Nursing Commons^™

Implementation Of Outpatient Cervical Ripening In The Community Hospital Setting: A Quality Improvement Process, April St Hilaire

DNP Scholarly Projects

Background: Cervical ripening is a critical component of labor induction. Outpatient cervical ripening using mechanical dilators offers a safe patient- centered alternative to inpatient management, with potential benefits in efficiency and patient satisfaction and cost savings.

Local Problem: At a community hospital setting with increasing induction rates, prolonged admission-to-delivery times and prolonged patient stays were observed in patients undergoing inpatient cervical ripening, prompting a need for more efficient, patient centered approaches.

Methods: Using the Plan-Do-Study-Act (PDSA) framework, an outpatient cervical ripening protocol was implemented over a 15-week period to compare inpatient versus outpatient cervical ripening using mechanical …

Determining Space Requirements For Small And Sick Newborns And Their Mothers In Health Facilities: A Systematic Review, Natalie Strobel, Georgia Whisson, Derek Swe, Rajesh Mehta, Amy Budrikis, Karen Edmond

Research outputs 2022 to 2026

Background There are currently no World Health Organization and United Nations Children Fund benchmarks or ‘norms’ for scaling up small and sick newborn (SSN) service delivery in health facilities in low- and middle-income countries (LMICs). Specifically, there is limited evidence on optimal bed space requirements in SSN units such as special care nurseries and neonatal intensive care units (NICUs). Through this systematic review, we aimed to gather evidence on the optimal space requirements needed for SSNs and their mothers in health facilities, particularly at level 2 district hospitals. Methods We included simulation, experimental, and observational studies, as well as guidelines …

A Quality Improvement Project: Increasing Nurse Satisfaction With Patient Educational Material Related To Pain Management Options During Labor, Madison Grant

Master's Theses and Capstones

BACKGROUND:

Pain management is a large portion of what nurses manage during the patient’s time on the labor and delivery unit. The primary forms of pain management that is available to women during this time includes epidurals, nitrous oxide, stadol/diphenhydramine, and nonpharmacological options such as breathing techniques. It is essential that patients are aware of all pain management options prior to entering the unit for delivery, however sometimes nurses have to help to close the educational gap.

LOCAL PROBLEM:

Within the microsystem, it was acknowledged that many patients lacked the education of their pain management options prior to delivery which …

A Quality Improvement Initiative To Reinforce Education To Increase Nurses’ Knowledge And Confidence In Patient-Centered Labor Positioning, Larkyn Baum

Master's Theses and Capstones

Background: Cesarean section (CS) delivery is an important and necessary intervention, yet comes with increased risks to the patient and fetus compared to vaginal birth. CS rates have been increasing globally, and implementing interventions to promote vaginal birth, especially for nulliparous, term, singleton, vertex (NTSV) patients is of interest to patients, providers, and institutions.

Local Problem: In 2024, the CS rate within the microsystem was 32%, more than double the WHO-recommended benchmark of 10–15%. Of all CS deliveries in 2024, 31% were nulliparous, term, singleton, vertex (NTSV) patients, who are considered optimal candidates for vaginal delivery. Given the elevated rate …

A Quality Improvement Initiative: Enhancing Knowledge And Confidence In Effective Eclamptic Seizure Management Among Maternity Nurses, Emma C. Donigian

Master's Theses and Capstones

Background: Preeclampsia and eclampsia (PE/E) are leading contributors to maternal morbidity and mortality rates globally. Timely recognition and intervention are essential for improving maternal outcomes. However, evidence indicates that healthcare professionals often lack sufficient knowledge and confidence in managing these conditions, highlighting a critical need for ongoing education to ensure safe, effective care.

Local Problem: At a small maternity unit in Northern New England, nurses expressed concern about their preparedness to manage eclamptic seizures, a rare but high-risk obstetric emergency. Although preeclampsia is commonly encountered, eclampsia occurs infrequently, limiting staff exposure and hands-on experience. This combination of low frequency and …

A Quality Improvement Project: Increasing Pre-Term Infant Safety By Enhancing Skin-To-Skin Time In The Nicu, Maureen A. Cassidy

Master's Theses and Capstones

Background: Skin-to-skin (STS) contact, also known as kangaroo care, is a critical intervention for preterm infants, especially for those in the neonatal intensive care unit (NICU). It promotes neurodevelopmental outcomes, physiological stability, and parental bonding. However, STS often falls below recommended daily levels due to a variety of berries. Exploring aids like belly bands may help address these barriers and promote improved outcomes.

