Nursing for Women''s Health最新文献

Objective

To reduce surgical site infections (SSIs) after cesarean birth through a bundled care approach.

Design

Quality improvement project.

Setting/Local Problem

In a community hospital obstetric unit, an increase in SSIs after cesarean birth was observed.

Participants

Nursing leaders, obstetricians, certified nurse-midwives, physician assistants, nurses, scrub technicians, a nursing professional development specialist, and an infection prevention practitioner.

Interventions/Measures

An interdisciplinary team was formed in early 2022, and an evidence-based care bundle including practice changes, education for the team, and enhanced education for patients undergoing cesarean birth was developed and implemented after a review of the literature was completed. All cesarean births were tracked pre- and postintervention to determine the rate of SSIs per 1,000 cesarean births.

Results

A decrease in the rate of SSIs after cesarean birth was observed from preintervention (18.2 per 1,000 cesarean births) to postintervention (11.8 per 1,000 cesarean births).

Conclusion

An evidence-based quality improvement care bundle using a multidisciplinary team approach was associated with reduced SSIs in an obstetric unit.

Objective

To understand if Mini International Psychiatric Interview (MINI) scores in pregnancy are associated with higher scores on the Edinburgh Postnatal Depression Scale (EPDS).

Design

Cross-sectional pilot study of participants who completed the EPDS during pregnancy and were then invited to complete the MINI.

Setting/Local Problem

An urban outpatient clinic at an academic medical setting from November 2020 to June 2021.

Participants

Convenience sample of 20 pregnant people.

Intervention/Measurements

Analysis of variance was used to examine differences based on EPDS scores and MINI symptom burden. Nonparametric tests (Mann–Whitney U or Kruskal–Wallis test) were used if assumptions were violated. Descriptive statistics were used to describe sample characteristics.

Results

Nine participants screened 9 or higher on the EPDS and completed the MINI. There were no significant differences in demographic variables by EPDS score. There were significant differences between demographic variables, including employment status (p = .003) and type of health insurance (p = .019), between participants who met criteria for at least one diagnosis on the MINI and those who did not. Participants with public health insurance met the criteria for four more diagnoses compared to people with private insurance. Participants not employed full-time had nearly five more diagnoses compared to those employed full-time. Higher EPDS scores were correlated with all measured MINI symptoms or diagnoses. Higher EPDS scores were significantly correlated with and showed a moderate to strong positive correlation to suicidality and antisocial personality disorder.

Conclusion

Pregnant individuals who score 9 or higher on the EPDS may also have other severe mental health diagnoses. Recognizing perinatal mood and anxiety disorders in this population can inform the development of screening protocols and interventions during pregnancy to improve maternal access to mental health treatment and symptom reduction.

Objective

To examine the effect of an Emotional Freedom Techniques (EFT) group intervention on perceived stress, depression, and anxiety symptoms in women in the postpartum period.

Design

A one-group pre- and posttest quasi-experimental design.

Setting/Local Problem

Postpartum depression (PPD) and anxiety affect nearly one in five women in the first 12 months after childbirth. The COVID-19 pandemic was associated with a significant worsening of symptoms of PPD, stress, and anxiety in this population. Mental health screening is the standard of care in perinatal settings. This practice has led to an increased rate of PPD and anxiety diagnoses and the need for evidence-based nonpharmacologic interventions to support mothers with PPD and anxiety.

Participants

Eleven mothers seeking care for lactation concerns who screened positive for PPD and anxiety symptoms.

Intervention/Measurements

A total of eight 1-hour group EFT sessions were offered to participants over a period of 4 weeks. During the group sessions, participants were taught how to perform the steps of EFT and apply it in a supportive group format. Measurement tools included the Subjective Unit of Distress Scale, Edinburgh Postnatal Depression Scale, and Generalized Anxiety Disorder–7. The preintervention and postintervention scores of these tools were compared using a paired-samples t test.

Results

After implementing EFT as a group intervention, we observed a reduction in mental health burden experienced by women in the postpartum period. There was a statistically significant decrease in depression (p = .003), anxiety (p <.001), and perceived stress (p <.001) scores 1 month after the EFT intervention.

Conclusion

These findings suggest that EFT may be a viable adjunctive intervention for managing depression, anxiety, and stress in the postpartum period. Further research with larger and more diverse samples is needed to confirm these findings.

Objective

To improve screening for perinatal mood and anxiety disorders (PMAD) and follow-up care while balancing team workload.

Design

Four rapid plan–do–study–act cycles were implemented over 8 weeks.

Setting/Local Problem

At baseline, only 2% of patients with PMAD were identified at a rural obstetric clinic, and none (n = 0 of 50) received screening with a validated tool. Of the 12 patients who had a current or prior history of PMAD, 92% (n = 11) were not screened for self-harm, and 67% (n = 8) received no referral. The clinic had no standardized care for PMAD.

