Nursing Commons^™

Maternal Mortality In Non-Hispanic Black Women, Amelia Major

Grace Peterson Nursing Research Colloquium

Background: The United States has the highest maternal mortality among all developed countries, among these mothers, non-Hispanic black women are three times more likely than women of any other racial group to die from pregnancy-related causes.

Purpose: To investigate racial disparities among pregnant women who die from pregnancy related causes (maternal mortality) and determine possible interventions to improve outcomes.

Methods: An integrative literature review was conducted to analyze peer-reviewed articles published from 2007 to 2018; a computerized search of literature was performed using Cumulative Index to Nursing and Health Literature (CINAHL), Proquest Nursing and Allied Health Sources, …

Determining Risk Factors To Decrease Maternal Mortality Related To Chronic Hypertension: An Integrative Literature Review, Chelsea Stellmach

Grace Peterson Nursing Research Colloquium

Background: Maternal mortality ratio (MMR) in the United States in 2015 was 26.4, higher than many other developed countries. Maternal deaths due to hypertensive disorders of pregnancy are on the rise, including chronic hypertension. Chronic hypertension is defined as blood pressure greater than or equal to 140/90 mmHg before pregnancy or during the first 20 weeks of gestation. This condition occurs in up to 5% of pregnancies which are more likely to result in adverse maternal outcomes. Nearly 40% of maternal deaths are preventable, especially those related to chronic diseases.

Objectives: The purpose of the integrative literature review was to …

Implementation Of A Transcutaneous Bilirubinometer On A Postpartum Unit At A Magnet Community Hospital, Riley O'Connell

Master's Projects and Capstones

A common clinical concern for all newborns in the first few days of life is the risk of hyperbilirubinemia. Hyperbilirubinemia if left untreated can lead to permanent hearing loss, neurological dysfunction, and even irreversible brain damage called kernicterus. Bilirubin monitoring and early intervention can prevent these adverse events from occurring. Best practice recommends the use of transcutaneous bilirubin (TcB) monitoring on all term, low-risk newborns (>38 weeks gestation at birth) at 24-hours of life. Replacing total serum bilirubin (TSB) draws through a heel stick, with TcB assessments leads to utilization of evidence-based practice. The transcutaneous bilirubinometer is a non-invasive, …

Experiences Of African American Mothers Following Infant Death, Katina W. Jones

Nursing Theses and Dissertations

African American women have been disproportionately affected by unfavorable birth outcomes for decades. Infant mortality rates for non-Hispanic African American women have been almost twice as high as that of Caucasian women for years. The goal of this study was to: (1) understand African American mothers’ experiences with infant death and (2) discover how African American mothers manage their grief following the loss of an infant. A review of the literature revealed African American women experience infant loss at a rate of 13.31 deaths per 1,000 live births compared to 5.63 for Caucasian women and 4.75-9.22 for other racial and …

Postpartum Hemorrhage: A Change Strategy, Alison Landis

Master's Projects and Capstones

Problem: Postpartum hemorrhage (PPH) is one of the leading causes of severe maternal morbidity and mortality. It is unpredictable and can occur with or without identified risk factors. A postpartum hemorrhage can happen rapidly, therefore it is important for the team to be trained and prepared to recognize and respond quickly to the situation, by quantifying blood loss at deliveries.

Context:The California Maternal Quality Care Collaborative (CMQCC) has created a toolkit to better prepare maternal child health teams for readiness, recognition, response, and reporting when a hemorrhage occurs. This program was rolled out on the unit in 2015 resulting …

Improving The Timing Of Antibiotic Administration In High-Risk Neonates, Jed Comuelo

Master's Projects and Capstones

Improving the Timing of Antibiotic Administration in High-Risk Neonates

Abstract

Problem: The rapid nurse turnover and improper use of the golden hour flowsheet are some of the factors that affect the timing of antibiotic administration. A review of 38 patient charts was done and only shows 20% received antibiotics within 1 hour.

