FACULTY OF HEALTH AND OCCUPATIONAL STUDIES NURSING DEPARTMENT,

Department of Caring Sciences MEDICINE AND HEALTH COLLEGE

Lishui University, China

The experience of nurses providing care for

puerperium women

A descriptive review

degree project

Chloe (Chen Zhu)

Haw (Xu Hao)

2023

Supervisor:Tao Xuemei（Vicky）
Examiner: Mikaela Willmer
Student thesis, degree project, 15 credits Nursing
Degree Thesis in Nursing
 Abstract
Background: The postpartum period, or puerperium, is an extremely important process
in a woman's life, leading to changes in all aspects of her life and having a significant
impact on her physical and mental health. This is also a time of very high morbidity and
mortality among women.
Aim: The aim of the review is to describe the experience of nurses providing care for
puerperium women.
Methods: This review was based on relevant English articles from 2012-2022, that
were retrieved by a selective search in PubMed, Cinahl, and PsycINFO databases.
Results: The nurse's experience in providing care to women during the puerperal period
showed that the provision of educational counselling, health guidance and psychological
care contributed to the physical and mental health of puerperal women. However, the
main factors affecting nurses' nursing quality were unfavorable working environment
and lack of medical resources, lack of nurses' professional knowledge and teamwork
ability.
Conclusions: It is important for nurses to be aware of the common symptoms and
typical diseases of the puerperal period, to make full use of limited resources, and to
provide timely physical and mental care for women during the puerperal period.
Key words: care, experience, nurse, postpartum period, puerperium
 摘要
背景：产后期，或产褥期，是一个妇女一生中极其重要的过程，会导致她生活各
方面的变化，对她的身心健康有重大影响。这也是一个妇女发病率和死亡率非常
高的时期。
目的：本综述的目的是描述护士提供护理产褥期妇女的经验。
方法：本综述基于2012-
2022年的相关英文文章，这些文章通过PubMed、Cinahl和PsycINFO数据库的选择
性搜索检索到。
结果：护士对产妇产褥期护理的经验表明，提供教育咨询、健康指导和心理护理
有助于产妇的身心健康。但影响护士护理质量的主要因素是工作环境不利、医疗
资源匮乏、护士专业知识和团队协作能力不足。
结论：护士了解产褥期常见症状和典型疾病，充分利用有限资源，及时为产妇提
供产褥期身心护理至关重要。
关键词：护理，经验，护士，产后期，产褥期
 Table of contents
1. Introduction .................................................................................................................1
1.1. Postpartum – definition .......................................................................................1
1.2. Puerperium – definition .......................................................................................2
1.3. Experience – definition........................................................................................2
1.4. Theory..................................................................................................................2
1.5. The nurse’s role ...................................................................................................3
1.6. Problem statement ...............................................................................................3
1.7. Aim ......................................................................................................................4
2. Method ..........................................................................................................................4
2.1. Design ..................................................................................................................4
2.2. Search strategy.....................................................................................................4
2.3. Selection criteria ..................................................................................................6
2.4. Selection process and outcome of potential articles ............................................6
2.5. Data analysis ........................................................................................................7
2.6. Ethical considerations ..........................................................................................8
3. Result ............................................................................................................................8
3.1. Experience of providing puerperium guidance and education effectively ..........9
3.2. Experience of providing psychological care .....................................................10
3.2.1. Nursing experiences for postpartum anxiety .............................................10
3.2.2. Nursing experiences for postpartum depression........................................10
3.3. Impact of the environment and resources to nurses ..........................................11
3.3.1. Unfavorable environmental factors in nursing work .................................11
3.3.2. Nursing experience of lacking medical resources .....................................12
3.4. Lack of nurses’ own professional knowledge and teamwork ability ................12
4. Discussion ...................................................................................................................13
4.1. Main results .......................................................................................................13
4.2. Results discussion ..............................................................................................13
4.3. Methods discussion ...........................................................................................16
4.4. Clinical implications ..........................................................................................17
4.5. Suggestions for future research .........................................................................17
4.6. Conclusions .......................................................................................................17
Reference ........................................................................................................................18
Appendix 1 Table 2
Appendix 2 Table 3
1. Introduction
Postpartum period or puerperium is an extremely important process in a woman's life.
Maternal morbidity and mortality during the puerperium are very high, with about half
of all maternal deaths occurring in the postpartum period (Schrey-Petersen, Tauscher,
Dathan-Stumpf & Stepan, 2021). Among them, puerperal infection, fever, thrombosis,
bleeding, and mental illness have a high incidence (Schrey-Petersen et al., 2021). All
aspects of puerperium women's life have changed, including psychological and
physiological aspects (Asadi, Noroozi & Alavi, 2021). Most puerperium women say
that after delivering, they feel less attractive, including changes in body shape, and a
decline in sexual function (Asadi et al., 2021). In addition, they are also under great
mental pressure (Asadi et al., 2021). The partners of puerperal women express their lack
of knowledge of postpartum care and they do not know how to better care for puerperal
women (Atkinson, Smith, Carroll, Sheaf & Higgins, 2021). But when puerperal women
are diagnosed with postpartum complications, the useful knowledge they receive from
doctors benefits the care of puerperal women (Atkinson et al., 2021). However, due to
cultural differences, women in different countries also experience different puerperal
experiences. For example, in China, puerperal women pay more attention to diet and
rest care as well as warm, such as reducing eating raw and cold food. While in other
countries like America, puerperal women are encouraged to get out of bed early to
promote physical recovery and they pay less attention to their diet and weight control
(Marshall, Abrams, Barbour, Catalano, Christian, Friedman, Hay, Hernandez, Krebs,
Oken, Purnell, Roberts, Soltani,Wallace & Thornburg, 2022). Therefore, when caring
for puerperal women, good evaluation and nursing are particularly important, and
nurses' experience in caring for puerperal women can provide help for them.

