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The NUR 301 Module 7 example, in full
When the Birthing Unit Closes: Loss of Rural Obstetric Services as a Community Nursing Issue and a Policy Response
[Student Name]
Southern New Hampshire University
NUR 301: Concepts of Professional Nursing Practice
Project Two
[Instructor Name]
[Date]
The organization, setting and figures below are a composite written as a model document. No real employer, client, colleague or patient is described.
When the Birthing Unit Closes: Loss of Rural Obstetric Services as a Community Nursing Issue and a Policy Response
Two years ago, the only hospital in composite Beaumont County, a rural county of about 21,000 residents, closed its labor and delivery unit. The hospital had been delivering roughly 140 babies a year, too few to staff the unit safely around the clock, and it could no longer recruit obstetric nurses or cover call. Since then, pregnant residents have traveled 55 to 70 miles to the nearest hospital with obstetric services. The local emergency department still sees women in labor, some of whom arrive too late to transfer, and the county's public health nurses report that more patients are missing prenatal visits because of the distance.
This paper examines the loss of rural obstetric services as a community nursing issue. It reviews the national evidence on closures and their effects, describes the nursing role on both sides of a closure, and proposes a two-part response supported by a state policy change. The argument is that a county cannot simply reopen a birthing unit it cannot staff, but nurses can make the time before, during and after birth safer for the families who now live far from one.
A National Pattern
Beaumont County is not unusual. Between 2004 and 2014, 9 percent of rural counties in the United States lost all hospital-based obstetric services, and by the end of that period more than half of rural counties had no hospital providing them (Hung et al., 2017). Closures were more common in counties with lower incomes, more Black residents and fewer obstetric clinicians, which means the loss falls hardest on communities that were already underserved. Closures have continued since then (Kozhimannil et al., 2020).
Losing a birthing unit changes outcomes, not only travel times. In an analysis of births in rural counties, Kozhimannil et al. (2018) found that in counties not adjacent to urban areas, the loss of hospital-based obstetric services was followed by increases in births outside hospitals, births in hospitals without obstetric units, and preterm births. Rural residents also face a higher risk of severe maternal morbidity and mortality than urban residents, even after accounting for differences in health and social factors (Kozhimannil et al., 2019). Taken together, the research shows that when a rural birthing unit closes, births do not disappear; they move to settings less prepared for them.
What Nurses See on Both Sides of a Closure
Emergency department nurses in Beaumont County now care for women in active labor, with postpartum hemorrhage, or with severe hypertension in pregnancy, often with no obstetric clinician on site. Most of these nurses were trained for adult emergencies and see an obstetric emergency only a few times a year, which makes it difficult to keep skills current. They describe fear when a precipitous birth occurs and uncertainty about when transfer is safe.
Public health nurses see the other side. Prenatal visits now require a round trip of more than two hours, and families without reliable transportation miss appointments. Postpartum follow-up has become harder, so conditions such as postpartum hypertension or depression are more likely to be recognized late. The county's public health nurses already run a small home visiting program for first-time parents, but it has capacity for only a fraction of pregnant residents.
Both groups describe the same gap: pregnant residents are now more likely to reach care late, and the nurses who do see them are least prepared for obstetric emergencies. That gap is where nursing can act.
Proposed Response
The response has two parts. The first is emergency obstetric readiness for the county's emergency department. All emergency nurses would complete an annual obstetric emergency course with hands-on simulation of precipitous birth, shoulder dystocia, postpartum hemorrhage and severe hypertension. The department would stock a standardized obstetric emergency cart and adopt protocols for hemorrhage and hypertensive emergency, with telehealth access to an obstetric nurse or physician at the regional referral hospital for real-time advice.
The second part is an expanded perinatal nurse home visiting program run by the county health department. Public health nurses would visit pregnant residents in the third trimester and after birth, check blood pressure, screen for depression, reinforce warning signs, and help families plan how and when they will travel to the birthing hospital. Visits in the first weeks after birth would focus on hypertension and mood, since those problems often arise after discharge from a distant hospital.
Policy Component
Neither part can be sustained by the county alone. The proposed policy is a state rural maternity readiness grant, administered by the state health department, that would fund annual obstetric emergency training and equipment for emergency departments in counties without a birthing unit and would support perinatal home visiting by public health nurses in those counties. The grant would require participating hospitals to adopt standard protocols, report obstetric emergency department visits and transfers, and maintain a transfer agreement with a regional birthing hospital.
