Jognn-Journal of Obstetric Gynecologic and Neonatal Nursing最新文献

Dysphoric milk ejection reflex (D-MER) is a dysregulation of emotions (dysphoria) that can occur during the milk ejection reflex and during breastfeeding or expressing breast milk. Symptoms of D-MER present suddenly and can include hopelessness, sadness, nervousness, irritability, nausea, dread, palpitations, and a hollow feeling in the stomach. Although D-MER was first reported in 2007, it remains understudied to date and should not be confused with postnatal depression or anxiety disorders. Knowing that they are experiencing symptoms of a named condition is very supportive for women who experience D-MER. It is important that health care professionals who interact with the breastfeeding dyad be aware of D-MER so they can provide supportive care, manage symptoms, and protect the breastfeeding relationship. In this article, we describe the case of a woman who experienced D-MER while she breastfed her newborn.

Objective: To more clearly understand the use of stigmatizing and nonstigmatizing language in electronic health records in hospital birth settings and to broaden the understanding of discrimination and implicit bias in clinical care.

Design: A secondary qualitative analysis of free-text clinical notes from electronic health records.

Setting: Two urban hospitals in the northeastern United States that serve patients with diverse sociodemographic characteristics during the perinatal period.

Participants: A total of 1,771 clinical notes from inpatient birth admissions in 2017.

Methods: We used Krippendorff's content analysis of categorial distinction to identify stigmatizing and nonstigmatizing language. We based our categories for the content analysis on our pilot study and preexisting categories described by other researchers. We also explored new language categories that emerged during analysis.

Results: We reviewed 1,771 notes and identified 10 categories that demonstrated stigmatizing language toward patients, nonstigmatizing language toward patients, and stigmatizing language among clinicians. We identified a new stigmatizing language category, Unjustified Descriptions of Social and Behavioral Risks. Positive or Preferred Language and Patient Exercising Autonomy for Birth are two new categories that represent language that empowers patients. Clinician Blame and Structural Care Barriers are new language categories that imply complex interprofessional dynamics and structural challenges in health care settings that can adversely affect the provision of care.

Conclusions: The results of this study provide a foundation for future efforts to reduce the use of stigmatizing language in clinical documentation and can be used to inform multilevel interventions to reduce bias in the clinical care in birth settings.

Objective: To develop a deeper understanding of the health care experiences of women of color affected by severe maternal morbidity (SMM) or birth complications in the United States and opportunities to improve the delivery of maternal health care.

Data sources: PubMed, CINAHL, Embase, and Scopus.

Study selection: We included qualitative studies on the experiences of pregnancy or childbirth among women of color in the United States published within the past 10 years (to reflect recent societal events and obstetric practices) in which researchers examined women's experiences of SMM or birth complications.

Data extraction: Five reports of qualitative research studies met inclusion criteria. We assessed the methodological quality of each study using the JBI (Joanna Briggs Institute) critical appraisal checklist for qualitative research. We extracted the following data from the included studies: participants' demographic characteristics (i.e., race/ethnicity, age, experiences), methodological characteristics of the studies (i.e., sample size, research design, data collection, data analysis), and individual study metaphors (i.e., concepts, phrases, participant quotes) related to the overarching themes.

Data synthesis: We used the meta-ethnographic approach of Noblit and Hare (1988; Meta-ethnography: Synthesizing qualitative studies; Sage) to critically examine studies, translate the studies into one another, and synthesize reciprocal translations. Four overarching themes emerged from the meta-synthesis: Lack of Knowledge; Stigma, Discrimination, and/or Bias; Provider Communication Issues; and Barriers to Care and Services. Each overarching theme had complicating factors, which represented factors that exacerbated problems, and mitigating factors, which represented factors that alleviated some negative experiences. Complex layers of varying demographic characteristics and social determinants of health shaped women's individual experiences.

Conclusion: The experiences of women of color with SMM or complications during pregnancy and/or childbirth reveal shortcomings in the delivery of maternal health care. Findings suggest opportunities for improvement across various levels of the health care system. Further qualitative studies using high-quality methodology are needed on this topic given that the research is limited.

Objective: To identify nurse perceptions of barriers to performing recommended infection prevention and control practices in labor and delivery to inform future resources tailored to this setting.

Design: Qualitative focus groups.

Setting: The 2023 annual convention of the Association of Women's Health, Obstetric and Neonatal Nurses, New Orleans, LA.

Participants: A convenience sample of 16 labor and delivery nurses.

Methods: Staff of the Centers for Disease Control and Prevention conducted two focus groups using a standardized script. Coding was performed by three reviewers using Krueger's systematic analysis process.

Results: Among the 16 participants, 94% were registered nurses, and 6% were advanced practice registered nurses. From our analysis of the data, five major themes emerged, including the following: Lack of Individual and Organizational Accountability in Implementing Recommended Infection Prevention and Control Practices; Inconsistent Application of Guidance Across State, Hospital, and Specialty; The Unpredictable Nature of the Labor and Delivery Setting; Labor and Delivery Is Not Prioritized in the Hospital for Infection Prevention and Control Resources; and Lack of Coordination Across Stages of Care From Prenatal to Postpartum.

Conclusion(s): We identified barriers experienced by nurses to consistently implementing infection prevention and control practices in the labor and delivery setting. These barriers can be addressed through targeted interventions and the development of obstetric-specific infection prevention and control resources.

Objective: To describe the mental health experiences of Muslim American women in the perinatal period.

Design: Qualitative descriptive.

Setting: Telephone interviews.

Participants: Eighteen Muslim American women who gave birth in the last 12 months.

Methods: We used a semistructured guide to conduct individual interviews and thematic network analysis to identify key themes across the interviews.

Results: Participants had a mean age of 32.5 years, 83% were White, and 17% were Asian. Educational attainment ranged from high school diploma to doctorate degree (83% completed a bachelor's degree or higher), and 83% reported U.S. citizenship. We identified four organizing themes: Need for Tailored Mental Health Support; Challenging Screening Experiences; Mental Health Experiences That Affect Maternal-Infant Bonding; and Faith, Culture, and Mental Health.

Conclusion: Findings underscore the need for culturally responsive mental health screening and enhanced support tailored to Muslim American women during the perinatal period. Health care providers should use culturally sensitive care approaches to build trust and enhance mental health outcomes.