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Articles 1081 - 1110 of 1299

Full-Text Articles in Nursing

Hospice And Palliative Care: Imperative To The Education Of Nursing, Crystal Lynn Jordan Jan 2017

Hospice And Palliative Care: Imperative To The Education Of Nursing, Crystal Lynn Jordan

Nursing Theses and Capstone Projects

Many advanced practice nursing programs do not have hospice and palliative care content included in their curricula. Reviewing the literature regarding the nature of hospice and palliative care content in advanced practice nursing curricula revealed few published studies. Rather than a small snapshot of what end-of-life care entails, it is vital to integrate end-of-life care into every aspect taught in advance practice nursing school. The purpose of this thesis was ascertain the nature of hospice and palliative care content contained in advanced practice nursing curricula. A survey was sent to advance practice nursing program directors asking for information related to …


Exploring The Impact Of A Training Programme On Acute Healthcare Professionals' Attitudes And Understanding Of Dementia, Orla Quirke Jan 2017

Exploring The Impact Of A Training Programme On Acute Healthcare Professionals' Attitudes And Understanding Of Dementia, Orla Quirke

Theses

Acute healthcare professionals lack education and training in dementia care. This results in people with dementia having poorer outcomes when admitted to the acute healthcare setting. An overarching aim of The National Dementia Strategy (2014) is the provision of optimal care for people with dementia in all healthcare and community settings. In response to this, Dementia Elevator a national inter-professional suite of educational programmes were developed by Dublin City University and the Health Service Executive to help individuals, communities and health systems engage positively with people with dementia. This study aimed to evaluate the impact of a four-hour dementia training …


Educational Model To Increase The Number And Diversity Of Rn To Bsn Graduates From A Resource-Limited Rural Community, Janice E. Hawkins, Lynn Wiles, Karen Karlowicz, Kimberly Adams Tufts Jan 2017

Educational Model To Increase The Number And Diversity Of Rn To Bsn Graduates From A Resource-Limited Rural Community, Janice E. Hawkins, Lynn Wiles, Karen Karlowicz, Kimberly Adams Tufts

Ellmer School of Nursing Faculty Publications

Increasing the number of BSN-prepared nurses at the bedside is directly linked to improved health care outcomes. However, employers are challenged to find enough BSN graduates to meet workforce demands. This article presents an educational model that uses evidence-based practices to increase enrollment, retention, and graduation rates of RN students in a BSN program (RN-BSN) in a resource limited rural community. This exemplar may equip nurse educators with strategies to adopt in their own communities.


Telehealth And Ehealth In Nurse Practitioner Training: Current Perspectives, Carolyn M. Rutledge, Karen Kott, Rebecca Poston, Christianne Fowler, Tina S. Haney Jan 2017

Telehealth And Ehealth In Nurse Practitioner Training: Current Perspectives, Carolyn M. Rutledge, Karen Kott, Rebecca Poston, Christianne Fowler, Tina S. Haney

Ellmer School of Nursing Faculty Publications

Telehealth is becoming a vital process for providing access to cost-effective quality care to patients at a distance. As such, it is important for nurse practitioners, often the primary providers for rural and disadvantaged populations, to develop the knowledge, skills, and attitudes needed to utilize telehealth technologies in practice. In reviewing the literature, very little information was found on programs that addressed nurse practitioner training in telehealth. This article provides an overview of both the topics and the techniques that have been utilized for training nurse practitioners and nurse practitioner students in the delivery of care utilizing telehealth. Specifically, this …


An Evaluation Of Critical Resources In Nurse Anesthesia Educational Programs, Lois E. Stewart Jan 2017

An Evaluation Of Critical Resources In Nurse Anesthesia Educational Programs, Lois E. Stewart

Theses and Dissertations

Advanced practice nurses fill a vital need in the U.S. by increasing access to needed healthcare. Certified Registered Nurse Anesthetists (CRNAs) are one type of advanced practice nurse with a long history of safe and effective peri-anesthetic care. Nurse anesthetists have a rich tradition of providing anesthetic care for rural and underserved communities, and are a primary provider of anesthesia for active and retired military personnel. CRNAs comprise over one-half of the actively practicing U.S. anesthesia workforce currently, and are able to function in any anesthetic care model. Nurse anesthesia educational programs (NAEPs) are the single source for new graduate …


Professional Nursing Value Development In Nursing Students Who Participate In International Service Learning, Heather Ferrillo Jan 2017

Professional Nursing Value Development In Nursing Students Who Participate In International Service Learning, Heather Ferrillo

Nursing Faculty Publications

Background: International Service Learning (ISL) is becoming widely used in nursing education as a means to provide global learning opportunities. Concrete outcomes for these experiences have not been clearly supported in previous research. Determining if ISL experience facilitate the development of Professional Nursing Values (PNV) can support the use of ISL as a viable pedagogy. Purpose: The purpose of the study was to determine if there were a difference in PNV development in students who participate in ISL as part of their clinical experiences compared to those who do not. The hypothesis was that there was a difference in the …


Empowerment Of Home Health Care Case Managers, Linda B. Melodia, Barbara Penprase, Linda L. Strong Jan 2017

Empowerment Of Home Health Care Case Managers, Linda B. Melodia, Barbara Penprase, Linda L. Strong

Nursing Faculty Publications

Background: Job satisfaction and feelings of empowerment positively impact home health care nurses by improving patient safety and patient outcomes. The project objective determined whether an empowerment educational module improved the feelings of empowerment and job satisfaction of registered nurses at a home health care agency. Methods: A quantitative, pre-test/post-test research study was conducted to measure the success of an empowerment educational module. Laschinger’s (2008) Nursing Worklife questionnaire was administered to 92 participating nurses, 46 were assigned to an experimental group and 46 were assigned to a control group. Participants in the experimental group were queried about their perceptions towards …


