Implementation Of A Community Health Worker (Chw) Training Program To Improve Birth Outcomes, Emiko Maruri

Doctor of Nursing Practice (DNP) Projects

Background

Those who have been affected by any adverse childhood experience (ACE) have an increased likelihood of poor birth outcomes. These include low infant birth weight, preterm delivery and can even lead to pregnancy loss.

Problem

Latina women have been identified by the Centers for Disease Control (CDC) as those most affected by ACEs. Further evidence supports those affected by 2 or more ACEs have poor birth outcomes.

Context

For this project, The Save the Children organization in partnership with the University of San Francisco Doctorate of Nursing Practice (USF DNP) students and Community Health Workers (CHWs) of the Central …

Improving Preeclampsia Education And Assessment Frequency Among Nurses And Patients With Non-Severe Features In A Postpartum Unit, Monica Heredia

Master's Projects and Capstones

Problem: This Quality Improvement project aimed to improve preeclampsia education among Registered Nurses (RNs) and simplify the preeclampsia assessment frequency for patients with non-severe features in the Mother-Baby Postpartum Unit at Hospital Y.

Context: The Quality Improvement project occurred in a 25-bed Mother-Baby Postpartum unit at Hospital Y. The nurse educators at Hospital Y requested that University of San Francisco (USF) nursing students focus on increasing preeclampsia education among nurses and reducing the nursing assessment frequency.

Interventions: Collect quantitative data through observation and hand anonymous questionnaires to the registered nurses and clinical nurse leaders (CNLs) to determine …

Give Love With Lovenox: Improving Nurse Education On Lovenox Prophylaxis To Reduce Pulmonary Embolism Risk On The Postpartum Unit, Jennifer G. Domingo Rn

Master's Projects and Capstones

This quality improvement project aims to improve nurse education about Lovenox prophylaxis to reduce the risk of pulmonary emboli – post-discharge – amongst high-risk postpartum women who underwent vaginal and cesarean deliveries on the family baby unit. This project took place in a Family Baby/Postpartum Unit at Hospital SC. This unit has a total of 25 beds with an increased prevalence of pulmonary embolism following cesarean delivery. Nurses were given anonymous pre- and post-survey questionnaires and provided educational sessions with distributed handouts. A unit needs assessment was conducted using the 5 P’s. Out of the 72 nurses on the staff …

Improving Education On Preeclampsia With Non-Severe Features And Frequency Of Assessment Among Nurses In The Maternal-Child Postpartum Unit, Alyssa J. Willsher

Master's Projects and Capstones

Problem: This Quality Improvement (QI) project aims to improve preeclampsia education among nurses and reduce the frequency of preeclampsia assessments among patients(without severe features) (SF) in the Mother-Baby postpartum unit at Hospital A. Nurses often stated that patients are unable to have uninterrupted rest periods with frequent assessments, which research shows is necessary for reducing patient blood pressure.

Context: The QI project is implemented in a 25-bed postpartum unit that cares for women and their newborns in the postpartum period. The unit’s nurse educator and nurse manager requested that the visiting University of San Francisco research group focus on simplifying …

Dodge The Fall: A Newborn Fall Prevention Initiative, Linda Nguyen

Master's Projects and Capstones

Problem: In the past year, three separate newborn fall incidents occurred on the postpartum unit at Hospital X. This project aims to increase nurse-to-patient education on newborn fall prevention, thereby reducing the number of newborn falls on the unit.

Context: This quality improvement project was implemented on the postpartum unit at a hospital located in San Francisco County. At this hospital, the postpartum unit consists of 10 beds in postpartum and 11 beds in antepartum. Currently, there is no standardized method used by registered nurses to prevent newborn falls.

Intervention: The requirement for mothers to sign the Pledge Form for …

Give Love With Lovenox: Reducing Pulmonary Embolism Risk In The Postpartum Unit Through Lovenox Prophylaxis Nursing Education, Guadalupe Sierra Arroyo

Master's Projects and Capstones

Problem: This quality improvement project aims to improve nurse education on Lovenox prophylaxis to reduce pulmonary embolism occurrence post-discharge amongst high-risk postpartum women who underwent vaginal/cesarean deliveries and to increase patient medication compliance in the Family Baby Unit (FBU) at Hospital X.

Context: The quality improvement project occurred on the Family Baby Unit (FBU) at Hospital X. This 25-bed unit has recently had an increased rate of pulmonary embolisms post-discharge due to poor Lovenox medication adherence amongst patients and lack of education among nurses.

