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

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IF 2 4区医学 Q2 NURSING

Jognn-Journal of Obstetric Gynecologic and Neonatal Nursing

Pub Date : 2025-11-01 DOI: 10.1016/S0884-2175(25)00275-8

引用次数: 0

Human Factors Evaluation of the Use of Workarounds Among Obstetric Nurses 产科护士使用变通方法的人为因素评价。

IF 2 4区医学 Q2 NURSING

Jognn-Journal of Obstetric Gynecologic and Neonatal Nursing

Pub Date : 2025-11-01 DOI: 10.1016/j.jogn.2025.07.004

Samantha L. Bernstein, Lisa-Marie O’Brien, Chrissie Connors

Objective

To identify and categorize components of the work system that obstetric nurses address using workarounds.

Design

Convergent parallel mixed methods.

Setting

Online survey distribution from September 7, 2024, to October 11, 2024, and virtual interviews from September 13, 2024, to November 20, 2024.

Participants

Registered nurses (N = 168) who worked in antepartum, intrapartum, and postpartum settings who completed an online survey and a subset (n = 30) who participated in semistructured interviews.

Methods

We collected data for the quantitative arm using the Nursing Workarounds Instrument and categorized the results according to the Systems Engineering Initiative for Patient Safety (SEIPS) model using descriptive statistics. For the qualitative arm, we used semistructured interviews to obtain a more in-depth understanding of the use of workarounds. We securely recorded, transcribed, checked for accuracy, and coded interviews using content analysis and the SEIPS components as a deductive framework. We used Dedoose software for data analysis and developed a joint display to facilitate data integration and interpretation.

Results

Workarounds were most frequently related to the technology and tools component of the SEIPS model, and most participants (n = 133, 79.2%) reported that problems with technology interfered with their work. Participants described the need to “override” emergency medication systems through workarounds in the electronic medical record and at medication dispensing cabinets. However, nearly all participants reported a preference for following procedures when possible (n = 163, 97.0%).

Conclusion

Participants innovated and implemented workarounds as adaptive responses to operational failures. Quality improvement efforts to improve the work system could reduce the need for workarounds during patient care.

目的：识别和分类产科护士使用变通办法解决的工作系统的组成部分。设计：收敛并行混合方法。设置：2024年9月7日至2024年10月11日进行在线调查分发，2024年9月13日至2024年11月20日进行虚拟访谈。参与者：完成在线调查的产前、产时和产后工作的注册护士（N = 168）和参加半结构化访谈的子集（N = 30）。方法：采用收敛混合方法进行研究。我们使用护理工作环境工具收集定量组的数据，并使用描述性统计根据患者安全系统工程倡议（SEIPS）模型对结果进行分类。在定性方面，我们使用半结构化访谈来更深入地了解变通方法的使用。我们安全地记录、转录、检查准确性，并使用内容分析和SEIPS组件作为演绎框架对访谈进行编码。我们使用Dedoose软件进行数据分析，并开发了一个联合显示器，以方便数据集成和解释。结果：变通方法最常与SEIPS模型的技术和工具组件相关，大多数参与者（n = 133, 79.2%）报告说技术问题干扰了他们的工作。与会者描述了通过电子病历和药物配药柜的变通办法“推翻”紧急药物系统的必要性。然而，几乎所有的参与者都表示在可能的情况下更倾向于遵循程序（n = 163, 97.0%）。结论：参与者创新并实施了变通方法，作为对操作失败的适应性响应。改善工作系统的质量改进工作可以减少患者护理期间对变通方法的需求。

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引用次数: 0

Development and Evaluation of a Conceptual Framework for the Use of Fetal Myelomeningocele Repair 胎儿脊髓脊膜膨出修复的概念框架的发展和评价。

IF 2 4区医学 Q2 NURSING

Jognn-Journal of Obstetric Gynecologic and Neonatal Nursing

Pub Date : 2025-11-01 DOI: 10.1016/j.jogn.2025.09.001

Stephanie A. Eyerly-Webb, Amanda J. Nickel, Amy M. Linabery, Emily F. Barthel, Shukri Jumale, Jill Palmer, Melinda Stober, Nicholas Juckel, Ian Wolfe, Saul Snowise, Clifton O. Brock, Stella K. Evans

Objective

To develop and evaluate a conceptual framework of the use of fetal myelomeningocele/myeloschisis (fMMC) repair.

