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Preterm birth in the United States is the leading cause of infant morbidity and mortality. The United States spends more per capita on healthcare than any other nation in the world, and still perinatal outcomes are disappointing when compared to other industrialized nations. Research and current clinical practice guidelines support the use of early and consistent prenatal care to lower risks for preterm birth, by acting as a key mechanism to monitor pregnancy and provide timely and appropriate interventions. Significant research has been completed to identify causative factors that lead to preterm birth. Overall, this literature has not had a substantial impact on decreasing preterm birth rates in the United States. Access to healthcare is one modifiable factor that can be influenced by policy change and potentially have a positive impact on lowering preterm birth rates. This dissertation examines geographical access to prenatal care services in Florida and its influence on preterm birth rates. The researchers used quantitative methods coupled with Geographic Information Systems to evaluate the relationship between potential access to prenatal care and preterm birth rates.

Background: Consumption of sugary drinks (SD) among children is a prevalent public health issue that is exacerbated by the powerful marketing of such beverages to youth. Methods: A secondary analysis of the International Food Policy Survey Youth Wave 2019 was conducted to assess the impact of self-reported exposure to SD marketing within the past 30 days or SD brand advertisements on youth brand preference and brand recall overall, by country, and by age group. Ordinal, multinomial, and binary logistic regression were used to examine these associations. Results: Youth brand preference and recall were positively associated with self-reported exposure to general and brand-specific SD marketing within and across all countries. Both children and adolescents were similarly impacted by SD marketing. Soft drinks, sports drinks, and fruit juice brands were most commonly recalled by youth. Conclusion: Global marketing policies should consider older children and adolescents to adequately protect and support child health.

Aim: The aim of this literature review was to explore the impacts of educational interventions integrated into antenatal care on knowledge of preeclampsia among pregnant women. Background: Preeclampsia has remained one of the leading causes of preventable maternal and infant mortality and morbidity. A lack of patient education and awareness of preeclampsia may lead to missed opportunities for diagnosis and preeclampsia complications. Methods: CINAHL Plus with Full Text, MEDLINE, and Education Full Text (H.W. Wilson) databases were utilized. Literature specifically focusing on preeclampsia educational interventions among pregnant women were considered. Results: There were eleven articles that fit the criteria of this review's search. The results of this review revealed that nine studies found positive outcomes and an increase in preeclampsia awareness among pregnant women when educational interventions were implemented into their antenatal care. Discussion: Educational interventions that improved patient knowledge on preeclampsia include booklets, pamphlets, videos, graphic cards, magnets, PowerPoint presentations, brochures, and verbal education. Nurses can implement these interventions in their practice to decrease maternal and infant mortality found among preeclampsia patients. Further research on preeclampsia knowledge is recommended among minority women and how educational interventions impact maternal and neonatal outcomes.

The purpose of this dissertation research was to explore the associations between, perceptions of, and patterns within the mother-father relationship and perceived stress among Black pregnant women. The conceptual framework guiding my dissertation research aligned with the Social Ecological Model and my interpretive framework upheld an intersectional, social constructivist positioning. First, I conducted an integrated literature review to identify what is known about the associations of mother-father relationship with perceived stress among pregnant and postpartum women, focusing on Black women in the U.S. This review included sixteen studies, six of which were conducted in the U.S., that reported significant associations of mother-father relationship with perceived stress among pregnant and/or postpartum women; however, data were limited among Black pregnant women. Next, I conducted a secondary analysis using a cross-sectional approach to examine the association of mother-father relationship with perceived stress among Black pregnant women. Women who reported higher levels of conflict and lower levels of involvement, closeness, and support within the mother-father relationship also reported higher levels of perceived stress. Finally, I conducted a secondary analysis using a convergent, mixed methods approach with ideal-type analysis to examine and describe the mother-father relationship and its role in experiences of perceived stress from the perspective of Black pregnant women. Women described unique, patterned experiences of mother-father relationship and perceived stress which emerged as five mother-father relationship typologies: (1) "Cared For," (2) "Managing Expectations," (3) "Just Friends, For the Kids," (4) "It's Complicated," and (5) "Can't be Bothered." This dissertation research adds knowledge related to: (1) associations of mother-father relationship with perceived stress among Black pregnant women; (2) comprehensive measures of mother-father relationship; and (3) an exemplar of ideal-type analysis which expands the discipline of nursing. These contributions inform future nursing research and clinical practice which address disparate health outcomes among this vulnerable population.

Delayed bathing of the newborn infant for twenty-four hours after birth can decrease potential newborn complications such as hypoglycemia, hypothermia, and improve the infants skin integrity and breastfeeding rates. The primary purpose of this literature review was to examine the health benefits of delaying initial bathing in newborns for twenty-four hours. A comprehensive review of the literature was performed using peer-reviewed, research articles from multiple databases focusing on delayed infant bathing after birth and health benefits. 15 articles met the inclusion criteria and answered the research questions. Two studies showed the effects of vernix caseosa on improved skin integrity and moisture in infants. Two additional studies revealed longer skin-to-skin contact with increased maternal satisfaction and comfort, allowing time for breastfeeding and sucking competence. Delayed bathing prevented hypothermia and decreased the incidence of hypoglycemia. All articles focused on infants’ health outcomes within hours of birth and physiologic findings of how delayed bathing can improve the infant’s adjustment to extrauterine environment. Delayed bathing in the neonate decreases the risk of hypoglycemia and hypothermia. Prolonging the time an infant remains covered in their mother’s vernix caseosa following birth is a viable measure for improving newborn health outcomes.

