Hyun Moon6, Miok Kim7

1Associate Professor, College of Nursing, Gachon University, Incheon, Korea

2Professor, Department of Nursing, College of Medicine, Soonchunhyang University, Cheonan, Korea

3Professor, Department of Nursing, Hallym University, Chuncheon, Korea

4Professor, Red Cross College of Nursing, Chung-Ang University, Seoul, Korea

5Associate Professor, Department of Nursing, Hannam University, Daejeon, Korea

6Associate Professor, Department of Nursing, College of Medicine, Chosun University, Gwangju, Korea

7Assistant Professor, College of Nursing, Dankook University, Cheonan, Korea

Corresponding author: Miok Kim Department of Nursing, College of Nursing, Dankook University, 119 Dandae-ro, Dongnam-gu, Cheonan 31116, Korea. Tel: +82-41-550-3888 Fax: +82-41-559-7902 E-mail: aprilsea@dankook.ac.kr

Received 28 May 2019       Revised 7 June 2019       Accepted 10 June 2019

Copyright © 2019 Korean Society of Women Health Nursing

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose:

Maternal Fetal Intensive Care Unit (MFICU), which provides intensive care to high-risk mothers with increasing maternal age and high-risk newborns, has become a new field of nursing work in South Korea. The present study was conducted to identify the educational needs and self-assessing clinical competence of nurses in MFICU.

Methods:

The education needs and competencies of MFICU nurses were measured through prepared questionnaires by researchers based on the previous studies on job analysis of nurses in MFICU. Data were collected from January 2019 to March 2019. The study involved 168 nurses working in MFICUs at 12 hospitals nationwide as study subjects. The data were analyzed using the SPSS WIN 23.0 program.

Results:

The education needs of nurses in MFICU had an average of 4.21 points (±0.50) and their nursing competence was average 3.38 points (±0.60). The items reported as high education needs but low competency by nurses in MFICU were as following: ‘postpartum hemorrhage and shock,’ ‘cardiopulmonary resuscitation (CPR) for neonate,’ ‘CPR during pregnancy,’ ‘disseminated intravascular coagulation,’ ‘sepsis,’ and ‘mechanical ventilation during pregnancy.’

Conclusion:

Based on these results, it is proposed that a comprehensive education program for nurses in MFICU should be developed by considering low capabilities among MFICU nurses as a priority factor.