Context: This microsystem is a 22-bed neonatal intensive care unit with an average of 900 admissions per year. The team is composed of doctors, nurses, respiratory therapist, and pharmacists. The budget needed for this project consists of the overtime pay needed to compensate nurses for attending additional staff …

Simulation Course Redesign, Hsuan Ho

Master's Projects and Capstones

The purpose of this project is to enhance the clinical nurse leader (CNL) nursing students’ learning experiences through simulation education, ensure that their learning outcomes meet course objectives, and increase students’ recognition of educational best practices in simulation.

This summer semester, the number of students in the obstetric course doubled and the course was changed from four scenarios held over two simulation days for four pre-licensure students each class to five simulation days with eight to ten students in attendance each class period. While the old student-to-instructor ratio was three to four to one, the new ratio is nine to …

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. …

An Exploration Of Nicu Nursing Staff Perspective On The Change From Pod To Private Room Patient Care, Julie Nickles

Dissertations

Neonatal Intensive Care Units (NICU) are designed to care for critically ill newborns who require constant care. The design of the NICU may have an impact on not only the patient and their family but also the nursing staff. Historically neonatal intensive care have employed a cohort model of care. In this model multiple infants are in the same room or pod. With success of single room maternity care, the increased need for changes in neonatal care became apparent. Today, new parents desire extended contact with their extremely preterm and often very sick infant. This trend has led a standard …

Aligning With Patient-Centered Medical Home Standards: Depression Screening In Women's Health, Charity Galgani

Dissertations

Problem: The Patient Centered Medical Home (PCMH) model of care improves health care quality and patient experience of care, and decreases costs. Depression screening is a requirement for becoming a PCMH. The purpose of this quality initiative was to obtain baseline data to describe depression screening rates among female adult patients receiving women’s health care within a Midwestern public health department seeking PCMH recognition.

Methods: The study utilized a descriptive, observational design and was guided by the Plan-Do-Study-Act framework. A retrospective medical record review was used to assess the rate of depression screening utilizing the PHQ-2 and PHQ-9 tools, and …

Alternatives In Magnesium Sulfate Treatment Courses: An Investigation Of Physician Prescribing Behaviors, Erin Williams

Dissertations

Problem: The gold standard for managing preeclampsia in the postpartum patient is 24- hours of magnesium sulfate as this is the time the patient is most susceptible to experiencing a seizure (American College of Obstetricians & Gynecologists, 2013). However, these patients are at an increased risk for experiencing adverse health outcomes, as well as interruptions in maternal-infant bonding due to the mother requiring a higher level of care. Methods: A one group pretest-posttest design was conducted to gain a better understanding of the current practice while also assessing the willingness of physicians to change prescribing behavior after receiving the research-based …

Journey Interrupted: A Phenomenological Exploration Of Miscarriage, Marit A. Watson, Vanessa D. Jewell, Sarah L. Smith

The Open Journal of Occupational Therapy

Background: Miscarriage is a significant life event that impacts occupational performance, identity, and competence and that influences perceptions of motherhood. Because of the lack of social rituals often attributed to the death of a loved one, miscarriages may result in disenfranchised grief, which impedes coping.

Methods: This phenomenological study explored the impact of miscarriage on relationships, perceptions of motherhood, and the meaning of occupation in the context of grief. Data was collected through semi-structured interviews (N = 4) and completion of a brief demographic questionnaire. The interviews were digitally recorded, transcribed verbatim, and reviewed to ensure accuracy. Using inductive thematic …

The Association Of Kangaroo Mother Care, Energy Conservation, And Bonding In Preterm Neonates, Dorothy Forde

Dissertations

Purpose:To examine the association of kangaroo mother care (KMC) on energy utilization and bonding as evidenced by reduced biochemical markers of adenosine triphosphate (ATP) degradation, hypoxanthine (Hx), xanthine (Xa), and uric acid (UA), and (allantoin), a measure of oxidative stress in preterm infants 24-36 weeks gestation. A secondary objective was to compare specific physiological parameters using bedside monitoring and perfusion and oxygenation of the gut using near-infrared spectroscopy (NIRS) during 1 hour of KMC compared to incubator care.