Local Problem: STS time in this NICU microsystem falls significantly below nationally recommended levels, with most preterm infants receiving less than one to two hours daily compared to the World Health Organization’s recommendation of 8-24 hours per …

The Association Between Implicit Bias From Healthcare Providers And Postpartum Depression Among Black Women., Chelsea T. Costa

Honors Undergraduate Theses

Postpartum depression is one of the most common issues that women face after birth. Many different factors can contribute to the development of postpartum depression, including perinatal complications, prenatal depression, or social factors. One of the social factors that Black women, specifically, face leading to postpartum depression is discrimination. The purpose of this literature review is to identify research that focuses on whether implicit bias and discrimination by healthcare providers contributes to postpartum depression among Black women. A literature review was conducted using databases including CINHAL Plus Text, CINHAL ULTIMATE, Medline, and APA Psycinfo, with terms that included “healthcare provider* …

Effects Of Pregnancy And Lactation Prebiotics Supplementation On Infant Allergic Disease: A Randomized Controlled Trial, Debra J. Palmer, Alana R. Cuthbert, Thomas R. Sullivan, Rachelle A. Pretorius, Johan Garssen, Kristina Rueter, Maria C. Jenmalm, Jeffrey A. Keelan, Desiree Silva, Susan L. Prescott

Research outputs 2022 to 2026

Background: Ingestion of prebiotics during pregnancy and lactation may have immunomodulatory benefits for the developing fetal and infant immune system and provide a potential dietary strategy to reduce the risk of allergic diseases. Objective: We sought to determine whether maternal supplementation with dietary prebiotics reduces the risk of allergic outcomes in infants with hereditary risk. Methods: We undertook a double-blind randomized controlled trial in which pregnant women were allocated to consume prebiotics (14.2 g daily of galacto-oligosaccharides and fructo-oligosaccharides in the ratio 9:1) or placebo (8.7 g daily of maltodextrin) powder from less than 21 weeks’ gestation until 6 months …

Moderate-To-Late Preterm Infants Benefit From The Early Collaborative Intervention: Primary Outcomes Of An Rct, Ulrika Birberg Thornberg, Felix Sebastian Koch, Charlotte Sahlén Helmer, Jonna Tell, Ellinore Nyberg, Thomas Abrahamsson, Evalotte Mörelius

Research outputs 2022 to 2026

Aim: This study aimed to determine the longitudinal impact of the EArly Collaborative Intervention (EACI), a three-session early intervention designed to enhance parent-infant interaction, on the developmental outcomes of preterm infants born between 30 + 0 and 35 + 6 weeks of gestation. Methods: This randomised controlled blinded study recruited families in two neonatal intensive care units in Sweden. In this one-year follow-up, 87 infants (standard care = 37, standard care with EACI = 50) were included in the intention-to-treat analysis. The primary study outcomes were cognition, receptive and expressive communication, and fine and gross motor development measured with the …

Determinants Of Short Interpregnancy Intervals In High-Income Countries: A Systematic Review, J. Dunne, D. Foo, J. Jancey, G. Pereira, B. Kefale, D. G. Belay, G. Dhamrait, A. T. Gebremedhin, K. B. Mruts, S. D. Nyadanu, A. Roy, G. A. Tessema

