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IMPLICATIONS TO REDUCE FETAL MORTALITY
Biophysical Profile: Implications to Reduce Fetal Mortality in Pregnant Women
Silvio Planas Gonzalez
University of Florida College of Nursing
1
IMPLICATIONS TO REDUCE FETAL MORTALITY
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Biophysical Profile: Implications to Reduce Fetal Mortality in Pregnant Women
Background and Significance
Every year, millions of women give birth in the United States. An increasing number of
these women are having difficulties throughout pregnancy and labor. According to Metz et al.
(2022), 10 to 20% of pregnant mothers admitted to hospitals have maternal and fetal problems
that are not recognized until later in the pregnancy. More than 289,000 women lose their lives
giving birth or during pregnancy each year (Heinke et al., 2020). Most of these fatalities can be
avoided. At least 12 million women experience pregnancy-related severe problems (Heinke et
al., 2020). In underdeveloped nations, which account for 99 percent of all maternal deaths
worldwide, with the bulk occurring in sub-Saharan Africa and southern Asia, the likelihood of
dying is significantly higher (Heinke et al., 2020).
Between 2000 and 2017, maternal deaths worldwide fell by 38 percent, from 342 to 211
per 100,000 live births (American College of Obstetricians and Gynecologists, 2020). Between
2000 and 2017, South Asia experienced the most significant overall percentage drop in measles,
mumps, and rubella, falling by 59 percent (Heinke et al., 2020). Sub-Saharan Africa saw a
remarkable 39 percent decrease in maternal mortality. The lifetime risk of maternal death is 1 in
5,400 in high-income countries compared to 1 in 45 in low-income countries (Heinke et al.,
2020). To achieve the worldwide Sustainable Development Goal of 70 maternal deaths per
100,000 live births, this rate must be reduced by more than half (Heinke et al., 2020) for
Sustainable Development Goal.
A missed biophysical profile ultrasound at 32 weeks generally leads to negative
pregnancy outcomes. Stillbirths and reduced fetal movements are the most common issues
associated with adverse pregnancy outcomes; others include intrauterine growth restriction and a
IMPLICATIONS TO REDUCE FETAL MORTALITY
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low or high amount of amniotic fluid (ACOG, 2021). A biophysical profile (BPP) is a diagnostic
examination used to assess the fetus’s condition at 32 weeks of pregnancy (Baschat et al., 2022).
The amniotic fluid content around the fetus, muscle tone, body movement, breathing movement,
and a non-stress test are measured.
A problem identified by this project is that most practitioners no longer perform the
biophysical profile ultrasound in the office and instead direct the patient to an ultrasound center.
The process of referring patients to an outside facility to perform the suggested biophysical
profile delays treatment by approximately two weeks resulting in fetal and maternal issues.
According to the American College of Obstetricians and Gynecologists, around 23,600 stillbirths
at 33 and 34 weeks of gestation are reported annually (American College of Obstetricians and
Gynecologists, 2020). Utilizing the BPP at 32 weeks may identify fetal abnormalities and
minimize the chances of stillbirths.
The extent of the problem is considerable since biophysical profiles are being delayed at
various health centers due to extended wait times for external appointments. External
appointments are unnecessary if practitioners are trained to complete the practice at the office as
recommended by the American College of Obstetricians and Gynecologists (Mellitus, 2018).
Implications of later ultrasonography include avoiding early identification of prenatal
abnormalities which could lead to fetal demise (Mellitus, 2018).
Purpose of the Project and Clinical Question
The proposed clinical solution was to perform BPP when patients visit the office at 32
weeks gestation to obtain results on the same day. The American College of Obstetrics and
Gynecology (ACOG) recommends using the biophysical profile for antepartum fetal surveillance
in pregnancies at elevated risk for adverse perinatal outcomes at or beyond 32 weeks (Shaddeau
IMPLICATIONS TO REDUCE FETAL MORTALITY
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& Burd, 2020). Because of a lack of training for new practitioners, the issue at my clinical
practice was the inability to follow the ACOG recommendation of performing the BPP in the
office. Instead, we were referring patients to an outside facility, which extended the timeframe
for getting the BPP, delaying the identification and treatment of issues and possibly leading to
fetal deaths. This resulted in noncompliance and raised the risk of fetal and maternal death.
According to office metrics, from May 1, 2022, to June 30, 2022, 93 patients were referred to an
outside facility to have their BPP performed. Of those 93 patients referred out for appointments,
51 patients had their appointments at 34 weeks. Only the remaining 42 could get their
appointments at 32 weeks. Out of those 51 delayed appointments, 29 had normal results. The
remaining 22 patients had 19 mothers hospitalized for abnormal fetal complications shown from
the BPP, and 13 babies died. These pregnant women were referred to an outside facility putting
them at risk of developing complications that were identified later, resulting in stillbirths or
maternal deaths. These were catastrophic events to the mother as such situations are likely
avoidable.
