Nursing for Women''s Health最新文献

This short review summarizes two recent U.S.-based studies in which researchers evaluated the impact of the COVID-19 pandemic on postpartum outcomes. The first study examined the neurodevelopmental status of infants born to women infected with SARS-CoV-2, and the second examined psychological risks to maternal–infant bonding. Results indicated that pandemic-related stressors likely contributed to diminished maternal–infant health outcomes. It is imperative that nurses stay informed on the latest science exploring the impact the pandemic has had on the health and well-being of pregnant persons and infants.

Objective

To assess the knowledge and perceptions of midwifery students regarding a midwifery-led model of care.

Design

Cross-sectional study.

Setting

A nursing college in North Karnataka, India. The midwifery-led care model is a relatively new concept in India. In 2018, guidelines on midwifery services in India were released during the Partners Forum held in New Delhi as the initiation of the model and with the support of the Ministry of Health and Family Welfare. The initiative began with the training of nurse practitioners in midwifery and is progressing.

Participants

Final-year diploma and bachelor’s degree students.

Methods

Participants completed an online survey, which consisted of a 20-item questionnaire with a 5-point Likert scale to collect their knowledge and perceptions of the midwifery-led model of care. Descriptive statistics were used to describe the knowledge and perceptions of the students, including the mean, standard deviation, frequency, and percentage. Chi-square analysis and the Pearson’s correlation coefficient were used to assess relationships between variables of interest.

Results

Among the 165 participants, 85.5% (n = 141) had a poor level of knowledge of the midwifery-led care model, and only 14.5% (n = 24) showed average knowledge, with none possessing adequate knowledge. Notably, gender was significantly associated with knowledge (p < .05), with female participants demonstrating lower knowledge levels compared to male participants. A substantial portion (76.4%, n = 126) had a negative perception of the midwifery-led care model, 23.6% (n = 39) had a neutral perception, and none had a positive perception. There was no significant correlation between students’ knowledge and perceptions of the midwifery-led model of care.

Conclusion

These results suggest that there is an urgent need for awareness, knowledge, and educational initiatives to help nursing students in India better comprehend the midwifery-led model of care and to strengthen the midwifery training in nursing colleges.

Hyperemesis gravidarum is the most common condition requiring hospital care for women during the first 20 weeks of pregnancy and may lead to malnutrition, dehydration, and vitamin deficiencies. Depletion of vitamins such as thiamine may result in the development of Wernicke encephalopathy, a severe neurological disorder that can increase the risk for mortality and morbidity for the mother and fetus. A lack of awareness regarding the relationship of hyperemesis gravidarum and Wernicke encephalopathy may result in delayed treatment and disease management. Glucose administration in the presence of thiamine deficiency may induce Wernicke encephalopathy; protocols are needed to ensure dextrose is used for women with hyperemesis gravidarum in times of prolonged vomiting and poor oral intake only after first administering thiamine. This article includes a discussion of best practices for thiamine supplementation with hyperemesis gravidarum and Wernicke encephalopathy.

Objective

To explore the experience of drug withdrawal among pregnant women in jail.

Design

A qualitative interpretive descriptive approach.

Setting/Problem

The care of incarcerated pregnant women constitutes a complex and significant public health problem. Many have substance use disorder (SUD) and cycle in and out of jails in their community, resulting in repeated experiences of drug withdrawal. Most jails do not provide medication-assisted therapy for management of withdrawal, a situation that violates standards of care set by leading health organizations. The experience of drug withdrawal among pregnant women in jail has not been qualitatively explored in the literature.

Participants

Five women completed interviews for the study.

Intervention

In-depth, qualitative interviews.

Results

Five themes with subthemes emerged from the interviews: Framing the Story Through Life History: I Need You to Know Where I Come From, Patterns of Thinking About Substance Use, The Manifestations of Withdrawal: Body and Mind, Perceived Punishment for Drug Use During Pregnancy, and Mixed Perceptions of Withdrawal Treatment.

Conclusion

Participants told a story beyond that of the physical withdrawal symptoms, revealing new insights into their maternal distress and the need for compassionate, nonstigmatized care to address physical and mental symptoms, as well as advocacy for the provision of an evidence-based standard of care. Nurses who care for pregnant women with SUD in the jail setting could benefit from collaborative relationships with other health care professionals in the community to reduce disparate health outcomes for this vulnerable population.

Objective

To improve screening for depression in patients who are initiating fertility treatment at a reproductive endocrinology and infertility (REI) center by screening all patients at their initial visit using the Patient Health Questionnaire–9 (PHQ-9).

Design

This quality improvement project was conducted using a plan–do–study–act cycle implemented with a postintervention study design.

Setting/Local Problem

A medium-size REI center in a mid-Atlantic U.S. metropolitan area where screening for mental health status in patients initiating fertility treatments was not occurring.

Participants

Patients who were scheduled in person with REI providers for a new patient consult regarding fertility were declared eligible.

Intervention/Measurements

The PHQ-9 was administered by providers at initial consults for patients seeking fertility treatments from October 2022 to February 2023. Three cycles of the plan–do–study–act model were used to execute change. For all patients who scored 5 to 9 (mild depression), conversations regarding counseling referrals occurred. For all patients who scored ≥10 (moderate to severe depression), a referral for counseling and medication management was generated. Data were analyzed via descriptive statistics.

Results

A total of 115 participants were included. A screening rate of 84.3% (n = 97) was achieved for patients initiating treatment. Of the 97 screened, 21 patients had a score of ≥5; 19 were given a referral for counseling. However, none of the patients attended a counseling session or started medication prescribed by their primary care provider during the 2-month follow-up period. Barriers identified included costs, personal preferences, and access to services.

Conclusion

The PHQ-9 screening tool was implemented at an REI clinic to improve the frequency of mental health screenings and provide necessary referrals. However, additional follow-up is needed to ensure patients are receiving appropriate mental health care.

Objective

To identify and evaluate barriers to and facilitators of screening for postpartum depression (PPD) during well-child visits in the United States. Additionally, to describe prior work on PPD screening tool evaluation and outcomes from PPD screenings conducted within the well-child setting.

Data Sources

A systematic review was conducted following Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. Five databases (Pub Med, PsycINFO, Web of Science, CINAHL, and Cochrane Library) were searched.

Study Selection

Randomized controlled trials, case studies, cross-sectional studies, case–control studies, cohort studies, qualitative studies, and quasi-experimental studies conducted in the United States were included. The Standard Quality Assessment Criteria Tool (QualSyst) was used to assess the methodologic quality of each included study.

Data Extraction

Sample, setting, methods, screening tools used, location of study setting, intervention, and salient findings were extracted and summarized for further analysis and synthesis.

Data Synthesis

Quantitative studies were rated on 14 aspects, and qualitative studies were rated on 10 aspects, per QualSyst. Studies received a score of 2, 1, 0, or not applicable based on scoring criteria, with higher scores indicating greater methodologic quality.

Conclusion

We found that barriers to PPD screening included concerns regarding time for screening, adequate training, and limited ability for referral. Facilitators of PPD screening included electronic prompts for providers, as well as tool availability and familiarity. Our results indicate that education and training about PPD screening in the pediatric setting are important next steps in addressing the rising concern of PPD in the United States.