Research outputs 2022 to 2026

Short interpregnancy intervals (IPIs) of <6–18 months are associated with adverse maternal and child outcomes. This study aimed to identify the individual, relationship, community, and societal factors that influence short IPIs in high-income countries. A comprehensive search was undertaken in CINAHL Plus, Ovid/EMBASE, Ovid/MEDLINE, Ovid/PsycINFO, ProQuest, PubMed, Scopus, Web of Science, and Google Scholar for articles published in English from 1st January 1990 to 26th October 2023. Studies were included if they reported an effect estimate of at least one determinant of pregnancy spacing in a high-income country. The quality of the included studies was assessed using the Johanna Briggs Institute Critical Appraisal Tool and Cochrane Risk Assessment Tool. Multi-level factors at the individual, relationship, community, and societal level were systematically identified through the socio-ecological model. This study is registered with PROSPERO (CRD42020176311). Of 2005 unique articles, 220 were identified for full-text review, and 55 met the inclusion criteria representing a total of 27,103,055 women from 13 high-income countries. All the included studies were deemed to be of moderate to high quality. Most of the studies reported determinants of short IPI at the individual level, with non-use of contraception the most common reported factor. Peer influence was a factor at the relationship level, and access to health care and reproductive services were impactful at the community and societal levels, respectively. Future research and efforts should support the development and implementation of policies and practices that support optimum pregnancy spacing from a comprehensive socio-ecological position.

Estimating The Number Of Hospital Beds For The Care Of Sick And Small Newborns: An Evidence-Based Systematic Approach, Bireshwar Sinha, Mohan Kumar, Deena Thomas, Natalie Strobel, Gagan Gupta, Karen Edmond, M. Jeeva Sankar

Research outputs 2022 to 2026

Background Current recommendations for neonatal bed requirements are largely assumption-based rather than data-driven. We aimed to estimate the number of beds per 1000 live births needed for the care of small and sick newborns. Methods We first extracted data from studies published between 2018 and May 2023. Then, due to considerable heterogeneity in the data, we performed a meta-analysis using a random effects model to estimate the number of neonatal admissions and the length of stay. We divided the total patient days (admission rate multiplied by the length of stay) by 365 to estimate the annual number of beds per …

Of Scents And Cytokines: How Olfactory And Food Aversions Relate To Nausea And Immunomodulation In Early Pregnancy, Dayoon Kwon, Daniel M.T. Fessler, Delaney A. Knorr, Kyle S. Wiley, Julie Sartori, David A. Coall, Molly M. Fox

Research outputs 2022 to 2026

Background: During pregnancy, the maternal body undergoes extensive physiological adaptations to support embryonic growth, including whole-body remodeling, that may induce odor and food aversions, as well as nausea and vomiting. The biological mechanisms behind odor and food aversions, as well as nausea and vomiting in early pregnancy, remain largely unexplored. Our study investigated associations between these changes and cytokine profiles during pregnancy. Methodology: A cohort of pregnant Latina women in Southern California (n = 58) completed a structured questionnaire on pregnancy "morning sickness"-related symptoms and aversions. Maternal plasma cytokine levels were measured between 5 and 17 weeks' gestation. Results: About …

Functional And Traditional Medical Management Of Endometriosis: An Integrative Review, Madison G. Daniels

Senior Honors Theses

Endometriosis, a progressive disease that affects many women worldwide, has been managed primarily through hormonal medication, pain management and surgical intervention. However, there is a growing desire among women to use more natural and holistic methods to control the progression of this disease as well as effectively manage the severe symptoms that accompany it. This integrative review examines the efficacy of functional management as compared to traditional medical management. The pathophysiology of each treatment method and provide statistical evidence as to its efficacy. The progression of the disease, symptom management, and related side effects are all taken into consideration in …

To Be Soft Again: A Phenomenological Study Of Uncertainty And Resilience In Childbearing During The Covid-19 Pandemic, Marcianna Nosek

Nursing and Health Professions Faculty Research and Publications

Background:

During the COVID-19 pandemic, uncertainty was exacerbated in experiences of pregnancy and childbirth as people navigated through uncharted territory. Building resilience may be one effective way to cope. However, for those who carry a heavier burden in upholding others, a societal expectation of “toughness” and the ability to endure may lead to an appearance of resilience, while on the inside, well-being may be compromised.

