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.

Neonatal palliative care (NPC) is an emerging subset of care in United States (US) neonatal intensive care units (NICUs) that provides relief for both infants and families at the end of life for infants with terminal diagnoses. Families play a large role in the decision-making process for their infant, but their experiences with and perceptions of the support and care provided to them via NPC is unclear. This literature review summarizes the state of knowledge on parents' perspectives of NPC while focusing on the specific factors that influence their experiences and satisfaction with NPC. This literature review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Findings of the literature review broadly include the importance of consistent communication with providers, parental involvement in the care process, and the minimization of infant suffering. Providers must focus on these important quality indicators to ensure they provide the best care possible to the patients and families that they serve. Further research must be done to investigate parent satisfaction and needs in relation to NPC more deeply and to develop interventions and protocols that better incorporate these needs.

No description available.

<p> The present thesis reports an experiment that investigated the phenomenon of asymmetric paw elevation in the tripedal stance of the Mongolian gerbil, and tested the Geschwind-Galaburda extra-genetic theory of human handedness. Neonate gerbils of both sexes were injected with testosterone propionate during the "critical" period of brain development. They were then assessed for asymmetry in eye opening, for anogenital distance, and for paw elevation and scent marking before and after puberty. Eye opening asymmetry was not affected by treatment. Paw elevation was affected by treatment, with treated gerbils of both sexes displaying more right elevations before and after puberty than untreated gerbils. Control females displayed systematic patterns in paw elevation before and after puberty. Adult gerbils in all conditions displayed more consistency in paw elevation than young gerbils. Anogenital distance was increased with treatment, but only in the females. Adult scent marking behavior was marginally reduced with treatment, but only in the males. Results are interpreted within the Geschwind-Galaburda theory of handedness, and the hormonal basis of paw elevation is discussed. </p> / Thesis / Master of Science (MSc)

Introduction: The practice of neonatal resuscitation involves superior technical skills, an ability to lead an interdisciplinary team as well as make clinical decisions based on complex dynamic transitional physiology within a narrow timeline. These skills are a mandatory component of pediatric residency training and have been assessed using standardized assessment tools such as certifying board exams, procedure checklists, and in training exams. Recent literature has raised concerns about trainees’ competency in the technical skills for neonatal resuscitation. This project sought to explore trainees’ perceptions of competency for neonatal resuscitation, as well as potential barriers that challenge this process. Methods: This project employed an interpretive design qualitative methodology, using an a priori educational theory incorporating the principles of social cognitive theory, deliberate practice, distributive practice, and ‘choke phenomenon’. Semi structured focus groups of residents and pediatricians were used for data collection. Interpretive analysis in the style of Crabtree and Miller was employed. Validity criteria as described by Lincoln and Guba were applied. Institutional ethics board approval was obtained. Results: The participants identified four attributes for competency in neonatal resuscitation required to ensure successful transition towards readiness for independent practice: (a) medical expertise, (b) leadership, (c) transferability, and (d) self-efficacy. The enablers and barriers towards acquisition of these four aspects during residency training and transition to practice were identified and explored. Conclusions: Through the self-reported experiences of trainees and practitioners and informed by educational theory, this study describes a “across rocky seas” graduated conceptual model of a sailing ship for competency acquisition in neonatal resuscitation. An understanding and application of this model may thus inform the development of new competency-based curricula. / Thesis / Master of Science (MSc) / The practice of neonatal resuscitation is challenging because practitioners are dealing with an infant who is critically ill, requiring multiple interventions within a very short duration of time. Despite residency training, literature reports challenges with acquiring and maintaining resuscitation skills. Using qualitative methods, specifically interpretive design, this project sought to explore trainees’ perceptions of competency for neonatal resuscitation, as well as potential barriers to this process. The principles of repeated exposure over different times in training, performance under pressure and the confidence in one’s abilities required to achieve a specific goal were used to inform data collection and analysis. The participants identified four attributes for competency in neonatal resuscitation required to ensure successful transition towards readiness for independent practice: (a) medical expertise, (b) leadership, (c) transferability, and (d) self-efficacy. Informed by educational theory, these constructs were then used to describe a conceptual model for competency acquisition in neonatal resuscitation

Purpose: To characterize the environment in both ground and aerial ambulances in an effort to identify and quantify the risk factors associated with intraventricular hemorrhage (IVH) in preterm infants, with the goal of developing a device to mitigate this problem. Methods: A small, stand-alone battery operated device was developed to characterize the environment inside neonatal transports. This device included an array of sensors to measure acceleration forces, sound levels, temperature, pressure, and light intensities. Two of the data acquisition devices were used to collect data inside and outside the transport incubator simultaneously for a period of thirty minutes during a test flight in a transport helicopter. Real-time digital signal processing was performed for the sound signals to reduce data. Furthermore batch digital signal processing was performed on an external computer to calculate the vibration spectrograms, occurrence of impulsive forces, and variations in ambient temperature, pressure and luminance. The results were compared between the two devices to determine whether the current transport incubator design is reducing or increasing the suspected risk factors. Results: The vibration levels registered in the transport incubator during flight were five times greater than in the crew cabin in the vertical direction. High vibration levels were registered in the horizontal direction in the transport incubator, which were not registered in the crew cabin. In contrast, vibration in lateral direction was nearly half of that registered in the crew cabin. Sound levels were on average 70 dBA in the transport incubator. Luminance levels reached values up to 6920 Lux. No major changes in temperature and pressure were registered. Conclusions: IVH is a serious consequence of transporting preterm infants from one health care facility to another and occurs in roughly one out of three infants. To address this problem, a transport monitoring device can help characterize the environment in these transports in an effort to design a new state of the art transport incubator to mitigate this problem. / Master of Science

Lung inflation is the most important, and most difficult step in newborn resuscitation. A wide variety of devices are used to achieve lung inflation, but there are relatively few data to guide clinicians in their choice of device. Methods: We tested the ability of instructors and trained candidates on a newborn life support course to deliver initial inflation breaths to a test lung, using a pressure limited blow-off valve, a 240-ml self-inflating bag and a 500-ml self-inflating bag in sequence. Results: Use of a 240-ml self-inflating bag was associated with shorter initial inflations of 1.8 s mean (95% CI 1.60¿1.99 s), compared with 2.42 s (2.24¿2.61 s), 2.40 s (2.08¿2.71 s) for 500-ml self-inflating bags and ¿Tom Thumb¿ T piece, respectively. Delivery of breaths within a target pressure range of 30 ± 5 cm H2O was significantly better using a T piece than either self-inflating bag (proportion within target range 0.05 (95% CI 0¿0.11), 0.17 (95% CI 0.12¿0.23), 0.89 (95% CI 0.83¿0.94) for 240-ml and 500-ml self-inflating bags and ¿Tom Thumb¿ T piece, respectively. Excessive pressure delivery with both sizes of self-inflating bag was frequent. Conclusions: These data do not support use of 240-ml or 500-ml self-inflating bags for resuscitation of newborn term infants. A variable pressure T piece blow-off system may be the easiest device to use for newborn resuscitation and the most reliable at delivering desired pressures for set times.

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.