-
MCN. the American Journal of Maternal...Planning safe and effective nurse staffing can be challenging for nurse leaders of labor and delivery units due to the dynamic nature of birth and unpredictable...
BACKGROUND
Planning safe and effective nurse staffing can be challenging for nurse leaders of labor and delivery units due to the dynamic nature of birth and unpredictable fluctuations in census and acuity. The electronic health record (EHR) has a vast source of patient data that can be used to retrospectively review patient needs and nurse staffing gaps that can serve as a basis for prospective planning for nurse staffing.
PURPOSE
This quality improvement project was initiated with the goal of developing real-time and longitudinal reports to quantify hourly nurse staffing needs based on patient census, acuity, and required clinical interventions from data that are contained with the EHR. The plan was to determine trends and nurse staffing needs for each 24-hour period every day of the week and identify ongoing staffing patterns to meet the Association of Women's Health, Obstetric, and Neonatal Nurses' (AWHONN) staffing guidelines.
METHODS
The obstetric nursing leadership team worked with the information technology specialists and developed an algorithm that identifies patient acuity level, indicated clinical interventions, and outlines necessary staffing requirements to provide safe high-quality care. Various reports were built in the EHR to inform the nursing leadership team about nurse staffing on a real-time and historical basis.
RESULTS
The reports provided quantitative data that supported a budgetary increase in nurse staffing and a more flexible nurse staffing scheduling system to meet the needs of the patients. The project was successfully implemented in all four of the hospital system maternity units.
CLINICAL IMPLICATIONS
Use of EHR in labor and delivery units is nearly universal. Working with the information technology specialists to integrate nurse staffing data into the EHR is one way to align nurse staffing with the AWHONN nurse staffing standards in real-time and for projections of nurse staffing needs based on unit historical patient data.
Topics: Electronic Health Records; Female; Humans; Infant, Newborn; Nursing Staff, Hospital; Personnel Staffing and Scheduling; Pregnancy; Prospective Studies; Retrospective Studies; Workforce
PubMed: 35466961
DOI: 10.1097/NMC.0000000000000838 -
Journal of Obstetric, Gynecologic, and... Jul 2022Since 1972, the year of the inaugural issue of Journal of Obstetric, Gynecologic, & Neonatal Nursing, substance use during pregnancy has remained a public health concern...
Since 1972, the year of the inaugural issue of Journal of Obstetric, Gynecologic, & Neonatal Nursing, substance use during pregnancy has remained a public health concern in the United States. This concern is currently exacerbated by factors such as the opioid and stimulant use crisis and widening health and social inequities for many women and families. The purposes of this historical commentary are to describe trends in the perception of women with substance use disorder and their infants and related sociolegal implications and to trace the evolution of related nursing practice and research during the past 50 years. We provide recommendations and priorities for practice and research, including further integration of support for the mother-infant dyad, cross-sectoral collaborations, and equity-oriented practices and policies.
Topics: Female; Humans; Infant; Infant, Newborn; Mothers; Obstetric Nursing; Pregnancy; Substance-Related Disorders; United States
PubMed: 35568096
DOI: 10.1016/j.jogn.2022.03.004 -
Asian Nursing Research Aug 2022The aim of this paper is to develop a scale for measuring the perinatal bereavement care competence of midwives and assess its psychometric properties. (Review)
Review
PURPOSE
The aim of this paper is to develop a scale for measuring the perinatal bereavement care competence of midwives and assess its psychometric properties.
METHODS
The Perinatal Bereavement Care Competence Scale was developed in four phases. (1) Item generation: 75 items were formulated based on a literature review and interviews with midwives. (2) Delphi expert consultation: 15 experts evaluated whether the items were clear/appropriate/relevant to the questionnaire dimensions, and the items were optimized. (3) Pilot test: The comprehensibility, acceptability, and time required to complete the questionnaire by midwives were assessed. (4) Evaluation of reliability and validity: The scale was validated by initial item analysis, exploratory and confirmatory factor analyses, and internal consistency reliability and test-retest reliability.