Intervention: Data was collected in the microsystem. This data was collected through questionnaires to assess nurses' …

Dodge The Fall: A Newborn Fall Prevention Initiative, Lenora Thompson

Master's Projects and Capstones

Problem: This newborn fall prevention initiative was developed in response to an increase in the number of newborn falls at a Bay Area hospital on the postpartum unit. This hospital had gone six years without a newborn fall but by September of 2023 had three falls on the postpartum unit.

Context: The setting for this newborn fall prevention initiative is an urban, NICU level III Bay Area hospital that provides high-risk obstetric care. This Bay Area hospital has 247 licensed patient beds; 10 beds make up the postpartum unit and 11 beds make up the antepartum unit which serve as …

Mentoring Nurses After Specialty Training Or Orientation In Labor And Delivery, Benjamin Jlopleh Worji

Master's Projects and Capstones

Mentoring Nurses After Specialty Training or Orientation in Labor and Delivery

Abstract

Background: The setting for this project was a northern California hospital-based healthcare system referred to as “Hospital KV.” Hospital KV is a non-profit, integrated hospital that operates to improve the community’s health. Hospital KV’s maternal child health (MCH) department comprises a labor and delivery(L&D) unit, a mother and baby unit (MBU), also referred to as a postpartum unit, and an intermediate nursery (IMN).

Problem: The hospital KV MCH department faced the challenge of a nursing shortage. The nursing shortage was associated with substantial challenges to Hospital KV, its …

Kangaroo Care And Improved Physiological Status In Preterm Infants, Kira Harkonen

Wisdom & Compassion: The LUSON Journal

Preterm births continue to cause long-term sequelae for infants worldwide. Interventions in the neonatal intensive care unit (NICU) that promote better outcomes can make an impact on preterm infants’ futures. The purpose of this review was to determine if kangaroo care has positive physiological effects on preterm infants in the NICU. Practice changes to enhance kangaroo care in the NICU include reducing barriers such as medical complexity and staff misconceptions as well as facilitating increased parental presence. The review of the literature found evidence to support the positive outcomes that kangaroo care has on neonates’ growth, vital signs, stress outcomes, …

Metformin Plus Insulin For Preexisting Diabetes Or Gestational Diabetes In Early Pregnancy: The Mompod Randomized Clinical Trial, Kim A Boggess, Arielle Valint, Jerrie S Refuerzo, Noelia Zork, Ashley N Battarbee, Kacey Eichelberger, Gladys A Ramos, Gayle Olson, Celeste Durnwald, Mark B Landon, Kjersti M Aagaard, Kedra Wallace, Christina Scifres, Todd Rosen, Wadia Mulla, Amy Valent, Sherri Longo, Laura Young, M Alison Marquis, Sonia Thomas, Ashley Britt, Diane Berry

Faculty, Staff and Student Publications

IMPORTANCE: Insulin is recommended for pregnant persons with preexisting type 2 diabetes or diabetes diagnosed early in pregnancy. The addition of metformin to insulin may improve neonatal outcomes.

OBJECTIVE: To estimate the effect of metformin added to insulin for preexisting type 2 or diabetes diagnosed early in pregnancy on a composite adverse neonatal outcome.

DESIGN, SETTING, AND PARTICIPANTS: This randomized clinical trial in 17 US centers enrolled pregnant adults aged 18 to 45 years with preexisting type 2 diabetes or diabetes diagnosed prior to 23 weeks' gestation between April 2019 and November 2021. Each participant was treated with insulin and …

Continuity Of Care In The Post-Partum Period, Ashley Quezada

MSN Capstone Projects

Maternal mortality rates in the United States have been a growing concern over the past decade, with rates continuing to climb as recent studies have been published. The total maternal mortality rate in the United States in 2018 was 17.4 and has increased to 32.9 as of 2021, while other developed countries continue to decline (Hoyert, 2023). The maternal mortality rate is the number of deaths per 100,000 live births. More than 50% of pregnancy-related deaths in the United States occur after delivery, in the post-partum period (Melillo, 2020). The purpose of this report is to not only bring light …

Effect Of Doula Care Education On Cesarean Section Rates: A Benchmark Study, Elena Rubio-Mcdonald

MSN Capstone Projects

A cesarean section (CS) is a vital maternal care intervention when necessary; however, the surgical procedure places childbearing women at direct risk for infection, hemorrhage, thromboembolism, injury to bladder or bowel, post-surgical pain, and complications from anesthesia. The risk of mortality associated with CS is four to five times more likely compared to vaginal delivery. Severe nursing shortages, high patient volumes, and patients with complex pregnancy related health concerns create barriers to the provision of continuous labor support (CLS) by labor and delivery (L&D) nurses. Partnering with certified doulas and implementing the CLS methods they employ may promote spontaneous vaginal …

