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

Background: Almost 6% of new mothers will experience postpartum depression (PPD) during the 12-month postpartum period.

Problem: PPD is often undiagnosed, underdiagnosed, and untreated, increasing the risk for maternal mortality, which is highest in the second half of the postpartum period.

Methods: This quality improvement project started with educating a pediatric clinic team about a PPD Screening and Referral Pathway and then applying it to their practice when seeing new mothers and their infants during the first 12 months postpartum.

Interventions: The PPD Pathway has instructions for the clinic team to give mothers the Edinburgh Postnatal Depression Scale (EPDS), complete the Receptionist Tracking Form, evaluate the EPDS, refer mothers who screen positive for PPD to behavioral health services, scan the EPDS into the mother's medical record, and complete the Referral Tracking Form.

Results: The clinic team screened 112 mothers in 15 weeks from July to October 2024. Overall EPDS scores indicated possible distress (n = 112, m = 5.79±5.83). Over 15 weeks, 25% (n = 28) of mothers screened positive and received a referral to behavioral health services. The average infant age at the time of positive screen was 18 weeks (m = 4.2±3.49). Positive screens were steady during the first 9 months of the postpartum year with 22.4% at 0-3 months, 21.2% at 3.5-6 months, and 25% at 6.5-9 months. However, positive screens peaked with 80% at 9.5 to 12 months. Results from the Normalization Measure Development (NoMAD) questionnaire indicate that the clinic team wants to continue the PPD Pathway, which became a clinic quality measure.

Conclusion: Pediatric nurse practitioners and physicians can fill a gap in maternal care by screening for PPD, which can begin or intensify after the final postpartum obstetric visit. A standardized PPD Pathway is effective, feasible, and sustainable within the pediatric clinic setting.

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.

Purpose: The purpose of this study is to describe the experiences of women with symptoms of perinatal mental health disorders who recently gave birth and participated in a virtual peer support specialist program for maternal mental health during the COVID-19 pandemic.

Study design and methods: A qualitative descriptive design was used to describe the experiences of six women with symptoms of perinatal mental health disorders who participated in a peer support specialist program. Participants were recruited from online Indiana-based Facebook parenting groups targeted to women with young children. Semi-structured interviews were conducted, and data were analyzed using a basic inductive content analysis.

Results: We identified three main themes: 1) Seeking help for mental health symptoms, 2) Receiving unbiased peer support, and 3) Improving mental health symptoms.

Clinical implications: Implications for nursing practice include developing strategies to increase peer networks for women in the perinatal period, increasing the screening of women for symptoms of perinatal mental health disorders, and conducting more research on the efficacy of a peer support specialist programs for improving maternal mental health.

Purpose: The purpose of this quality improvement project was to promote newborn thermoregulation.

Background: Thermoregulation is a primary concern in the newborn population because poor thermoregulation contributes to impaired metabolic functioning, specifically glucose and respiratory regulation. In severe cases, if untreated, impaired thermoregulation can lead to increased risk of morbidity and mortality.

Methods: Two types of newborn bathing methods were evaluated for their effects on thermoregulation in a sample of healthy newborns: traditional sponge baths and immersion swaddle baths. Nurses monitored newborn temperatures pre- and postbathing. Temperatures were taken immediately prebath then postbath for each bathing technique until the infants were warm. Weekly data were collected over the course of 6 weeks, with 2 cycles of sponge and swaddle baths for comparison. The goal was to decrease the amount of time infants spent under the warmer after their first bath. Three Plan-Do-Study-Act cycles were initiated throughout this project to monitor existing bathing methods as well as successful implementation of the change.

Results: Ninety newborns were enrolled; 30 preintervention and 60 newborns per postintervention (30 per cycle). Postintervention, significant improvements in thermoregulation were found among immersion swaddle bath infants in shorter return times to baseline prebath temperatures ( p = .001).

Conclusion: In this project, introduction of immersion swaddle bathing positively correlated with improved thermoregulation in newborns. Using swaddle bathing instead of traditional sponge bathing may potentially have positive implications in other newborn settings. More research is needed on types of newborn bathing techniques.

Purpose: Medicaid-eligible pregnant women are a chronically stressed population with various negative perinatal effects due in part to their challenging financial status. Increasingly, they use social media to obtain social support; however, experiences of using social media for social support are unknown. The purpose of this study was to explore experiences of Medicaid-eligible pregnant women using Facebook groups.

Study design and methods: Semistructured interviews of pregnant women who used Facebook groups for social support were conducted. Eligibility or insurance coverage by Medicaid was considered as a proxy for low socioeconomic status. Thematic analysis was completed.

Results: Fourteen pregnant women were interviewed. Several themes were identified. The overarching theme was social support through an online community, connections, and information support with affirmation woven through to build connections. Participants felt nurses, midwives, and physicians should recommend Facebook groups to obtain social support.

Clinical implications: Most participants found their experiences via Facebook overwhelmingly positive, even if they had some negative encounters. Participants found social support via Facebook groups. Recommendations for nurses include recognizing social media as a venue to access social support, starting peer-led communities for Medicaid-eligible women using social media, and engaging in policy work on social media recommendations for pregnant women. It is unknown what effect this social support has on their chronic stress.