Therefore, this project aimed to educate nurse practitioners in the office to perform
biophysical profiles in-office rather than referring pregnant patients to an outside facility for
ultrasonography at 32 weeks. By educating the providers, the project would meet DNP essentials
IV (Information Systems/Technology and Patient Care Technology for the Improvement and
Transformation of Healthcare) and VI (Inter-Professional Collaboration for Improving Patient
and Population Health Outcomes). Lastly, the project was to raise awareness about the need to
practice biophysical prenatal fetal surveillance in pregnant women during ACOG-recommended
weeks.
IMPLICATIONS TO REDUCE FETAL MORTALITY
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The PICO question that was guiding the DNP project was as follows: In pregnant women
(P), how does the use of biophysical profile (BPP) in OB/GYN offices starting at 32 weeks (I) as
compared to referring the patient to external ultrasound centers (C) improve early detection of
fetal abnormalities by reducing time in medical appointments and patient compliance with
timeliness and outcomes of appointment? (0).
Literature Review
Keywords in the search process included biophysical profile, high-risk pregnancy,
stillbirth, ultrasound, and nurse training. Databases searched for the literature include EBSCO,
Google Scholar, PubMed, and CINAHL. The inclusion criteria for the literature were peered
reviewed work published not more than five years from the current year, must include use of a
biophysical profile, clear abstracts which clearly show what the study is about, methodology and
conclusion, and the research participants were pregnant women. The exclusion criteria include
participants below 18 years, vague abstracts, and titles.
Definition of Key terms

Biophysical profile- is a diagnostic examination used to assess the fetus’s condition at 32
weeks of pregnancy (Baschat et al., 2022).

High risk pregnancy- a pregnancy that carries higher health risks for the expectant
mother, the unborn child, or both.

Stillbirth- the loss or death of a newborn prior to or during delivery.

Ultrasound- a medical examination that records real-time images of the interior of your
body using high-frequency sound waves
IMPLICATIONS TO REDUCE FETAL MORTALITY

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Nurse training- the roles and responsibilities involved in providing physical care for
patients, as well as the integration of several disciplines that both hastens the patient’s
recovery and aids in maintaining it.
Summary of Literature
Biophysical profiles in-office practice
According to Zieleskiewicz et al. (2018), pregnancy-related problems are uncommon but
can appear suddenly. In most cases, the risk is low, but it can be a serious problem that can
endanger the woman’s health and the fetus’s life. These appear in low-risk units (pregnancy cases
that are low-risk) and can progress rapidly, making it difficult to find professional diagnostic
support. The authors recommend using point-of-care ultrasound for treatment and differential
diagnosis (Zieleskiewicz et al., 2018). In obstetrics, Point of Care Ultrasonography (POCUS) is
essential for the evaluation of pregnant patients. Rapid assessment, which is easy to apply and
interpret, can provide important information for managing obstetric problems (Ego et al., 2020;
Zielskiewicz et al., 2018). The full 30-minute biophysical profile (BPP) ultrasound test examines
the fetus’s health and monitors the fetal heart rate (Baschat et al., 2022).
After practicing ACOG recommendation by performing the BPP in the office, a
significant drop in stillbirths regarding fetal outcomes resulted (Baschat et al., 2022). One-third
of all stillbirths were eradicated as a result of this practice. A study by Awad et al. (2018) further
discovered that patients who had a routine BPP had no stillbirths, in contrast to those who were
hospitalized following decreased fetal movements (Awad et al., 2018). This study demonstrates
that the suggested intervention will help the patient’s health and the caliber of care offered for
expectant moms to prevent treatment and diagnosis delays. Therefore, creating biophysical
profiles in-office at week 32 allows medical professionals to identify fetal and maternal
IMPLICATIONS TO REDUCE FETAL MORTALITY
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pregnancy early, rather than referring patients, which causes a two-week delay in care and makes
scheduling an appointment for the patient difficult (Ejaz, Anjum, and Bhatti, 2021). Therefore,
teaching professionals to offer in-office biophysical assessments to expectant mothers is critical.
Adverse outcomes of pregnancies
Around 4,600 stillbirths each year in the United States are caused by major congenital
impairments, according to Heinke et al. (2020). One in five stillborn fetuses (6/1,000 fetuses in
the entire U.S. population) have been recorded in the United States of America. According to
their research, there is an overall risk of stillbirth associated with each afflicted fetus of 11 to 490
per 1,000 (Heinke et al., 2020). To put these risks into perspective, pregnant women are two to
eighty-two times higher than the overall risk of stillbirth connected to pregnancy in the U.S.
population as a whole. Due to this high number of negative pregnancy outcomes, Brackett et al.
(2022) and Heinke et al. (2020) claims that therapeutic intervention and counseling are necessary
after a prenatal diagnosis.
Zahid et al. (2020) established the role of the biophysical profile in predicting fetal
outcomes in high-risk pregnancies. In South Asian countries like India, around one out of every
2,500 live births are recorded. There is a chance that a pregnancy will have issues, and
environmental and contextual factors can affect this. Because of the interaction of personal and
environmental factors, some pregnancies are categorized as high-risk because they may have a
higher likelihood of having a poor pregnancy result. The results demonstrated that high-risk
pregnancies led to a high morbidity and mortality rate in both the mother and the unborn child.