RESULTS
The final scale consisted of six dimensions and 25 items: maintaining belief (three items), knowing (four items), being with (six items), preserving dignity (four items), enabling (five items), and self-adjustment (three items). Exploratory factor analysis yielded a six-factor structure that was consistent with the theoretical framework and explained 70.8% of the total variance. Confirmatory factor analysis indicated a good fit for the six-factor model. Cronbach's α for the scale was 0.931, and the test-retest reliability coefficient was 0.968.
CONCLUSION
The Perinatal Bereavement Care Competence Scale is a valid and reliable instrument for measuring the competence of midwives in caring for bereaved parents who have experienced perinatal loss.
Topics: Bereavement; Factor Analysis, Statistical; Female; Grief; Humans; Midwifery; Perinatal Death; Pregnancy; Professional Competence; Psychometrics; Reproducibility of Results; Surveys and Questionnaires
PubMed: 35716897
DOI: 10.1016/j.anr.2022.06.002 -
Midwifery May 2022To determine the relationship between perceived obstetric violence and the risk of postpartum depression (PPD). (Observational Study)
Observational Study
OBJECTIVE
To determine the relationship between perceived obstetric violence and the risk of postpartum depression (PPD).
DESIGN
A cross-sectional observational study SETTING: During 2019 in Spain PARTICIPANTS: 782 women who had given birth in the preceding 12 months in Spain.
MEASUREMENTS
Online questionnaires were distributed to the women via their midwives and women's associations. The questionnaire included sociodemographic and clinical variables, and questions regarding the mothers' perception of obstetric violence globally and in its different forms: verbal, physical and psycho-affective. The response rate was 93.65%. Crude and adjusted odds ratios (OR and aOR, respectively) were estimated using binary logistic regression. Risk of PPD was estimated by the Edinburgh Postnatal Depression Scale (EPDS).
FINDINGS
The mean EPDS score was 8.34 points (standard deviation: 3.80), with 25.4% (199) at risk of PPD (≥ 10 points). Risk factors for PPD included, multiparity (aOR: 1.62, 95% CI:1.10-2.39), newborn NICU admission (aOR: 1.93, 95% CI: 1.06-3.51), experiencing verbal obstetric violence (aOR: 2.02, 95% CI: 1.35-3.02), and psycho-affective obstetric violence (aOR: 2.65, 95% CI: 1.79-3.93). The perception of support during pregnancy, birth, and the puerperium was found to be a protective factor: aOR 0.15 (95% CI: 0.04-0.54) for women who perceived enough support and aOR 0.13 (95% CI: 0.0-0.45) for women who received much support KEY CONCLUSIONS: One in four women are at risk of PPD. Multiparous women, those whose newborn required NICU admission, those who lacked partner support, and those who experienced verbal or psycho-affective obstetric violence had a higher prevalence of PPD risk.
FUNDING
The authors declare that this study was conducted without funding.
Topics: Female; Humans; Infant, Newborn; Pregnancy; Cross-Sectional Studies; Depression, Postpartum; Postpartum Period; Prevalence; Risk Factors; Violence
PubMed: 35272086
DOI: 10.1016/j.midw.2022.103297 -
The Journal of Perinatal & Neonatal... 2020One of the most complex clinical problems in obstetrics and neonatology is caring for pregnant women at the threshold of viability. Births near viability boundaries are... (Review)
Review
One of the most complex clinical problems in obstetrics and neonatology is caring for pregnant women at the threshold of viability. Births near viability boundaries are grave events that carry a high prevalence of neonatal death or an increased potential for severe lifelong complications and disabilities among those who survive. Compared with several decades ago, premature infants receiving neonatal care by today's standards have better outcomes than those born in other eras. However, preterm labor at periviability represents a more complex counseling and management challenge. Although preterm birth incidence between 20/7 and 25/7 weeks has remained unchanged, survival rates at earlier gestational ages have increased as perinatal and neonatal specialties have become more adept at caring for this at-risk population. Women face difficult choices about obstetric and neonatal interventions in light of uncertainties around survival and outcomes. This article reviews current neonatal statistics in reference to short- and long-term outcomes, key concepts in obstetric clinical management of an anticipated periviable birth, and counseling guidance to ensure shared-decision making.