Nurses would play a central role in advancing the policy. The county's public health nurses and emergency nurses can provide testimony about what they see, and state nursing organizations can help frame the proposal for legislators. A modest grant program is more realistic than reopening closed units, and it directs resources to the nursing workforce already present in the community.
Stakeholders and Evaluation
Key stakeholders include pregnant residents and their families, emergency and public health nurses, the county hospital's leadership, the regional birthing hospital, the county health department, state legislators and the state health department. Hospital leaders may worry about cost and liability, and the grant's funding for training and equipment is designed to address the first concern, while standard protocols and telehealth support address the second.
Evaluation would use data the grant already requires. For the emergency department, measures would include the number of obstetric emergencies, the proportion managed according to the new protocols, and time to transfer. For the home visiting program, measures would include the proportion of pregnant residents enrolled, postpartum blood pressure checks completed within ten days of birth, and depression screens completed. Over several years, the county could compare its rates of out-of-hospital births and severe maternal complications with those of similar counties without the program.
Conclusion
The closure of rural birthing units is a growing community health issue with measurable effects on where and how safely babies are born. In a county that cannot reopen its unit, nurses can still reduce the risks by preparing emergency departments for obstetric emergencies and by extending perinatal care into the home. A state grant program would make those efforts sustainable. For the nurses of Beaumont County, the issue is not whether obstetric care exists in their community but whether they are prepared to provide the part of it that now falls to them.
References
Hung, P., Henning-Smith, C. E., Casey, M. M., & Kozhimannil, K. B. (2017). Access to obstetric services in rural counties still declining, with 9 percent losing services, 2004-14. Health Affairs, 36(9), 1663-1671. https://doi.org/10.1377/hlthaff.2017.0338
Kozhimannil, K. B., Hung, P., Henning-Smith, C., Casey, M. M., & Prasad, S. (2018). Association between loss of hospital-based obstetric services and birth outcomes in rural counties in the United States. JAMA, 319(12), 1239-1247. https://doi.org/10.1001/jama.2018.1830
Kozhimannil, K. B., Interrante, J. D., Henning-Smith, C., & Admon, L. K. (2019). Rural-urban differences in severe maternal morbidity and mortality in the US, 2007-15. Health Affairs, 38(12), 2077-2085. https://doi.org/10.1377/hlthaff.2019.00805
Kozhimannil, K. B., Interrante, J. D., Tuttle, M. K. S., & Henning-Smith, C. (2020). Changes in hospital-based obstetric services in rural US counties, 2014-2018. JAMA, 324(2), 197-199. https://doi.org/10.1001/jama.2020.5662
How this NUR 301 Module 7 example is structured
Project Two asks a nurse to move from a problem in the community to a response that nurses can lead or support, so the paper follows that path. It opens with the composite county and what changed when its birthing unit closed. National research then shows that the county is part of a larger pattern, with measurable effects on where and how early babies are born. A section on nursing explains what emergency and public health nurses now face. The response has two parts, emergency obstetric readiness for the local emergency department and a perinatal nurse home visiting program, backed by a proposed state policy. Stakeholders and an evaluation plan close the argument.
Get NUR 301 Module 7 written to your instructions
Send the Project Two guidelines and rubric, your Module 6 preparation if you have it, and the community issue you chose. The desk writes Project Two to those instructions in 24 to 48 hours; the first sample is free. The paper above is an original model document written by our desk, not a submitted student paper and not an official Southern New Hampshire University document.
NUR 301 Module 7 questions, answered
What is NUR 301 Project Two usually about?
Project Two, as the course now runs, typically asks students to analyze a nursing issue in the community and propose a response, which may include a policy recommendation or revision. It usually builds on a preparation assignment from the previous module. The guidelines and rubric in your classroom decide the required sections and whether a paper or presentation is expected.
Does Project Two need a policy component?
Many versions ask for one, either a change to an organizational policy or a proposal directed at a public body. Even when it is optional, linking the response to a policy shows that the change can outlast the individuals who start it. State who would adopt the policy and how it would be funded.
How do I choose a community nursing issue I can actually support with evidence?
Pick an issue that national research has studied and that you can also describe locally, through county data, health department reports or your own practice setting. Issues with a clear population, measurable effects and an identifiable nursing role are easiest to develop into a strong Project Two.