Objectives:

This study is part of a larger phenomenological study that explored the broad research question: What is the lived experience of childbearing during the COVID-19 pandemic? Specific themes of uncertainty and resilience are reported …

Still Faces, Different Places: An Assessment Of The Literature On The Face-To-Face Still Face Procedure For Cultural Congruence, Merilyn Arikkat, Leslie B. Lantz, Patricia Kinser

UROP Posters

Cultural understanding is a factor that impacts reliability of research results for observational studies. It is important to include participants of minority groups in research, as many people of color face disproportionate challenges in terms of healthcare access and resources. Within the context of mother-infant attachment, a technique known as the Face-to-Face Still Face procedure can be utilized to observe attachment styles and the bond between a parent and their infant. In order to combat subjectivity within the coding process for this Face-to-Face Still Face procedure, cultural congruence between the participants being observed in the study and the coding researchers …

Effectiveness And Safety Of Intravenous Iron Therapy In Outpatient Obstetrical Clinic For Treatment Of Iron-Deficiency Anemia During Pregnancy, Ellen M. Murrin, Olivia S. Lebeau, Lillian Singer, Mark A. Kassab, Peyton Kalan, Julie Costanzo, Scott A. Sullivan, George L. Maxwell, George R. Saade, Antonio F. Saad

Department of Obstetrics & Gynecology Faculty Publications

Background

Iron-deficiency anemia (IDA) affects over one-third of pregnant patients globally, contributing to severe maternal morbidity and adverse neonatal outcomes. Oral iron supplementation, while cost-effective, is limited by poor absorption, significant gastrointestinal side effects, and poor adherence. The use of intravenous (IV) iron addresses many of these concerns, including eliminating GI side effects and the need for daily therapy. However, administration of IV iron in pregnant patients is typically restricted to specialized infusion centers or hospitals due to concerns about acute side effects, cost, resource utilization, the need for fetal heart rate monitoring, and extended infusion times.

Methods

This descriptive …

The Efficacy Of Physical Activity Or Exercise Among Individuals With Cerebral Palsy: An Umbrella Review Of Systematic Reviews, Majed M. Alhumaid, Faris Yahya I. Asiri, Mohamed A. Said, Justin A. Haegele

Human Movement Studies & Special Education Faculty Publications

Introduction

Cerebral palsy (CP) is the most common childhood disability, affecting 1.5-3 per 1000 live births. Physical exercises have been shown to improve muscle and limb outcomes in CP. This systematic review critically appraises existing systematic reviews on the effects of physical activity and exercise on physical, functional, and psychosocial outcomes in individuals with CP compared to those without.

Methods

Using a PICO framework, the question was: In patients with CP, do physical activity and exercise improve muscle- and limb-related outcomes compared to no intervention or usual care? PubMed, Cochrane, ISI Web of Science, and Embase were searched for systematic …

Quality Over Quantity: Doula Perspectives On Equity, Access, And Quality Of Care In Black Maternal Health Outcomes, Terry-Ann E. Lynch

West Chester University Graduate Theses, Dissertations, and Final Projects

Black maternal mortality in the United States is a public health crisis. There are a plethora of reasons as to why maternal and fetal deaths disproportionately impact Black women. From a public health perspective, health disparities are an area of concern in marginalized communities, with Black maternal mortality being a risk factor. “According to the Centers for Disease Control and Prevention (CDC), in 2021, the maternal mortality rate for non-Hispanic Black (subsequently, Black) women was 69.9 deaths per 100,000 live births, 2.6 times the rate for non-Hispanic White (subsequently, White) women (26.6)” Maternal Mortality Rates in the United States, 2021” …

“But The Trauma Did Not Fade Away” Childhood Sexual Abuse, Adolescent Pregnancy, And Rurality, Cynthia H. Mcniss

Electronic Theses and Dissertations

Childhood sexual abuse (CSA) and adolescent pregnancy are critical public health issues that intersect in complex ways, particularly in rural areas. Adolescents who have experienced CSA are at a significantly higher risk of becoming pregnant before the age of 19 compared to their peers without such a history (Madigan et al., 2014). Rurality is also associated with elevated rates of adolescent pregnancy due to various socio-economic and healthcare access challenges ("Rural Health Information Hub," 2024). This study employed a grounded theory approach to develop a comprehensive understanding of the social and psychosocial processes influencing the choices, actions, and decisions of …

A Program To Support Kangaroo Care Of Preterm Infants In The Nicu For The Caregivers, Katherine Blake Carby Cooksey, Mary Jan Greer, Debbie Johnson

