<p>Abstract Delivering a preterm baby who is admitted to a neonatal intensive care unit can be an enormous hardship for parents and families, and especially for mothers. The consequences of prematurity alter the parental role, affect their confidence in caring for the baby, and subsequently may impact infant outcomes. Adequately educating mothers of premature babies using an evidence-based practice approach may help them gain the confidence and skills needed to care for their infants. The purpose of this project was to create a tool kit to educate mothers of premature babies about the essential components of caring for their babies, establish content validity of the tool kit among clinical experts, and make recommendations about the use of the tool kit in the neonatal intensive care unit. Polit, Beck, and Owen?s framework was used to establish content validity. Neonatal intensive care nurses who were considered ?experts? using Benner?s novice-to-expert theory (n = 7 reviewed the tools which were quantitatively computed and yielded an Item Content Validity Index value range of 0.86 to 1.00, and a Scale Content Validity Index of 0.97, reflecting that the content met the objectives of the toolbox. Positive social change can be realized through use of the tool kit in the neonatal intensive care unit to educate mothers in the care of their preterm babies, thus improving both maternal and infant outcomes.

<p> Postpartum hemorrhage is the leading cause of maternal mortality and morbidity globally and affects women with a gestational age of 20 weeks and above. To determine whether the utilization of synthetic Pitocin in the intra-partum period has any association to postpartum hemorrhage, the primary investigator encouraged clinicians to continuously utilize the Triton OR to quantify the blood loss for 24 hours after vaginal delivery. The project also entailed chart review of 30 women who labored and delivered at a local hospital in the State of Georgia. One group was given synthetic Pitocin to induce and or augment their labor while the other group did not. Two clinical questions guided the project. What is the difference in the amount of blood loss within 24 hours of vaginal delivery between women who had their labor induced and or augmented with synthetic Pitocin compared to those who spontaneously labored and delivered? Is there any association between the utilization of synthetic Pitocin for the induction and or augmentation of labor, and post-partum hemorrhage within 24 hours of vaginal delivery? Jean Watson theory of human caring guided guide the project. A quantitative comparative design was utilized for the project. The mean blood loss for those women who received synthetic Pitocin was 279.20 milliliters, while that of women who did not receive synthetic Pitocin was 293.67 milliliters; hence there was no association between the utilization of synthetic Pitocin in the intra-partum period and postpartum hemorrhage (<i>p</i> >.05). Conducting the project on a larger scale is paramount in determining whether there is any association between synthetic Pitocin utilization in the intra-partum period and postpartum hemorrhage.</p><p>

<p> <b>Background:</b> There have been significant gains in smoking cessation among pregnant women, but the rate of postpartum relapse remains high. Smoking is harmful to both the mother and child's health and women need to be educated about the risk of relapse and effective strategies to remain smoke free. The high rate of early postpartum relapse suggests that interventions must take place soon after delivery. Perinatal nurses are in the ideal position to begin the introduction of relapse prevention strategies, but many do not feel confident in providing these interventions. Despite evidence that nurses can be effective in providing tobacco counseling, few nurses actually follow through with recommended guidelines and assist and arrange follow up care. </p><p> <b>Methods:</b> A multi-site, interventional study was conducted using a pre-test/post-test design. A total of 162 perinatal nurses from four hospitals participated in a smoking cessation and relapse prevention counseling education program. Participants completed pre, post and one month follow up tests assessing perceived knowledge, attitude, self-efficacy, and behavior toward smoking cessation and relapse prevention counseling in the postpartum period. Descriptive statistics were used to characterize respondents; one way repeated ANOVAs were used to evaluate differences in scores on attitude, self-efficacy, knowledge and behavior. </p><p> <b>Results:</b> There was a significant increase in scores on knowledge, self-efficacy and behavior from pretest to follow up test. Although quitline referral scores increased from pre to follow-up test, the scores were very low. There were no significant differences in scores related to participant age, years of experience or level of education. OB nurses had significantly higher scores than neonatal nurses on all constructs. </p><p> <b>Conclusions/Implications:</b> Results indicate that a brief educational program is effective in increasing perinatal nurses' tobacco counseling knowledge, self-efficacy and behavior. Specific tobacco counseling educational programs for neonatal nurses need to be developed. Interventions are needed to increase nurses' quitline referrals for postpartum women at risk of smoking relapse.</p>