1.1.Postpartum – definition

Six weeks after delivery of the placenta is called postpartum (Schrey-Petersen et al.,
2021). It is considered the fourth stage of pregnancy and is defined as the time between
childbirth and the return of a woman's reproductive organs to their pre-pregnancy state
(Romano, Cacciatore, Giordano & La Rosa, 2010). This is the most critical and
vulnerable stage (WHO). They will go through a series of physical and psychological
changes, longing to return to where they were before pregnancy, but feeling

1
overwhelmed when caring for a new baby and experiencing unprecedented levels of
exhaustion and responsibility (Bane S, 2015).

1.2.Puerperium – definition

The puerperium begins one to two hours after the placenta exits, and the end time is not
fixed (Salim & Gualda, 2010). It is generally considered within 40 days postpartum
(approximately 6 weeks) (Ospina Romero, Muñoz de Rodríguez & Ruiz de Cárdenas,
2012). This is a continuous pregnancy-related adaptive process (Varner, 1998). During
this period, maternal physical function will gradually recover: uterine rejuvenation,
vaginal tension and external genitalia, abdominal wall tension, endocrine,
cardiovascular and urinary stability (Ospina Romero et al., 2012). However, it is worth
noting that many complications can also occur during this period (Schrey-Petersen et al.,
2021).

1.3.Experience – definition

Experience is a familiar, functional refinement of knowledge(Polit & Beck, 2012). It

has the ability to generalize, identify patterns, and make predictions (Polit & Beck,
2012). Experience plays an essential role in the development of nursing (Arbon,2004).
It can help nurses increase professional knowledge and clinical skills accumulation,
promote nurses Long-term career development (Arbon,2004). Besides, experience is an
important source of research topics that have had a profound impact on nursing research
(Polit & Beck, 2012).

1.4.Theory

Watson's theory of care believes that nursing is the process and transformation of care
between people, and human care is the core and essence of nursing practice(Ospina
Romero et al., 2012). In Watson's theory, nursing encompasses "knowledge, thoughts,
values, philosophy, commitment and action, and a degree of passion" (Watson, 1988).
Health is the unity and coordination of mind and body (Alligod & Marriney Tomey,
2014). Human being is "the unity of mind, body, spirit and nature" (Watson, 1996). The
environment is the social, spiritual, and cultural condition in which the patient finds
(Alligod & Marriney Tomey, 2014). She proposes ten elements of care: establishing a
humanitarian-altruistic value system; instilling confidence and hope; cultivating
2
sensitivity to the self and others; establishing relationships of help, trust, and care;
encouraging and accepting the expression of positive and negative emotions by clients;
systematically using problem-solving solutions to make decisions; promoting
interpersonal teaching and learning; supportive, protective, and corrective psychological,
social, and spiritual environments; assisting in meeting human needs; and allowing for
the existence of existential, phenomenological, and spiritual forces (Alligod & Marriney
Tomey, 2014). When nurses care for puerperium women, they need to integrate the
essence and love of care and healing into the service to make patients feel warm.

1.5.The nurse’s role

Promoting health, preventing disease, restoring health, and alleviating suffering are the
four basic duties of a nurse (Marteau, 2012). Nurses play a pivotal role in helping
postpartum women prevent complications and conduct health education (Mutic, Jordan,
Edwards, Ferranti, Thul & Yang, 2017). Therefore, as nurses who take care of
puerperium women, with the purpose of restoring their physical and mental health, they
should understand the nursing needs of puerperium women with different reproductive
methods, and do their best to provide them with humanized care of medical care (do
Nascimento Cassiano, de Holanda, de Souza Costa, Rosado de Morais & do Oliveira
Maranhão, 2015). At the same time, nurses should also provide guidance and
personalized educational activities to women after childbirth, so that women in the
puerperium have a better nursing experience (do Nascimento Cassiano et al., 2015).

1.6.Problem statement

Puerperal nursing affects postpartum women's physiological, psychological and social

adaptation and many other aspects. It is of great significance for nurses to do a good
work in puerperal nursing to ensure maternal and child health. However, in previous
studies, the experience of nurses in the care of women during puerperium was limited
and monotonous, and few studies fully described the experience of puerperium from the
perspective of nurses. The nursing experience of nurses to puerperium women affects
whether nurses can provide good psychological and physiological nursing for
puerperium women and promote their postpartum recovery. Different experiences have
different influences on guiding nurses' clinical nursing skills and humanized caring. In
addition, it can also guide the women’s partners to provide more comprehensive care for

3
puerperium women. Therefore, the authors believe that it is necessary to deeply
understand the nursing experience of puerperium women.

1.7.Aim

The aim of the review is to describe the experience of nurses providing care for
puerperium women.

2. Method

2.1.Design

The authors conducted a descriptive literature review (Polit & Beck, 2012).

2.2.Search strategy

We searched for articles in the PubMed, Cinahl as well as PsycINFO databases under
specific restriction criteria, as shown in Table 1. The search terms "puerperial woman"
AND "nurse" AND "experience" were searched either individually or together, MeSH
terms and free text were used to search effectively and Boolean words such as AND,
OR were used to combine the individual search terms. Additionally, we chose the
articles with the limits of “English” and “Ten years”. In the search (see Table 1), we
scanned the titles and abstracts of the 332 articles, and finally selected the 10 articles
that may be useful for the literature review.

