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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.

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.