<p> The old practice of separating the mother-baby-dyad was without measurable benefits to mothers or their infants. Evidence has shown that skin-to-skin care (SSC) prevents hypothermia and hypoglycemia, decreases crying during painful procedures in newborns, and reduces maternal anxiety, stress, and postpartum depression. Rooming-in care (RIC) has been linked to an increase in the rate of breastfeeding and mother-infant interaction, as well as a decrease in the infant morbidity rate. This project assessed the effect of an educational intervention to increase rates of SSC and RIC in an obstetric unit, in addition to measuring nurses&rsquo; attitudes and barriers in relation to SSC and RIC. The obstetric nurses received educational content related to SSC and RIC based on Kotter&rsquo;s model of change. A pre and postintervention evaluation showed a significant increase in the rates of SSC and RIC from pretest of 10%, to posttest of 96%; and RIC from pretest of 10% to posttest of 92%. Using a Wilcoxon test, a significant difference was found from pretest to posttest for every subscale score of the Mother-Newborn Skin-to-Skin Contact Questionnaire and Nurse Attitudes and Barriers to nonseparation Scale (<i>p</i> &lt; 0.001), with the exception of belief about obstacles for SSC, which yielded a nonsignificant change (<i>p</i> = 0.57). This DNP project led to changes in the organization&rsquo;s culture, including the closure of the well-baby nursery. This project promoted social change across the organization, in that the team health care providers delivered evidence-based, standardized, unbiased, and family-centered care to the mother-baby dyad. </p><p>

<p> Women and men&rsquo;s preferences for delivery services in rural Ethiopia Nancy Beam Aims: This study aims to determine the combination of facility-based delivery care attributes preferred by women and men; if gender differences exist in attribute preferences; and key demographic factors associated with attribute preferences. </p><p> <b>Background:</b> Despite programs to promote facility-based delivery, which has been shown to decrease maternal and neonatal mortality, 80% of women in rural Ethiopia deliver at home without a skilled birth attendant. </p><p> A review of the Ethiopian literature on factors associated with delivery location revealed several weaknesses in research methods that need to be addressed. First, research participants were almost exclusively women, although male partners often make decisions about delivery location. Second, most quantitative study designs are similar in content to the Ethiopian Demographic Health Survey, limiting the generation of new knowledge. Third, cultural practices identified in qualitative studies as barriers to facility-based delivery have not been included in quantitative studies. This study addressed these weaknesses by using discrete choice experiment methodology to elicit preferences for delivery service attributes, including support persons in the delivery room, staff training and attitude, cost, distance and transportation availability. </p><p> <b>Methods:</b> A cross-sectional, discrete choice experiment was conducted in 109 randomly selected households in rural Ethiopia in September-October 2015. Women, who were pregnant or who had a child &lt; 2 years old, and their male partners were interviewed. After completing a demographic questionnaire, male and female respondents were asked separately to choose between facility-based scenarios that reflected various attributes for delivering their next baby. Data were analyzed using a multilevel mixed-effects logistic regression model. </p><p> <b>Results:</b> Both women and men preferred health facilities where medications and supplies were available, a support person was allowed in the delivery room, cost was low, and doctors performed the delivery. Women also valued free ambulance service, while men favored nearby facilities with friendly providers. Men are disproportionately involved in making household decisions, including decisions about whether their wives seek health care. Yet, men are often unaware of their partners&rsquo; prenatal care attendance. </p><p> <b>Implications:</b> The Ethiopian government and health facilities could increase facility births in rural areas by responding to families&rsquo; delivery service preferences.</p>

<p> Adolescent pregnancy and parenthood have been identified as national public health problems and are topics of intense debate in the United States because of their impact on maternal and child health and on the social and economic well-being of the nation. While many types of parenting programs are available to the adolescent mother, not one approach has emerged as the most effective to decrease subsequent pregnancies and to improve mother and child health. Using Husserl's Phenomenology as a philosophical underpinning, what it means to be a pregnant adolescent living in a group home was explored. Data were collected from volunteers who had lived in two group homes in a suburban county in the Mid-Atlantic area of the U.S. In-depth, one-on-one interviews using a semi-structured guide were completed with eight participants. Giorgi's steps for analysis of the verbatim transcripts were used to develop <i> essences and the essential structure</i> about the phenomenon understudy. The participants' ages when they lived in the group home ranged from 13-17 years; the time they lived in the group home was between one to two years and some adolescents, after delivery, lived in the group home from six months to two years. Three themes emerged, each with subthemes, describing the participants' experiences: <i>The environment with its rules and structure was experienced as either supportive or not in day-to-day living; Balancing adolescent expectations and needs impacted pregnancy and parenting; and Defining motherhood focused on the basics and was influenced by the participants' own mothering</i>. The study's fmdings were compared and contrasted with well-known nursing, individual development, and parenting theories and relevant research findings. Nurses who care for adolescents throughout their pregnancy and the postpartum period are uniquely positioned to influence their development as mothers. </p>