4
Table 1. Results of database searches.

Database Limits and Search terms Number Possible

search data of hits articles
(excluding
doubles)
Medline via English, “puerperium”(free text) 31170
PubMed Ten years
2022-09-18
Medline via English, “nurses’ experience” (free 28108
PubMed Ten years text)
2022-09-18
Medline via English, “puerperium” AND 14701
PubMed Ten years “women”
2022-09-18
Medline via English, (((puerperium[MeSH 181 6
PubMed Ten years Terms]) OR (Puerperium))
2022-09-18 AND (nurse)) AND
(experience)
Cinahl English, “puerperium”(free text) 7313
Ten years
2022-09-18
Cinahl English, “nurses’ experience” (free 35056
Ten years text)
2022-09-18
Cinahl English, “puerperium” AND 4583
Ten years “women”
2022-09-18
Cinahl English, (((puerperium[MeSH 110 3
Ten years Terms]) OR (Puerperium))
2022-09-18 AND (nurse)) AND
(experience)
PsycINFO English, “puerperium”(free text) 2036
Ten years
2022-09-18
PsycINFO English, “nurses’ experience” (free 10424
Ten years text)
2022-09-18
PsycINFO English, “puerperium” AND 1229
Ten years “women”
2022-09-18
PsycINFO English, (((puerperium[MeSH 41 1
Ten years Terms]) OR (Puerperium))
2022-09-18 AND (nurse)) AND
(experience)
Total:10

5
2.3.Selection criteria

Exclusion criteria applied by authors were articles that were only concerned with
physicians’ experience of providing care for puerperium women and women’s
experience of puerperium as well as all literature reviews. Inclusion criteria for articles
included in the degree project was that they were relevant for the aim of the review i.e.
nurses’ experience of providing care for puerperium women, empirical scientific articles
using a qualitative or quantitative approach.

2.4.Selection process and outcome of potential articles

The titles, abstracts, and keywords of the articles were first browsed to determine
whether they were useful for answering research questions from literature reviews,
eventually 332 articles were obtained. The authors then excluded 49 literature reviews,
remaining 283 articles. After quickly reading of the results and discussion sections of
the article, 152 articles that were not nurses providing care for puerperium women and
121 articles not related to he theme and aim of the study were excluded, finally
remaining 10 articles. The authors carefully elaborated on each step in the selection
process in Figure 1 (see Figure 1).

6
 Figure 1: The process of article screening

Total：332

Relevant papers Relevant papers Relevant papers

identified in PubMed identified in Cinahl identified in PsycINFO
(n=181) (n=110) (n=41)

Studies (n=49) were literature

reviews

Studies excluded after

reviewing of title and
abstract (n=283)
Studies (n = 152) found to be not
the nurses’ experience of
providing care for puerperium
women.
Studies after screening
the all text (n=131)

Studies (n=121) were irrelevant to

the review’s aim and specific
question

Total of 10 articles
included

2.5.Data analysis

All articles that were consistent with our research aim were discussed and categorized
by the two authors for several times. In particular, in the results section of the articles,
the authors summarized the similarities and differences between nurses' experiences in
caring for women in the puerperium. According to Polit & Beck, the authors used a

7
matrix method for data analysis, which clearly listed topics and made it easier to
identify and review articles (Polit & Beck, 2012). The article processed with the help of
two templates (i.e. matrixes), one of which was used to organize the results section of
the articles, was read and carefully processed to identify similarities and differences
between the nurses' experiences of caring for women in the puerperium. The other was
used to list the authors, titles, designs (possible methods), participants, data collection
methods, and data analysis methods of all articles.

2.6.Ethical considerations

Degree project was free of plagiarism. Articles selected by authors were read
objectively and earnestly, and it was free from influence of the author’s own subjective
perspectives and attitudes (Polit & Beck, 2012). The results presented in their entirety
and was not modified by the authors at will, nor did it represent the authors’ wishes
(Polit & Beck, 2012).

3. Result
Usually, the arrival of a baby was a cause for celebration for women and their partners.
However, in our study, we found that when caring for puerperium women, their
physical and mental changes need to be better looked at and focus on. In this case,
nurses’ experience of providing care for puerperium women could be divided into
several parts. Figure 2 showed the relevant results, while table 2 (see Table 2 in
appendix1) and 3 (see Table 3 in appendix 2) showed the comprehensive results .

Providing puerperium guidance and Providing psychological care

education - Nursing experiences for postpartum
anxiety
- Nursing experiences for postpartum
depression

Impact of the environment and

resources
- Unfavorable environmental factors
- Nursing experience of lacking medical
resources Lack professional knowledge and
teamwork ability

8
Figure 2：The findings and categories of the results

3.1.Experience of providing puerperium guidance and education

effectively

Nurses believed that many women's bodies undergo a series of changes after giving
birth, such as constant bleeding in the womb or loss of shape due to weight gain.
Therefore, the experience of nurses showed that providing puerperal guidance and
education had an important impact on puerperium recovery and health of puerperal
women (Trop, Gendenjamts, Bat-Erdene, Doripurev, Ganbold, Bayalag & Withers,
2018). The safety of puerperium women could be protected by providing them with
health assessment education and alerting them to risk signs (Kohi, Aston, Mselle,
Macdonald, Mbekenga, Murphy, White, OHearn, Price & Jefferies, 2017). In addition,
nurses found that since most young women have poor diet and exercise habits, it was
particularly important for nurses to provide relevant diet and exercise guidance to
puerperium women (Lucas, Olander & Salmon, 2020). Also, on relationship of
puerperal women and infants, as a bridge between the mother and baby after separation,
the nurse for postpartum women from mother to child relationship between education
and guidance, promote the interaction between mother and baby and body contact, try
from the Angle of mother baby's status feedback, which was advantageous to the
harmonious development of maternal and child relationship and women's physical and
mental health (You & Kim, 2020). At the same time, nurses felt that many women
rarely talked about their sex life, which they considered to be a sensitive topic and
unacceptable (Alnuaimi, Almalik, Mrayan, Mohammad & Alshraifeen, 2020). In
providing health guidance and education to postpartum women and their partners,
nurses encouraging women to discuss sexual problems were of great help in guiding the
recovery of postpartum sex. Puerperium women with different cultural traditions,
religious beliefs and scientific perspectives had different views on when to resume
sexual life (Alnuaimi et al., 2020). For example, many women believed that when
bleeding stopped they could start having sex (Alnuaimi et al., 2020). But in reality,
resuming sex too early could lead to complications such as infection and pain. Therefore,
the majority of nurses agreed with the idea of providing contraceptive information and
sex education to women immediately after giving birth, as part of their duties (Alnuaimi

9
et al., 2020; Botfield, Tulloch, Contziu, Phipps, Bateson, Wright, McGeechan & Black,
2021). The nurses suggested that puerperal sex education and counselling could be
provided to puerperal women through the community, clinics, schools or websites to
help them cope with a range of physical changes (Alnuaimi et al., 2020).

