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Problem Statement

A problem statement is a simplified, brief description of a problem or issue that is

needing to be addressed. A problem statement is a key communication tool that informs

everybody what has been or is being done towards fixing the problem and it also pinpoints the

goals and expected outcomes of the project. The problem statement in this assessment will

address the needs of a target population. The evidence will be supported with multiple literary

resources.

P – The intended patient population is pregnant and postpartum African American women.

I – The plan is implementing early patient education on preeclampsia – i.e., statistics for

preeclampsia and maternal mortality for African American women, signs, and symptoms,

recommended lifestyle changes, and when they should seek care.

C – The alternative to the plan is comparing the data to the patients who do not actively work in

conjunction with the providers for the early prevention/management of preeclampsia.

O – The outcome I’m seeking is increased awareness of preeclampsia complications to prevent

hospital admissions and negative patient outcomes.

T – The time frame required is twelve months because that will account for assessments

performed throughout the entire pregnancy and twelve week postpartum period.

Need Statement

Preeclampsia is a rare, but serious medical condition that is diagnosed when you develop

extremely high blood pressure and proteinuria (large amounts of protein in your urine) before

and after delivering a baby often up until six weeks. After analyzing the issue, I identified more

than one need for my project – health promotion, education, prevention, and management, with

the focus primarily being on patient education. Addressing these needs is very important because

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if misdiagnosed or left untreated, preeclampsia can unfortunately result in the death of the

mother. A key piece of evidence that supports the urgency of the need comes from a USA

TODAY article – “Every year, more than 50,000 women suffer severe injuries or complications

related to childbirth, and approximately 700 die. Of those caused by blood pressure and

hemorrhage, about half could be prevented, experts say” (Kelly, 2018, para. 7).

Population and Setting

The population I will be targeting with my project is pregnant and postpartum African

American women. It is important that I address my identified needs within this population

because I am African American, and I have read multiple alarming articles on racial disparities in

maternal health. “Black women are three times more likely to die from a pregnancy-related cause

than white women. Multiple factors contribute to these disparities, such as variation in quality

healthcare, underlying chronic conditions, structural racism, and implicit bias” (CDC, 2021,

para. 2).

The setting I will be targeting with my project is the OB/GYN clinic that I work at

presently. Ninety percent of our patient population is underserved and so it is important that my

identified needs are addressed in this setting because these women need somebody to be their

advocate and bring awareness and fight for their equality and safety in healthcare. The average

number of prenatal appointments is about twelve to fourteen, depending on when they find out

they’re pregnant and seek prenatal care. For the first six months they have monthly

appointments, for months seven and eight they have bi-weekly appointments, and for month nine

they have weekly appointments until they deliver. Preeclampsia is often discovered in the third

trimester; however, some women don’t seek prenatal care until the third trimester so that may

change the frequency of their appointments or result in a delivery as soon as possible.

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Intervention Overview

The OB/GYN clinic is extremely goal-oriented for a healthy pregnancy and safe delivery.

There are multiple interventions in place for the large population they serve. The first

appointment the patient is scheduled for is an education appointment where they are asked a

complete medical history and by the end of the appointment it is determined whether they need

to be seen by a low-risk or high-risk nurse practitioner or MD. If they have a history of high

blood pressure or preeclampsia in a prior pregnancy, they are ordered hypertension labs on top of

the standard prenatal labs. This intervention addresses the identified prevention and management

need because by ordering those labs, high blood pressure is likely to be caught and treated early

with medication and dietary changes. Also, at their education appointment they are taught and

provided with nutritional facts. This intervention addresses the identified education and

management needs. Depending on how far along the patient is at the education appointment they

are asked if they are experiencing headaches, facial/extremity swelling, or visual disturbances

which are key characteristics of preeclampsia. This intervention addresses the identified

education and management needs.

Comparison of Approaches

A potential interprofessional alternative to the initial intervention overview is scheduling

and ordering the standard prenatal labs along with the hypertension labs for everyone prior to

their first appointment, then combining the prenatal education and initial prenatal appointment

into one visit instead of doing the education appointment and labs, then scheduling the initial

prenatal appointment which sometimes isn’t available for two weeks. This alternative would fit

my target population because the OB/GYN clinic serves a lot of African American women, and a

lot of the patients develop preeclampsia. Drawing the labs first will ensure that they will be

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available for the provider to review prior to the first appointment. This will also ensure they

receive the proper education for their pregnancy, for example if they are at high risk of

developing preeclampsia or if they have just been diagnosed. The clinic uses MyChart which

informs the patients of their lab results, however, a lot of them do not have active accounts, so if

their provider messages them regarding their labs they may not see the results or messages.

Ordering the prenatal labs first will guarantee that the patient, educator, and provider are all on

the same page at the first visit.