Keywords: Nurses, Education, Clinical competence, Pregnancy high-risk

REFERENCES

1.Statistics Korea. Results of statistics on birth and death in 2018 [Internet]. Daejeon: Statistics Korea;2019. [cited 2019 May 20]. Available from:. http://m.kostat.go.kr/board/board_view.action?bmode=read&a-no=373361.
2.Korean Society of Maternal Fetal Medicine. The survey on the actual conditions of delivery room and delivery of high-risk pregnancy. Sejong: Ministry of Health and Welfare;2012.
3.National Medical Center. Support for high-risk mothers and newborns [Internet]. Seoul: National Medical Center;2019. [cited 2019 May 6]. Available from:. https://www.ppm.or.kr/contents/contentsView.do;jses-sionid=C6B0CDD50C7D2B3F0831C9CD81C92C2B?MENUID=A01020203.
4.Kim HY., Moon CS. Integrated care center for high risk pregnancy and neonate: an analysis of process and problems in obstetrics. Korean Journal of Perinatology. 2014. 25(3):140–152. CROSSREF.
crossref
5.Lee EJ., Yoo EK. The experience of unwanted department relocation of the nurse. Journal of the Korean Society for Wellness. 2017. 12(2):37–48. CROSSREF.
6.Royal College of Anesthetists. Care of the critically ill woman in childbirth; enhanced maternal care 2018 [Internet]. London: Royal College of Anesthetists;2018. [cited 2019 May 20]. Available from:. https://www.rcoa.ac.uk/news-and-bulletin/rcoa-news-and-statements/enhanced-maternal-care-guidelines-2018.
7.ACOG practice bulletin No. 211: critical care in pregnancy. Obstetrics and Gynecology. 2019. 133(5):e303–e319. PUBMED.
8.Kim HJ., Kim JI., Ahn S., Kim MH., Kim Y., Cho KS, et al. Job analysis of maternal fetal intensive care unit nurses using DACUM technique. Journal of Korean Clinical Nursing Research. 2018. 24(1):10–22.
9.Study Group of Women's Health Nursing Curriculum. Women's health nursing I. 9th ed.Paju: Soomoonsa;2018.
10.Study Group of Women's Health Nursing Curriculum. Women's health nursing II. 9th ed.Paju: Soomoonsa;2018.
11.Korean Society of Obstetrics and Gynecology. Obstetrics. Seoul: Koonja Publisher;2015.
12.Cunningham FG., Leveno KJ., Bloom SL., Dashe JS., Hoffman BL., Casey BM, et al. Williams obstetrics. 25th ed.New York: McGraw-Hill Education;2018.
13.Gilbert ES. Manual of high-risk pregnancy and delivery. 5th ed.St. Louis: Mosby Elsevier;2010.
14.Queenan JT., Spong CY., Lockwood CJ. Protocols for high-risk pregnancies: an evidence-based approach. 6th ed.Hoboken: John Wiley & Sons;2015.
15.Campbell B., Mackay G. Continuing competence: an Ontario nursing regulatory program that supports nurses and employers. Nursing Administration Quarterly. 2001. 25(2):22–30.
crossref
16.American College of Obstetricians and Gynecologists; Society for Maternal-Fetal Medicine. Obstetric care consensus No. 6: periviable birth. Obstetrics and Gynecology. 2017. 130(4):e187–e199.
17.Oh SY. Obstetrical management of periviable birth. Korean Journal of Perinatology. 2015. 26(1):1. CROSSREF.
crossref
18.Green M., Rider C., Ratcliff D., Woodring BC. Developing a systematic approach to obstetric emergencies. Journal of Obstetric, Gynecologic, and Neonatal Nursing. 2015. 44(5):677–682.
crossref
19.Jang KS., Kim H., Kim NY. A study for development of competency-based continuing education system depending on nurses clinical ladder. Journal of the Korea Contents Association. 2018. 18(12):503–515.
20.Kim H., Park H. Health-care needs of high-risk pregnant women hospitalized in maternal-fetal intensive care units: a mixed-methods design. Korean Journal of Women Health Nursing. 2018. 24(2):196–208. CROSSREF.
crossref
21.Waldron JA., Asayama VH. Stress, adaptation and coping in a maternal-fetal intensive care unit. Social Work in Health Care. 1985. 10(3):75–89.
crossref
22.Matsumoto Y., Nakai A., Nishijima Y., Kishita E., Hakuno H., Sakoi M, et al. Absence of neonatal intensive care units in secondary medical care zones is an independent risk factor of high perinatal mortality in Japan. The Journal of Obstetrics and Gynaecology Research. 2016. 42(10):1304–1309.
crossref
23.Zuckerwise LC., Lipkind HS. Maternal early warning systems-towards reducing preventable maternal mortality and severe maternal morbidity through improved clinical surveillance and responsiveness. Seminars in Perinatology. 2017. 41(3):161–165.
crossref
24.Go JH. Core competencies of nurses' continuing education programs [dissertation]. Seoul: Chung-Ang University;2014. p. 212.
25.Kim MS., Jung HK., Kim SM., Kim MH. Perceptions and intention to use of smart-based continuing nurse education among nurse education managers and staff nurses. Journal of Health Informatics and Statistics. 2016. 41(3):307–317. CROSSREF.
crossref