To better manage high-risk pregnancies, it is essential to forecast poor fetal outcomes. As a
result, the biophysical profile provides a practical and reliable technique for identifying
undesirable prenatal outcomes.
IMPLICATIONS TO REDUCE FETAL MORTALITY
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In undeveloped countries, maternal and neonatal death rates are high, and studies on the
maternity and neonatal referral systems in difficult situations are limited (Harahap, Handayani,
and Hidayanto, 2019). According to Harahap, Handayani, and Hidayanto (2019), certain
adjustments must be made to reduce maternal and newborn mortality. One of the adjustments
might be a stronger referral system and relationships between the different levels of the facility.
This is because referrals can determine how well the health system is functioning (Harahap,
Handayani, and Hidayanto, 2019). This study also endorses BPP training in offices.
Training to improve clinical abilities
Kirkham (2018) offers a training strategy to improve clinical abilities. He advises
simulation training for nursing students to practice their clinical skills in a safe environment.
After a simulated training session, a debriefing is necessary to go through any positive or
negative parts of the event. Planning is essential for producing practical simulation training.
Overall, the use of simulated training sessions for medical students and nurses enables the
expansion of knowledge and gives these groups the ability to develop technical and nontechnical skills in a safe environment.
Strengths, limitations, and gaps in the literature
One strength in the literature is that they support the need to practice biophysical profiles
at 32 weeks in-office in high-risk pregnancies to predict the perinatal outcome. However, the
literature also claims that BPP has considerable financial and workforce costs. This increases the
risk of obstetric interventions, which could potentially result in prematurity and maternal
complications, and has the potential to be harmful. A literature gap identified was the need for
more substantial evidence that screening and monitoring programs directly affect stillbirth rates
IMPLICATIONS TO REDUCE FETAL MORTALITY
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in low-risk, unselected populations. According to the literature, there are widespread flaws in the
planning and analysis of studies using screening and monitoring techniques.
Conceptual and Theoretical Framework
I choose the Stetler Model as the EBP model for nursing in my EBP proposal, and it will
be utilized to guide EBP implementation for this quality improvement project. While it was
designed to be used by individuals as part of their profession, focusing on the critical thinking
process, it can also be utilized by groups of practitioners to create formal organizational changes
(Indra, 2018). The Stetler Model created a prescriptive technique to help nurses “complete three
crucial phases of critical thinking” in connection to study findings (Karl & Mion, 2020).
Validation, comparative evaluation, and decision-making were among the phases. According to
Stetler (1994), it was not founded on any single conceptual framework or research and instead
concentrated on studies that evaluated causal hypotheses rather than a broader spectrum of
studies (Karl & Mion, 2020). The model was updated to include conceptual foundations and a set
of assumptions.
The model’s five steps are preparation, validation, comparative evaluation and decisionmaking, translation and implementation, and evaluation. In the preparation phase, the clinician or
organization must identify a vital purpose or problem and the potential importance and effect of
both internal and external elements (Valizadeh et al., 2020). In the validation phase, it is crucial
to determine whether to accept or reject the study’s potential to inform practice by evaluating the
strengths and limitations of its utilization-focused findings (Valizadeh et al., 2020). The team
eliminates unreliable sources during this stage but may decide that a study with questionable
methodology might yield valuable information. The team decides this is finished. The translation
and implementation phase is finished by confirming the kind, degree, and mode of application,
IMPLICATIONS TO REDUCE FETAL MORTALITY
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figuring out how the knowledge will be used in practice, and selecting evidence-based
documentation for dissemination (Valizadeh et al., 2020). The development of plans to either
formally or informally implement the change is done during this phase, which aids in guiding the
project into applying new information. The last phase, the evaluation phase, entails evaluating
the information and determining the information’s purpose (Valizadeh et al., 2020). After the
evaluation step, a choice is taken regarding how to bring about the change.
The need for critical thinking and decision-making is stressed (Indra, 2018). To facilitate
the transition from research to EBP, the Stetler Model provides an easy-to-follow procedure
based on critical thinking and decision-making (Valizadeh et al., 2020). Following each phase of
the model, a strategy can be built based on the most relevant data to aid in implementing the
project addressing the issue (Valizadeh et al., 2020). One of the advantages of this paradigm is
that it can be applied to both individuals and organizations. The concept can be applied in both
inpatient and outpatient settings, and if successful in the hospital context, it can help with the
transition from inpatient to outpatient care.
Methodology
Design
This project provided an implementation of evidence-based guidelines to include training
for ultrasound use for high-risk pregnancies. The project compared outcomes from patients
whose appointments were delayed pre-intervention to outcomes from patients who obtained their
biophysical profile in-office post-intervention.
Setting
This quality improvement project was conducted in my clinic, where we have two
OB/GYN medical doctors and three Nurse Practitioners, including myself. The setting is a four-
IMPLICATIONS TO REDUCE FETAL MORTALITY
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room space equipped with specialized ultrasound machines and 4 licensed gynecological beds.