Topics: Female; Gestational Age; Humans; Infant, Newborn; Neonatal Nursing; Neonatology; Obstetrics; Practice Guidelines as Topic; Pregnancy; Premature Birth; Survival Rate
PubMed: 32332444
DOI: 10.1097/JPN.0000000000000473 -
Journal of Obstetrics and Gynaecology :... Oct 2022Childbirth self-efficacy is a useful measure for determining a woman's confidence in managing childbirth and for determining any preconceptions that require...
Childbirth self-efficacy is a useful measure for determining a woman's confidence in managing childbirth and for determining any preconceptions that require reinforcement. Childbirth self-efficacy is also particularly helpful in advising not only how to cope with birth, but also maternal well-being and fostering the improvement of a wide variety of perinatal outcomes. The present study aims to determine the factors affecting childbirth self-efficacy in pregnant women. The sample size consisted of 380 pregnant women between the ages of 18 and 45. Data were collected via face to face interviews using the Childbirth Self Efficacy Scale Short Form (CBSEI-32) in the Akdeniz University Hospital between November 2019 and February 2020 and used Chi-squared Automatic Interaction Detector analyses, resulting in a mean CBSEI-32 score of 244.279 ± 45.121. As a result of the analysis, it was seen that income status affects self-efficacy, and personal experiences such as foetal loss affect a woman's childbirth self-efficacy. In addition, it was also found that the level of prenatal education affected childbirth self-efficacy. Health professionals should assess pregnant women during the antenatal period in terms of their childbirth self efficacy and prepare personalised training programs and plan initiatives to increase perceptions of self-efficacy.IMPACT STATEMENT Childbirth self-efficacy is one of the important psychological parameters to determine a woman's belief in her confidence in managing childbirth and to measure women's perceptions of her need for reinforcement. Sociodemographic and obstetric characteristics of women affect their childbirth self-efficacy perception positively and negatively. Women's birth self-efficacy can be improved positively with prenatal education. In addition, it is one of the interesting findings of the study that the self-efficacy level of women who had a previous low experience was high. Women's childbirth self efficacy can be improved with trainings and appropriate nursing interventions. For this reason, it is important to determine the factors affecting the self-efficacy perception of women. In future studies, the childbirth self-efficacy perceptions of women in different samples (risky pregnancy, disabled pregnant, etc.) should be measured.
Topics: Humans; Female; Pregnancy; Adolescent; Young Adult; Adult; Middle Aged; Pregnant Women; Self Efficacy; Parturition; Delivery, Obstetric; Prenatal Care
PubMed: 35959843
DOI: 10.1080/01443615.2022.2109412 -
Midwifery Dec 2022Perineal injury is the most common complication of vaginal delivery, and labor and delivery (L&D) nurses are crucial in managing and educating women following perineal...
Self-assessment of nursing preparedness and knowledge in the care of patients with obstetric anal sphincter injuries and utilization of a computer-based learning module for continued nursing education in the United States.
IMPORTANCE
Perineal injury is the most common complication of vaginal delivery, and labor and delivery (L&D) nurses are crucial in managing and educating women following perineal trauma.
OBJECTIVE
The aims of this study were to assess L&D nurse experience, knowledge, and self-perception of preparedness in caring for women with obstetric anal sphincter injuries (OASIS) and to compare pre- and post-test scores using a computer-based learning module (CBL) for OASIS nurse education.
STUDY DESIGN
All L&D nurses were invited to complete a voluntary, self-assessment questionnaire inquiring about prior experience, training, and education and current clinical practice in caring for patients with OASIS. They were also asked to answer ten knowledge-based questions about OASIS. The primary outcome was change in pretest and posttest knowledge-based scores after completion of CBL.
RESULTS
Forty-one L&D nurses voluntarily responded to the self-assessment survey. Of respondents, 20% answered they were "very comfortable", 48% "comfortable", 23% "neutral," and 8% "uncomfortable" for caring for women with OASIS post-delivery. Fifty-three percent of reported having no formal education in nursing school about OASIS and 35% reported no formal training while at work. The average pretest knowledge test score was 66.3% and 93.5% (p < 0.001) after completion of the CBL.