3.2.Experience of providing psychological care

3.2.1. Nursing experiences for postpartum anxiety

Anxiety and depression were very common in postpartum women. Nurses indicated that
during the process of providing care, postpartum anxiety was very normal, especially
for mothers of the first birth, and that it could be manifested as excessive concern about
their children (Ashford, Ayers & Olander, 2017). However, it was difficult for nurses to
determine when postpartum women would experience postpartum anxiety in their work
(Ashford et al., 2017). Therefore, nurses found that visiting them as much as possible
and helping them as they could was a good way to ease postpartum women's anxiety,
(Ashford et al., 2017). Many nurses have expressed that they payed more attention to
the mental health in puerperal (Ashford et al., 2017). To provide effective support for
women, nurses said that offering psychological training in the puerperal period was
significant for promoting mental health in postpartum women, which was also
beneficial to their work (Ashford et al., 2017). For example, high-quality perinatal
mental health services would provide detailed care plans for the birth process of some
women with obvious mental health problems, and this was what the nurses need to
improve in the future (Ashford et al., 2017).

3.2.2. Nursing experiences for postpartum depression

Some nurses described postpartum depression as a mood disorder during pregnancy or

after childbirth, which could manifest itself as mood swings, such as sudden crying,
laughter, or anger (Trop et al., 2018). Others believed that only the symptoms that were
very severe and that were prolonged were considered as postpartum depression and
sadness (Trop et al., 2018). According to the experience of proving care for postpartum
women, spousal relationships, especially in postpartum women's lack of partner support,
male violence, and excessive alcohol consumption were considered to be important
causes of postpartum depression (Trop et al., 2018). Identification and treatment of
1
postpartum depression was challenging for nurses. Since women may not directly show
symptoms of postpartum depression, observing their performance and their
understanding of their living environment was critical for nurses to identifying and
treating postpartum depression (Trop et al., 2018). For example, cold or sad facial
expressions and weak voices might be signs of postpartum depression, talking with
women about their living conditions and their feelings, and engaging women's family
members in discussions to improve their awareness of postpartum depression was also
one of the most important ways to help the nurses identify depression (Trop et al., 2018).
In addition, nurses agreed that it was particularly vital to make postpartum women raise
awareness of postpartum depression, such as antenatal care visits including guidance
sessions on maternal mental health (Trop et al., 2018). Some nurses also indicated that
the screening tools outlined in the NICE guidelines could better help to screen for
postpartum depression (Ashford et al., 2017). What’s more, due to the lack of training
and practical experience in mental health, nurses lacked confidence in their ability to
identify and help women with postpartum depression, which also led to the difficulty to
identify and treat postpartum depression (Trop et al., 2018).

3.3.Impact of the environment and resources to nurses

3.3.1. Unfavorable environmental factors in nursing work

Almost all the nurses mentioned that the crowded space was not conducive to the
development of effective care work and the participation of family supporters
(Macdonald, Aston, Murphy, Jefferies, Mselle, Price, O'Hearn, White, Mbekenga &
Kohi, 2019). They said that postpartum mothers and babies need to stay in the hospital
as long as possible to complete immediate and continuous assessments as well as ensure
the safety of the mothers and babies, so it was essential for mothers to be hospitalized
for 24 hours after delivery (Kohi et al., 2017). But as a matter of fact, the overcrowded
hospital environment, the lack of beds for postpartum women and their newborns as
well as the lack of enough staff to return home too early could affect their safety and
cannot fully meet their needs (Kohi et al., 2017; Macdonald et al., 2019). While nurses
provide thorough physical assessments and health education for postpartum women to
identify signs of danger at home, their short time with postpartum women might lack
insufficient time to process and learn a lot of health information they teach them (Kohi

1
et al., 2017). In addition, nurses also expressed that a stable and timely medical service
system had played a significant role in the conduct of nursing work (You & Kim, 2020).
Emergency service response was slow and ambulances rarely arrive on time, failing to
meet the norms and standards for taking women to hospital within 60 minutes, thus
leading to treatment delays (Ramavhoya, Maputle, Lebese & Makhado, 2021).

3.3.2. Nursing experience of lacking medical resources

Nurses complained that the lack of medical equipment not only affect the service
progress, but also intensify the conflict between them and the women's families
(Macdonald et al., 2019). They were dissatisfied with the confusion of the government
organization developing the maternal and child healthcare policy, which led to problems
in the allocation of perinatal healthcare resources and the equity of services such as drug
access and purchase (Macdonald et al., 2019). Furthermore, nurses described that a lack
of professional staff easily led to increased workload and poor implementation of
guidelines, such as successful implementation of maternal care guidelines at night
requiring at least two nurses to remind and assist each other in case someone forgets the
steps to manage women (Ramavhoya et al., 2021). The increase in workload not only
affected the mental health of nurses, such as excessive pressure, uncontrolled emotional
control, but also could easily cause physical exhaustion (Macdonald et al., 2019). But
for all that, they strove to overcome these difficulties efficiently (Ashford et al., 2017;
Macdonald et al., 2019).