The clinic is a private, not-for-profit general medical facility located in a major city in the state.
In Florida, the clinic center is part of a hospital. The key stakeholders were gynecologists,
patients, nurses, physicians, and obstetricians. A faculty member who is a perinatologist was also
approached to join the role group in addition to these specialists to offer their professional insight
into translating evidence practice into the clinic. The managers and clinicians at the practice
location were additional stakeholders.
Participants
The project aims to introduce the Biophysical Profile tool to the workplace, including
training the practitioners. They would perform ultrasounds on patients, and the front desk staff
would schedule the ultrasound. The training was provided during lunch since it is a busy office.
Intervention and Data Collection Procedures
A pre-and post-education survey will be used to gather information on the Nurse
Practitioners’ understanding of the BPP protocol. Data collection will be covered in two phases:
data before and after training. Those who are available and willing to engage in the study will be
chosen as participants. Before beginning the simulation-based education program on the BPP
protocol, pre-educational data will be gathered from the Nurse Practitioners to compare with the
results after the training. The survey involves asking the Nurse Practitioners information about
themselves through a series of questions. The DNP student will then watch the training and
assess the nurse practitioners by having them repeat instructions and give a return demonstration
while being trained. Even though it is not necessary, more days for training will be scheduled
because it is necessary to ensure the nurse practitioners give a return demonstration and do an
IMPLICATIONS TO REDUCE FETAL MORTALITY
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office simulation using obstetrical mannequins that are stable and unstable while performing a
Biophysical Profile Ultrasound
Tool
Epic Electronic Health Record tool will extract data for evaluation. Epic software is an
example of Electronic Health Records (EHRs) technology. If put into practice would lead to
better communication, improved screening practices, and accurate recordkeeping. This system
can be used to gather information from the participants that could help determine if the
intervention is effective or not. This tool will gather data on patients’ outcomes before and after
the practitioners utilize the new technique.
Project Approvals
The Nurse Practitioners currently employed at the office will receive training in the
Biophysical Profile from a qualified consultant. The recommended practice will be implemented
as the clinical office’s default practice. This will standardize practice approaches in the
gynecological professional practice to eliminate variability. The intervention is expected to have
the desired effect of lowering pregnancy-related morbidity and mortality.
Implementation Timeline
The project will take two months to complete in total. Table 1 below displays the
suggested timeline.
Week 1
Team Formation &
norming
Guideline draft
2
3
4
5
6
7
8
IMPLICATIONS TO REDUCE FETAL MORTALITY
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Role Group
Appraisal
Presentation to
Management
Review based on
feedback
Presentation to
Practitioners
Revision & final
presentation
Table 1: Project Timeline
Evaluation Plan/Analysis Plan
The feedback data obtained will be examined topically and presented in a PDF document
for analysis. Using thematic analysis, the main themes will be presented in PowerPoint to the
stakeholders, who will then discuss these findings. It is important to note that the feedback from
the nurses will be kept unidentified and anonymous for confidentiality. Based on this
information, discussions will be held to identify enhancements and make modifications.
Data Analysis
A Microsoft Excel spreadsheet will be used to assemble the pre-and post-intervention
data and analyze it for changes. The demographic data’s mean, percentages, frequencies, and
standard deviation will be determined by descriptive analysis. The DNP student will be using the
pre and post-survey, the competency assessment, and the outcomes as compared to
preintervention.
Dissemination and Sustainability Plan
One important strategy that all staff members are informed of the findings and
recommendations of the DNP Project will involve the creation of poster presentations around the
IMPLICATIONS TO REDUCE FETAL MORTALITY
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organization. Podium presentations will be more effective at disseminating project information
among staff members because they are more interactive, offer more opportunities for networking
and in-depth discussions, and have greater graphic flexibility that allows the presentation of all
types of project data. Additionally, the project’s short-term goal is to develop a sustainable office
protocol, and that goal can be met by including the guideline in the official management policy.
To ensure updates based on the most recent evidence and subsequently improvements in
evidence-based practice, ongoing improvements through review teams like the proposed role
group will be required.
RESULTS
Prior to the implementation of the project data was collected from May 1, 2022, to June
30, 2022, 93 patients were referred to an outside facility to have their BPP performed. Of those
93 patients referred out for appointments, 51 patients had their appointments at 34 weeks. Only
the remaining 42 could get their appointments at 32 weeks. Out of those 51 delayed
appointments, 29 had normal results(See Table 1). The remaining 22 patients had 9 mothers
hospitalized for abnormal fetal complications shown from the BPP, and 13 babies died (See
Table 2). After the training implementation, 44 patients were seen at 32 weeks in a period of one
month, and none of the patients were referred to an external facility for ultrasonography,
allowing us to have 100% compliance with BPP being performed in the office. Having abnormal
results in the office is unpredictable, even with BPP done in the office with 100% compliance.
