Doctoral Project Defense: Janee Stevenson

Candidate: Janee Stevenson

Major: Doctor of Nursing Practice

Advisor: Ella Heitzler, Ph.D.

Title: Timely Receipt of Prenatal Care: Implementation of a Nurse-Initiated Protocol in a Correctional Facility

The number of incarcerated individuals of childbearing age is rapidly increasing within the United States. Approximately 5-10% of women entering the correctional system are pregnant. While the eighth amendment mandates prenatal care must be provided to all incarcerated individuals, many correctional facilities lack sufficient prenatal care standards.

This project used a mixed-methods design to evaluate the effectiveness of implementing a nurse-initiated prenatal protocol on time-to-order and time-to-implementation of community pregnancy standards. The project also aimed to evaluate the nurses’ intention to change practice using the Continuing Professional Development – Reaction Questionnaire (CPD-RQ) and to explore the nurses’ perceived barriers to implementing the nurse-initiated protocol.

Fifty de-identified charts were reviewed.  Time-to-order for prenatal diet and scheduled first OB appointment dropped significantly from pre post (p < .001). Time-to-order for prenatal vitamins and bottom bunk was lower post-implementation; however, the differences were not statistically significant (p = 0.171 and p = 0.181, respectively). Time-to-order and time-to-implementation for HIV lab, prenatal labs, and Beta Hcg labs increased post-implementation; however, prenatal labs were the only statistically significant variable (p < 0.032).

The sample included 44 licensed nurses who completed an adapted CPD-RQ following a 30-minute educational intervention. The lowest scoring construct for the use of nurse-initiated protocol (M = 4.73, SD = 1.85) and COWS assessment (M = 4.69, SD = 1.98) was “Social Influence.” In contrast, the highest scoring construct was “Beliefs about Consequences” for the nurse-initiated protocol (M = 6.89, SD = 0.40) and COWS assessment (M = 6.87, SD = 0.41). “Beliefs about Capabilities” for COWS were significantly higher than for the protocol (p < .001).

Twenty-five participants responded to the qualitative survey three months post-implementation that evaluated the nurses’ perceived barriers to implementing the nurse-initiated protocol. Three themes emerged: lack of integration into the electronic health record, interruption of the flow of care, and limited resources. Among a population already at risk for adverse outcomes during the prenatal period, improving time-to-order, time-to-implementation, and standardized documentation practices in a correctional healthcare setting may significantly impact the overall quality of healthcare provided and maternal-fetal outcomes.