3.4.Lack of nurses’ own professional knowledge and teamwork ability

In the process of providing care to women in puerperium, the lack of professional
knowledge and teamwork ability of nurses was common (You & Kim, 2020). For
example, only a small proportion of nurses had received formal training in training and
education on family planning and contraceptive counselling (Botfield, Tulloch, Contziu,
Phipps, Bateson, Wright, McGeechan & Black, 2021). Regarding IRD, nurses said that
they had never learned relevant knowledge during their undergraduate study or outside
the course, but they were in urgent need of such knowledge (Gustavsson & Eriksson-
Crommert, 2020). In the care of postpartum depressed women, nurses had only a basic
understanding of postpartum depression and limited training and practical experience in
the treatment of postpartum depressed women, resulting in their lack of confidence in
1
identifying and helping depressed postpartum women (Trop et al., 2018). Problems with
teamwork also made it difficult for nurses to provide care. For example, nurses did not
agree on the need for medical care when managing patients with increased IRD because
of a lack of cross-specialty and teamwork (Gustavsson & Eriksson-Crommert, 2020). In
addition, nurses also mentioned that when providing dietary and exercise advice to
puerperal women, they could only provide some basic knowledge due to the lack of
specialized training (Lucas et al., 2020).

4. Discussion

4.1.Main results
This review emphasized that in the experience of nurses providing care for puerperal
women, their unfavorable working environment and lack of medical resources, lack of
nurses' professional knowledge and teamwork ability as well as providing physical and
psychological educational counseling and health guidance were the main outcomes of
this study. Nurses helped puerperium women to restore their physical and mental health,
alerted them to dangerous signs, and identify and treat postpartum depression. At the
same time, as a bridge between mother and baby, nurses promoted the harmonious
development of the relationship. Failure to reach the ambulance in time at the event of
an accident would affect the safety of puerperium women. The lack of medical
equipment due to the allocation of prenatal healthcare resources and the lack of fairness
in the access and purchase of drugs had led to the increased workload and poor
implementation of nurses. Lacking expertise and teamwork ability among nurses was
common because of the insufficient formal training and systematic education of their
expertise.

4.2.Results discussion

4.2.1. Experience of providing puerperium guidance and education

effectively

Through a comparative analysis of the results, we found a high degree of consensus.

1
The provision of educational counseling and health guidance for puerperal women was
agreed upon in (Alnuaimi et al., 2020; Ashford et a l., 2017; Botfield et al., 2021; Kohi
et al., 2017; Lucas et al., 2020; You & Kim, 2020). Effective health guidance played an
important role in the physical and mental health of puerperial women, which could not
only accelerate the recovery of physical strength, but also help women develop good
living habits and reduce psychological pressure. This was also mentioned in (Caraher ,
1998): the organic combination of health promotion and patient education was
conducive to improving the quality of care and promoting the recovery of patients. As
stated in Watson's theory of care, health was the unity and coordination of body and
mind (Alligod & Marriney Tomey, 2014). Man was the unity of mind, body, spirit and
nature (Watson, 1996). Providing health education for puerperal women was not only
the responsibility of nurses, but also a reflection of nurses 'respect for women's rights.
At the same time, there were some differences in the results of the articles. We found
that, in terms of providing health education consultation, the nurses in the article
(Gustavsson & Eriksson-Crommert, 2020) believed that providing health assessment
education for women during the puerperium could remind women to pay attention to
some dangerous signs and protect the safety of postpartum women. In the literature
(Lucas et al., 2020), there was more emphasis on providing relevant postpartum diet and
exercise guidance for puerperium women, which was due to the poor diet and exercise
habits of most young women. It was a wise choice for nurses to provide more targeted
personalized guidance when facing different groups of puerperium women.

4.2.2. Experience of providing psychological care

In providing psychological care for puerperal women, the article (Macdonald et al.,
2019) was more inclined to identify and solve the postpartum anxiety problems. And
(Trop et al., 2018) payed attention to the identification and treatment of postpartum
depression. However, these two aspects were the most common psychological problems
that women encounter when nurses provide care for puerperium women. Puerperial
women were faced with a variety of physical and psychological troubles. Nurses, as
health advocates, should give timely psychological nursing and master good
psychological nursing skills, so as to provide better help for them.

1
4.2.3. Impact of the environment and resources to nurses

The adverse effects of lack of medical resources in the nursing of puerperium women
were mentioned in (Alnuaimi et al., 2020; Ashford et al., 2017; Kohi et al., 2017;
Macdonald et al., 2019; Ramavhoya et al., 2021; You & Kim, 2020). Scarce medical
equipment and staff deficiencies hindered the completion of care work. Adequate
medical and health resources were the basis for the smooth progress of medical and
health work, and also the key element to promote the comprehensive development of
the health industry (Pu, 2021). For example, in (Macdonald et al., 2019), nurses
complained that the lack of medical equipment not only affected the service, but also
intensified the contradictions between them and women's families, and hindered the
health recovery of women during the puerperium. This idea was also involved in
(Ashford et al., 2017). In addition, it was also mentioned in (Baratieri & Natal, 2019)
that the lack of human and material resources also had a certain impact on the work of
nurses.
The lack of medical resources in nursing work was also described diversely in different
articles. For example, in article (Macdonald et al., 2019), the lack of staff led to the
increased pressure of nursing work, which seriously affected the physical and mental
health of nursing staff. This corresponds with the care mentioned in Watson theory
including knowledge, thought, values, philosophy, commitment and action, and a
degree of passion (Watson, 1988). Once nurses lose their enthusiasm for their work,
they would not be able to provide high-quality care services to their patients. The article
(Kohi et al., 2017) mentioned that the overcrowding of the hospital environment causes
the mothers to go home too early, thus affecting the safety of the mothers. Therefore, it
could be seen that how to allocate health resources scientifically and reasonably, make
full use of limited resources, and improve the physical and mental health of puerperal
women was a difficult problem that nurses often meet when caring puerperial women,
which needs to be solved imperatively.

4.2.4. Lack of nurses’ own professional knowledge and teamwork ability

The same theme mentioned in (Alnuaimi et al., 2020; Botfield et al., 2021; Gustavsson
& Eriksson-Crommert, 2020; Lucas et al., 2020; Trop et al., 2018; You & Kim, 2020)
was the lack of expertise and teamwork that nurses recognize in providing care for
puerperal women. A large part of this problem was mentioned in (Botfield et al., 2021;
1
Gustavsson & Eriksson-Crommert, 2020), that was, the nurses received less training
and lack of practical experience. Regular vocational training provided a guarantee for
improving the quality of nursing work, and was also a necessary condition for the
continuous progress of nursing technology. Teams with good cooperation ability were
considered to be more competitive and efficient medical organizations (Morley &
Cashell, 2017). As stated in (Pronovost & Weaver, 2018), high quality care and a safe
environment required reliable teamwork.