Initial Outcome Draft

Ultimately, the end goal and outcome of this project is increasing awareness of

preeclampsia complications to prevent hospital admissions and negative patient outcomes for

African American women. This outcome illustrates the purpose of my intervention because

African American women are my target population and by implementing early patient education

with willing and determined patients there will be a decrease in diagnoses and complications.

This outcome illustrates what I hope I accomplish with my intervention because I’m hoping by

being selective of my target population it will highlight the racial disparities in maternal health.

This outcome establishes a framework that can be used for the improvement in the quality of

care because it may result in hypertension labs being added onto the standard prenatal labs for all

pregnant women. Also, my hope with early education intervention is that a woman will

recognize any signs of postpartum preeclampsia early and seek medical care as soon as possible.

Time Estimate

Roughly, the time frame needed for developing my intervention is four months of

studying women from the third trimester until the end of postpartum. This time frame is realistic

because it will provide me with the data necessary to prove that my project needs to be

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implemented. Potential challenges that may impact this time frame are women who properly

managed their symptoms but were not willing to participate in the study or women who didn’t

manage their signs and symptoms but are willing to participate in the study. The time frame

needed for implementing my intervention is twelve months which would allow a continuous

assessment from the beginning of the pregnancy until the end of the risk mark for postpartum

preeclampsia. This time frame is realistic because it allows the time to study a patient that sought

early prenatal care, was identified at risk, or diagnosed early, and was aware of the postpartum

risk and avoided readmission. A potential challenge that may impact this time frame is a woman

who started prenatal care late and was diagnosed without much time for developing a

management plan.

Literature Review

High blood pressure disorders like preeclampsia are one of the top preventable causes of

death in childbirth in the U.S., often resulting because of a lack of safety measures in hospitals

(Kelly, 2018, para. 1).

Preeclampsia signs and symptoms usually start after week twenty of pregnancy.

However, some women develop preeclampsia without any signs or symptoms. Hypertension

(high blood pressure) may have a slow or sudden onset. If you’re diagnosed too early to deliver

your baby, you and your baby are at increased risk of complications (Mayo Foundation, 2020,

para(s). 1, 3, 5).

Preeclampsia affects two to eight percent of pregnancies around the world. However, in

the United States, it’s the cause of fifteen perfect of premature births. A baby is considered

preterm if they are born before week thirty-seven of pregnancy (Preeclampsia, 2020, para. 3).

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There are quite a few signs and symptoms of preeclampsia. You will get your blood

pressure checked at every single prenatal visit. A blood pressure of 140/90 or higher with a

repeat blood pressure equally higher will prompt the doctor to go ahead and order some repeat

hypertension labs, a nonstress test, and an ultrasound just to be safe and check on the baby. Other

commonly experienced symptoms include a headache unrelieved by medication, facial/hand/feet

swelling, weight gain (two to five pounds in one week), shortness of breath, and visual

disturbances (Herndon, 2021, para(s). 8, 9).

The Covid-19 pandemic as well as increasing racial justice is highlighting disparities in

healthcare for people of color, specifically within maternal and infant health. “Maternal and

infant mortality rates in the U.S. are far higher than those in similarly large and wealthy

countries, and people of color are at increased risk for poor maternal and infant health outcomes”

(Artiga et al., 2020, para. 1).

In the United States, racial disparities in maternal mortality may be larger than what has

been reported in the past. Preeclampsia and eclampsia were the leading causes of maternal death

for black women. Unfortunately, African American women have a mortality rate five times

higher than those of white women. Black women are 3.5 times more likely than white women to

experience a late maternal death which occurs between six weeks and one year postpartum.

““Further research into the experiences of people of color can inform efforts to improve health

care systems and, thus, improve the birthing experience for all,” Thoma says. “We need new

models of care before, during, and after birth to address these inequities.”” (Black Women, 2020,

para(s). 1, 7, 10).

Maternal mortality is becoming a public health and human rights emergency because a

lot of the deaths could be prevented. Lack of access and poor quality of care, especially amongst

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women with lower socioeconomic levels, are a couple of the main reasons for racial disparities.

Basically, black women are undervalued. They are not monitored as carefully as white women

are. When they do present with symptoms, they are often dismissed” (AHA, 2019, para(s). 5-7).

Risk factors for preeclampsia include a history of high blood pressure or kidney disease

prior to pregnancy, a history of high blood pressure or preeclampsia in a previous pregnancy,

obesity, age > 40, multiple gestation, a family history of preeclampsia, and African-American

ethnicity. Non-white women are more likely than white women to develop preeclampsia again in

subsequent pregnancies (NICHD, n.d., para. 2).

Preeclampsia treatment is based on how far along you are in your pregnancy and how

severe your preeclampsia is. For the women that are diagnosed with preeclampsia and are past

thirty-seven weeks, they may be advised on delivering early. For the women that are less than

thirty-seven weeks, if their preeclampsia is severe the baby will be delivered, but if it is mild,

they may get the option of bedrest with an increase in prenatal appointments (Jacobson & Zieve,

2020, para(s). 3, 4).