Table 1.
Characteristics of Subjects (N=168)
Variables Categories n(%) M±SD Range
Sex Female 168 (100.0)    
Total clinical career (month) <60 97 (57.7) 77.01±74.81 1–364
  ≥61, <120 38 (22.6)    
  ≥121 33 (19.6)    
Career of delivery room (month) Have 163 (97.0) 39.10±53.58 1–352
  Don't have 5 (3.0)    
Career of maternity ward (month) Have 158 (94.0) 23.73±31.48 1–240
  Don't have 10 (6.0)    
Career of obstetrics & gynecology outpatient (month) Have 148 (88.1) 10.32±9.58 9–112
  Don't have 20 (11.9)    
Career of intensive care unit (month) Have 148 (88.1) 12.97±16.97 9–120
  Don't have 20 (11.9)    
MFICU nurse job education in the last year Participation in education        
Unit Have 101 (60.1) 7.51±5.27 1–36
  Don't have 67 (39.9)    
Conference Have 58 (34.5) 5.15±3.32 1–12
  Don't have 109 (64.9)    
Nursing Society Conference Have 28 (16.7) 2.11±3.07 1–16
  Don't have 140 (83.3)    
Medicine Society Conference Have 38 (22.6) 1.58±1.40 1–8
  Don't have 130 (77.4)    

M±SD=mean±standard deviation; MFICU=maternal fetal intensive care unit.