4.3.Methods discussion
The strength of this descriptive literature review lied in the representativeness and
general applicability of its content. By using MeSH words and free text in PubMed and
Cinahl as well as PsycINFO databases, the authors conducted an effective search of the
literature, and finally selected 10 articles related to the purpose of this review, and
clearly described the screening process in the form of tables and flow charts, making the
search results more reliable and accurate. Also, the authors used two templates to
compare and summarize the results of each literature to advance this review more
effectively. The use of charts made the research data and process of this paper more
intuitive and clear, which was conducive to understanding and application. In addition,
the authors used "10 years" as a limitation of 2012-2022 literature, the results were
fresher and more credible, making the results more convincing (Polit & Beck, 2012). At
the same time, descriptive articles helped to provide vivid and detailed descriptions of
specific things, which were more creative and dynamic than other articles (Polit & Beck,
2012). The authors' choice of articles with qualitative research could gain an insight into
the experience of nurses in nursing puerperial women, and summarize the research
results to make the research results more exploratory. This review also had some
drawbacks. For example, the results of studies in multiple papers might be biased
without direct study interviews. The authors had only the articles in English and cannot
no fully understanding of the current findings (Polit & Beck, 2012). At the same time,
the authors had limitations in the search for literature content, and some articles were
excluded, but in line with the research purpose and the content. Because the
professional knowledge learned at this stage was relatively general, and the research
method adopted by the authors was relatively simple, so the research view may be not
thorough enough analysis.

1
4.4.Clinical implications
Nurses should provide person-centred care to meet patients' health needs and maintain
their professional competence by engaging in continuous professional development and
lifelong learning (ICN, 2012). Therefore, the results of this study fully illustrate the
experience of different nurses in caring for women during the puerperal period. Thus, it
can be seen that nurses need to constantly master the knowledge of common symptoms
and typical diseases during the puerperal period, make full use of limited resources, and
timely assess the physical and mental conditions of puerperal women, in order to
improve the quality of care, so as to better help puerperal women recover health, away
from postpartum diseases or complications.

4.5.Suggestions for future research

In future studies, it will be critical to better understand the effectiveness of nurses in
caring for women during the puerperal period under the influence of the current
environment. For example, at the present stage, whether the clinical program for nursing
women during the puerperal period has been changed, whether there is still a lack of
medical equipment in the work, whether nurses can fully use the knowledge and
experience of nursing and the ability of teamwork to give patients physical and
psychological health guidance, so as to promote the recovery of patients.

4.6.Conclusions
In summary, this review shows that nurses identify a wide range of challenges affecting
daily care by summarizing their experience of caring for postpartum women. At the
same time, it is particularly important to constantly change and improve the nursing
program to help puerperal women deal with their physical and psychological troubles
and to give them proper nursing measures so as to better care for puerperal women. This
is not only good for the health of puerperal women, helping them to stay away from
postpartum diseases or complications, but it can also promote advances in the nursing
profession.

1
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2
 Appendix 1
Table 2. The table legend should indicate the content of the table.

Author(s) Title Design Participants Data collection Data analysis

(possibly method(s) method(s)
approach)
Jessica R. Botfifield, Melanie Contraception Qualitative& Number: 128 Data were collected through a Data analysis was through counting and
Tulloch, Hannah Contziu, provision in the Exploratory They were all anonymous survey, which proportional collection the results of the
Hala Phipps, Deborah Bateson, postpartum period: study midwives in a included demographics, survey.
Sarah M. Wright, Kevin Knowledge, views large tertiary attitudes issues, knowledge
McGeechan, Kirsten I. Black and practices of referral hospital issues, and practice issues.
2020/Australia midwives and a smaller
metropolitan
hospital in NSW.

Danielle Macdonald, Megan
Aston, Gail Tomblin Murphy,
Keisha Jefferies, Lilian T.
Mselle, Sheri Price, Shawna
O’Hearn, Maureen White,
Columba Mbekenga, Thecla W.
Kohi
2018/Australia
Providing postpartum Qualitative& Number: 13 Data were collected through Data analysis was carried out through the
care with limited Exploratory 10 nurse-midwives interviews, and in-depth method of discourse analysis. And several
resources: study and 3 obstetricians interviews were then translated transcripts were independently analyzed by
Experiences of nurse- from three regional into text and then English. study team members after themes were jointly
midwives and hospitals and their identified and compared.
obstetricians in urban affiliated health
Tanzania centers in Dares
Salaam, Tanzania.

Catharina Gustavsson and
Martin Eriksson-Crommert
2020/England
Physiotherapists’ and Qualitative& Number: 16 Focus group discussions as well The authors and two midwife students analyzed
midwives’ views of Exploratory They worked in as semi-structured topic guides the text files through qualitative content
increased inter recti study primary care, were used to facilitate analysis and induction methods. First read
abdominis distance including 7 communication and through identifying text and classify the
and its management midwives and 9 interactions. In addition, the content related to the research question into
in women after physical therapists. discussion was audio-recorded subcategories. The accuracy of the
childbirth and transcribed into text. interpretation was then reconfirmed by re-
reading the text until a consensus was reached.