There were 7 patients out of 44 hospitalized for having abnormal results and 1 baby died(See
Table 3). After the first month, data collection was conducted for another month indicating
improvement after the implementation of the Biophysical Profile Ultrasound in the office for two
continuous months. A total amount of 33 patients were seen at 32 weeks during the second
IMPLICATIONS TO REDUCE FETAL MORTALITY
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month after the training, none of the patients were referred to an external facility for
ultrasonography, allowing us to have 100% compliance of BPP being performed in office. There
were 2 patients out of 33 were hospitalized for having abnormal results and no fetal
casualties(See Table 4).
Table 1.
Normal Results
Abnormal
Results
Appointments at 34 weeks (Delayed)
Appointments at 32 weeks (Normal).
Total No.Referred to Outside Facilities
Totals
51
29
22
42
93
Table 2.
Hospitalizations
9
Dead Babies
13
Total Number of Patients Hospitalized
9
IMPLICATIONS TO REDUCE FETAL MORTALITY
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Table 3.
Hospitalizations
7
Dead Babies
1
Normal Results
36
Total Number of Patients
44
Table 4.
Hospitalizations
2
Dead Babies
0
Normal Results
31
Total Number of Patients
33
Summary
The main objective of this project was to increase nurse practitioners’ understanding of
the use of biophysical profiles in the workplace as a standard procedure. As a reaction to
organizational change, some Nurse Practitioners initially resisted the change, which was to be
IMPLICATIONS TO REDUCE FETAL MORTALITY
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expected. However, after participating in a few training sessions, they became receptive and
showed enthusiasm for the program’s implementation. As a result of the staff’s slow adoption of
the office adjustments, patient outcomes could have been better during the first month of project
implementation. The nurse practitioners began to put what they had learned in training into
practice during the first and second month of the project, and biophysical profiles were routintely
practiced in the office, This led to patients having more successful results, which led to fewer
unsuccessful outcomes.
Regarding the execution of this project, several things could have been done differently,
including my participation in the capacity of a nursing leader. I have expertise in building
relationships with my coworkers and other stakeholders and directing them toward better care
and health in my capacity as a director of nursing. Regular communication might have
encouraged the team to adopt policy quicker. Any team’s success depends on regular
communication, but it might be especially critical in a dynamic and complex industry like
nursing. Being a DNP professional means having several duties that call for autonomous work
and teamwork. Maintaining open lines of communication may guarantee that everyone is aware
of crucial information and that it is communicated as soon as possible. Also, by concentrating on
collaboration, it may have been feasible to create the most efficient means of exchanging
thoughts and feelings, which may have helped the nurses adapt to change faster. By doing so,
they would have been able to use their expertise to give their patients the best care possible
without resistance.
In summary, the project aimed to train nurse practitioners to do biophysical profiles on
pregnant patients in the office at 32 weeks rather than sending them to a different location for
ultrasonography. The goal was to provide patients with high-quality care while increasing
IMPLICATIONS TO REDUCE FETAL MORTALITY
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efficiency and lowering expenses. The quantity of in-office biophysical profiles completed was
used to gauge the project’s success. By harnessing the abilities of nurse practitioners in the office,
the ultimate objective was to enhance patient outcomes and lessen the demand for healthcare
resources. This project has demonstrated how biophysical profiles can be used to spot possible
problems with fetal growth or welfare. Early detection of these problems can result in prompt
intervention and better outcomes for both mother and child. By running the biophysical profiles
in-office, healthcare professionals can swiftly identify problems, offer prompt treatment, or, if
necessary, refer patients for additional testing or intervention. Biophysical profiles are frequently
quicker and more convenient than conventional ultrasound appointments. They may be carried
out during routine OB/GYN office visits, negating the need for patients to make additional
appointments at distant ultrasound facilities. Biophysical profiles (BPPs) can also improve
patient compliance with suggested appointments and follow-up care in the OB/GYN office. It is
crucial to remember that BPPs might not be appropriate for all patients and circumstances, and
that in some circumstances a referral to an outside ultrasonography center would still be
required. When deciding on the best course of action, healthcare professionals should utilize
their clinical judgment and take into account the unique needs of each patient. For sustainability,
a policy is being developed to incorporate the guidelines into current practice. The policy is
supported with the the data from the DNP project.The project that was conducted helped
significantly inform the policy and revisions are still being conducted to finalize into a policy.
IMPLICATIONS TO REDUCE FETAL MORTALITY
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References
American College of Obstetricians and Gynecologists. (2020). Management of stillbirth.
Obstetric Care Consensus No. 10. Obstet Gynecol, 135(3), 110-132.
ACOG. (2021, June). Indication for Outpatient Antenatal Fatal Surveillance. Retrieved from
https://www.acog.org/-/media/project/acog/acogorg/clinical/files/committeeopinion/articles/2021/06/indications-for-outpatient-antenatal-fetal-surveillance.pdf
Awad, N. A., Jordan, T., Mundle, R., & Farine, D. (2018). Management and Outcome of
Reduced Fetal Movements—is Ultrasound Necessary?. Journal of Obstetrics and
Gynaecology Canada, 40(4), 454-459.