Lactation Benefits, Experiences, And Education In Bereaved Mothers: A Literature Review, Grace Davis

The Eleanor Mann School of Nursing Undergraduate Honors Theses

Abstract

Background: Parents who lose an infant through miscarriage, elective termination, or stillbirth experience perinatal bereavement (Centers for Disease Control and Prevention, 2022). A bereaved mother’s grief could be influenced by lactation as most will still experience lactation regardless of their loss. Generally, these women are solely taught to suppress their milk production, oftentimes resulting in discomfort, leakage, clogged ducts, and even mastitis (Carroll et al., 2020). To prevent adverse effects, bereaved mothers need a comprehensive list of options and education regarding lactation including donation, expression, and suppression. Bereaved mothers' lactation experiences, education, and benefits are vital areas to be …

Postpartum Visitation Policies, Jenna B. Holderman, Morgan E. Matthews

The Eleanor Mann School of Nursing Undergraduate Honors Theses

Background: Continual support for the birthing person during labor improves delivery outcomes and overall childbirth experiences. How many support people are present and their relation to the birthing person varies based on individual preference, family dynamics, and sociocultural expectations. During the Covid-19 pandemic, many hospitals implemented a one-visitor policy for deliveries. With these new guidelines in place, the length of hospital stays significantly decreased, and there were a variety of opinions towards these restrictions.

Purpose: The purpose of this study was to explore birthing persons’ overall sentiment towards visitors in the immediate postpartum period.

Methods: The current study analyzed …

Breastfeeding In Public: A Review Of Literature And Service Learning Experience, Taylor Jehlik, Makenzie Carney

The Eleanor Mann School of Nursing Undergraduate Honors Theses

This article explores the perceptions and beliefs of first-time expectant mothers, their family members, and their social network about breastfeeding in public places. We used experience through Tiny Tusks and reviewed literature to get a better understanding of what social factors play a role in mothers' decisions to breastfeed in public.

Pain Assessment Tools For Use In Infants: A Meta-Review, Diana Arabiat, Evalotte Mörelius, Kreshnik Hoti, Jeffery Hughes

Research outputs 2022 to 2026

Background: Identifying pain in infants is challenging due to their inability to self-report pain, therefore the availability of valid and reliable means of assessing pain is critical. Objective: This meta-review sought to identify evidence that could guide the selection of appropriate tools in this vulnerable population. Methods: We searched Scopus, Medline, Embase, CINAHL, MIDRIS, EMCare and Google Scholar for eligible systematic reviews. Eligible reviews documented psychometric properties of available observational tools used to assess pain in infants. Results: A total of 516 reviews were identified of which 11 met our inclusion criteria. We identified 36 pain assessment tools (evaluated in …

Certified Midwives: An Exploration Of Their Impact On Maternal Health Outcomes – A Comprehensive Literature Review, Heather Hollister

Capstone Experience: Master of Public Health

Maternal health outcomes in the United States have been consistently worse than other high-income countries, with a disproportionate impact on women of color. Midwives have long played an important role in maternal health worldwide. The literature review examines the evidence for midwives as key contributors to improving maternal health outcomes. The paper reviews the existing literature on midwifery, including the impact on maternal health, labor and delivery outcomes, and patient satisfaction. Electronic searches were conducted through Cochrane Library, CINAHL, Medline and Embase. Articles were screened according to inclusion and exclusion criteria including that they must be a randomized study; participants …

Facility-Based Audit System With Integrated Community Engagement To Improve Maternal And Perinatal Health Outcomes In Rural Pakistan: Protocol For A Mixed Methods Implementation Study, Zahid Memon, Wardah Ahmed, Shah Muhammad, Sajid Bashir Soofi, Shanti Chohan, Arjumand Rizvi, Paul Barach, Zulfiqar Ahmed Bhutta

Centre of Excellence in Women and Child Health

Background: Maternal and newborn mortality in Pakistan remains as a major public health challenge. Pakistan faces significant infrastructure challenges and inadequate access to quality health care, exacerbated by sociocultural factors. Facility-based audit systems coupled with community engagement are key elements in achieving improved health system performance. We describe an implementation approach adapted from the World Health Organization audit cycle in real-world settings, with a plan to scale-up through mixed methods evaluation plan.
Objective: This study aims to implement a locally acceptable and relevant audit system and evaluate its feasibility within the rural health system of Pakistan for scale-up.
Methods: The …

Decreasing The Risk For Type Ii Diabetes After Gestational Diabetes: An Integrative Review, Tara Call, Melissa Field

Master of Science in Nursing Final Projects

Abstract

Aim: This integrative review aimed to review studies on the risk of developing type II diabetes (T2DM) after a diagnosis of gestational diabetes mellitus (GDM) and available programs to mitigate this risk. The research question that guided this review was: For women diagnosed with gestational diabetes, what programs are available to decrease risk factors for developing T2DM later in life?