a
Sun Young You & Ah Rim Kim
2020/England
Karimeh Alnuaimi , Mona
Almalik , Lina Mrayan , Khitam
Mohammad , Reem Ali, and
Ali Alshraifeen
2020/England
Miriam T. Ashford
, Susan Ayers and Ellinor K.
Olander
2016/England
Grace Lucas, Ellinor K. Olander
BPsych, Debra Salmon
2019/England
South Korean nurses’ Qualitative& Number: 12 In-depth, semi-structured The interview recordings were heard more than
lived experiences Descriptive Age: with a mean interviews three times during transcription to ensure
supporting study age of 32.33 were used and recorded, accuracy. In addition, interviews were heard
maternal postpartum They were nurses additional interviews such as while reading transcriptions and notes to ensure
bonding in the working at six phone, mail, or face-to-face understanding the true meaning of the
neonatal tertiary hospitals in were adopted under special participants. Moreover, the interview data were
intensive care unit South Korea. circumstances. checked and annotated and coded, and then the
similar content was grouped and classified to
be fully visible in the themes.
“Resumption of Qualitative& Number: 22 Data were collected by means Transcripts were compared to the audio
Sexuality and Health Descriptive Consisted of 7 of focus group discussion, and recordings to ensure accuracy. In addition, by
Education in study midwives, 13 then all citations were determining the common themes of the text to
Postpartum nurses, and 2 translated into English. reveal the content of the record: each
Period: From obstetricians from researcher independently analyzed and coded
Jordanian Health the 3 primary care the transcripts, identified the main themes and
Care Professionals’ centers. matched the relevant themes, and when the
Perspectives” new themes appeared, they read them again to
determine.
Supporting women Qualitative& Number: 13 Data were collected and audio- The recorded interviews were transcribed
with postpartum Exploratory Age: over 18 years recorded by face-to-face verbatim and the transcriptions were analyzed
anxiety: exploring study old interviews or telephone / Skype, and managed. First by carefully reading all the
views and They were and after the interview, transcriptions to identify the relevant features
experiences of working in the participants completed the and generating the initial code,
specialist community National Health questionnaires. then, again grouped into larger themes.
public health nurses Service (NHS).
in the UK
Healthcare Qualitative& Number: 11 Data were collected through The data were analysed using a thematic
professionals’ views Exploratory Including telephone interviews. approach and coded in the three domains of
on supporting young study midwives, family capability, opportunity and motivation within
mothers nurses and health the theoretical framework of the COM‐B
with eating and visitors. model.
moving during and
after pregnancy: An
interview study using
the COM‐B
framework
b
Thecla W Kohi, Megan Aston, Saving lives with Qualitative& Number: 13 Data was collected through The data were analyzed using feminist post-
Lilian T Mselle , Danielle caring assessments: Exploratory Including 10 audio recordings. structuralism (FPS) methodology and discourse
Macdonald , Columba How Tanzanian study nurse- midwives analysis.
Mbekenga, Gail nurse-midwives and and 3 obstetricians.
Tomblin Murphy, Maureen obstetricians
White, Shawna OHearn, Keisha negotiate postpartum
Jefferies practices
2017/Australia

Justin Trop, Battulga Postpartum Qualitative& Number: 15 Data were collected through The data were analysed using a content
Gendenjamts, Undral Bat- depression in Descriptive Including 5 nurse- interviews and audio analysis approach to the transcripts of the audio
Erdene, Doljinsuren Doripurev, Mongolia: A study midwives, 1 family recordings. tapes to discover the main important themes
Solongo Ganbold, Munkhuu qualitative clinic nurse, 4 and to develop an extensive coding scheme.
Bayalag, Mellissa Withers exploration of health obstetrician-
2018/America care providers’ gynaecologists
perspectives (OB-GYNs), 2
family physicians,
1 psychologist, 1
monk, and 1
traditional healer.

Thifhelimbilu Irene Ramavhoya,
Maria Sonto Maputle, Rachel
Tsakani Lebese, Lufuno
Makhado
2021/Africa
Midwives’ Qualitative& Number: 18 Data were collected through Data were analyzed by transcribing participant
challenges in the Exploratory Midwives working unstructured interviews. interviews and continuing with the 8-step
management of study in primary health Tesch Open coding method.
postpartum care facilities.
haemorrhage at rural
PHC facilities of
Limpopo province,
South Africa: an
explorative study

