Mcn-The American Journal of Maternal-Child Nursing最新文献

Purpose: Research on remote monitoring for postpartum patients is lacking, particularly in a Spanish speaking population. We examined satisfaction and engagement with remote blood pressure monitoring by preferred language and other participant characteristics.

Study design and methods: This was an observational longitudinal ohort study of n = 388 Asian, Black, and Hispanic postpartum patients from four hospitals from Philadelphia and New York City recruited between 2022 and 2023. English and Spanish speaking patients were enrolled. Participants were asked to track their blood pressures for 12 weeks after birth via a two-way text platform. We examined engagement with the platform (≥70% response to text prompts).

Results: Most participants reported satisfaction with the program, with 92.0% of English speakers and 96.4% of Spanish speakers reporting satisfaction. Spanish speakers were more likely to engage in the program than English speakers (risk ratio: 1.22; 95% CI: 1.03, 1.44; adjusted risk ratio: 1.21; 95% CI: 1.01, 1.46).

Clinical implications: Among Spanish speakers, text-message-based remote blood pressure monitoring during the postpartum period was satisfactory. Spanish speakers were just as, if not more, likely than English speakers to engage in the remote monitoring program, suggesting the potential utility of remote monitoring for postpartum follow-up among a population at increased risk of adverse maternal outcomes.

Background: Pregnancy is typically considered to be a joyous time, but complications during birth can be traumatizing for patients and their families, affecting their mental health and well-being. Traumatic births are linked to postpartum mental health conditions like depression and post-traumatic stress disorder, leading to significant consequences for mothers, infants, and families.

Purpose: This quality improvement project sought to evaluate whether addressing perinatal trauma through debriefing mitigates the effects of perinatal trauma.

Methods: A program was implemented at a high-risk level IV maternal care hospital that focused on providing comprehensive mental health support to women experiencing significant complications during their birth. Structured debriefs with a registered nurse, optional mental health and pastoral care consultations, impact of event mental health screening, and follow-up assessments were conducted with these mothers. Surveys were administered at the end of the program to determine the effectiveness of the project and the impact of event scoring compared at birth, and 2 and 4 weeks.

Results: Most mothers (84%) found the opportunity to discuss their experience with a registered nurse beneficial. During the clinical debriefs with mothers, a major influence on the mother's perception of her birth was the effectiveness of communication between her and her health care team.

Clinical implications: When labor and birth include traumatic events, debriefing with the patient and follow-up after hospitalization can be helpful to patients and their families in answering questions and understanding what happened and why. Communication with the patient and her family by members of the health care team is critical to patient satisfaction.

Purpose: To explore the personal meanings of being diagnosed with cancer while pregnant in the context of becoming a mother.

Study design and methods: Using a longitudinal, interpretive phenomenological design, women participated in three in-depth, semi-structured interviews. Data were analyzed using interpretive/hermeneutic analysis.

Results: Ten women were interviewed twice during pregnancy and once within 8 weeks postpartum. Three major themes with nine subthemes were identified: The Embodied Understandings of Cancer and Pregnancy (I Still Can, I No Longer Can, I Must); Pregnancy Disrupted (All I Heard was Cancer, Mom Guilt, Meanings of the Pregnancy); and Early Motherhood Disrupted (Birth as a Finish Line or a New Starting Point, The Balancing Act, Mothering Intentions) . Participants described varying degrees of collision they experienced as their mothering identities, intentions, and capabilities collided with cancer. Cancer forced many participants to confront disrupted expectations they held for pregnancy, birth, and early motherhood.

Clinical implications: Nurses and other health care professionals can provide anticipatory guidance and skillful clinical care that recognizes the complexities of disrupted mothering expectations and intentions in all those with cancer during pregnancy. Meeting these needs through tailored support, education, and interventions can balance pregnancy, birth, and postpartum care with cancer management.

Purpose: The purpose in this study was to examine the association of maternity nurse education provided by the hospital with exclusive breastmilk feeding (EBF) and, secondarily, to evaluate the mediating role of in-hospital breastfeeding education for mothers on this relationship.

Study design methods: We used a cross-sectional analysis of the 2022 Maternity Practices in Infant Nutrition and Care (mPINC) survey, which included hospital-level practices related to breastfeeding support, nurse education by the hospital about breastfeeding, and patient education in U.S. hospitals and territories. Data from 1,994 of the 2,779 eligible U.S. hospitals (72% response rate) that participated in the mPINC survey were analyzed.

Results: Hospitals without all required hands-on breastfeeding skills reported significantly lower EBF rates (β = -3.995, 95% CI [-6.37, -1.62]). A lack of all hands-on breastfeeding skills was associated with lower maternal breastfeeding education (β = -0.266, 95% CI [-0.32, -0.22]), and higher maternal breastfeeding education was associated with higher EBF scores (β = 3.244, 95% CI [1.16, 5.33]).

Clinical implications: Hospitals should prioritize hands-on breastfeeding skills for nurses and breastfeeding education for mothers to increase EBF rates.

Purpose: The purpose of this study was to describe US nurses' perspectives and practices on maternal position changes during labor.

Study design: We conducted a national survey of nurses working in labor and delivery units in the past year.

Methods: The survey was disseminated through social media and email with snowball sampling. Our primary objective was to characterize the proportion of nurses using position changes during labor and nurses' reported indications for position changes. Secondary outcomes included the use of position change circuits and reasons position changes were not initiated. We used descriptive statistics to characterize responses and bivariate analyses to compare respondents who reported circuit use in their practice to those who did not.

Results: Among 498 respondents, 99% reported using maternal position changes during labor and 96% believed labor maneuvers are effective and improve outcomes. Nurses routinely reported using positional maneuvers for indications of slow labor progress, suspected occiput posterior, and suspected asynclitic fetal position. Commonly reported reasons for not using position changes included patient BMI, patient preference, fetal monitoring, and a lack of knowledge. Approximately two-thirds of nurses using maneuvers included a circuit of positions. Of the 20 listed maneuvers in the survey, seven were used by >50% of respondents and most likely to be used in a circuit of position changes. Use of circuits was more common among younger nurses. Region of the country was not a factor in use of circuits.

Clinical implications: Position changes are a frequently used intrapartum intervention with limited high-quality supporting evidence linking specific positions or circuits of positions to specific labor and birth outcomes. Further research is needed on the effectiveness of circuit-based position changes in labor, especially in cases of prolonged first stage of labor.