Design

Exploratory sequential mixed methods study.

Setting

Midwest Fetal Care Center, Minneapolis, Minnesota.

Participants

Fetal care experts (n = 7) and health records of patients evaluated for fMMC repair (n = 159).

Methods

Through an expert roundtable, we developed a conceptual framework for the use of fMMC repair based on Andersen’s behavioral model of health service use (qualitative). We selected variables from our conceptual framework that were available in existing health records to examine associations between contextual and individual factors and eligibility for and use of fMMC repair (quantitative).

Results

Our conceptual framework (qualitative) included predisposing contextual factors (prenatal health care, community norms), enabling contextual factors (health care/insurance policies, referral patterns, center attributes), predisposing individual factors (demographics, beliefs), and enabling individual factors (finances, eligibility). In the quantitative analysis, we found that very few factors were associated with eligibility or use of fMMC repair, with the exception of private health insurance (p = .01), although we did not measure several contextual factors. Most participants (n = 148, 93%) resided in very low/low maternal vulnerability counties, and we observed no differences between the surgical disposition groups (p = .15).

Conclusions

We developed a framework to identify and conceptually relate contextual and individual-level characteristics that may affect the use of fMMC repair. Our conceptual framework may be used by future researchers to fully evaluate the access to and use of fMMC repair.

目的：发展和评估胎儿髓膜膨出/髓裂（fMMC）修复的概念框架。设计：探索性顺序混合方法研究。地点：明尼苏达州明尼阿波利斯中西部胎儿护理中心。参与者：胎儿护理专家（n = 7）和fMMC修复评估患者的健康记录（n = 159）。方法：通过专家圆桌会议，我们在Andersen的卫生服务使用行为模型（定性）的基础上，开发了fMMC修复使用的概念框架。我们从我们的概念框架中选择了现有健康记录中可用的变量，以检查环境和个人因素与fMMC修复资格和使用之间的关联（定量）。结果：我们的概念框架（定性）包括易感环境因素（产前保健、社区规范）、使能环境因素（卫生保健/保险政策、转诊模式、中心属性）、易感个人因素（人口统计学、信仰）和使能个人因素（经济状况、资格）。在定量分析中，我们发现除了私人健康保险外，很少有因素与fMMC修复的资格或使用相关（p = 0.01），尽管我们没有测量几个背景因素。大多数参与者（n = 148, 93%）居住在非常低/低产妇脆弱性县，我们观察到手术处理组之间没有差异（p = 0.15）。结论：我们开发了一个框架来识别和概念上联系可能影响fMMC修复使用的上下文和个人水平特征。我们的概念框架可以被未来的研究者用来全面评估fMMC修复的获取和使用。

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引用次数: 0

Access to Health Care 获得医疗保健。

IF 2 4区医学 Q2 NURSING

Jognn-Journal of Obstetric Gynecologic and Neonatal Nursing

Pub Date : 2025-11-01 DOI: 10.1016/j.jogn.2025.07.001

Association of Women’s Health, Obstetric and Neonatal Nurses

引用次数: 0

Enhancing JOGNN’s Online Presence for Better Access to Evidence 加强johnn的在线存在，以更好地获取证据。

IF 2 4区医学 Q2 NURSING

Jognn-Journal of Obstetric Gynecologic and Neonatal Nursing

Pub Date : 2025-11-01 DOI: 10.1016/j.jogn.2025.10.003

Joyce K. Edmonds

引用次数: 0

The REDUCED Trial: A Cluster Randomized Trial for REDucing the Utilization of Cesarean Delivery for Dystocia 减少试验：一项减少剖宫产难产利用率的聚类随机试验。

