Medicine and Health Sciences Commons^™

Implicit Bias Training For Perinatal Nursing, Racheal Lakine-Harden

Dissertations

Problem: Maternal and fetal morbidity and mortality is a rising health care crisis in the United States. Black women are disproportionately affected. Clinician implicit bias and medical racism have been named as factors in this crisis. Recommendations to address this public health peril include; educating and raising awareness among front-line perinatal nursing staff on implicit bias and its consequences for Black women. The purpose of this project is to evaluate the impact of implicit bias training on nurses’ awareness of implicit bias, attitudes, and beliefs about disparities, and the likelihood to engage in behaviors to reduce or address racial bias …

Implementation Of Quantitative Blood Loss Tool To Detect Postpartum Hemorrhage After Vaginal Delivery, Rachael Williams

Dissertations

Problem Maternal deaths and comorbidities related to postpartum hemorrhage (PPH) continue to be high despite being quite preventable. The delay in recognition and treatment of PPH due to the use of imprecise estimated blood loss (EBL) instead of precise measurement using quantitative blood loss (QBL) attributes to this issue.

Methods For this quality improvement (QI) project, a descriptive, observational design was used to gather quantitative data regarding QBL implementation instead of EBL as well as the number of PPH’s identified. A pilot cohort of staff nurses participated by documenting QBL two hours after each delivery. The nurses were given an …

Maternal-Fetal Attachment And Its Relationship To Quality Of Life In Pregnant Women With Diabetes, Cheryl Ann Angel

Dissertations

Background: Maternal-fetal attachment (MFA) is the bond between a mother and her unborn child during pregnancy. Pregnant women with diabetes are considered high-risk and their numbers are expected to increase as levels of obesity rise and women wait longer to have children. This researcher has observed health care providers instructing pregnant women with diabetes about diabetes self-management (DSM) activities such as “dietary management” and encouraging the women to make those changes for their baby. However, some women remained unable to successfully engage in DSM behaviors despite having exhibited signs of MFA, e.g., expressing “thoughts of the fetus” to health care …

Feasibility Of Online Nutritional Counseling And/Or Remote Self Weighing In Pregnant Women With Obesity, Rebecca Mattson

Dissertations

Purpose

The purpose of this feasibility study is to determine the magnitude of effect using a combination of weekly weights and an online registered dietician to control excessive gestational weight gain in pregnant women with obesity using a pilot randomized controlled trial.

Specific Aims

There are three specific aims. Aim 1: Describe the study population in terms of sociodemographic influences (e.g., ethnicity, age, weight, and height) and obstetrical influences (i.e., parity and pregnancy weight). Aim 2: Measure participant satisfaction with the study interventions of weekly weighing and online nutrition counselling. Aim 3: (a) Explore the differences in gestational weight …

Barriers And Facilitators To Opioid Use Treatment And Recovery Services During Pregnancy, Loralie Woods

Dissertations

Purpose: To identify barriers and facilitators to opioid use treatment and recovery services among pregnant and nonpregnant women who misuse opioids.

Background: Over 130 Americans die daily after overdosing on opioids. Women have not been immune from opioid use disorders (OUDs), with a 4-fold increase from 1999-2010. The prevalence of opioid use among pregnant women increased from 1.5 per 1,000 hospital deliveries to 6.5. Although the annual National Surveys on Drug Use and Health (NSDUH) has provided information on risk factors for OUD related to socioeconomic and demographic factors, no studies using this data have identified barriers to opioid use …

Improving Maternal Outcomes Through Labetalol Algorithm Utilization For Hypertensive Disorders Of Pregnancy, Hailee B. Taylor

Dissertations

Hypertensive disorders of pregnancy can have negative effects on both mothers and neonates and are a major contributor to the increasing morbidity and mortality affecting women pregnant women in the United States. Treatment algorithms are available for treatment of hypertensive disorders of pregnancy when treatment criteria are met. With proper use of these algorithms, healthcare personnel can decrease the mortality and morbidity rates, which will increase patient safety and decrease healthcare spending. This research project focused on implementing The American College of Obstetricians and Gynecologists’ (ACOG) Labetalol treatment algorithm to treat patients diagnosed with severe preeclampsia. Prior to implementation, data …

Optimizing The Involvement Of Women With Opioid Use Disorder In The Care Of Their Infants Experiencing Neonatal Abstinence Syndrome, Rebecca Boedeker

Dissertations

The incidence of opioid use disorder (OUD) has grown to epidemic proportions. Infants exposed to opioids inutero are likely to experience withdrawal symptoms during the hours and days immediately following birth, known as Neonatal Abstinence Syndrome (NAS). Research indicates maximizing non-pharmacologic, supportive management decreases Neonatal Intensive Care Unit (NICU) admissions, the length of stay, and the severity of NAS. The purpose of this project is to evaluate the effects of an antepartum consult designed to prepare mothers with OUD to participate in this nonpharmacologic care. The Women and Infants Substance Help (WISH) Center delivers prenatal care for women with OUD. …

Birth Record Analysis Of Gestational Diabetes: Applications For Intervention Planning, Elizabeth L. Macquillan

Dissertations

Gestational diabetes (GDM) rates in the U.S. and in Michigan have increased over the past several decades, along with the increases in Type 2 Diabetes Mellitus and obesity. GDM is associated with adverse health outcomes for mothers and their offspring. Many current maternal-infant health (MIH) programs in Michigan do not target women with GDM. This study aims to assess state-level rates of GDM in pregnancy with a combination of statistical and spatial analyses using Geographic Information Systems (GIS) for the purpose of informing content and location of public health interventions.