Study design: A randomized controlled trial (RCT) examining the effects of 1-hour of KMC or 1-hour incubator care on urinary markers …

An Assessment Of Maternal Mortality In Papua New Guinea: An Explanatory Sequential Mixed Methods Approach, Jennifer Litau

Adventist Human-Subject Researchers Association

Research into the serious manifestation of maternal mortality in Papua New Guinea is essential for formative knowledge and intervention. Explanatory sequential mixed methods approach employed first involved SPSS analyses of Gulf Provincial Hospital’s obstetric data revealing high rates of home deliveries by mothers. Interviews in high incidence communities provided explanations and mortality experiences.

The Effect Of A Mindfulness Intervention On The Depression Symptoms Of Mothers In Treatment For An Opioid Use Disorder, Karen Alexander

Electronic Theses and Dissertations

BACKGROUND: Mothers in treatment for an opioid use disorder experience a high prevalence of depression which may influence their relationship with their child. In the general population, mindfulness-based parenting intervention has been seen in the literature to have a clear positive effect on maternal depression. No research has been published regarding the effect of mindfulness intervention on maternal depression of women in treatment for an opioid use disorder.

OBJECTIVES: To describe the characteristics of mothers in treatment for opioid use disorder, including depression and adverse childhood experiences, and to evaluate the characteristics associated with participation in a mindfulness intervention. Lastly, …

Comparison Of Two Methods Of Pediatric Triage Education, Catherine Recznik

Electronic Theses and Dissertations

Introduction. The majority of pediatric emergency patients are seen in mixed-age emergency departments and triaged by general emergency nurses. Educational methods for teaching pediatric triage education to general emergency nurses have not been well studied, and previous studies of the use of the Emergency Severity Index in children have been performed primarily in centers that are high volume for pediatrics. Methods. A repeated measures, randomized crossover study comparing two different methods of pediatric triage education was conducted. Participants were general emergency triage nurses recruited from a general emergency department that is classified as low volume for pediatrics. Each participant was …

Preterm Labor Assessment Toolkit Implementation, Mandi Wilkins

Doctor of Nursing Practice Scholarly Projects

ABSTRACT

PRETERM LABOR ASSESSMENT TOOLKIT IMPLEMENTATION

Mandi Mae Wilkins

Every year 10% of babies in the United States are born premature. Prematurity is the leading cause of infant mortality. Standardized preterm labor (PTL) assessment protocols reduced preterm birth rates, decreased costs, and resulted in more timely diagnoses and prevented the overtreatment of pregnant women who were not experiencing true preterm labor. At a Midwestern, Level II trauma hospital with regional neonatal intensive care unit and 700 annual deliveries, a Preterm Labor Assessment Toolkit (PLAT) was implemented and pre- and post-data garnered. The toolkit contained a provider algorithm and an order …

Nurses' Breastfeeding Knowledge And Confidence After Education Session, Anna Caroline Tillman

The Eleanor Mann School of Nursing Undergraduate Honors Theses

Background: Education is an essential part of the nursing profession. Nurses should be teaching their patients every day, ensuring they understand the most reliable evidence-based practices. In breastfeeding education, however, there is a lack of education to expectant mothers on common breastfeeding methods, how to overcome common barriers, and general breastfeeding knowledge. If nurses can be effectively educated in breastfeeding knowledge and build their confidence in teaching their patients, then mothers will receive more thorough and helpful breastfeeding education. The hope in educating both nurses and mothers is to increase breastfeeding exclusivity rates to meet Healthy People2020 goals.