Table 2.
Need of Education and Recognition Related to MFICU Nurse Job Competency (N=168)
Categories Items NOT RJC D Difference (NOT-RJC)
    M±SD M±SD M±SD
Physiology of pregnancy 1. Physiological and nutritional adaptation during pregnancy 4.10±0.78 3.46±0.71 0.64±0.92
  Subtotal 4.10±0.78 3.46±0.71 0.64±0.92
Preconception care 2. Genetic disease 3.82±0.80 2.98±0.79 0.83±0.87
  3. Teratogen 4.08±0.86 3.08±0.78 0.99±0.92
  4. Drug use during pregnancy 4.54±0.67 3.60±0.85 0.94±0.87
  Sub total 4.14±0.65 3.22±0.67 0.92±0.74
Medical complication 5. Pregnancy and diabetes, gestational diabetes 4.64±0.67 3.89±0.87 0.75±0.96
of pregnancy 6. Pregnancy and heart disease 4.40±0.66 3.31±0.96 1.09±1.09
  7. Pregnancy and kidney disease 4.25±0.81 3.20±0.83 1.04±1.03
  8. Pregnancy and autoimmune, rheumatic diseases 4.18±0.81 3.05±0.85 1.13±0.92
  9. Pregnancy and thromboembolism 4.35±0.76 3.32±0.87 1.02±0.91
  10. Pregnancy and lung disease and dyspnea (RDS) 4.19±0.88 3.16±0.99 1.02±1.03
  11. Pregnancy and maternal anemia 4.19±0.87 3.52±0.88 0.63±1.01
  12. Effect of obesity during pregnancy 3.94±0.98 3.37±0.80 0.53±0.96
  13. Pregnancy and thyroid disease 4.22±0.78 3.48±0.86 0.74±0.93
  14. Pregnancy and acute, chronic hepatitis 4.18±0.89 3.18±0.85 0.95±1.00
  15. Pregnancy and asthma 4.00±0.90 3.10±0.88 0.89±0.88
  16. Pregnancy and epilepsy 4.18±0.85 3.14±0.98 1.03±1.03
  17. Pregnancy and autoimmunity, thrombocytopenia (ITP) 4.39±0.81 3.31±0.86 1.04±0.96
  18. Pregnancy, liver, biliary disease 4.02±0.81 3.06±0.82 0.95±0.91
  19. Smoking, drinking, drug abuse 4.07±0.97 3.57±0.88 0.50±1.09
  20. Pregnancy and infectious diseases 4.48±0.86 3.49±0.94 0.89±0.99
  21. Pregnancy and sexually transmitted infectious diseases 4.38±0.72 3.44±0.80 0.94±0.88
  22. Pregnancy and neuropsychiatric disorders 4.05±0.89 2.93±0.85 1.12±1.03
  23. Pregnancy and malignant neoplasms 3.90±0.97 2.81±0.89 1.08±1.02
  24. Pregnancy and urinary disease 3.92±0.89 3.12±1.00 0.79±1.07
  Sub total 4.19±0.63 3.27±0.64 0.92±0.69
Fetal health assessment 25. Fetal health assessment: BPP, NST 4.72±0.58 4.01±0.88 0.71±0.94
  26. Abnormal amniotic fluid 4.58±0.60 3.83±0.84 0.75±0.94
  27. Quad test and DNA test (antenatal congenital anomaly test) 4.27±0.77 3.18±0.89 1.08±1.00
  28. Normal fetal ultrasonographic findings 4.51±0.78 3.40±1.05 1.11±1.01
  29. Abnormal fetal ultrasonographic findings 4.48±0.72 3.21±0.97 1.26±0.99
  30. Fetal blood test 3.78±1.08 2.94±1.07 0.82±1.13
  31. Fetal heart rate evaluation during labor 4.69±0.55 4.01±0.96 0.67±0.94
  32. Placenta blood flow measurement (Doppler) 4.54±0.69 3.63±0.96 0.91±1.04
  33. Intrauterine growth retardation 4.61±0.58 3.70±0.88 0.91±0.90
  Sub total 4.46±0.51 3.54±0.68 0.92±0.72
Obstetric procedure 34. Induced labor 4.69±0.55 4.01±0.95 0.68±0.98
  Sub total 4.69±0.55 4.01±0.95 0.68±0.98
Obstetric anesthesia 35. Obstetric anesthesia 4.06±0.94 3.21±1.02 0.79±1.03
  Sub total 4.06±0.94 3.21±1.02 0.79±1.03
Postpartum care 36. Family planning (contraception) 3.71±0.99 3.42±1.01 0.29±1.11
  37. Breastfeeding 4.25±0.83 3.69±1.03 0.55±1.05
  Sub total 3.98±0.80 3.31±0.85 0.66±0.96
High-risk pregnancy 38. Pregnancy and gastrointestinal diseases 3.89±1.16 3.29±0.95 0.50±1.10
  39. Psychological adaptation of high-risk pregnant women 4.12±0.82 3.42±0.95 0.70±1.10
  40. Intrauterine fetal death and bereavement care 4.33±0.72 3.49±0.96 0.84±1.06
  41. Hemorrhagic complication of early pregnancy (spontaneous abortion) 4.32±0.76 3.63±0.95 0.69±1.08
  42. Incompetent cervix 4.62±0.57 3.90±1.02 0.72±1.04
  43. Hyperemesis gravidarum 3.97±091 3.45±0.97 0.51±1.11
  44. Ectopic pregnancy 3.96±0.94 3.37±1.01 0.58±1.13
  45. Gestational choriocarcinoma 4.04±0.95 3.23±1.05 0.81±1.14
  46. Hemorrhagic complication of late pregnancy (placenta previa, abruptio 4.74±0.50 3.87±0.95 0.86±1.00
  placentae)      
  47. Disseminated intravascular coagulation 4.56±0.65 3.43±0.98 1.13±1.04
  48. Hemolytic incompatibility (Rh, ABO) 4.24±0.79 3.30±1.07 0.94±1.26
  49. Hypertensive disorders (preeclampsia, etc) 4.76±0.48 4.01±0.96 0.75±0.95
  50. Preterm labor 4.73±0.61 4.10±0.91 0.63±1.01
  51. Multiple pregnancy 4.54±0.72 3.93±0.97 0.60±1.07
  52. Premature rupture of membranes 4.81±0.43 4.01±0.94 0.79±0.96
  53. Amnionitis 4.52±0.70 3.61±0.97 0.90±1.00
  54. Trauma during pregnancy 3.93±092 3.07±0.97 0.86±1.08
  55. Pregnancy and depression 3.96±0.90 3.10±0.95 0.97±1.16
  56. Prevention of cerebral palsy 3.90±0.95 2.93±1.02 1.14±1.40
  57. Fetal transfusion and fetal treatment 3.96±0.95 2.82±1.17 1.45±1.16
  Sub total 4.29±0.53 3.49±0.72 0.79±0.79
CPR during pregnancy 58. Mechanical ventilation during pregnancy 4.11±0.83 2.66±1.02 1.52±1.27
  59. CPR during pregnancy 4.29±0.81 2.76±1.08 0.89±1.09
  Sub total 4.19±0.76 2.71±1.00 1.48±1.13
High-risk labor 60. Dystocia 4.26±0.82 3.36±0.91 0.80±1.17
  61. Post-term pregnancy 4.10±0.91 3.29±0.97 1.20±1.03
  62. Amniotic fluid embolism 4.49±0.70 3.28±1.07 1.00±1.17
  63. Nursing during amniotic fluid infusion and amniotic membrane rupture 4.40±0.79 3.40±1.09 1.11±1.25
  Sub total 4.31±0.68 3.33±0.89 0.97±0.99
Newborn CPR 64. Newborn resuscitation 4.58±0.72 3.46±1.16 1.11±1.25
  Subtotal 4.58±0.72 3.46±1.16 1.11±1.25
High-risk postpartum 65. Postpartum hemorrhage and shock 4.76±0.47 3.58±0.98 1.27±1.11
  66. Sepsis 4.48±0.75 3.20±0.98 1.08±1.17
  Sub total 4.61±0.53 3.39±0.90 1.22±0.98
Law and ethics 67. Ethical dilemmas and legal considerations in perinatal care 3.99±0.97 2.87±1.09 1.08±1.17
  Sub total 3.99±0.97 2.87±1.09 1.08±1.17
Total   4.21±0.50 3.38±0.60 0.86±0.63

