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

Objective: To increase the percentage of women with severe-range blood pressure during the perinatal period who are treated within 30 min from 25% to at least 50% within 8 weeks.

Design: Plan-Do-Study-Act model comprising four 2-week cycles with data-driven tests of change every cycle.

Setting: A high-volume, community, academic obstetric triage.

Patients: We conducted interventions with women identified at risk for or diagnosed with hypertensive disorder of pregnancy (N = 182). In addition, we surveyed a convenience sample of women (n = 30) about their understanding of hypertension care and maternity care staff (n = 39) about their knowledge of treatment for hypertensive disorders of pregnancy.

Intervention/measurements: We implemented two interventions: standardized screening for hypertensive disorders of pregnancy using a modified preeclampsia early recognition tool and an algorithm-based checklist for effective treatment for hypertensive disorders of pregnancy. We measured use and outcomes through chart review and analyzed data with descriptive statistics.

Results: After the intervention, the percentage of women treated within 30 min increased to 97%. Mean medication administration times decreased from 41.4 to 11.2 min (p < .001), which demonstrated a significant improvement in care.

Conclusion: Standardized screening and care improved time to treatment among women with hypertensive disorders of pregnancy. This advanced practice nurse-led initiative is adaptable for widespread implementation.

Objective: To describe attitudes about trauma-informed care among nurse and physician leaders in birthing hospitals.

Design: Descriptive, cross-sectional survey study.

Setting: In-person meeting in Maryland.

Participants: Nurses (n = 23) and physicians (n = 7) who worked in leadership roles in birthing hospitals.

Methods: We administered a survey that included the Attitudes Related to Trauma-Informed Care (ARTIC-45) scale. We used descriptive statistics and analysis of variance to analyze the data.

Results: The mean ARTIC-45 score for participants was 5.52 (SD = 0.47, range = 4.00-6.43). The Underlying Causes of Problem Behavior and Symptoms of Trauma subscale had the lowest mean score (M = 5.04, SD = 0.74), and the System-wide Support for TIC subscale had the greatest variation (SD = 1.15, range = 1.8-7.0).

Conclusion: Overall, participants had favorable attitudes toward trauma-informed care. The greatest variation in responses was related to attitudes about systems-level support for the provision of trauma-informed care. Organizational support of trauma-informed care is foundational to its provision; therefore, it is essential that health care leaders who work in birth settings recognize the root causes of trauma among their patient populations and critically assess existing systems and policies to ensure that trauma-informed care is consistently provided.

Long-standing mandates in the United States require universal ophthalmic prophylaxis with erythromycin for all neonates, although recent evidence has led to reconsideration of this practice. This intervention was originally adopted to prevent blindness caused by Neisseria gonorrhoeae (gonococcal ophthalmia neonatorum, GON) and Chlamydia trachomatis (chlamydial ophthalmia neonatorum, CON). Today, however, prenatal screening and treatment have rendered such infections rare at birth. Current population data indicate that GON is exceedingly uncommon in the United States and that erythromycin is ineffective at preventing CON. Moreover, concerns regarding antimicrobial resistance, medication shortages, and early microbiome disruption call into question the rationale for maintaining this policy. In this analysis, we integrate contemporary epidemiologic and policy evidence to support the conclusion that continuing universal prophylaxis provides minimal clinical benefit, exposes newborns to unnecessary antibiotics, and conflicts with modern principles of antibiotic stewardship. Risk-based prevention models already adopted in many high-income countries offer a safer and more evidence-aligned alternative. Nurses are uniquely positioned to lead this transition through patient education, antibiotic stewardship, and advocacy for evidence-based neonatal care.

Objective: To examine the psychometric properties of the newly developed Birth Environment Assessment Scale (BEAS).

Design: Descriptive psychometric study.

Setting: Online survey in the United States distributed from April-May 2024.

Participants: Adult women who give birth in the past 5 years (N = 343).

Methods: We determined content validity, evaluated internal consistency, and conducted exploratory factor analysis (EFA) and confirmatory factor analysis (CFA). We used the Edinburgh Postnatal Depression Scale, the Postpartum Specific Anxiety Scale, and the Perceived Stress Scale to evaluate the validity of the BEAS scores. To test for measurement invariance by race, we performed a multigroup analysis.