<p> The American Academy of Pediatrics (2012); the American College of Obstetricians and Gynecologists (2016); and the Association of Women&rsquo;s Health, Obstetric, and Neonatal Nurses (2015) endorses breastfeeding exclusively for six months, followed by continuation with complementary foods through age one year to achieve the most personal and public health benefits. However, while most mothers initiate breastfeeding, the majority do not meet their goals due to lack of support (CDC, 2016). </p><p> The Affordable Care Act mandates coverage for breastfeeding support, but federal, state, and insurance policies are not conducive to making such benefits accessible. </p><p> Electronic registration and medical record documentation allow for improved tracking and decreased risk to the facility. </p><p> This paper outlines the development and implementation of administrative practices in an existing Registered Nurse/Internationally Board-Certified Lactation Consultant (RN-IBCLC) led outpatient lactation clinic at a Baby Friendly (2012) designated facility with goals of increasing access to lactation support postpartum, improving patient outcomes, and realization of financial viability. Expected outcomes included identification of best practices and implementation strategies for the following: a. provider collaboration including outreach efforts to trigger referrals. b. number of dedicated hours per week to offer services. c. cost/benefit analysis. d. registration and documentation process. e. model of care. f. funding source. </p><p> Tests of change through plan-do-study-act (PDSA) cycles were based on the outcome of a gap analysis. Modifications to implementation were made dependent on PDSA cycle findings until optimized RN-IBCLC-led outpatient lactation clinic administrative practices for the facility and processes became streamlined. </p><p> Despite limited literature to guide administrative practices, the project met the aims of patient registration and electronic health record (EHR) documentation. However, extensive policy and systems barriers existed that prevented success in identifying a workable revenue stream despite the efforts of this investigator in collaboration with parent system-level managed care, finance, and compliance departments. </p><p> The solution agreed upon to provide sustainability to the program was to utilize outpatient lactation visits as a community benefit to quantify lost revenue of services provided and aid the hospital. Even though the lack of revenue equaled lack of department growth, the community benefit option added a layer of stability to the program as it stands. </p><p> This project provides a model for other organizations examining best practices in administrative and funding options for IBCLC-led outpatient lactation clinics. Thereby; creating sustainable breastfeeding support leading to improved health of mothers, babies, and the community.</p><p>

<p> Traumatic birth is a term used to describe a wide-range of negative physical and mental birthing events and outcomes. An estimated one-third of women perceive mental trauma during birth. Aside from deterioration of maternal mental health, the effects of perceived traumatic birth can be observed in the entire family. Although research shows the relationship of traumatic birth to mental health, the majority has focused on European or European-American women. The profound psychological impact of birth trauma has been passed off as common to all women without considering culture, race, or context. Little is known about birth trauma experiences of Mexican immigrant women. Since Mexican immigrants comprise the largest ethnic-minority group in the United States attention to perceived traumatic birth on their health status is clear. </p><p> The purpose of this dissertation research was to describe and understand the impact of a perceived traumatic birth, the range of responses produced, and the life course context in which it occurs in Latina immigrants from Mexico. </p><p> Although recruitment took place in a low-income community-based health center in Fresno, California, most interviews were conducted in the participants&rsquo; homes. In addition to field observation and photography, twenty-one interviews were conducted with seven Mexican immigrant mothers who provided first-person accounts of their perceived traumatic births and the life course context in which it occurred. Facilitated by a certified Spanish interpreter, all interviews were recorded, transcribed verbatim and analyzed via an iterative grounded theory process. </p><p> The results suggest that, in addition to the birth event, for these Mexican immigrant mothers, the process contributing to perceived traumatic birth is embedded in the profound adversity of their unique life context. The burden of crossing a militarized border, the fear of deportation, and lack of trust, mandates a self-protective silence that obscures both the adversity they endure and the resulting maladaptive psychological responses. Consequently, for Mexican immigrant mothers, undocumented status, adversity, mistrust, and the self-mandated silence that surrounds it, may be major factors affecting not only their perceived traumatic births, but their overall health. Findings inform further research, practice, and policy related to the unique needs of Mexican immigrant mothers. </p>

<p> A nutritional method commonly used to deliver feedings to premature infants is the use of a gavage tube. To measure for any undigested breastmilk or formula, a gastric aspirate is checked prior to the next feeding. There is a gap in practice as to what to do if these aspirates signify feeding intolerance. The project question centered on identifying evidence-based guidelines in the literature that would help to define best practices related to feeding intolerance of gavage-fed infants. The Johns Hopkins Nursing Evidence-Based Practice model and the Appraisal of Guidelines Research and Evaluation provided the frameworks for gathering and evaluating evidence as well as the process used in forming the practice guideline. The primary methods employed were a team approach that included a Neonatal Intensive Care Unit (NICU) Project Team and NICU expert opinion along with a literature review conducted by the doctor of nursing practice student. The NICU Project Team collected the NICU experts&rsquo; input via surveys they developed and distributed as well as e-mails to authors identified from the literature review. The surveys yielded a 76% response rate from the registered nurses and a 59% response rate from the medical providers. All data collected were shared and descriptive statistics were used to evaluate the data. One of the central research findings was that gastric aspirates should no longer be routinely obtained on stable infants and, if used in evaluating feeding intolerance, they must be used in combination with other indicators. An enteral feeding guideline was developed to reflect this finding that can be shared with other NICUs and nurseries in the United States and globally to decrease the morbidity and mortality of neonates.</p><p>

Thesis (M.S.)--Boston University