IF 2 4区医学 Q2 NURSING

Jognn-Journal of Obstetric Gynecologic and Neonatal Nursing

Pub Date : 2025-11-01 DOI: 10.1016/j.jogn.2025.10.004

Ellise D. Adams PhD, RN

引用次数: 0

Period Poverty Across the Life Course 贯穿一生的贫困时期。

IF 2 4区医学 Q2 NURSING

Jognn-Journal of Obstetric Gynecologic and Neonatal Nursing

Pub Date : 2025-11-01 DOI: 10.1016/j.jogn.2025.10.007

Summer Sherburne Hawkins

Period poverty, defined as inadequate access to menstrual hygiene products due to financial constraints, is a hidden yet pressing public health issue in the United States. Between one-half and two-thirds of adolescents and women experience period poverty, leading to medical, mental health, educational, economic, and social consequences. In this column, I review the epidemiology of period poverty, gaps in research and screening, the importance of patient-provider partnerships, and policy implications. I conclude with information from professional organizations and the call to screen for period poverty in clinical settings.

经期贫困的定义是由于财政拮据而无法获得经期卫生用品，这是美国一个隐藏但紧迫的公共卫生问题。一半至三分之二的青少年和妇女经历经期贫困，导致医疗、心理健康、教育、经济和社会方面的后果。在本专栏中，我回顾了经期贫困的流行病学、研究和筛查方面的差距、患者-提供者伙伴关系的重要性以及政策含义。我总结了来自专业组织的信息以及在临床环境中筛查经期贫困的呼吁。

引用次数: 0

Case Report of Piperacillin-Induced Toxic Epidermal Necrolysis During Pregnancy 妊娠期哌拉西林致中毒性表皮坏死松解1例报告。

IF 2 4区医学 Q2 NURSING

Jognn-Journal of Obstetric Gynecologic and Neonatal Nursing

Pub Date : 2025-11-01 DOI: 10.1016/j.jogn.2025.07.007

Dongqi Yang, Liping Zhou

Toxic epidermal necrolysis (TEN) is a rare condition in the general population, and its occurrence during pregnancy is even more uncommon. Toxic epidermal necrolysis is associated with a high mortality rate that necessitates prompt referral to a specialized burn center upon diagnosis to optimize patient outcomes. In the case presented, the patient was treated in the obstetrics department, where nursing staff may have had limited experience in managing TEN. Currently, no established guidelines are available for the nursing care of patients with TEN during pregnancy. In this case report, we detail the nursing care process for a patient who developed TEN during early pregnancy, provide novel insights, and contribute to the limited literature on the management of pregnancy-associated TEN.

中毒性表皮坏死松解症（TEN）在一般人群中是一种罕见的疾病，在怀孕期间发生更是罕见。中毒性表皮坏死松解与高死亡率相关，需要在诊断后立即转诊到专门的烧伤中心，以优化患者的预后。在本病例中，患者在产科接受治疗，那里的护理人员可能在管理TEN方面经验有限。目前，尚无针对妊娠期TEN患者护理的既定指南。在本病例报告中，我们详细介绍了一位在妊娠早期发生TEN的患者的护理过程，提供了新的见解，并为妊娠相关TEN的管理提供了有限的文献。

引用次数: 0

Patient Disability Status and the Use of Stigmatizing Language in Clinical Notes During Hospital Admission for Birth 住院分娩患者残疾状况及临床记录中污名化语言的使用

IF 2 4区医学 Q2 NURSING

Jognn-Journal of Obstetric Gynecologic and Neonatal Nursing

Pub Date : 2025-11-01 DOI: 10.1016/j.jogn.2025.08.003

Sarah E. Harkins, Ismael I. Hulchafo, Jihye Kim Scroggins, Caroline Walsh, Meghan Didier, Maxim Topaz, Veronica Barcelona

Objective

To examine the association between patient disability status and use of stigmatizing language in clinical notes from the hospital admission for birth.

Design

Cross-sectional study of electronic health record data.

Setting

Two urban hospitals in the northeastern United States.

Participants

Patients at more than 20 weeks gestation admitted for birth from 2017 to 2019 (N = 19,094).

Methods

We used a natural language processing algorithm to identify categories of stigmatizing language used in free-text clinical notes (N = 211,841 unique clinical notes). We employed multivariable logistic regression to estimate adjusted odds ratios (aORs) and 95% confidence intervals (CIs) for each stigmatizing language category by disability status, which we determined by ICD-10 (International Classification of Diseases, 10th revision) codes.

