Nursing for Women''s Health最新文献

Objective: To explore pediatric health care providers' perceptions of their role in screening mothers for postpartum depression (PPD).

Design: Descriptive, qualitative methodology.

Setting: Pediatric care providers from five different institutions in the Chicago metropolitan area.

Participants: Eleven providers who see infants within their first year of life were interviewed.

Intervention/measurements: Participants were interviewed regarding their perceptions of their role in the early detection of PPD.

Results: During the interviews and coding, six themes were identified: Screening Formally and Informally, Providers Perceiving Their Role, I Think There Should Be More Education, Falling Through the Cracks, Clinical Missed Pathways, and A Supportive Organization Has an Impact on the Role of the Provider.

Conclusion: This study demonstrates the need to increase awareness and ensure that proper national guidelines are implemented by health care providers, policymakers, and organizations to secure a proper and efficient protocol to ensure the practice of screening all mothers. In addition, the results from this study have implications for public policy, nursing practice, education, and further research.

Objective: To update and establish content validity for the Checklist of NICU Caregiver Behaviors.

Design: Structured literature review and Delphi analysis.

Setting/local problem: Neonates born prematurely or who are sick in the NICU are frequently exposed to harmful stimuli that can affect brain development and result in adverse neurodevelopmental outcomes. In response to this risk, NICU caregiving now encompasses protecting and promoting neurodevelopment to affect long-term outcomes for neonates and their families. Developmentally supportive care (DSC) includes internationally recognized best practices for the care of neonates in the NICU. Implementation and operationalization of DSC is a priority for neonatology. Although evidence-supported guidelines exist for effective DSC strategies in the NICU, no validated tool exists to support implementation at the point of care.

Participants: Nine expert reviewers from the United States and India including four occupational therapists, one nurse practitioner, one clinical nurse specialist, and three neonatal medicine specialists.

Intervention/measurements: The Checklist of NICU Caregiver Behaviors had been updated based on a structured review of the evidence. The updated checklist was then shared with a group of professionals with DSC expertise who provided further recommendations using a modified Delphi survey process.

Results: The project yielded the current NICU Caregiver Behavior Checklist. Expert reviewers provided 53 actionable recommendations in Round 1 and 18 actionable recommendations in Round 2 to support clarity and use of the tool. In response, the NICU Caregiver Behavior Checklist was reformatted as a collection of five checklists, each representing a core measure of DSC; the introduction section was expanded; language was broadened; and clarifications were provided to promote observations of target behaviors and allow for more site-specific recommendations and assessments.

Conclusion: This evidence-based tool can be used as part of DSC education, as a self-assessment tool, and as a measure of NICU caregivers' use and quality of DSC.

Objective: To describe midwife leaders' (i.e., midwives in managerial positions) perspectives on the forms of obstetric violence (OV) women experience in hospitals in Nigeria.

Design: An interpretative qualitative phenomenological approach and the community readiness model (CRM) were used.

Setting: Three hospitals in Nigeria, where OV is recognized as a violation of fundamental human rights that negatively affects maternal and child health outcomes.

Participants: Six midwife leaders were purposively selected, with two representatives from select government-owned hospitals throughout Nigeria.

Intervention/measurement: Data collection was carried out through key informant interviews and analyzed thematically using NVivo software.

Results: Six themes emerged, highlighting various forms of OV observed by midwife leaders: Physical Abuse, Verbal Abuse, Discrimination Based on Specific Patient Attributes, Nonconsented Care, Nonconfidential Care, and Detainment of Patients.

Conclusion: The findings substantiate the persistent occurrence of OV in government-owned facilities, emphasizing the urgent need for preventive measures to mitigate its detrimental effects on maternal and child health outcomes.

Objective: To increase the number of episodes of vitamin D teaching in the primary care setting for parents of human milk-fed infants and to explore pediatric clinicians' knowledge of vitamin D supplementation in human milk-fed infants and their perception of project intervention usefulness.

Design: Quality improvement project using a quasi-experimental, pretest-posttest design.

Setting/local problem: Despite recommendations from the American Academy of Pediatrics, vitamin D supplementation adherence rates for human milk-fed infants remain low. Parents report vitamin D supplementation teaching in pediatric primary care to be inadequate.

Participants: Three pediatricians and two pediatric nurse practitioners.

Interventions/measurements: A vitamin D educational session for clinicians and an embedded vitamin D template within the electronic health record were implemented into clinicians' daily documentation workflow. Pre- and postintervention vitamin D adherence and clinician-parent teaching data were extracted via chart review for the first four consecutive well-infant maintenance visits. Survey questionnaires assessed clinicians' knowledge about vitamin D supplementation guidelines and intervention content use.

Results: Descriptive statistics and t tests were used to analyze the data. There was a statistically significant 55% change in clinician-parent vitamin D education after the intervention (p = .05). The postintervention vitamin D adherence monitoring documentation demonstrated an increase that was clinically significant for this practice site. One hundred percent of the clinicians reported that the electronic health record template was useful for monitoring vitamin D adherence, and 80% of clinicians stated they would change their practice based on the intervention.

Conclusion: Clinicians' adoption and use of the electronic health record template represents a positive impact. Clinician education and an embedded electronic health record template were associated with an increase in the number of clinician-parent teaching episodes regarding vitamin D supplementation in an infant's first 2 months of life and were associated with clinician behavior change surrounding adherence monitoring.