Objective: The …

Perceptions Of Pediatric Nurses And Parents Of Hospitalized Children Engaged In Shared Decision Making., Lisa English Long

Electronic Theses and Dissertations

Achievement of optimal quality in today’s healthcare environment practices means that clinical practices must be based on evidence. Evidence-based practice (EBP) is the integration of research findings, clinician expertise, and patient-centeredness that includes a focus on preferences and values (Melnyk & Fineout-Overholt, 2015). An area within EBP needing increased attention is the aspect of patient preferences and values. The process of Shared Decision Making (SDM) incorporates assessment of preferences and values within a process in which where patients, families and healthcare professionals collaborate to make decisions regarding patient care. The purpose of this study was to describe perceptions of parents …

Causes Of Late Preterm Infant Hospital Readmission Rates In Relation To Feeding, Kaitlyn Reid

The Eleanor Mann School of Nursing Undergraduate Honors Theses

Abstract

Background:

In the U.S., late preterm (LP) births, which occur at 34^0/7-36^6/7 weeks gestation, make up the largest and fastest-growing group of preterm births. Although there is a trend of increased rates of LP infant readmissions compared to term infant readmissions, the relationship between LP infant morbidities and method of feeding has not been extensively studied.

Objective:

The purposes of this study were to 1) identify the primary causes of LP infant hospital readmissions and, 2) correlate the primary causes of LP infant hospital readmissions with the method of feeding.

Methods:

The design of this nonexperimental …

Retrospective Analysis Of Obstetric Sepsis Screening, Holly A. Champagne

Doctoral Projects

This project was designed to evaluate outcomes following implementation of routine screening for sepsis in the obstetric population. A retrospective analysis of the electronic medical record of 204 women who met sepsis criteria using obstetric-adjusted systemic inflammatory response syndrome (SIRS) criteria and a source of infection was the method used. Outcomes were evaluated for neonates born to the women who developed sepsis during labor. The incidence of sepsis was 0.401 per1,000 and included those with antepartum, intrapartum, or postpartum admissions. The setting was a tertiary center with 5,075 deliveries over the study period. There were 92 (45.2%) who had sepsis, …

Obstetric Nurses’ Perceived Barriers To Immediate Skin To Skin Contact After Cesarean Birth, Joelene Sarmiento Balatero

Doctoral Projects

Despite the strong evidence supporting immediate skin to skin contact (SSC) after birth, research suggests that patients who undergo cesarean births do not have the same opportunities for SSC as patients who undergo vaginal births. There are limited studies regarding provider attitudes surrounding the practice of immediate SSC after cesarean birth. The aim of this research was to understand obstetric nurses’ perceived barriers to immediate SSC after cesarean section.

An exploratory qualitative design was used for the project. The semi-structured, open-ended interviews were conducted via video conferencing. Conventional content analysis methods were used to analyze the data, which yielded the …

Maternal Obesity And Fetal Macrosomia: An Integrative Review Of The Literature Regarding Interventions, Charity Stalcup

Senior Honors Theses

Research suggests pre-pregnancy obesity is associated with an increased risk of macrosomia in the newborn. Since women are expected to gain weight during pregnancy, the standard recommendation of weight loss for obesity is not ideal for this population. In this systematic review of the literature regarding interventions for maternal obesity to reduce fetal macrosomia, 149 articles were screened using three different databases to identify recent randomized controlled trials related to this topic. A total of 11 full text articles were analyzed and included in the review. The articles addressed nutritional, lifestyle, and pharmacological interventions. The results indicated there is currently …

World Health Organization Decision Making Tool For Family Planning- Can We Increase Iud Use?, Kim Anna

Graduate Theses, Dissertations, and Capstones

Background and Purpose: Worldwide unintended pregnancy rates are reported at 40% of all pregnancies. The United States has an unintended pregnancy rate of 45%. Contraception is safe and available for most women. Many providers lack evidence-based tools and current information in assisting clients to choose a highly effective contraceptive method. Intrauterine devices (IUD) and implants are highly effective contraception. The American College of Obstetricians and Gynecologists (ACOG) and the American Academy of Pediatrics (AAP) recommend IUDs and implants as first tier contraception for most sexually active females.