Participants

Patients (n = 253) screened at initial pregnancy intake, early in the third trimester, and at the 6-week postpartum visit.

Intervention/Measurements

Following the screening, brief intervention, and referral to treatment model, patients were screened using the Edinburgh Postnatal Depression Scale, and brief intervention and referral to treatment were used with a point-of-care checklist. Data were collected three times weekly for run chart analysis, and team surveys measured workload.

Results

At the end of 8 weeks, effective screening for PMAD and follow-up care were achieved for 98% of patients and included screening, education, shared decision-making for management, referral, and clinic and phone follow-up to support mental health care uptake.

Conclusions

Standardizing screening and follow-up care can increase identification of PMAD and increase uptake of mental health care. For sustainability, a decision aid can streamline patient–provider communication and reduce visit length.

In this commentary, we present an overview of the accelerating trend toward community-based models for pregnancy care. Doula services, as part of community care programs, are the major target for new coverage changes. Obstetric professionals who include community care providers in their treatment plans can benefit from these local resources in the prenatal, birthing, and postpartum stages of patient management. Including community care programs may help achieve goals of improving health outcomes and health equity.

Objective

To test the feasibility of using telehealth to deliver nutritional counseling by tracking gestational weight gain remotely using Bluetooth weight scales.

Design

Quasi-experimental feasibility study.

Setting

One-on-one nutritional counseling was conducted remotely via a telehealth platform using a registered dietitian.

Participants

Twenty-nine pregnant individuals ages 18 years or older, between 12 and 27 weeks’ gestation, with a prepregnancy body mass index of ≥30 kg/m², singleton fetus, and English proficiency were recruited for the study. Among the 29 potential participants, 20 completed the initial survey and met the criteria; 11 completed the study.

Methods

This study tested the feasibility of using telehealth to deliver nutritional counseling for 30 minutes, once a week, for 6 weeks. Self-weighing was tracked through a preconfigured Bluetooth scale given to study participants that enabled weight data to be automatically uploaded each time the scale was used.

Results

Among the 11 study participants receiving Bluetooth scales, adherence to self-weighing was high (81%). All five participants randomized to nutritional counseling found that telehealth visits with a registered dietitian were easy to use and helpful. Although participants who received nutritional counseling gained 2.5 lb less than those who did not receive nutritional counseling (p = .523), there was no significant difference between the intervention group and historical control individuals (p = .716).

Conclusion

Incorporating telehealth for nutrition counseling and accurate remote weight data collection may be part of a comprehensive strategy to address gestational weight gain in high-risk pregnant populations. Further research with larger samples is needed.

Vasomotor symptoms of menopause, more commonly called hot flashes and night sweats, affect up to 80% of individuals going through the menopausal transition. Hormone therapy with estrogen and often progesterone is the most effective treatment for these symptoms. Many people, however, cannot take estrogen or do not want to take hormones. Many individuals seek nonhormonal, over-the-counter treatment options that have little safety and efficacy information to support their use. In March 2023, the U.S. Food and Drug Administration approved fezolinetant (Veozah), a neurokinin 3 receptor antagonist for the treatment of vasomotor symptoms of menopause. This article presents an overview of fezolinetant, including appropriate usage, adverse effects, its use in special populations, and implications for nursing practice.

Respiratory syncytial virus (RSV) infects nearly all infants in their first year of life and is the leading cause of hospitalization for infants younger than 1 year of age in the United States. Historically, the only option for RSV prevention was palivizumab. However, not all infants are eligible for palivizumab, it requires multiple doses per RSV season, and it is costly. In July 2023, the U.S. Food and Drug Administration approved nirsevimab for the prevention of RSV-associated lower respiratory tract infections for all infants. Nirsevimab inhibits RSV from fusing to cellular membranes and thereby neutralizes the virus in the body. Nirsevimab is expected to significantly reduce the health and economic burdens of RSV. This article provides an overview of nirsevimab, potential adverse effects, and implications for nursing practice.

Immigrant women in the United States are at an elevated risk of poor maternal health outcomes due to cultural, linguistic, or socioeconomic barriers that may lead to critical delays in obtaining adequate health care. Ensuring access to high-quality, culturally appropriate perinatal health care is crucial to improve the health and well-being of immigrant mothers and their children. Various aspects of perinatal health care for immigrant women can be improved through community engagement strategies. Barriers can be addressed by involving community members in designing and delivering culturally appropriate maternal health services. Some strategies discussed in this commentary include working with community health workers, encouraging telehealth through community health workers, providing breastfeeding and mental health support within cultural norms, and involving community-based doulas and midwives.