c

Table 3. The table legend should indicate the content of the table.
Author(s)
Jessica R. Botfifield,
Melanie Tulloch, Hannah
Contziu,
Hala Phipps, Deborah
Bateson,
Sarah M. Wright, Kevin
McGeechan, Kirsten I.
Black
2020/Australia
Danielle Macdonald,
Megan Aston, Gail
Tomblin Murphy, Keisha
Jefferies, Lilian T. Mselle,
Sheri Price, Shawna
O’Hearn, Maureen White,
Columba Mbekenga,
Thecla W. Kohi
2018/Australia
Aim
The aim of the study was to
address ‘what is the
knowledge, views and
practices of midwives
regarding contraception
provision in the postpartum
period?’
The aim of the study was to
explore nurse-midwives’ and
obstetricians’ experiences of
providing postpartum care in
Tanzania.
Appendix 2
Results
1.Most midwives agreed that it was valuable to inform women immediately after giving birth.
2.The majority considered it was the midwife’ s duty to provide information about contraception and they were
indeed providing contraceptive advice to postpartum women.
3.Only a small percentage of midwives reported having formal training in family planning, general contraceptive
counseling, and contraceptive methods.
Four themes were identified: space, equipment, staffing and government responsibility.
1.Space: Nurse-midwives believed that the lack of beds was not conducive to their care and evaluation of postpartum
patients, but also to the husband's care for their wives.
2.Equipment: Most nurse-midwives expressed that the scarcity and availability of equipment was not helpful to their
care for postpartum women.
3.Staff: Participants said that the lack of professional staff could easily lead to increased workload, affecting their
physical and mental health.
4.Government responsibility: Nurse-midwives expressed dissatisfaction with the government 's chaotic maternal and
child health policies. Because this led to problems in the allocation of perinatal health resources and equity of services
such as drug access and purchase.
d
Catharina Gustavsson and The aim of the study was to
Martin Eriksson-Crommert explore the views of midwives
2020/England and physiotherapists in
primary care regarding the
increased IRD in women after
delivery and their management
issues.
Sun Young You & Ah Rim The aim of the study was to
Kim explore the experiences of
2020/England nurses supporting infants
admitted in the NICU and their
families in the bonding
process.
Karimeh Alnuaimi , Mona The aim of the study was to
Almalik , Lina Mrayan , explore the views and attitudes
Khitam Mohammad , of healthcare professionals
Reem Ali, and regarding postnatal sex
Ali Alshraifeen education in Jordan.
2020/England
Miriam T. Ashford The aim of this study was to
, Susan Ayers and Ellinor explore HVs’ experience with
K. Olander supporting women with
2016/England postpartum anxiety in their
clinical practice and their
views on currently available
support and services for
postpartum anxiety.
1.Participants said there was no agreement on whether increased IRD required medical care.
2. Participants perceived they lack expertise about increased IRD. They are all in urgent need of relevant knowledge.
3 Most participants reported a lack of interprofessionalism and teamwork in managing patients with increased IRD,
and that the issue of increased IRD should be highly valued.
1.Nurses said they were a bridge between postpartum separated mothers and babies.
2. Challenges in providing mother-child relationship support:
1)Stable systems and adequate medical staff were seen essential to support care.
2)Nurses expressed they adopted a home-centered therapeutic care environment to help meet the individualized needs
of postpartum women.
3)In addition, providing education and guidance for postpartum women was considered a good way to promote the
relationship between preterm infants and mothers, but the lack of knowledge training and education of nurses was a
major problem.
1 Participants revealed that cultural traditions, poor communication, overload of nurses 'work, and nurses' unclear
responsibilities and lack of relevant knowledge were among the main reasons for no sexual behavior education in
Jordan.
2. Participants said that different cultural traditions, religious beliefs, and scientific perspectives have led to different
attitudes about when to resume sexual behavior.
3 Nurses indicate that men dominate the time to sexual sexual behavior in postpartum women.
4 All participants believed that sex education for pregnant women and their partners was very necessary, especially for
postpartum sexual knowledge.
5 Participants suggested that women could receive written materials or educational courses and counseling through
clinics, schools, or websites.
1.HVs said they often encounter and help women with postpartum anxiety in their professional practice. There were
three main approaches: (1) identifying mental health problems (following national guidelines) (2) referring relevant
services , and (3) providing listening support.
2.Four themes were identified in the interview: (1) identifying screening problems (HVs emphasized that postpartum
anxiety was a normal imagination, and they tried to determine when anxiety occurs) (2) the importance of training
(HVs described the importance of mental health training for supporting postpartum women) (3) the use of services
(when serving women with postpartum anxiety, HVs said that such people tend to use health care services heavily,
causing a surge in their work pressure) (4) Current service delivery (HVs indicated they have several services
recommended for women)
e
Grace Lucas, Ellinor K. The aim of this study was to
Olander BPsych, Debra explore the experiences of
Salmon health professionals in
2019/England supporting diet and exercise in
young women during and after
pregnancy.
Capability:1. Own personal knowledge: Providing support for eating is primarily tacit knowledge. Specialist
knowledge: Little training in diet and exercise 2. Change talk: Encouraged young women to ‘find their own answers’
with support. Direct talk: It was best not to ‘beat around the bush’ and ‘be honest’.
Opportunity: 1. Social opportunity: Obesity crisis. 2. The lives of young women are described as particularly unstable,
especially when it comes to housing and relationships.
Motivation: 1. When asked about diet and exercise in general, the most immediate concern was infant health rather
than the eating habits of young women. 2.Physical activity is difficult for young women because of difficult living
circumstances.

Thecla W Kohi, Megan The aim of this study was to There are three themes:
Aston, Lilian T Mselle , explore the experiences of 1. Caring assessments save lives: Complete a comprehensive assessment to identify danger signs, keep mother and
Danielle Macdonald , nurse-midwives and baby safe.
Columba Mbekenga, Gail obstetricians in conducting 2. Institutional and social constructions of safety and danger signs: the importance of mothers and babies staying 24
Tomblin Murphy, Maureen postnatal care assessments and hours after delivery in the hospital
White, Shawna OHearn, how they can be constructed 3. Centering care on assessments: Mothers are warned of certain danger signs through health assessment education.
Keisha Jefferies through individual, social and
2017/Australia institutional discourses.
Justin Trop, Battulga The aim of this study was to 3. Most formal health providers expressed only a basic understanding of postnatal depression and had limited training
Gendenjamts, Undral Bat- clarify the perspectives and in treating women with this condition.
Erdene, Doljinsuren experiences of Mongolian 4. Spousal relationships have a particularly strong impact on PPD, with lack of support, intimate partner violence and
Doripurev, Solongo health care providers with excessive alcohol consumption among men being the main factors. At the same time, women's economic ability and
Ganbold, Munkhuu postpartum depression. living conditions are also major determinants.
Bayalag, Mellissa Withers 5. It is difficult to identify and treat postpartum depression due to lack of training, time constraints and other barriers.
2018/America 6.Perhaps the most critical thing to determine if a woman is suffering from postpartum depression is to talk to them
about their life situation and how they feel.
7.The best way to identify and treat postpartum depression is to talk to women.
Thifhelimbilu Irene The aim of the study was to 8.1. Theme "Challenges Faced by midwives in Managing PPH Women"
Ramavhoya, Maria Sonto explore the challenges 9.2.Five sub-themes：
Maputle, Rachel Tsakani experienced by midwives in 10.(1)Difficulties experienced lead to feelings of frustration and confusion due to a lack of knowledge about what to
Lebese, Lufuno Makhado managing women with PPH. do.
2021/Africa 11.(2)In most cases, midwives work with junior nurses who follow the orders of the midwife. But nights in particular
have led to failure to comply with and implement maternal care guidelines.
12.(3)Lack of time and human resources has hampered consultation of the guidelines.
13.(4)PPH can occur with or without a history of PPH, so midwives must always be ready to deal with sudden
emergencies.
14.(5)The delayed response of the emergency services resulted in delayed treatment.