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 literature review investigates nursing interventions to reduce decibel levels in the neonatal intensive care unit (NICU). The secondary purpose of this review was to evaluate if the interventions to reduce noise in the NICU had different outcomes for normal weight premature infants and infants afflicted with neonatal abstinence syndrome. The data bases for completing this review were Google Scholar, the Cumulative Index to Nursing and Allied Health Literature (CINAHL Plus), PubMed, and Elton B. Stephens Co. (EBSCO). The key search words included ‘NICU and decibels', ‘reducing decibels', ‘neonatal abstinence syndrome' ‘decibels', ‘preterm infants' and 'normal weight preterm infant*'. The inclusion criteria were research articles from 2008 to 2020, articles with a focus on normal weight premature infants and normal weight infants determined to be addicted to a recreational or illicit substance after birth. The results yielded 8 articles meeting inclusion criteria and screened for relevance to the topic. Data indicated there is a need for further research into using multiple interventions. One intervention alone can currently not reduce decibel levels to the recommended level. Conclusions: Currently the research states private rooms reduce decibel levels the most out of the other intervention listed in the study. Further research with long-term neuro-cognitive data collection over a longer period of time and larger sample sizes is needed to evaluate the use of interventions to reduce high level, decibel noise found in the NICU.

Thesis (M.S.)--Boston University / PLEASE NOTE: Boston University Libraries did not receive an Authorization To Manage form for this thesis or dissertation. It is therefore not openly accessible, though it may be available by request. If you are the author or principal advisor of this work and would like to request open access for it, please contact us at open-help@bu.edu. Thank you. / 2031-01-01

While Fetal Alcohol Syndrome Disorder is a recognized problem with alcohol ingestion during the formation of facial features, Fetal Alcohol Spectrum Disorders are not as widely recognized. These disorders result from exposure to alcohol throughout pregnancy when the brain and nervous system are developing. The resulting disorders include attention deficit disorders, social disorders, inappropriate behaviors, learning disorders, and intellectual disability. The incidence of children with alcohol-related disorders is increasing as evidenced by children needing special services in the educational systems. It is unknown how much alcohol ingestion is safe during pregnancy or how genetic factors are involved in the development of these disorders. Women often get conflicting information from the media and other resources about safe levels of alcohol consumption during pregnancy. Abstinence of alcohol ingestion is the only known prevention of such intellectual disorders. It is hypothesized that women of childbearing age may not be knowledgeable of the relationship between drinking and the implications of alcohol exposure on fetal development. The purpose of this research is to determine what women of childbearing age know about alcohol consumption during pregnancy and if there is a knowledge deficit that exists among women of a certain age or women that use specific resources for health information. The researcher surveyed 40 female students at East Tennessee State University by using true or false questions concerning alcohol consumption related to fetal development in order to determine if a knowledge deficit exists. Based on the findings, it may be determined if women of childbearing age need educational materials from a reliable source.

The objectives of this study were to determine whether there was an association between clinical nursing knowledge of four birthing positions and current evidence-based research of those same positions and also to identify possible areas where nursing knowledge of those birthing positions was inadequate. This pilot study used convenience sampling to survey registered nurses (RNs) and licensed practical nurses (LPNs) on labor and delivery units. The survey was distributed to three hospitals in the southeastern United States, and twenty-four RNs and LPNs participated. Participants’ knowledge did not reflect current clinical evidence in two key areas, (1) the best position to minimize blood loss and (2) the best position to decrease the likelihood anal sphincter tears. Respectively, only 13% and 27.3% of participants selected the correct position. Continuing education for maternity nurses regarding current evidence-based practice concerning various birthing positions remains a need, and incorporating this could include more frequent opportunities for education classes and unit inservices. Results from this study should not be generalized, and more research is needed in this area to validate these findings.

The admission of an infant to the Neonatal Intensive Care Unit (NICU) has the potential to produce significant stress for the mothers of these infants. Researchers suggest that this may contribute to difficulties with coping following discharge. Past research on this topic has been primarily focused on Caucasian women. Approximately 9% of the U.S. population is of Mexican heritage; therefore, this population is significantly underrepresented in the existing literature. For this reason, the purpose of this grounded theory study was to identify the basic social processes used by English-speaking mothers of Mexican heritage who have experienced the admission of an infant to the NICU. Maximum variation sampling was utilized to recruit 15 English-speaking mothers of Mexican heritage who were at least 18 years of age and had experienced the admission of an infant to the NICU. The women were recruited from various locations in San Antonio, Texas. Data collection was conducted through audio-taped, semi-structured individual interviews and transcribed field notes. Data analysis consisted of constant comparison, open coding of data, and theoretical coding. This investigation resulted in the substantive theory making sure my baby is cared for by being there for my baby. The process began with the unexpected event of having an infant in the NICU and played out in the context of opposing forces: trying to be the mother or making meaningful connections. The mothers developed strategies for managing this situation by balancing responsibilities, leaving part of me with my baby, and watching over. The process concluded with one of two consequences: bringing my baby home or losing my baby. The theory that emerged from this study offers insight for researchers, nurse educators, and neonatal nurses who provide care for English-speaking, Mexican-heritage mothers and their infants as well as for the care of all NICU mothers and their infants. / text