Implementation of the POST-BIRTH Warning Signs Program in Varied Clinical Sites

To explore the factors that influence the implementation of the Association of Women's Health, Obstetric and Neonatal Nurses POST-BIRTH Warning Signs education program.

Qualitative focus groups.

Online focus groups conducted via Microsoft Teams in the United States.

A purposive sample of 23 registered nurses from 17 states who implemented the POST-BIRTH Warning Signs (PBWS) education program.

Participants represented a variety of practice settings, including critical access hospitals (n = 14), a freestanding emergency department (n = 1), maternity care deserts (n = 2), high-resource emergency departments (n = 5), and a high-resource obstetric unit (n = 1). We conducted six focus groups and analyzed the data using Krippendorff's method for qualitative content analysis to cluster data units and identify emergent themes.

We identified five convergent themes and ranked them in descending order based on the number of participants who described each thematic construct: Mountains to Climb in Achieving PBWS Implementation Success, Getting It Right Before They Go Home, The Cost of Unrecognized Warning Signs, Bridging the Gap Between Emergency Department and Obstetric Divides, and The Forgotten Year.

We found that implementing the PBWS education program exposed systemic challenges and presented pathways to progress. Participants highlighted the need for collaboration, timely education, and sustained support to ensure successful implementation. Our findings can guide future implementation and strategies to improve safety after birth in a variety of practice settings.