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

Abstract: Per- and polyfluoroalkyl substances (PFAS) constitute a large class of chemicals with widespread exposure in the United States. They are commonly used in products because they repel water, stain, and grease. Concerns about the health impacts from PFAS exposures continue to grow as science has linked this chemical family with a wide range of health effects. A recent report by the Agency for Toxic Substances and Disease Registry ( ATSDR, 2024 ), along with findings from the National Academies of Sciences, Engineering, and Medicine ( NASEM, 2022 ), found sufficient evidence for the following health effects in children: decreased antibody response, dyslipidemia, and decreases in birthweight. For pregnant patients, health effects include gestational hypertension and preeclampsia. Some of these chemicals can pass through human breastmilk and when tested, are routinely found in umbilical cord blood and fetal organs ( ATSDR, 2021 ). Concerns for human health prompted the U.S. Environmental Protection Agency (EPA) to recently regulate five different PFAS and combinations of them. We offer clinical perspectives based on the most current literature to reduce health effects including methods to reduce exposure, implications of lab testing, and clinical management considerations. This topic is important because of widespread human exposure. PFAS may bioaccumulate in humans; may increase cancer risk; have long half-lives in humans; and may affect the developing fetus and child. PFAS levels exceed EPA's Lifetime Health Advisory (LTHA) in drinking water in most states. An overview of this issue and related health concerns is presented in the context of implications for maternity and pediatric patients.

Background: Current education and evaluation methods to support safe monitoring and interpretation of electronic fetal monitoring (EFM) tracings lack rigor. The purpose of this scoping review was to assess the state of EFM education and competence evaluation.

Methods: A systematic search was conducted of peer-reviewed articles between January 2011 and December 2023 using CINAHL, PubMed, and Web of Science. The publications reviewed included findings on EFM education and competence evaluation. Data were synthesized into identified themes.

Results: The search produced 192 initial publications, and after review and analysis, nine were included in the final analysis. The themes identified included educational and evaluation methods and the curricular design. The type of competence evaluation used and the inclusion of essential EFM interpretation components were noted. Processes for the development of curricula and the use of an educational theory were also highlighted. The definition of competence, the effectiveness of educational interventions and evaluation measures, and the inclusion of intra- and interrater consistencies of interpretations were identified as key themes. Of the interventional studies, most used e-learning or a hybrid method including e-learning. An evaluation tool measured effectiveness in most studies; however, many did not set a passing standard. Some operationalized rigorous tools, but few measured the essential components of EFM interpretations or considered interrater consistencies of participants' EFM interpretations.

Clinical implications: There is need to improve education and evaluation of EFM tracing interpretation skills after participating in initial fetal monitoring courses, including integrating evidence-based educational design practices and rigorous learner evaluation to ensure safe and accurate EFM interpretations.

Background: Keeping mothers and babies together after birth has long been described as best practice; however, most organizations in the United States move newborns requiring a higher level of care to a different unit in the hospital. The leadership team at a level II, four-bed neonatal intensive care unit in a community hospital averaging 1,400 births per year recognized an opportunity to potentially improve the care for maternity patients and their families.

Intervention: Instead of high-risk newborns being cared for in the neonatal intensive care unit while their mothers were on the postpartum unit, an innovative model applied the concepts of rooming-in and couplet care in a new way, keeping mothers and their babies that need a higher level of care together. Mothers and babies remain together in a Labor-Delivery-Recovery-Postpartum/Neonatal Intensive Care (LDRP/NICU suite).

Methods: The purpose of the new model of care was to improve patient and family experiences. Data were collected for 2 years prior and for 2 years after implementation of the new model of care. Participants included birth mothers of NICU babies on their day of discharge.

Results: Results include improved employee and provider engagement. Birth volumes have increased since this practice change. This model of care has been successful in our facility and offers the opportunity for families to stay together throughout both mother and newborn's hospital stays.

Objective: In this study, we sought to explain how Latino family caregivers make decisions about where infants sleep using grounded theory methodology.

Setting: Latino family caregivers were recruited from the Midwest using purposive theoretical sampling via social media and word-of-mouth.

Methods: Participants were interviewed virtually via Zoom. Interviews were audio recorded and transcribed. Open coding, selective coding, and theoretical coding were used to create themes and categories.

Results: Forty-five Latino family caregivers participated. The basic social process of Latino family infant sleep decision-making was Caregiver Vigilance . There were three outcomes of the process ( placement in a crib, intentional bedsharing , or unintentional bedsharing ). Six factors ( pediatrician recommendations, family caregivers' beliefs about infant sleeping behaviors, grandmother's advice, postpartum fatigue, breastfeeding , and bonding ) influenced each outcome in patterned ways.

Conclusion: Safe infant sleep decisions among caregivers in the Latino community are complex. Our findings can help nurses assess the needs of the Latino population and address intentional and unintentional bedsharing.

Purpose: To explore the effects of anxiety on the birth experience among Hispanic adolescents 13 to 19 years of age without comorbid major depression, along with selected obstetric and demographic variables.

Study design and methods: Cross-sectional study with a secondary analysis design using demographic information, a subjective rating of the birth experience and anxiety level, and an objective anxiety score using the Edinburg Postnatal Depression Inventory-A (EPDS-A) from 127 Hispanic adolescents.

Results: We found two variables to affect the birth experience: self-reported anxiety (p = .001) and type of birth (p = .001). Three additional variables neared significance indicating potential promise of importance: stress (p = .06), parity (p = .06), and unplanned pregnancy (p = .055). Remaining variables including objective measure of anxiety (p = .504), age (p = .144), and infant complications (p = .153) did not affect the birth experience.

Clinical implications: Our findings encourage attention by nurses and other clinicians to the effects of self-reported anxiety, stress, type of birth, parity, and unplanned pregnancy on the adolescent's birth experience and highlight the importance of an assessment of the birth experience in early postpartum. Prior research on an association between negative birth experiences and potential mental health consequences supports postpartum follow-up for at-risk adolescents.