CONCLUSIONS
Most L&D nurses in this study reported having very limited formal nursing education in OASIS. Regardless of this lack of formal training, the majority of L&D nurses in this sample described themselves as comfortable caring for patients with OASIS post-delivery. Completion of a CBL was associated with higher OASIS knowledge scores.
Topics: Humans; Pregnancy; Female; United States; Anal Canal; Self-Assessment; Perineum; Delivery, Obstetric; Education, Nursing; Computers; Obstetric Labor Complications; Lacerations; Retrospective Studies; Risk Factors
PubMed: 36115272
DOI: 10.1016/j.midw.2022.103483 -
Archives of Medical Science : AMS 2023The aim of this study was to evaluate the effects and mechanisms of salvianolic acid B (Sal B) in preeclampsia treatment by and study.
INTRODUCTION
The aim of this study was to evaluate the effects and mechanisms of salvianolic acid B (Sal B) in preeclampsia treatment by and study.
MATERIAL AND METHODS
Rats were randomly divided into 5 groups. In order to establish the model of preeclampsia, endotoxin was administered to the rats in the Sal B intervention and model groups. The systolic blood pressure (SBP) of the tail artery and urine protein concentration were observed at different points, the miRNA-155 and CXCR4 gene expression levels by RT-PCR and the CXCR4 and p-AKT protein expression by WB assay. Using HTR8/SVneo to explain the mechanisms; evaluating the miRNA-155 and CXCR4 mRNA expression by RT-PCR assay, measuring the cell invasion and migration by transwell and wound healing assay in different groups; evaluating the CXCR4 and p-AKT protein expression by WB assay and p-AKT nucleation volume by cellular immunofluorescence were evaluated.
RESULTS
Compared with the normal group, the systolic blood pressure and urine protein were significantly increased in the model group ( < 0.05), serum NO concentration was significantly down-regulated (all < 0.05), CXCR4 and miRNA-155 mRNA expression was significantly different and CXCR4 and p-AKT protein expression was significantly suppressed (all < 0.05). With Sal B supplement, the SBP, urine protein and NO concentration were significantly improved with dose-dependent (all < 0.05). In the cell experiment, the cell invasion and migration ability were significantly improved with Sal B supplement (both < 0.05). However, with miRNA-155 transfection, the cell invasion and migration ability were suppressed with Sal B treatment (both < 0.05).
CONCLUSIONS
Sal B improved preeclampsia via regulation of miRNA-155/CXCR4 in the in and study.
PubMed: 37034524
DOI: 10.5114/aoms.2020.92938 -
Nursing For Women's Health Jun 2021To improve key discharge metrics and achieve more consistency in clinical care, a team at our large health care system developed and implemented the use of an obstetric...
To improve key discharge metrics and achieve more consistency in clinical care, a team at our large health care system developed and implemented the use of an obstetric milestone pathway (OMP). The OMP was integrated into daily multidisciplinary discharge rounds, during which nurses discussed the plan of care and progress toward discharge for each woman and her newborn. The OMP provided nursing staff with a tool for implementing a plan of care and for preparing a woman and her newborn for discharge. Use of the OMP was associated with a decrease in clinical errors, improved patient satisfaction scores, and decreased costs related to length of stay. By using Six Sigma techniques and gaining participation of front-line staff, our team developed a clinical pathway intended to improve the quality, safety, and efficiency of maternal/newborn care.
Topics: Evidence-Based Practice; Female; Health Plan Implementation; Humans; Infant, Newborn; Length of Stay; Patient Care Team; Patient Discharge; Pregnancy; Teaching Rounds
PubMed: 33905672
DOI: 10.1016/j.nwh.2021.03.002 -
Nursing For Women's Health Oct 2022
Topics: Humans; Nursing Assistants
PubMed: 36057515
DOI: 10.1016/j.nwh.2022.07.003