Baschat, A. A., Galan, H. L., Lee, W., Devore, G. R., Mari, G., Hobbins, J., … & Manning, F. A.
(2022). The role of the fetal biophysical profile in the management of fetal growth
restriction. American journal of obstetrics and gynecology, 226(4), 475-486.
Borade, J. S., & Sharma, S. P. (2018). The role of modified biophysical profile in predicting
perinatal outcome in high risk pregnancies. International Journal of Reproduction,
Contraception, Obstetrics and Gynecology, 7(6), 2288.
Brackett, E. E., Hall, E. S., DeFranco, E. A., & Rossi, R. M. (2022). Factors Associated with
Occurrence of Stillbirth before 32 Weeks of Gestation in a Contemporary Cohort.
American Journal of Perinatology, 39(01), 084-091.
IMPLICATIONS TO REDUCE FETAL MORTALITY
20
Ego, A., Monier, I., Skaare, K., & Zeitlin, J. (2020). Antenatal detection of fetal growth
restriction and risk of stillbirth: population‐based case–control study. Ultrasound in
Obstetrics & Gynecology, 55(5), 613-620.
Ejaz, S., Anjum, M. N., & Bhatti, S. K. (2021). Sonographic Comparison of Fetal Biophysical
Profile in Diabetic and Non-Diabetic during Third Trimester. Asian Journal of Allied
Health Sciences (AJAHS).
Harahap, N. C., Handayani, P. W., & Hidayanto, A. N. (2019). Barriers and technologies of
maternal and neonatal referral system in developing countries: a narrative review.
Informatics in Medicine Unlocked, 15, 100184.
Heen, M., Lieberman, J. D., & Meithe, T. D. (2020). A comparison of different online sampling
approaches for generating national samples.
Heinke, D., Nestoridi, E., Hernandez-Diaz, S., Williams, P. L., Rich-Edwards, J. W., Lin, A. E.,
… & Yazdy, M. M. (2020). Risk of stillbirth for fetuses with specific birth defects.
Obstetrics and gynecology, 135(1), 133.
Indra, V. (2018). A review on models of evidence-based practice. Asian Journal of Nursing
Education and Research, 8(4), 549-552.
Jha, S., & Dangal, G. (2020). Role of Modified Biophysical Profile in High Risk Pregnancy in
Predicting Fetal Outcome. Journal of Nepal Health Research Council, 18(3), 401-405.
Karl, J., & Mion, L. (2020). Research data in hospitals and health systems. In Data for Nurses
(pp. 31-46). Academic Press.
Kirkham, L. (2018). Exploring the use of high-fidelity simulation training to enhance clinical
skills. Nursing standard, 32(24), 44-53.
Mellitus, G. D. (2018). ACOG practice bulletin. ACOG: Washington, DC, USA.
IMPLICATIONS TO REDUCE FETAL MORTALITY
21
Metz, T. D., Clifton, R. G., Hughes, B. L., Sandoval, G. J., Grobman, W. A., Saade, G. R., … &
Archer, S. W. (2022). Association of SARS-CoV-2 infection with serious maternal
morbidity and mortality from obstetric complications. JAMA, 327(8), 748-759.
Mukhtar, R., Hussain, M., Mukhtar, M. A., Sherood, I., Mehmood, R., & Khan, M. S. (2019).
Role of antenatal screening for congenital anomalies by grey scale ultrasound to reduce
the perinatal mortality and morbidity. Global J Med Res, 19.
Shaddeau, A. K., & Burd, I. (2020). Antenatal Monitoring After Preterm Prelabor Rupture of
Membranes. Obstetrics and Gynecology Clinics, 47(4), 625-632.
Stefanovic, V. (2020). Role of obstetric ultrasound in reducing maternal and neonatal mortality
in developing countries: From facts to acts. Donald School Journal of Ultrasound in
Obstetrics and Gynecology.
Valizadeh, L., Zamanzadeh, V., Babaei, N., & Avazeh, M. (2020). Challenges and strategies for
implementing evidence-based practice in nursing: a systematic review. Research in
Medical Education, 12(3), 55-67.
Zahid, N., Zia, K., Shahzad, R., Athar, A., Azeems, I., & Toheed, R. (2020). Role of Modified
Biophysical Profile in Predicting Fetal Outcome in High Risk Pregnancies. National
Editorial Advisory Board, 31(11), 8.
Zieleskiewicz, L., Bouvet, L., Einav, S., Duclos, G., & Leone, M. (2018). Diagnostic
point‐of‐care ultrasound: applications in obstetric anaesthetic management. Anaesthesia,
73(10), 1265-1279.
IMPLICATIONS TO REDUCE FETAL MORTALITY
22
IMPLICATIONS TO REDUCE FETAL MORTALITY
23
Table 1
Literature Evidence Matrix
Pub. Year;
Author’s
Last Name
Zahid et al.
