Nursing for Women''s Health最新文献

Objective: To examine the relative accuracy of the Morse Fall Scale (MFS) and the Obstetric Fall Risk Assessment System (OFRAS) in predicting obstetric patients' fall risk.

Design: Retrospective comparative analysis of the MFS and the OFRAS in obstetric inpatients.

Setting: A 560-bed urban teaching hospital in Hawaii.

Participants: Eighty-five records of people hospitalized for childbirth.

Methods: Adequate power modeling and statistical analyses were completed using the programs R packages Version 4.0.1 and SAS Version 9.4. Subsequently, a ratio of 17 fall records to 68 nonfall records (1:4) with similar dates of admission were reviewed. Investigators collected the MFS score/risk level as documented and the required data points to obtain the OFRAS fall risk score/level. Logistic regression models were fit using the MFS and OFRAS as predictors of falls. Results are expressed as odds ratios with 95% confidence intervals and p values to test for statistical significance. Receiver operating characteristic (ROC) curves were derived from logistic regression results and graphed to compare the instruments. Areas under ROC curve (AUROCs) were calculated to display the specificity and sensitivity of the risk assessment tools.

Results: Data for 85 pregnant or postpartum people were included in the sample. Analysis of AUROCs demonstrated that the OFRAS is more sensitive and specific for obstetric patients than the MFS. The OFRAS showed significance (p < .001) in predicting falls compared to the MFS (p = .40). Associations between fall scores and falls were examined in separate conditional logistic regression models.

Conclusion: The OFRAS demonstrated higher sensitivity and specificity in fall risk prediction. The MFS performed similarly to random chance regarding obstetric fall risk prediction. The potential exists to better anticipate patient falls, protect staff from injury related to patient fall, and decrease organizational risk using a population-specific tool.

Objective: To explore breast, colorectal, and cervical cancer screening experiences among Arabic-speaking refugee women in Massachusetts.

Design: Qualitative descriptive.

Setting: The research was conducted in central Massachusetts, an area with a large refugee population from the Middle East. Despite cancer being the leading cause of death among Middle Eastern women aged 40 to 79 years, refugees experience significant disparities in cancer screenings. These refugees often pass through intermediary countries before permanently resettling, leading to preventive care becoming a lower priority as other life stressors take precedence.

Participants: Eleven women participated. Participants had an average age of 47 years; had come from Iraq, Syria, and Egypt; and had been in the United States an average of 7 years.

Methods: In 2022, semistructured individual interviews were conducted in person or via Zoom. An interview guide, constructed based on components of the Health Equity Implementation Science Framework and an expert panel of partners, refugee women, and medical providers, was used. Conventional content analysis was used to analyze the data.

Results: Three themes emerged: Facilitators of Cancer Screening, Barriers to Cancer Screening, and Interpreter-Related Factors. Women positively described providers' efforts to provide knowledge regarding screenings; however, language barriers, the invasive nature of some screenings, and scheduling appointments for screening posed significant obstacles.

Conclusion: This study highlights the unique health challenges faced by Arabic-speaking refugee women, focusing on their beliefs, experiences in clinical encounters, and communication regarding cancer screenings. Nurses can address these challenges by providing culturally sensitive care and building relationships with community resources.

Objective: To identify demographic disparities in rates of alcohol screening and brief intervention (ASBI) aimed at reducing the risk of alcohol-exposed pregnancy (AEP).

Design: Electronic health record data were analyzed to examine documented ASBI rates and contraceptive methods for patients who had wellness visits between June 1, 2020, and October 31, 2022.

Setting/local problem: This study included 15 health centers affiliated with Planned Parenthood of Southern New England (PPSNE) and 35 health centers affiliated with Planned Parenthood of the Great Northwest, Hawaii, Alaska, Indiana, Kentucky (PPGNHAIK). Affiliates collaborated on a 4-year project implementing universal ASBI to reduce risky alcohol use and prevent AEPs.

Participants: Data included 29,659 patients assigned female at birth, ages 18 to 49 years, who completed a wellness visit at a participating health center.