Fall 2024 OTD Capstone Symposium

This presentation is about an educational program developed to help educate the caregivers about kangaroo care while their baby is in the neonatal intensive care unit (NICU). This program is to emphasis in the occupations of social interaction and family involvement with kangaroo care. Caregivers/parents are able to learn about the what kangaroo care is, the different type methods of kangaroo care, the benefits of kangaroo care, the importance of kangaroo care while being in the NICU. This program development for the caregivers is able to help with their journaling experience while in the NICU and adjusting kangaroo care into …

Maternal Adverse Childhood Experiences And Infant Visual-Limbic White Matter Development, Catherine H. Demers, Benjamin L. Hankin, Mercedes Hoeflich Haase, Erin Todd, M. Camille Hoffman, C. Neill Epperson, Martin A. Styner, Elysia Poggi Davis

Psychology: Faculty Scholarship

Background

Maternal adverse childhood experiences (ACEs) are robust predictors of mental health for both the exposed individual and the next generation; however, the pathway through which such intergenerational risk is conferred remains unknown. The current study evaluated the association between maternal ACEs and infant brain development, including an a priori focus on circuits implicated in emotional and sensory processing.

Methods

The sample included 101 mother-infant dyads from a longitudinal study. Maternal ACEs were assessed with the Adverse Childhood Questionnaire dichotomized into low (0 or 1) and high (≥2) groups. White matter microstructure, as indexed by fractional anisotropy (FA), was assessed …

Journey To Baby-Friendly: Standardizing Patient Breastfeeding Education In The Postpartum Microsystem, Emily Korwin

Master's Projects and Capstones

Problem Low breastfeeding rates remain a global challenge and a cause of adverse infant health outcomes despite the benefits of exclusive breastfeeding. In response, UNICEF and the WHO developed the Baby-Friendly Hospital Initiative (BFHI) to promote, protect, and support breastfeeding for infant growth and development. Context Hospital A is a mid-size hospital in Northern California. It has 24 labor, 13 antepartum, and 33 postpartum beds and serves a diverse population of patients. Intervention After a literature review, microsystem assessment, stakeholder survey, and root cause analysis, a standardized infant feeding nurse patient education checklist was developed and aligned with Baby-Friendly teaching …

Journey To Baby-Friendly Designation: Standardizing Infant Feeding Education, Jasmine Geronimo Ibay

Master's Projects and Capstones

Problem The influence of formula companies in hospitals has caused a decrease in national breastfeeding rates, increasing risks of adverse health outcomes among infants. In response, the World Health Organization (WHO) and the United Nations Children’s Fund (UNICEF) launched the Baby-Friendly Hospital Initiative (BFHI) in 1991 to support breastfeeding practices for infant development and eliminate commercial interests of formula companies from hospitals. Context The quality improvement (QI) project was conducted at Hospital A’s Birth Center, serving a diverse population of patients in the greater East Bay of Northern California. The microsystem has 24 labor beds, 13 antepartum beds, and 33 …

Patient-Centered Language During Peripartum Bedside Reports, Krystal H. Nguyen

Master's Projects and Capstones

Problem Using complex medical language that excludes the patient can result in lower patient satisfaction, increased miscommunication, and heightened anxiety for patients. Hospital A’s peripartum mesosystem currently does not have a training on the use of patient-centered language during labor and delivery (L&D) patient transfers to postpartum (PP). Context Hospital A is an urban tertiary care medical center located in the Bay Area, with its peripartum mesosystem consisting of 35 L&D and postpartum beds distributed across two floors. Intervention Through analysis of stakeholder engagement, an ongoing literature review and a mesosystem needs assessment, potential barriers to implement patient-centered language in …

Baby-Friendly Hospital Initiative: Becoming Baby-Friendly Designated, Krystal Angelique Mora

Master's Projects and Capstones

Section I: Abstract

Problem Despite efforts to increase breastfeeding rates, the influence of formula companies has contributed to the decrease in rates, affecting the health outcomes of infants. In response, the Baby-Friendly Hospital Initiative (BFHI) introduced standardized education for nursing staff to support infant growth and development. Context Hospital A Birth Center is a 33-bed culturally diverse unit that provides care to mothers in Northern California, delivering approximately 7,400 babies each year and helping patients transition into motherhood. Aim The quality improvement project aims to enhance the retention of BFHI-aligned education provided during hospitalization by 26.2%, raising retention rates among …