(2020)
Title
Type of
Study
Design
Role of
Modified
Biophysical
Profile in
Prospective
Predicting Fetal study
Outcome in
High-Risk
Pregnancies
The role of the
Baschat et al. fetal biophysical
profile in the
Literature
management of review
fetal growth
(2022)
restriction
Sample/Setting
Main
Support for or Link to
Outcomes/Findings
Project
Level of Evidence
110 women,
Avicenna
Medical
College and
Hospital,
Lahore,
Department of
Obstetrics and
Gynecology
Pregnant women need for
In predicting
unfavorable prenatal intervention that reduces
outcomes, a modified mortality on fetus.
Level IV
biophysical profile is Use of biophysical profile
an effective and
at 32 weeks is OB/GYN
valuable method.
offices is important
When biophysical
profile assessment is
The study
integrated with fetal
utilizes doppler
growth retardation
and amniotic
monitoring, over
fluid volume to
gestational age,
determine
changes in clinical
surveillance
behavior, and
frequency
management issues
are well addressed.
The review shows the
need for the biophysical
profile to detect fetal
problems that are not
recognized until later.
Level V
IMPLICATIONS TO REDUCE FETAL MORTALITY
Antenatal
Shaddeau & Monitoring
Burd
After Preterm
Review
Prelabor Rupture
(2020)
of Membranes
Kirkham
(2018)
Preterm
prelabor
rupture of
membranes
24
Antepartum maternal
and fetal status
The review shows the
monitoring is
need for the biophysical
performed to decide profile to detect fetal
when delivery should problem.
begin.
Level VII
Exploring the
The experience of
use of highThird-year
implementing
fidelity
nursing
simulated training
This study raises the
simulation
Experimental students and
sessions for nurses importance of training for
Level IV
training to
study
foundation
and medical students nurses and medical
enhance clinical
level 1 medical allows for the
students
skills. Nursing
students
expansion of
standard
knowledge.
Role of
Antenatal
Screening for
Congenital
Anomalies by
Mukhtar et al.
Grey Scale
(2019)
Ultrasound to
Reduce the
Perinatal
Mortality and
Morbidity
All pregnant women
should be screened
Prospective
with a secondThis study raises the need
observational Radiology
trimester ultrasound, for an intervention for
Level IV
study
pregnant women.
department of preferably by an
MINAR cancer experienced
radiologist.
hospital
Jha & Dangal Role of
Modified
(2020)
Biophysical
Crosssectional
study
Women with
congenital
anomalies
172 patients
Paropakar
Maternity and
There were more
vaginal deliveries
and fewer
Need for biophysical
profile as it fewer adverse Level VI
fetal outcomes.
IMPLICATIONS TO REDUCE FETAL MORTALITY
Profile in HighRisk Pregnancy
in Predicting
Fetal Outcome
Women’s
Hospital
Borade &
Sharma
(2018)
The role of
modified
100 patients
biophysical
Prospective
profile in
observational BSTRH
predicting
study
perinatal
Hospital
outcome in highrisk pregnancies
Stefanovic
(2020)
Role of Obstetric
Ultrasound in
Reducing
Maternal and
Neonatal
Review
Mortality in
Developing
Countries: From
Facts to Acts
Awad et al.
Retrospective
Management
579 patient
and Outcome of review
25
unfavorable fetal
outcomes in high-risk
pregnancies with a
normal modified
biophysical profile.
A modified
biophysical profile, a
simple and
inexpensive timesaving approach, is Women with high risk
an important prenatal pregnancies have a need
fetal monitoring test for biophysical profile
that predicts perinatal intervention.
outcomes and
enables timely
intervention in highrisk pregnancies.
The introduction of
Developing and ultrasound in the
low-income
management of the
count
pregnancies is
important.
Patients discharged
after the usual
Level IV
Need for an ultrasound
Level VII
management intervention.
Women with high risk
pregnancies have a need
Level VII
IMPLICATIONS TO REDUCE FETAL MORTALITY
(2018)
Reduced Fetal
Movements—is
Ultrasound
Necessary?
Charts review
26
nonstress test (NST), for biophysical profile
BPP performed very intervention.
well (no stillbirth),
and patients admitted
after DFM had a
higher cesarean
section rate.
More than six out of
ten stillbirths in this
Factors
study happened
Associated with
before the American
Occurrence of
College of
This study raises the need
Brackett et al. Stillbirth before Case-control
15,998 women Obstetricians, and
for an intervention for
Level IV
32 Weeks of
study
(2022)
Gynecologists
pregnant women.
Gestation in a
recommended that
Contemporary
ANFS be started at
Cohort
32 weeks of
pregnancy.
Heinke et al.
(2020)
Risk of stillbirth
19,170 cases
for fetuses with Retrospective
10 states in
specific birth
cohort
USA
defects
Because the rate of
stillbirth due to a
birth abnormality
was higher than the Need for a intervention to
chance of stillbirth in reduce pregnancy
Level IV
the United States,
complications.
some estimates may
be skewed by
elective termination.