Cardiovascular disease (CVD) is the leading cause of mortality in women in the United States, and the physiologic changes that occur during perimenopause and menopause can increase women's risk of CVD. Physical activity levels decrease with age, but physical activity can effectively reduce both menopausal symptoms and CVD risk in women. Interventions to increase physical activity and reduce menopausal symptoms and CVD risks in women are often not comprehensive and are unsustainable due to individual contextual barriers. Furthermore, there is a lack of counseling, education, and support for women related to both the menopause transition and prevention of CVD. Theory-based, collaborative interventions addressing physical, social, contextual, individual, and other socioecological factors seem to be the most effective and sustainable and are needed to increase physical activity, reduce CVD risks, and enhance quality of life in menopausal women.

Objective: To understand the perinatal experiences of women with gestational diabetes mellitus (GDM) who intended to breastfeed.

Design: Qualitative descriptive study.

Setting: Online focus groups conducted via Zoom.

Participants: Women who had GDM in their most recent pregnancy, had a full-term birth in the United States, and were no more than 18 months postpartum.

Methods: Virtual focus groups were held between November 2022 and August 2023. Focus group transcripts were coded and analyzed to identify major themes and subthemes.

Results: Three major themes and 14 subthemes emerged: (a) Challenges, including subthemes of GDM Diagnosis, Doubt, Physical Challenges, Balancing Demands, Lack of Support, and Pressure or Judgment; (b) Lack of Informationor SupportFrom Health Care Providers, with subthemes of Separation of GDM From Breastfeeding, Inadequate Information or Support, and Provider Neutrality; and (c) Facilitating or Motivating Factors, including subthemes of Knowledge; Intention, Confidence, and Determination; and Positive Support.

Conclusion: Women with GDM experienced many breastfeeding challenges and felt they had received little information or support from health care providers, including but not limited to nurses. They also expressed feelings of pressure or judgment about their infant feeding choices, reported a desire to know more about the connection between GDM and breastfeeding, and highlighted the value of having support systems in person or online.

Objective: To evaluate whether the use of a labor mirror during the active pushing phase of the second stage of labor is associated with a shorter duration of pushing. Additionally, we examined maternal and neonatal outcomes secondary to mirror use versus non-mirror use.

Design: Retrospective observational cohort study.

Setting/local problem: Community hospital in the midwestern United States with a Level 3 maternity center and approximately 2,000 births annually.

Participants: Four hundred fifty-three women ≥18 years old who had a singleton pregnancy at term (37-41 weeks' gestation) with a spontaneous vaginal birth.

Intervention/measurements: The use of a ceiling-mounted labor mirror offered before or at the beginning of the active pushing phase of the second stage of labor. Use was determined by patient choice.

Results: One hundred seventy-seven (39.1%) women elected use of the labor mirror. Mirror users and nonusers were similar in terms of clinical and demographic characteristics except for epidural use (93.2% vs. 86.6%, respectively; p = .0298). Among nulliparous women who used the mirror, second stage labor duration was shortened by an average of 19.4 minutes (p = .0198). This effect was not seen in multiparous women (p = .2208). Mirror users and nonusers did not differ on rates of postpartum hemorrhage (p = .5498) or chorioamnionitis (p = .6528). Among nulliparous and multiparous women, Apgar scores and NICU admission rates did not differ between mirror users and nonusers.

Conclusion: The labor mirror represents a simple, noninvasive tool for labor and delivery units. Use of the labor mirror during the active pushing phase of the second stage of labor may be associated with decreased pushing duration for nulliparous women.

When a grieving patient needed support, a nurse did her very best to provide it.

Objective: To evaluate the enhanced recovery after surgery (ERAS) protocols used and amount of opioids administered during hospitalization for cesarean birth after the ERAS protocols were implemented.

Data sources: A search was conducted in CINAHL Complete, Scopus, and PubMed for sources published in English between January 2018 and December 2023. Search terms were cesarean AND opioid∗ AND eras OR erac OR enhanced recovery.

Study selection: Eligible studies were conducted in the United States, used key pain management components from the ERAS guidelines, and reported results for in-patient postsurgical opioid use.

Data extraction: Data obtained were for post-ERAS implementation only and included authors, date, sample size, study location, participant inclusion and exclusion criteria, methods, interventions used (ERAS guideline components), and morphine milligram equivalents (MME) used during the hospital stay.

Data synthesis: Weighted averages were calculated for results reported as means and percentages. Descriptive summaries were used for the remainder of the results.

Results: Twenty-six studies were found, accounting for 19,961 individuals' post-ERAS experiences. Although 30% of participants experienced a scheduled cesarean birth, 70% experienced all types of cesarean births, including scheduled, urgent, or emergent. There was substantial heterogeneity of the data reported, especially for how opioid use was measured and analyzed and time frames for opioid use. In 11 studies that reported MME as means, the weighted average for in-patient opioid use was 54 MME per stay. In only 17 studies, researchers reported the number of women who experienced an opioid-free recovery, which averaged 40% of the women.

Conclusion: While implementation of key components of the ERAS protocol is associated with reduced opioid exposure for women experiencing scheduled and nonscheduled cesarean births, a benchmark for the amount of in-patient opioid use was not established. Still, this review offers evidence regarding best practices, lessons learned, and outcome analysis strategies. These findings can support perinatal teams who are considering implementing ERAS for cesarean birth, or those looking for further improvements.