Some of the causes of preeclampsia can be controlled – provide education to the patient

regarding a diet with little or no added salt, a water intake of at least six to eight glasses of water

a day, no fried foods, exercising, elevating their feet multiple times a day, and some patient may

be required to go on a prophylactic medical treatment of a daily baby aspirin (APA, 2021, para.

15).

The evidence provided from the literature review validates my identified needs of health

promotion, education, prevention, and management because it talks about preeclampsia and how

rare of a complication it is, educates patients on the risk factors and potential additional

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complications they may experience from it, and how you can lessen your chance of developing it

and how you can manage your symptoms if you are diagnosed early.

Existing Health Policy

Hospitals are responsible for following a standard set of protocols and practices to ensure

consistent, safe healthcare for all women. The severe hypertension during pregnancy and the

postpartum period bundle highlights clinical practices that should be implemented in all

women’s health settings. A program of the American College of Obstetricians and Gynecologists

(ACOG), the Council on Patient Safety in Women’s Health Care, developed this standard

outline.

This healthcare policy will impact the way I am addressing my identified needs because it

will provide an outline for everybody to be on the same page regarding the management and

treatment of preeclampsia (Preeclampsia Foundation, n.d., para(s). 1-3).

Conclusion

After conducting a very thorough literature review, there is evidence proving that there is

a need for the health promotion of preeclampsia and African American women specifically

should receive education on prevention and management of the complication because they are at

the greatest risk of developing preeclampsia.

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References

American Heart Association. (2019, February 20). Why are black women at such high risk of

dying from pregnancy complications? www.heart.org. Retrieved January 23, 2022, from

https://www.heart.org/en/news/2019/02/20/why-are-black-women-at-such-high-risk-of-

dying-from-pregnancy-complications

Artiga, S., Pham, O., Orgera, K., & Ranji, U. (2020, November 10). Racial Disparities in

Maternal and Infant Health: An Overview. KFF. Retrieved January 23, 2022, from

https://www.kff.org/report-section/racial-disparities-in-maternal-and-infant-health-an-

overview-issue-brief/

Black Women Over Three Times More Likely to Die in Pregnancy, Postpartum Than White

Women, New Research Finds. PRB. (n.d.). Retrieved January 23, 2022, from

https://www.prb.org/resources/black-women-over-three-times-more-likely-to-die-in-

pregnancy-postpartum-than-white-women-new-research-finds/

Centers for Disease Control and Prevention. (2021, April 9). Working Together to Reduce Black

Maternal Mortality. Centers for Disease Control and Prevention. Retrieved January 22,

2022, from https://www.cdc.gov/healthequity/features/maternal-mortality/index.html

Herndon, J. (2021, October 27). What are the causes and symptoms of preeclampsia? Healthline.

Retrieved January 23, 2022, from https://www.healthline.com/health/preeclampsia

Jacobson, J., & Zieve, D. (2020, October 5). Preeclampsia – self-care. MedlinePlus. Retrieved

January 23, 2022, from https://medlineplus.gov/ency/patientinstructions/000606.htm

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Kelly, C. (2018, July 27). What is preeclampsia? and does it still kill women in the US? USA

Today. Retrieved January 22, 2022, from

https://www.usatoday.com/story/life/allthemoms/2018/07/27/what-preeclampsia-and-

does-still-kill-women-u-s/795635002/

Mayo Foundation for Medical Education and Research. (2020, March 19). Preeclampsia. Mayo

Clinic. Retrieved January 23, 2022, from https://www.mayoclinic.org/diseases-

conditions/preeclampsia/symptoms-causes/syc-20355745

Preeclampsia Foundation . (n.d.). Hospital Guidelines And The Preeclampsia Patients’ Bill Of

Rights. Preeclampsia Foundation – Saving mothers and babies from preeclampsia.

Retrieved January 23, 2022, from https://www.preeclampsia.org/the-news/community-

support/hospital-guidelines-and-the-preeclampsia-patients-bill-of-rights

Preeclampsia. American Pregnancy Association. (2021, December 9). Retrieved January 23,

2022, from https://americanpregnancy.org/healthy-pregnancy/pregnancy-

complications/preeclampsia/

Preeclampsia. Home. (2020, October). Retrieved January 23, 2022, from

https://www.marchofdimes.org/complications/preeclampsia.aspx

U.S. Department of Health and Human Services. (n.d.). Who is at risk of preeclampsia? Eunice

Kennedy Shriver National Institute of Child Health and Human Development. Retrieved

January 23, 2022, from

https://www.nichd.nih.gov/health/topics/preeclampsia/conditioninfo/risk