Results

Approximately 3% of patient records (n = 550) included ICD-10 codes for disability. Clinicians were more likely to use stigmatizing language for patients with disabilities compared with patients without disabilities (aOR = 1.75, 95% CI = [1.47, 2.09]). For patients with disabilities compared with patients without disabilities, clinicians were also more likely to use stigmatizing language in the difficult patient category (aOR = 1.96, 95% CI = [1.65, 2.33]) and the unilateral/authoritarian decisions category (aOR = 1.27, 95% CI = [1.06, 1.53]). We found no significant differences for the marginalized language/identities category by patient disability status (aOR = 1.19, 95% CI = [0.87, 1.62]).

Conclusion

The use of stigmatizing language in birth hospitalization notes differed by patient disability status. Stigmatizing language should be used as a marker of bias and an opportunity for clinicians to reflect on their thoughts, words, and actions. Patient-centered documentation and care practices are needed to improve perinatal health for all.

目的：探讨新生儿住院时临床记录中患者残疾状况与污名化语言使用的关系。设计：电子健康记录数据的横断面研究。环境：美国东北部的两家城市医院。参与者：2017年至2019年住院分娩的20周以上妊娠患者（N = 19094）。方法：采用自然语言处理算法识别自由文本临床笔记（N = 211,841个独特临床笔记）中使用的污名化语言类别。我们采用多变量逻辑回归来估计由残疾状况决定的每个污名化语言类别的调整优势比（aORs）和95%置信区间（CIs），我们由ICD-10（国际疾病分类，第10版）代码确定。结果：大约3%的患者记录（n = 550）包含ICD-10残疾代码。与无残疾患者相比，临床医生更容易对残疾患者使用污名化语言（aOR = 1.75, 95% CI =[1.47, 2.09]）。对于残疾患者，与无残疾患者相比，临床医生在困难患者类别（aOR = 1.96, 95% CI =[1.65, 2.33]）和单边/专制决策类别（aOR = 1.27, 95% CI =[1.06, 1.53]）中也更容易使用污名化语言。我们发现边缘化语言/身份类别因患者残疾状况而无显著差异（aOR = 1.19, 95% CI =[0.87, 1.62]）。结论：出生住院记录中污名化语言的使用因患者残疾状况而异。污名化的语言应该被用作偏见的标志，也是临床医生反思自己的思想、言语和行为的机会。需要以患者为中心的记录和护理实践，以改善所有人的围产期健康。

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引用次数: 0

Cervical Ripening and Labor Induction and Augmentation, 6th Edition 宫颈成熟和引产和增强，第6版。

IF 2 4区医学 Q2 NURSING

Jognn-Journal of Obstetric Gynecologic and Neonatal Nursing

Pub Date : 2025-11-01 DOI: 10.1016/j.jogn.2025.03.002

Kathleen Rice Simpson

Cervical ripening and induction and augmentation of labor are common procedures in labor and birth units. The potential risks and benefits of the procedures should be explained to women so they can make an informed decision. Nurses should be knowledgeable about the methods and medications used and be skilled in maternal-fetal assessment. Adequate nurse staffing as per the AWHONN (2022c) Standards for Professional Registered Nurse Staffing for Perinatal Units is required to monitor the woman and fetus to promote the best possible outcomes.

This practice monograph includes information on mechanical and pharmacologic methods for cervical ripening; labor induction and augmentation with oxytocin, a high alert drug; and nurse staffing levels needed to provide safe and effective care during cervical ripening and labor induction and augmentation.

宫颈成熟和引产是产房和产房常见的程序。应该向妇女解释手术的潜在风险和益处，以便她们做出明智的决定。护士应了解所使用的方法和药物，并熟练掌握母胎评估。根据AWHONN （2022c）围产期专业注册护士配备标准，需要配备足够的护士来监测妇女和胎儿，以促进最佳结果。这个实践专著包括信息机械和药理学方法的宫颈成熟；催产素（一种高度警戒药物）引产和增强；在宫颈成熟和引产过程中需要提供安全有效的护理人员。

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Jognn-Journal of Obstetric Gynecologic and Neonatal Nursing

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