Results: We identified a two-factor solution through EFA and CFA, and we determined a unidimensional factor structure through item analysis. We found that the BEAS scores correlated with the theoretically relevant psychological variables of postpartum depression, postpartum anxiety, and stress, which demonstrated criterion validity. A multigroup analysis of the BEAS indicated the factor structure was stable across racial groups.

Conclusion: We found evidence to suggest that the BEAS is a valid measure of a woman's perceptions of the birth environment. The BEAS is a new tool that can be used to create supportive, comfortable birth environments.

Objective: To examine factors associated with cesarean birth by race and ethnicity in a health system with a large proportion of midwife-attended births.

Design: Retrospective cohort study using electronic heath record data.

Setting: A multihospital regional health system of community and academic hospitals on the Colorado Front Range.

Participants: Data from the births of women admitted for labor and birth from January 1, 2018 to January 31, 2020 (N = 10,473).

Methods: We identified cesarean births and categorized them by maternal race and ethnicity and the type of provider who managed the labor. We used descriptive statistics to characterize the sample. We used multivariable logistic regression to examine associations among cesarean birth, maternal race and ethnicity, and provider type accounting for hospital geographic location, maternal age, and insurance status by parity.

Results: Cesareans accounted for 13% of total births and 22.4% of births among nulliparous women with term singleton pregnancies with the fetus in vertex position. Nearly 33% of total births were attended by midwives. Compared with non-Hispanic White women, odds of cesarean birth were significantly higher for nulliparous Black/African American women (odds ratio (OR) = 1.55, 95% confidence interval (CI) [1.13, 2.13], p < .05), Asian women (OR = 1.54, 95% CI [1.02, 2.32], p < .05), Hispanic women (OR = 1.36, 95% CI [1.11, 1.65], p > .05), and women of all other races (OR = 1.70, 95% CI [1.27, 2.27], p < .001) as well as multiparous Hispanic women (OR = 1.60, 95% CI [1.18, 2.25], p < .05) and multiparous women of all other races (OR = 2.60, 95% CI [1.64, 4.13], p < .001). Cesarean birth was more likely when a physician compared with a midwife managed the labor course in nulliparous births (OR = 1.38, 95% CI [1.30, 1.50], p < .001) and multiparous births (OR = 1.60, 95% CI [1.36, 1.90], p < .001).

Conclusion: Although overall rates of cesarean birth were low in comparison with state and national averages, racial disparities persisted. Our study findings are aligned with those from previous studies in which researchers demonstrated lower use of cesarean birth with midwifery care and reinforce the importance of examining multilevel influences on cesarean birth.

Objective: To test the association between Prenatal Care Coordination (PNCC) participation during pregnancy and maternal health outcomes among Medicaid beneficiaries in Wisconsin.

Design: Retrospective cohort study using data from birth records linked to Medicaid claims.

Setting: Wisconsin, United States.

Participants: Beneficiaries with live births funded by Medicaid from 2011 to 2019 (full sample: N = 192,511 births; sibling sample: n = 91,329 births).

Methods: We used conventional and sibling fixed effects (FE) linear probability models to test associations between PNCC (none, assessment/care plan only, or service receipt) and maternal health outcomes, including severe maternal morbidity (SMM), any postpartum visit (within 30 days after birth or within 90 days after birth), emergency department (ED) admission within 30 days after birth, and the Kotelchuck Index of prenatal care adequacy. We adjusted our regression models for demographic, health, and birth characteristics.

Results: In conventional models, PNCC service receipt was positively associated with the likelihood of having a 30-day postpartum visit (7.2 percentage points (pp); 95% confidence interval (CI) [6.5, 7.8pp]), a 90-day postpartum visit (7.1pp; 95% CI [6.5, 7.7pp]), and an ED admission (2.3pp; 95% CI [1.8, 2.7pp]). In bias-limiting sibling FE models, PNCC service receipt was positively associated with having a 30-day postpartum visit (2.6pp; 95% CI [1.4, 3.9pp]) and an ED admission (1.1pp; 95% CI [0.3, 2.0pp]), and it was negatively associated with having SMM (-0.4pp; 95% CI [-0.6, -0.1pp]) and having adequate prenatal care (-1.3pp; 95% CI [-2.2, -0.4pp]).

Conclusion: The mixed evidence regarding the benefit of PNCC indicates the program's potential and opportunities for improvement as well as the need to evaluate similar programs in other states.