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

英文中文

Care Coordination During Pregnancy and Maternal Health Outcomes in a Medicaid Population. 医疗补助人群孕期护理协调与孕产妇健康结果

IF 2 4区医学 Q2 NURSING

Jognn-Journal of Obstetric Gynecologic and Neonatal Nursing

Pub Date : 2025-11-08 DOI: 10.1016/j.jogn.2025.10.011

David C Mallinson, Kate H Gillespie, Yamikani B Nkhoma-Mussa, Madelyne Z Greene

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.

目的：检验威斯康星州医疗补助受益人孕期产前护理协调（PNCC）参与与孕产妇健康结局之间的关系。设计：回顾性队列研究，使用与医疗补助申请相关的出生记录数据。背景：威斯康星州。参与者：2011年至2019年由医疗补助计划资助的活产受益人（全样本：N = 192,511例出生；兄弟姐妹样本：N = 91,329例出生）。方法：我们使用传统和兄弟姐妹固定效应（FE）线性概率模型来检验PNCC（无PNCC、仅评估/护理计划或服务接收）与孕产妇健康结局之间的关系，包括严重孕产妇发病率（SMM）、产后任何就诊（出生后30天内或出生后90天内）、出生后30天内急诊（ED）入院以及产前护理充分性的Kotelchuck指数。我们根据人口统计、健康和出生特征调整了回归模型。结果：在传统模型中，PNCC服务收据与产后30天访问的可能性呈正相关(7.2个百分点（pp）；95%可信区间（CI） [6.5, 7.8pp])、产后90天就诊（7.1pp; 95% CI [6.5, 7.7pp]）和急诊科入院（2.3pp; 95% CI [1.8, 2.7pp]）。在偏倚受限的兄弟姐妹FE模型中，PNCC服务接收与产后30天就诊（2.6pp; 95% CI [1.4, 3.9pp]）和ED入院（1.1pp; 95% CI [0.3, 2.0pp]）呈正相关，与SMM （-0.4pp; 95% CI [-0.6, -0.1pp]）和充分的产前护理（-1.3pp; 95% CI [-2.2, -0.4pp]）呈负相关。结论：关于PNCC益处的混合证据表明该计划的潜力和改进机会，以及评估其他州类似计划的必要性。

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引用次数: 0

The Evolution of Grounded Theory 扎根理论的演变。

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.2025.08.002

Cheryl Tatano Beck DNSc, CNM, FAAN

引用次数: 0

Implementation of Team Communication and Nurse Feedback to Reduce Cesarean Rates 实施团队沟通和护士反馈以降低剖宫产率。

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.2025.07.005

Jennifer L. Suess, Rhoda Vandyck, Michelle Telfer

Objective

To implement an interprofessional communication tool before non-emergent cesarean births and evaluate individual nurse cesarean rates for women with low-risk pregnancies.

Design

A quality improvement initiative using four Plan–Do–Study–Act cycles over a 6-month period in 2022.

Setting

U.S. Mid-Atlantic maternity unit with a Level III NICU during the COVID-19 pandemic.

Patients/Participants

Nulliparous women with term singleton pregnancies in which the fetus was in vertex presentation (NTSV) who underwent non-emergent cesareans (N = 868) and their interprofessional clinical teams, including nurses, certified nurse midwives, attending physicians, and resident physicians.

Interventions

Implementation of a validated, adapted communication tool for use by the clinical team before non-emergent cesareans. We added individual nurse cesarean rates for women with NTSV pregnancies to the existing clinical audit and feedback process. We collected compliance data through chart reviews and an Epic report.

Main Outcome Measure(s)

Rates of compliance with use of the tool and variation in individual nurse cesarean rates for women with NTSV pregnancies.

Results

Compliance with use of the tool averaged 62% and peaked at 77% during active education efforts but declined to 33% after implementation. We noted wide variation in individual nurse cesarean rates for women with NTSV pregnancies (0.00%–45.45%) among nurses who managed 10 or more eligible births over 5 months. We identified positive outliers or nurses who consistently had low cesarean rates.

Conclusion

Achieving high compliance with the use of an interprofessional communication tool before non-emergent cesareans requires sustained education and engagement. Integrating the communication tool into existing workflows may enhance its long-term effect. The variability in individual nurse cesarean rates that we found suggests a need for further investigation into nursing practices that support physiological birth and reduce unnecessary cesareans.

目的：应用非紧急剖宫产前专业间沟通工具，评价低危妊娠妇女个体护士剖宫产率。设计：在2022年为期6个月的时间内，采用四个计划-执行-研究-行动周期进行质量改进倡议。环境：在COVID-19大流行期间，美国大西洋中部的三级新生儿重症监护病房。患者/参与者：接受非紧急剖宫产且胎儿处于顶点呈现（NTSV）的足月单胎妊娠妇女（N = 868）及其跨专业临床团队，包括护士、注册护士助产士、主治医师和住院医师。干预措施：在非紧急剖宫产前实施一种经验证的、适应的沟通工具，供临床团队使用。我们在现有的临床审计和反馈过程中增加了NTSV妊娠妇女的个别护士剖宫产率。我们通过图表审查和Epic报告收集合规数据。主要结果测量：NTSV妊娠妇女的工具使用依从率和个别护士剖宫产率的变化。结果：使用该工具的依从性平均为62%，在积极教育期间达到77%的峰值，但在实施后下降到33%。我们注意到，在5个月内管理10个或更多合格分娩的护士中，NTSV妊娠妇女的个别护士剖宫产率差异很大（0.00%-45.45%）。我们确定了积极的异常值或一直具有低剖宫产率的护士。结论：在非紧急剖宫产手术前使用跨专业沟通工具需要持续的教育和参与。将通信工具集成到现有工作流中可以增强其长期效果。我们发现个体护士剖宫产率的差异表明需要进一步研究支持生理性分娩和减少不必要剖宫产的护理实践。

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引用次数: 0

Critical Juncture for Newborn Screening in the United States 美国新生儿筛查的关键时刻。

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.2025.08.004

Mindy B. Tinkle

In April 2025, the U.S. Department of Health and Human Services (HHS) eliminated a key committee in the national newborn screening system, the Advisory Committee on Heritable Disorders in Newborns and Children (ACHDNC). The ACHDNC is responsible for assessing scientific evidence and recommending new policies and conditions for nationwide newborn screening. In the absence of the ACHDNC, no formal process exists for reviewing and recommending new conditions nationwide. In this article, I examine the implications of the committee’s termination and consider possible policy pathways to fill the resulting gap, including a model proposed in a recent National Academies of Sciences, Engineering, and Medicine report. These policy considerations are occurring during a time of major restructuring within HHS in terms of shifting priorities, organizational realignment, and budget debates. Nurses can play a vital role in shaping newborn screening policy through advocacy, collaboration, and education.

2025年4月，美国卫生与公众服务部（HHS）取消了全国新生儿筛查系统中的一个关键委员会——新生儿和儿童遗传性疾病咨询委员会（ACHDNC）。ACHDNC负责评估科学证据，并为全国新生儿筛查提出新的政策和条件建议。在没有全国人权委员会的情况下，没有正式的程序来审查和建议全国的新条件。在本文中，我研究了委员会终止的影响，并考虑了可能的政策途径来填补由此产生的空白，包括最近美国国家科学院、工程和医学报告中提出的一个模型。这些政策考虑是在卫生与公众服务部在转移优先事项、组织重组和预算辩论方面进行重大重组期间发生的。护士可以通过宣传、合作和教育在制定新生儿筛查政策方面发挥至关重要的作用。

引用次数: 0

At Your Service 随时为您服务

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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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

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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

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