Background: Women who experience GDM have an increased risk of developing T2DM at a rate of eight times higher than those with no history of GDM (Song et al., 2017). The risk for T2DM after a diagnosis of GDM …

Perception Regarding Respectful Maternity Care Among Postnatal Mothers, Rithughosh K P, Sreeja G. Pillai

Manipal Journal of Nursing and Health Sciences

Introduction: Every woman has the right to receive Respectful Maternity Care(RMC). Evidence of disrespect and abuse is reported globally. In India, almost every woman goes through some level of disrespect and abuse during childbirth, even though studies on RMC among postnatal mothers of Indian and Kerala origin are scarce. So, exploring this would be of great use in evidence-based fine-tuning of RMC services to promote quality maternal and newborn care. Objective: Assess the perceptions regarding RMC among postnatal mothers. Methodology: Quantitative approach with descriptive cross-sectional design was used to collect data from 250 postnatal mothers based on consecutive sampling …

Stress And Coping Strategies Adopted By Mothers Of Children Admitted In Pediatric Intensive Care Unit., Anisha P. R, Remya U R

Manipal Journal of Nursing and Health Sciences

Introduction: Planned or unplanned hospitalization increases the family’s stress and anxiety level. Hospitalization creates stress as they interrupt normal routines and place increased demands on parents who must further divide their time between the normal responsibilities and their hospitalized child. Many parents feel a lack of control and sense of powerlessness when their child is hospitalized. Objectives: The objectives of the study were to identify the stressors and coping strategies adopted by mothers of children admitted in pediatric intensive care unit and to determine the co-relation between stressors and coping strategies adopted by mothers of children admitted in PICU. Methods: …

Oral Sucrose And The Relation To Neonatal Pain Perception, Meagan L. Burns

MSN Capstone Projects

Pain is “an unpleasant sensory and emotional experience associated with actual or potential tissue damage” (Treede, 2018). The phenomenon of pain is a personal and unique experience that many of the world’s population has experienced in some form or fashion throughout their lifetime. Neonates are exposed to many painful procedures and/or situations due to various medical ailments that may require a neonatal intensive care unit (NICU) admission. Infants have a special place in the hearts of adults all over the world, and any interventions that would increase the likelihood of diminishing or removing perceived pain in this population are likely …

Access To Pediatric Neurology Training And Services Worldwide:A Survey By The International Child Neurology Association, Jo M Wilmshurst, Coriene Catsman- Berrevoets, Donald L. Gilbert, Lakshmi Nagarajan, Pauline Samia, Esra Serdaroglu Serdaroglu, Chahnez Triki, Jorge Vidaurre, Biju Hameed

Paediatrics and Child Health, East Africa

Pediatric neurology is the medical subspecialty responsible for diagnosing and managing diseases and disorders of the nervous system in childhood and adolescence. In many, but not all, regions of the world, the discipline of pediatric neurology is recognized as a specialty or subspecialty of either neurology or pediatrics. Significant knowledge and competencies in this area are necessary to be effective in clinical practice. The need for this is driven by the high burden of disease from neurologic conditions in children and the effect on their families. As the first part of a multistaged project under the auspices of the International …

World Allergy Organization (Wao) Diagnosis And Rationale For Action Against Cow's Milk Allergy (Dracma) Guidelines Update – X – Breastfeeding A Baby With Cow's Milk Allergy, Vicki Mcwilliam, Merryn Netting, Evelyn Volders, Debra Palmer, Ignacio Ansotegui, Stefania Arasi, Amal H. Assa'ad, Sami L. Bahna, Antonio Bognanni, Rose Kamenwa

Paediatrics and Child Health, East Africa

Cow’s milk allergy is rare in exclusively breastfed infants. To support the continuation of breastfeeding an infant after diagnosis with a cow’s milk allergy, it is critical to examine the evidence for and against any form of cow’s milk elimination diet for lactating mothers. In this narrative review, we highlight the lack of high-quality evidence, hence subsequent controversy, regarding whether the minuscule quantities of cow’s milk proteins detectable in human milk cause infant cow’s milk allergy symptoms. Current clinical practice recommendations advise a 2–4 week trial of maternal cow’s milk dietary elimination for: a) IgE-mediated cow’s milk allergy only if …