Intervention/measurements: Electronic health record data encompassed demographic characteristics, contraception method, patient-completed alcohol screening score, and clinician-documented brief interventions.

Results: Although alcohol screening rates exceeded 85% of eligible visits, brief intervention completion rates for those at risk for AEP were low: 70.5% were missed at PPSNE and 78.2% were missed at PPGNHAIK. At PPSNE, Hispanic patients at risk for AEP were least likely to receive a brief intervention (75.9% missed) compared to Black (67.7%) or white (67.5%) patients (p < .001). At PPGNHAIK, Asian/Pacific Islander patients were most likely to miss receiving a brief intervention (92.2%) compared to Black (72.9%), race unknown (79.5%), white (77.9%), and multiracial/other (78.4%) patients (p < .003).

Conclusion: Universal ASBI is recommended to normalize asking about alcohol in reproductive health care, reduce subjectivity, and ensure that all patients benefit from alcohol education or intervention. Variation in screening rates and contraception type contribute to demographic differences in risk of AEP.

Objective: To assess the knowledge and use of emergency contraception (EC) and to identify factors associated with the perceptions of EC use among female college students in Ghana.

Design: A descriptive cross-sectional study.

Setting: Nursing-midwifery and teacher-training colleges in Ghana.

Participants: A convenience sample of 400 female college students.

Methods: Data were collected using a four-part structured questionnaire. Descriptive statistics, chi-square tests, and univariable and multivariable regression analyses were performed.

Results: Most participants (n = 352; 88.0%) reported hearing about EC. However, only 10.0% (n = 40) knew about the copper-bearing intrauterine device as an EC. Friends (n = 216; 54.0%) were reportedly the primary source of information about EC. Concerns about serious adverse effects were the top reason for not using EC (n = 354; 88.5%). In contrast, facilitators for use included availability, easy access, partner agreement, affordability, and family discussions. Teacher-training college students who were single were more likely to have negative perceptions of EC use than nursing-midwifery students who were married or living with a partner.

Conclusion: Although the results highlight the limited knowledge and use of EC among female college students in Ghana, they also point to the potential for more effective education to improve knowledge and use of EC.

In March 2021, the March of Dimes, U.S. Department of Health and Human Services, and Reproductive Health Impact convened a group of leading maternal health experts to offer guidance and ensure accountability for the design and implementation of the Maternal HealthCARE project, a quality improvement (QI) collaborative to address racial equity and the disparity gap in maternal health outcomes. The Black Maternal Health Stakeholder Group (BMHSG) provided recommendations and insights that served as the foundation of the QI project. From the BMHSG meeting, four themes emerged, which highlighted the underlying causes of maternal health disparities: racism, lack of accountability, poor data transparency, and inadequate patient-centered care. The BMHSG's recommendations provide actionable ways for hospitals to drive change and advance equity within their organizations. These insights offer a roadmap for QI work that places the experience and expertise of Black maternal health experts at the forefront, offering a promising way for hospitals to dismantle systemic and institutional racism in maternity care.

Objective: To implement use of custom whiteboards to improve bedside communication and shared knowledge between clinicians and patients.

Design: Quality improvement project using a seven-step evidence-based practice framework and Plan-Do-Study-Act cycles to redesign custom communication boards for specific patient (antepartum, labor, postpartum) populations.

Setting/local problem: Two California university medical center inpatient obstetric units where Hospital Consumer Assessment of Healthcare Providers and Systems scores in nursing communication had trended down at a time when whiteboards were being underused in patient rooms.

Participants: Staff of approximately 170 nurses, 30 physicians, and 8 midwives.

Intervention/measurements: The project was implemented from January 2020 through July 2020; the first phase was completed in the postpartum unit, and the second phase was completed in the antepartum unit. Staff surveys and board use audits were used to collect preimplementation and postimplementation data. Third-phase labor boards were designed but were not yet implemented due to budget constraints.

Results: Project data supported that the new boards encouraged more complete information and facilitated bedside communication better than the previous iteration.

Conclusion: A customized communication board designed for a specific patient population is an effective tool to promote patient-centered care. Communication boards can reinforce safe nursing practice, facilitate discussion, and improve the patient experience.