M±SD=mean±standard deviation; MFICU=maternal fetal intensive care unit; NOT=need of education; RJC=recognition of job competence; NST=non stress test; BPP=biophysical profile; RDS=respiratory distress syndrome; ITP=immune thrombocytopenia; CPR=cardiopulmonary resuscitation.

Table 3.
Suggestions for MFICU
Categories n(%) Sub-categories n(%) Contents
Clarifying the criteria for MFICU admission and nurse's job and qualifications 24 (34.8) Criteria and scope of MFICU admission 10 (14.5) Establishing clear criteria for admission of MFICU (5) Deciding whether to be admitted to the MFICU according to the doctor's personal judgment (3)
    Description of MFICU nurse qualifications 8 (11.6) Expansion of MFICU admission criteria (including postpartum bleeding) (2) Legislation on mandatory education of nurses working MFICU (3) MFICU working nurse qualifications and duties (2) Optimization of MFICU nursing payment system (2)
    Regulations and guidelines for MFICU nurses' job 6 (8.7) Improving the quality of MFICU nursing (1) Education for MFICU nursing jobs (1) Development of MFICU nursing area (1) Extensive nursing job (1) Nurse practice guidelines (1) MFICU Infection manual (1) Treatment plans for patients with MFICU (1)
Building education system and sharing information 23 (33.3) Lack of education 12 (17.3) Lack of education expanded nursing job (2) Limitations of Individual learning (2) Needs education at an association or academia level (2) Expansion of continuing education for maternal care (2) Lack of unit education in the hospital (2) Lack of educational support from the hospital (1)
    Sharing information and materials 7 (10.2) Systematic education system (1) Sharing educational materials and information from academies and hospitals (3) Meeting between MFICU hospitals (1) MFICU integrated education manual (1)
    Accessible teaching method 4 (5.8) Educational materials for reference (1) Lack of professional books (1) Accessible methods (external, internal, online, etc.) (1) Mobile phone apps (1), videos (1), online (1)
Professional education for medical complications and care of high-risk childbirth 16 (23.2) Maternity nursing 7 (10.2) Ultrasonic application and interpretation (3) Pregnancy, childbirth, postpartum women's nursing (2) Care for women during labor (2)
    High-risk maternity nursing 6 (8.7) Critical care in childbearing (3) Medical complication of pregnancy (3)
    Providing emotional support 3 (4.3) Emotional support for fetal loss (2) Management of nurses' stress (1)
Promotion and support of MFICU 6 (8.7) Promotion of MFICU 3 (4.3) Guidance on high-risk pregnancy support projects (1) Public promotion of MFICU (1) Statistics and reporting on utilization of MFICU (1)
    Hospital's interest and support 3 (4.3) Proper management of hospital (1) Hospital manager's interest (1) Preparation of therapeutic environment (1)
Total 69 (100.0)   69 (100.0)  

MFICU=maternal fetal intensive care unit.

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