IMPLICATIONS TO REDUCE FETAL MORTALITY
Sonographic
Comparison of
Fetal
Ejaz, Anjum, Biophysical
& Bhatti
Prole in
(2021)
Diabetic &
Crosssectional
study
200 patients
Non-Diabetic
during Third
Trimester
Ego et al.
(2020)
27
The majority of
pregnant diabetic and This study raises the need
non-diabetic women for an in office
Level IV
had normal fetal
biophysical profile
features and BPP
training for practitioners.
score.
Antenatal
Stillbirths caused by
detection of fetal
undiagnosed
growth
development failure
Need for a intervention to
restriction and Case–control 30,000 births are devastating
reduce pregnancy
Level IV
risk of stillbirth: study
French districts events for parents
complications.
population‐based
and a major source of
case–control
concern for medical
study
professionals.
Barriers and
technologies of
Harahap,
maternal and
Handayani & neonatal referral Literature
Hidayanto
system in
review
(2019)
developing
countries: A
narrative review
Journals and
conference
papers
The usage of
technology should
This study highlights the
also be used to track need for an in office
Level VII
the referral’s
biophysical profile.
effectiveness.
IMPLICATIONS TO REDUCE FETAL MORTALITY
Diagnostic
point‐of‐care
Zieleskiewicz ultrasound:
et al.
applications in
obstetric
(2018)
anaesthetic
management
Review
PubMed
database
28
The significance of
point-of-care
ultrasound in critical
patients is becoming
more widely
This study raises the need
accepted, and it is
for a biophysical profile Level VII
becoming a valuable intervention.
tool in the
therapeutic arsenal of
obstetric
anaesthetists.
ASN NUR 2300 Signature Assignment
Instructions:
Details
Medical Surgical Individual Paper
Goal: To demonstrate student understanding of Medical Surgical issues for the Adult Population and apply this knowledge to a case
study.
Outcomes: Students can expect to gain collaboration skills, knowledge, and clinical expertise for a Medical Surgical scenario involving
evidenced based medical and surgical treatment relevant to nursing practice.
Guidance/clarifications: Students are strongly encouraged to use instructor office hours if you have questions or require clarifications
about this assignment.
Topics
These topics have been chosen to assure that they meet all of the criteria in the rubric in order to ensure student success for this
assignment. If a group wishes to select a different topic, it must be pre-approved ASAP by their instructor.
▪
▪
▪
▪
▪
▪
▪
▪
▪
▪
▪
▪
Duodenal Ulcers
Colorectal Ulcers
Appendicitis
Peritonitis
Pancreatitis
Cirrhosis
Diabetes Mellitus
Diabetes Insipidus and SIADH
Thrombolytic
Addison Disease and Cushing Disease
Hypothyroidism and Hyperthyroidism
AKI
▪
▪
Peritoneal Disease
Hemodialysis
Course Student Learning Outcome Address (CSLOs)
#1. Apply the nursing process as means to identify different etiologies, symptoms, and treatments of health conditions affecting the
adult and geriatric population (EPSLO 1, 6)
#3. Formulate evidence-based nursing care plans for adult and geriatric clients experiencing common health alterations (EPSLO 1,
6)
End of Program Student Learning Outcomes Address (EOPSLOs)
#1. Provide nursing care that enhances the healthcare delivery setting to protect clients and health care personnel.
#7. Use knowledge of growth and development across the lifespan to provide client-centered teaching.
ELA: 80% of the students will achieve a grade of 78% or higher.
Medical Surgical Paper Rubric
Signature Assignment
Criteria
Ratings/Comments
Format: (Length of Paper: At least 6 pages, do
not exceed 8 pages (excludes cover page,
references and appendices). Tables can be placed
in Appendix, but in-text content still
needed/summarized for the corresponding
section.
Required plagiarism review: All papers will be
reviewed for plagiarism):
8 pts
References: APA 7th edition (in-text and
reference list). References: At least 5 references
within the past 4-5 years. Prioritize published
guidelines (journal articles) and research articles
over UpToDate, etc. *Remember to appropriately
label and reference all tables/charts/graphics
utilized within the paper according to APA
format.
6 pts
Introductions: Introduce the reader to an
overview of the clinical problem. Briefly explain
what your paper will cover.
Criteria
Points
6 pts
Rating Comments
Points
Background: Provide a brief overview of facts
about the clinical problem/indication and include
any pertinent epidemiologic statistics across the
lifespan.
Current Medical/Surgical Treatment Options:
Include prescription, over the counter and
alternative therapies; briefly summarize lifespan
considerations. Consider a chart or table to better
describe/explain.
Case Presentation: Do not include any personal
health information in the paper. Brief case
presentation (1/2 to 2/3 page) which includes
pertinent: demographics, presenting
signs/symptoms, H&P, Diagnosis, Treatment,
Complications, Outcomes, as they are most
relevant to the focused case scenario.
Implications for the Registered Nurse: how will
you integrate this knowledge into your practice
and what will be the initiatives considered for
health promotion and disease Prevention.
15 pts
25 pts
25 pts
15 pts