Optimizing Peripartum Bedside Reports Through Patient-Centered Communication, Harpreet Kaur

Master's Projects and Capstones

Abstract

Background Effective patient-centered communication (PCC) during bedside shift reports (BSR) is crucial in peripartum care, where patients face physical recovery and emotional adjustment. However, communication gaps during transitions from labor and delivery (L&D) to postpartum (PP) units can lead to patient dissatisfaction and misinterpretation of care instructions. Hospital A, an urban tertiary care medical center in San Francisco, operates a peripartum mesosystem across two floors with 35 dedicated beds. Aim The project aims to increase patient satisfaction by implementing patient-centered language in bedside reports for peripartum units from 70% to 80% for a three-week period. Methods Stakeholder engagement, a …

Developing A Trauma-Informed Family-Centered Care Toolkit For Neonatal Intensive Care Unit Nurses, Sonja A. Alli-Casella

DNP Qualifying Manuscripts

Background: The neonatal intensive care unit (NICU) may be a stressful, traumatizing, or re-traumatizing experience for parents of critically ill newborns and infants.

Problem: NICU nurses and other healthcare providers may not realize their impact on parental stress responses as neonatal care providers may not have adequate training to support adults experiencing acute emotional distress.

Methods: Strong evidence supports using family-centered care (FCC) in the NICU to promote bonding and parental involvement in caring for their infants. This manuscript aims to review current research and literature on trauma-informed care training and its impact on nurse confidence in managing dysregulated adults, …

Enhancing Ob Healthcare: Impact Of Black Nurse Representation, Devi Wolfe-Reese

Honors Capstones

Increasing Black nurse representation in obstetrics (OB) care is crucial for improving maternal and infant health outcomes, reducing health disparities, and building trust between patients and providers. Research shows that diverse healthcare teams lead to better patient outcomes, including lower mortality rates and higher patient satisfaction. Black nurses bring critical cultural competence to OB care, strengthening patient-provider relationships and ensuring that care is tailored to the unique needs of Black families. A more diverse nursing workforce promotes better collaboration, enhances inclusivity, and contributes to a more equitable healthcare system overall.

To achieve these goals, healthcare institutions must prioritize diversity by …

Educational Program On Depression And Anxiety For Low Socioeconomic Postpartum Latina Mothers, Lizbeth Valdez Duran

Nursing | Student Research Posters

Postpartum depression (PPD) and postpartum anxiety are common mental health conditions that women experience after childbirth. PPD involves intense feelings of extreme sadness, and diminished interests in activities that once brought them happiness. Postpartum anxiety involves constant worry and fear, often centered on the well-being of the baby. Symptoms may include restlessness or irritability, panic attacks, and trouble concentrating or sleeping. Barriers to treating depression and anxiety among Latinas include a lack of awareness or understanding of mental health issues. (Lopez et al., 2018).

Health Literacy refers to the individual's ability to understand and process health-related information. By assessing a …

Caesarean Section And Associated Factors In Nigeria: Assessing Inequalities Between Rural And Urban Areas—Insights From The Nigeria Demographic And Health Survey 2018, Emmanuel O. Adewuyi, Wole Akosile, Victory Olutuase, Aaron Akpu Philip, Rhoda Olaleru, Mary I. Adewuyi, Asa Auta, Vishnu Khanal

Research outputs 2022 to 2026

Introduction: When medically indicated, caesarean section (CS) can be a life-saving intervention for mothers and their newborns. This study assesses the prevalence of CS and its associated factors, focussing on inequalities between rural and urban areas in Nigeria. Methods: We disaggregated the Nigeria Demographic and Health Survey 2018 and performed analyses separately for Nigeria’s overall, rural, and urban residences. We summarised data using frequency tabulations and identified factors associated with CS through multivariable logistic regression analysis. Results: CS prevalence was 2.7% in Nigeria (overall), 5.2% in urban and 1.2% in rural areas. The North-West region had the lowest prevalence of …