Exposure to incarceration through a partner or first-hand experience can lead to a higher probability of negative outcomes on either infant or maternal well-being postpartum. This can be measured by length of pregnancy, infant birth weight, and maternal depression screening. The purpose of this literature review was to identify the impact of incarceration on maternal and infant outcomes for women exposed to incarceration at some point during the length of their pregnancy. A comprehensive review of the literature using peer reviewed research articles from multiple databases on maternal and infant outcome disparities in pregnant incarcerated women. Seventeen articles met the inclusion criteria and focused on the research question. Of the 17 studies, 12 showed a negative impact on either infant or maternal outcomes. Four studies were inconclusive. One study found no negative impact of exposure to incarceration on either maternal or infant outcomes. Exposure to incarceration does provide some negative effects on infant/maternal outcomes, at this time, the effects are under researched and require further investigation to determine if this risk factor is more strongly correlated with negative outcomes when compared to other similar life-stress events.

The purpose of this dissertation research was to examine the associations among racial discrimination, social support, and psychological distress among Black pregnant women. The dissertation was guided by the Ecological Systems theory which has three domains that pertain to this research: individual, interpersonal, and community. A literature review was conducted to investigate what is known about the association between racial discrimination and psychological distress among Black pregnant women. This review found that seventeen of the nineteen studies included reported a positive association between racial discrimination and psychological distress among Black pregnant or postpartum women. Limited research focused on the potential moderating effect of social support on the association between racial discrimination with psychological distress among Black pregnant women. Using a cross-sectional design, this dissertation research examined the moderating effect of social support on the association of racial discrimination with psychological distress among a sample of 599 Black pregnant women. I found that experiences of racial discrimination were related to lower levels of social support and higher levels of psychological wellbeing among these women. Social support related to lower levels of psychological wellbeing; however, social support did not moderate the association of racial discrimination with psychological distress in this sample. Finally, I found that the most frequently reported experiences of discrimination were in a store or restaurant and on the street or public setting and the least frequently reported experience was getting medical care among women in this study. Women who reported discrimination in all, but one situation reported lower levels of psychological wellbeing compared with women who did not report discrimination in these situations. This dissertation research adds to the knowledge related to the associations among racial discrimination, social support, and psychological distress among Black pregnant women.

The purpose of this dissertation research was to examine the associations among experiences of racial discrimination, perceived stress and birth satisfaction among Black women, and to examine the mediating effect of perceived stress on the association of experiences of racial discrimination with birth satisfaction among Black women. The first manuscript is an integrative literature review which evaluates prior research of the association of stress with birth satisfaction, with consideration to studies that included Black women in their samples. This review revealed a need for further research evaluating stress and birth satisfaction specific to Black women. The second manuscript examines the associations among racial discrimination, perceived stress, and birth satisfaction among a sample of 154 Black women. Experiences of racial discrimination were positively correlated with perceived stress. Perceived stress was negatively correlated with birth satisfaction. Experiences of discrimination were not related to birth satisfaction. Racial discrimination had a positive effect on perceived stress, and perceived stress had a negative effect on birth satisfaction. Racial discrimination had no direct effect on birth satisfaction; therefore, perceived stress was not applicable as a mediator in the model. The third manuscript presents challenges and successful strategies faced in the recruitment and retention of Black women in the immediate postpartum period. This dissertation adds to the current body of knowledge regarding the effects of racial discrimination on perceived stress, and the relationship between perceived stress and birth satisfaction, while also presenting successful recruiting strategies of Black postpartum women in nursing research, which is crucial to reducing racial disparities in health care.

This study aimed to explore children’s experiences of art therapy in order to create a theory of change processes within school-based art therapy. A total of 14 children were interviewed at two different schools, along with their parents, teachers, and art therapists. All children had received art therapy within the last 12 months. Semi-structured individual interviews were undertaken with 40 participants. Children completed a craft activity within their interview as a visual expression of their therapy experience. Interview data was analysed using grounded theory methodology. The results generated three theoretical models. The first model highlighted the systemic nature of the art therapy as well as describing it as mysterious. Model 2 described the processes within art therapy, focusing on the individualised child-centred nature of the intervention. Art doing was considered central to the children’s expressions and developing understandings. Model 3 described the trajectory of change for the children. The study recommends that psychologists consider art therapy for children who are struggling to verbalise their difficulties; that clinicians focus on therapeutic experiences being fun and enjoyable for the child, as well as embedded within the child’s system; and lastly that clear target problems are identified at the start of therapy.