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

Purpose: Failure to rescue is the inability to prevent death by timely diagnosis and treatment of a complication. Nurses have a duty to surveil, identify crisis indicators, and take action when necessary. A gap exists in resuscitation literature about mother-baby nurses' experiences identifying neonatal or sudden unexpected postnatal collapse (SUPC) and taking action once discovered, two components of rescue that are critical to quality care. To address the gap, this study investigated mother-baby nurses' experiences identifying and taking action during SUPC.

Study design and methods: For this qualitative descriptive study, mother-baby nurses from three hospitals in Colorado who experienced SUPC participated in semi-structured individual interviews.

Results: Six mother-baby nurses were interviewed in 2021 or 2022. They ranged in age from 29 to 48 years and had between 5 and 25 years of experience. Five of the nurses had completed the Neonatal Resuscitation Program course. Qualitative content analysis revealed two themes. The Assumption of Well represents factors related to identifying SUPC: Family Bonding, Mother-Baby Unit Environment, Teamwork, and Nursing Practice. The Balancing Act of Mother-Baby Nursing highlights those related to taking action: Physical Environment, Patient Experience/Satisfaction, Interdepartmental Culture, and A Low Volume Event.

Clinical implications: Mother-baby nurses, who navigate many challenges as they identify and react to SUPC, should be cognizant of its potential influencing factors. Suggestions for organizations such as increased nurse education, parent education, and nurse staffing based on national standards are provided to optimize nurses' ability to identify and treat SUPC.

Abstract: Amniotic fluid embolism (AFE) is a life-threatening complication occurring during pregnancy, labor, or birth and is characterized by sudden cardio-respiratory collapse and disseminated intravascular coagulopathy. Amniotic fluid embolism is unpredictable, sudden, and complex. Amniotic fluid embolism is one of the causes of peripartum maternal mortality and morbidity in the United States. Nurses and other health care professionals responding to severe maternal events, such as an AFE, may experience trauma, which can lead to reduced executive functions, and challenges with memory, organization, prioritization, and emotional regulation. Amniotic fluid embolism patients and families also experience shock and trauma and may have a difficult time receiving and understanding information conveyed after the event. Communication frameworks commonly used in oncology and trauma settings have been successful in helping plan and guide the delivery of bad news while increasing patient and family understanding. Existing communication frameworks do not address the impact of perinatal nurse and health care professional trauma on their ability to communicate with their patients effectively. Based on feedback from the AFE survivors and clinicians, the AFE Foundation developed the AFE Effective Communication Guide. The Guide acknowledges and validates the impact of perinatal nurse and health care professional trauma and assists them in the planning and execution of effective, trauma-informed communication with patients and families after an AFE or other severe maternal events.

Introduction: Doulas are skilled paraprofessionals who provide supportive care to pregnant women and birthing people resulting in improved outcomes. However, conflicts persist between health care providers and doulas in hospital-based maternity care teams. Few studies have addressed this phenomenon from the doulas' perspective, particularly doulas from racial and ethnic minority backgrounds.

Methods: This qualitative study used individual semi-structured interviews to explore the experiences and perspectives of perinatal doulas caring for pregnant women from various backgrounds. Transcriptions were analyzed.

Results: Seven doulas participated, five of whom self-identified as Black or African American. Three themes were identified: Barriers to Including Doulas in Team-Based Care, Facilitators to Improving Interdisciplinary Collaboration, and Educational Needs and Support. Doulas emphasized the need for mentorship and support for novices transitioning to hospital settings, particularly when caring for high-risk patients.

Conclusions: Doulas are integral in advocating for pregnant women from diverse backgrounds and helping them to navigate complex health care systems. Given the inequities affecting Black and African American maternity patients, incorporating racial minority doulas in team-based care is critical. Career development and mentorship can help novice doulas integrate smoothly into hospital environments.

Background: This integrative review used Whittemore and Knafl's (2005) framework to critique the available quantitative evidence examining multiple types, prevalence, and impact of psychological trauma in labor and delivery nurses. This review synthesizes the quantitative evidence on multiple types of trauma in this population.

Methods: Inclusion criteria were quantitative and mixed-methods studies of labor and delivery nurses examining types of trauma as defined by Foli's Middle-Range Theory of Nurses' Psychological Trauma. Studies on patient trauma from nursing care were excluded. CINAHL, Scopus, Medline, PubMed, and Web of Science databases were searched for studies electronically available through April 8, 2024. The Joanna Briggs Institute critical appraisal tools facilitated quality and bias assessments. A conceptual model based on Foli's theory contextualizes the findings.

Results: Nine studies (five cross-sectional descriptive, one longitudinal, and three mixed-methods) are included in this review. Across all studies, unique aspects of the labor and birth nurse role were found to contribute to trauma, including exposure to perinatal death and fetal demise, high rates of patient trauma, an increasingly medicalized birth environment, and emotional burnout. Labor and birth nurses experienced psychosomatic symptoms, negative effects on their relationships and quality of life, and increased rates of attrition, although nurses also identified specific system supports to decrease these effects.

Discussion: Limited research exists on the types of and impact of trauma experienced by labor and delivery nurses. This integrative review aims to address this gap in knowledge, while also suggesting implications for future research and policy. There is emerging evidence that post-traumatic growth is possible in this population with system support, yet many nurses are unaware of or have inadequate access to such resources. More research is needed to fully understand the magnitude of this population's psychological trauma and provide effective support strategies.