Blood Culture Versus Antibiotic Use For Neonatal Inpatients In 61 Hospitals Implementing With The Nest360 Alliance In Kenya, Malawi, Nigeria, And Tanzania: A Cross-Sectional Study, Sarah Murless-Collins, Kondwani Kawaza, Nahya Salim, Elizabeth Molyneux, Msandeni Chiume, Jalemba Aluvaala Aluvaala, William Macharia, Veronica Chinyere Ezeaka, Opeyemi Odedere, Donat Shamba

Paediatrics and Child Health, East Africa

Background: Thirty million small and sick newborns worldwide require inpatient care each year. Many receive antibiotics for clinically diagnosed infections without blood cultures, the current ‘gold standard’ for neonatal infection detection. Low neonatal blood culture use hampers appropriate antibiotic use, fuelling antimicrobial resistance (AMR) which threatens newborn survival. This study analysed the gap between blood culture use and antibiotic prescribing in hospitals implementing with Newborn Essential Solutions and Technologies (NEST360) in Kenya, Malawi, Nigeria, and Tanzania.

Methods: Inpatient data from every newborn admission record (July 2019–August 2022) were included to describe hospital-level blood culture use and antibiotic prescription. Health Facility …

Breastfeeding Support In Your Pocket: Evaluating The Impact Of A Mobile App On Maternal Success, Maygan Brandt

Nursing | Student Research Posters

No abstract provided.

The Effect Of Nursing Education On The Utilization Of Kangaroo Mother Care And Weight Gain Of Preterm And Low Birth Weight Infants, Jhenalynn Valete

Nursing | Student Research Posters

Kangaroo Mother Care (KMC), often referred to as skin-to-skin contact, is an intervention for preterm and low birth weight infants, involving the practice of the mother or caregiver holding the newborn against their bare chest (Cleveland Clinic, 2023). This is a cost-effective and natural way to enhance health outcomes such as temperature regulation, weight gain, respiratory function, pain mitigation, and facilitation of breastfeeding for the neonate (Jefferies et al., 2012).

Nursing staff may have limited knowledge regarding KMC which creates challenges in effectively educating parents. This information prompts the following question: “Can Nurse Education about the Importance of Kangaroo Mother …

Can Machine Learning Methods Be Used For Identification Of At-Risk Neonates In Low-Resource Settings? A Prospective Cohort Study, Babar S. Hasan, Zahra Hoodbhoy, Amna Khan, Mariana Nogueira, Bart Bijnens, Devyani Chowdhury

Department of Paediatrics and Child Health

Introduction: Timely identification of at-risk neonates (ARNs) in the community is essential to reduce mortality in low-resource settings. Tools such as American Academy of Pediatrics pulse oximetry (POx) and WHO Young Infants Clinical Signs (WHOS) have high specificity but low sensitivity to identify ARNs. Our aim was assessing the value of POx and WHOS independently, in combination and with machine learning (ML) from clinical features, to detect ARNs in a low/middle-income country.
Methods: This prospective cohort study was conducted in a periurban community in Pakistan. Eligible live births were screened using WHOS and POx along with clinical information regarding pregnancy …

Factors That Influence Receiving An Instrumental Assisted Birth: An Evidence-Based Project, Douglas Nanu, Madison Schatz, Gabriel Alemayehu, Teresa Rangel

Central Division Nurse Clinical Inquiry Conference

No abstract provided.

Preliminary Efficacy, Feasibility And Safety Of Intra-Umbilical Oxytocin To Reduce The Time To Placental Delivery At Caesarean Section: An Exploratory Randomized Trial, Katrin Middleton, Fungai Mbengo, Thandisizwe R. Mavundla, George J. Hofmeyr

Research outputs 2022 to 2026

Background: Delayed placental separation either after vaginal birth or caesarean birth is an important cause of postpartum haemorrhage, among other causes such as uterine atony. Intra-umbilical oxytocin has been shown to reduce the time to placental delivery after vaginal birth. However, the efficacy of intra-umbilical oxytocin to reduce the time to placental delivery following caesarean section birth is not known. Objectives: To explore the preliminary efficacy, feasibility and safety of intra-umbilical oxytocin to reduce the time to placental delivery at caesarean section. Methods: A double-blind, placebo-controlled, exploratory randomized clinical trial was conducted at a tertiary hospital in the Eastern Cape …