Existing data from 2013 Michigan birth records (107,743 births) were …

Sleep Disordered Breathing And Pregnancy: Prevalence And Outcomes At Delivery, Ryan Lyle Nations

Dissertations

Introduction
Sleep Disordered Breathing (SDB) during pregnancy is associated with maternal and neonatal morbidity, and in-hospital mortality. A recent prevalence study using the Nationwide Inpatient Sample reported an obstructive sleep apnea (OSA) prevalence of 7.3 per 10,000 in 2013, a rate of 24% per year over the last decade. The rise in prevalence mirrors the rise in obesity. Military Treatment Facilities (MTF) have seen an increase in obesity and related co-morbidities with an unknown prevalence of SDB. Most studies have been conducted in high-risk populations; the general prevalence of SDB and its association with adverse pregnancy outcomes in a military …

Influence Of Maternal Prior Life Adversity On The Psycho-Neuroendocrine-Immune Profile During Pregnancy, Karen J. Kotz

Dissertations

Pregnancy is accompanied by a multitude of physical and psychological changes. Adaptation to these changes through reduced anxiety and attenuated stress responsiveness is necessary across gestation and into the postpartum period for optimal maternal-infant health. In contrast, exposure to higher amounts of stressors during pregnancy can disrupt neuroendocrine-immune processes required for successful pregnancy outcomes. Evolving evidence demonstrates that exposure to adversity early in life has long-lasting effects on stress response systems that alter stress reactivity during adulthood. Given this evidence, it is posited that women who experience greater pre-pregnancy adversity during their childhood are at greater risk for negative maternal-infant …

Factors And Health Promoting Behaviors That Influence Maternal And Infant Outcomes In Older Pregnant Thai Women, Supawadee Thaewpia Phd, Msn, Rn

Dissertations

This dissertation summarizes research conducted in partial fulfillment of the program requirements for the Doctor of Philosophy in Nursing degree from the Hahn school of Nursing and Health Sciences, University of San Diego. The results of the dissertation research are organized as three discrete papers. Article one is entitled; "Reliability and Validity of Thai Translations of Instruments Measuring Psychosocial Factors and Health Promoting Behaviors among Older Pregnant Thai Women." This article describes the dissertation research study in which the selected instruments were piloted at an antenatal clinic in Thailand. The article determines the instruments' ability to examine perceived benefits, perceived …

Cord Blood Collection In Pregnant Women For Stem Cell Research, Irene Carr Phd

Dissertations

Umbilical cord blood (UCB) stem cells form commonly banked types of human tissue. Confusion remains about sources of stem cells and their use. Birth is a once in a lifetime opportunity with 74 million births per year in the world and four million occur in the United States. Cord blood contains hematopoietic stem cells and pluripotent mesenchymal cells (Moise, 2005). There is a surge of interest in the clinical use and research investigation of umbilical cord blood for transplantation and regenerative medicine. Clinicians need increased awareness and education of options for private versus public donation and banking of cord blood …

Gestational Diabetes, Depression, And The Impact On Maternal Child Health Outcomes, Mary Alice Byrn

Dissertations

Antenatal depression occurs in about 20% of all pregnancies and gestational diabetes occurs in up to 14% of all pregnancies. Although there is sufficient information on (1) depression during pregnancy and (2) depression and diabetes, there is little information about depression and gestational diabetes. This comparative, longitudinal research study was done to better understand the relationship between gestational diabetes and depression. The study aims were the following: (1) to determine whether women with gestational diabetes had more depression than women without gestational diabetes, (2) to determine whether factors predictive of depression in pregnant women with gestational diabetes were different from …

Prenatal Maternal Attachment: The Lived Experience, Regina Ann Leva-Giroux Dnsc

Dissertations

Prenatal maternal attachment and the practice of health promoting behaviors during pregnancy are considered universal phenomena to women. Yet, the understanding of these phenomena from the lived experiences of pregnant women has not been well researched. The purpose of this phenomenological study was to describe the experience of maternal attachment to the unborn child and how that attachment might relate to the practice of these behaviors during pregnancy. The participants in this study were ten English speaking women, college educated, professionally employed, who were pregnant for the first time. Unstructured interviews were conducted with the participants at 14–16 weeks and …

Being Pregnant And Using Drugs: A Retrospective Phenomenological Inquiry, Merry A. Armstrong Dnsc, Msn

Dissertations

Qualitative methodology was employed to conduct a phenomenological inquiry describing the structure of the experience of being pregnant and using drugs. The purpose of the study was to explore the nature of women's experience and perception of the interaction, relationship, and intersection of contextual phenomena of lifestyle, pregnancy, and substance abuse. Data gathering and analysis was accomplished using guidelines provided by Spiegelberg and Van Manen. Eleven mothers voluntarily participating in a recovery program described their prior experience of being addicted and pregnant during 2 conversations with the researcher. Through transcript analysis of the first audio-taped interview, major and minor themes …

Pregnancy Outcome In Military And Civilian Women, Karen Messersmith Heroman Dnsc

Dissertations

Low birth weight and prematurity account for much of the morbidity and mortality in the neonatal period as well as for much of the cost in newborn care. The purpose of this investigation was to determine if two groups of pregnant women, military enlisted and civilian dependents, differed in selected risk factors (smoking, alcohol consumption, weight gain, prenatal care, work patterns, life stress, and social support) or in pregnancy outcome (infant birth weight and gestational age). The House (1981) theory of stress, social support, and health served as the framework for this study. Since little has been published on pregnancy …