Methods: Implementation of the World Health Organization Decision-Making Tool (WHO DMT) for contraceptive …

Nursing Interventions For Neonatal Abstinence Syndrome, Sierra Harris

Scholars Week

This project serves to explore evidence for three nursing interventions aimed at neonatal abstinence syndrome including: breastfeeding, kangaroo care, and rooming-in. Many nursing interventions and policies are aimed at treating the symptoms despite limited research supporting their effectiveness. Further investigation into these interventions and policies regarding neonatal abstinence syndrome needs to be addressed in order to improve the quality of care for affected neonates and decrease the stigma surrounding neonatal abstinence syndrome.

Addressing Extreme Vulnerability: Remaining Barriers To Neonatal Healthcare Delivery In Conflict Areas, Olivia Palmer

Independent Study Project (ISP) Collection

Global statistics show that world-wide neonatal mortality rates are not yet within the target range set by Sustainable Development Goals and reflect persistent violations of the fundamental right to health for newborns around the world. While there is a wide base of knowledge on the main causes of death and minimum standards of care for neonatal health in stable and low-resource settings, there is a significant gap in knowledge regarding the unique circumstances of neonatal healthcare situated in conflict settings. The main objectives of this research are to elaborate on the current state of neonatal healthcare in conflict areas and …

Perceptions Of Chinese Women Coming To The United States To Give Birth: Birth Tourism, Juanita Childs Jaramillo

Doctoral Projects

Birth experiences and perceptions vary greatly among different cultures. There has been an increase in Chinese women who specifically come to the United States (US) to give birth to their child and return back to their native country after being cleared at the postpartum checkup. This practice is known as birth tourism. The aim of this study is to explore the perceptions of childbirth and postpartum experiences among Chinese birth tourists. Twelve women self-identifying as Chinese, between the ages of twenty-four and thirty-eight, who came to the US to give birth to their child, and who were able to read …

Comparison Of Serum And Cervical Cytokine Levels Throughout Pregnancy Between Preterm And Term Births, Kristin Ashford, Niraj R. Chavan, Amanda T. Wiggins, Molly Malany Sayre, Andrea Mccubbin, Agatha S. Critchfield, John O'Brien

Nursing Faculty Publications

Objective To assess differences in cytokine levels in cervicovaginal fluid (CVF) and serum across trimesters between women with preterm births (PTBs) and full-term births.

Study Design This multicenter study enrolled 302 women with a singleton gestation. CVF and serum cytokines, interleukin 1α (IL-1α), IL-1β, IL-6, IL-8, IL-10, C-reactive protein (CRP), tumor necrosis factor (TNF)-α, and matrix metalloproteinase (MMP)-8, were measured. Women with at least one cytokine assessment and noted PTB status in their medical record were retained in the study (N = 272). Data were analyzed using mixed modeling (main effects of PTBs and time/trimester).

Results For the CVF …

Abcs Of Safe Sleep, Alyson Hill Rn, Jennifer Markey Rn, Bailey Ritter Rn, Ashley Smith Rn, Aaron Smithson Rn

Presentations

PICO Question

Does education and teaching to parents and family regarding safe sleep practices increase the compliance of safe sleep for infants 0-12 months on 4 Sutherland compared to the current practice?

Aim Statement

The objective of the evidence based practice project is to increase Safe Sleep compliance by improving education given to parents and family from 20% to 90% by February 2018

Ed Staff Morale, Madison Wilkins Rn, Tonya Cross Rn, Brittany Schmalzbach Rn, Noah Olla Rn, Fred Richards Rn, Emily Pendleton Rn

Presentations

PICO Question

PICO Question & Aim Statement

• (Population, Intervention, Comparison, Outcomes Measures)

• P: ED Nurses and Support Staff

• I: Huddle Recognition and prizes

• C: No recognition

• O: Improved nursing morale

 To increase the median morale of nursing and support staff from 74% to 80% as measured by Daily Pulse by March of 2018