Improving Healthcare Provider Knowledge In Acute And Primary Transgender Health Needs: The Implementation Of A Clinical Education Program With Urgent Care And Emergency Room Staff And Providers, Tonia Lower Dec 2016

Improving Healthcare Provider Knowledge In Acute And Primary Transgender Health Needs: The Implementation Of A Clinical Education Program With Urgent Care And Emergency Room Staff And Providers, Tonia Lower

Doctor of Nursing Practice Scholarly Projects

The purpose of this project was to improve knowledge and identify personal bias and beliefs in the acute and primary healthcare needs of transgender persons, through the implementation of a clinical education program with healthcare providers and staff working within the urgent care and emergency department settings. The need for such a program exists due to the lack of suitable and accessible healthcare that may lead to misdiagnosis, delay of treatment and poor health outcomes. Including clinical education in the acute and primary healthcare needs of transgender persons that can be integrated into healthcare organizations may aid in the improvement …


The Impact Of Short Papers On Clinical Decision Making Skills Of Nursing Students, Tara R. Hayes Dec 2016

The Impact Of Short Papers On Clinical Decision Making Skills Of Nursing Students, Tara R. Hayes

Nursing Theses and Capstone Projects

Clinical decision making and critical thinking are fundamental skills to ensuring the success of undergraduate nursing students. Nursing faculty, and specifically clinical nursing faculty, are responsible for encouraging the development of these types of skills as students work in direct patient care. Traditional methods of clinical evaluation include lengthy case studies, concept mapping, and discussion board participation. While these methods have been in effect for some time, clinical short paper assignments are a fresh, innovative way to challenge students as they refine their critical thinking and clinical decision making abilities. No statistically significant difference was found between the perceived level …


Electronic Communication Among Anesthesia Providers, Joseph K. Wells Dec 2016

Electronic Communication Among Anesthesia Providers, Joseph K. Wells

Doctoral Projects

Facilities in the United States are utilizing electronic communication devices (ECDs) for their nursing staff on intensive care units, general medical-surgical floors, and chemotherapy floors, but it is underutilized in the operating room where seconds truly matter (Wu et al., 2012). Situations arise daily within operating rooms that require quick and decisive communication to avoid poor patient outcomes. The ultimate goal is to prevent poor patient outcomes by enhancing communication among anesthesia providers.

This doctoral project evaluated an anesthesia group in southeast Mississippi regarding their satisfaction with current devices used for communication. This anesthesia group utilized smart phones and public …


Directly Comparing Handoff Protocols For Pediatric Hospitalists, Elizabeth H. Lazzara, Robert Riss, Brady Patzer, Dustin C. Smith, Y. Raymond Chan, Joseph R. Keebler, Sarah D. Fouquet, Evan M. Palmer Dec 2016

Directly Comparing Handoff Protocols For Pediatric Hospitalists, Elizabeth H. Lazzara, Robert Riss, Brady Patzer, Dustin C. Smith, Y. Raymond Chan, Joseph R. Keebler, Sarah D. Fouquet, Evan M. Palmer

Publications

BACKGROUND AND OBJECTIVES: Handoff protocols are often developed by brainstorming and consensus, and few are directly compared. We hypothesized that a handoff protocol (Flex 11) developed using a rigorous methodology would be more favorable in terms of clinicians’ attitudes, behaviors, cognitions, or time-on-task when performing handoffs compared with a prevalent protocol (Situation Background Assessment Recommendation [SBAR]).

METHODS: Using a between-groups, randomized control trial design (Flex 11 versus SBAR) during a pilot study in a simulated environment, 20 clinicians (13 attending physicians and 7 residents) received 3 patient handoffs from a standardized physician, managed the patients, and handed off the patients …


Replicable Interprofessional Competency Outcomes From High-Volume, Inter-Institutional, Interprofessional Simulation, Deborah Bambini, Matthew Emery, Margaret De Voest, Lisa Meny, Michael J. Shoemaker Oct 2016

Replicable Interprofessional Competency Outcomes From High-Volume, Inter-Institutional, Interprofessional Simulation, Deborah Bambini, Matthew Emery, Margaret De Voest, Lisa Meny, Michael J. Shoemaker

Peer Reviewed Articles

There are significant limitations among the few prior studies that have examined the development and implementation of interprofessional education (IPE) experiences to accommodate a high volume of students from several disciplines and from different institutions. The present study addressed these gaps by seeking to determine the extent to which a single, large, inter-institutional, and IPE simulation event improves student perceptions of the importance and relevance of IPE and simulation as a learning modality, whether there is a difference in students’ perceptions among disciplines, and whether the results are reproducible. A total of 290 medical, nursing, pharmacy, and physical therapy students …


Exploring The Relationship Between And Among Registered Nurses' Spiritual Well-Being, Spiritual Care Perspectives, And Their Provision Of Spiritual Care In Acute Care Settings, Barbara J. Kitchener Aug 2016

Exploring The Relationship Between And Among Registered Nurses' Spiritual Well-Being, Spiritual Care Perspectives, And Their Provision Of Spiritual Care In Acute Care Settings, Barbara J. Kitchener

Seton Hall University Dissertations and Theses (ETDs)

Abstract

Despite acknowledgment that spiritual care is an essential aspect of holistic nursing care, nurses often feel ill-prepared for, uncomfortable with, and uncertain about providing spiritual care. Studies have indicated that nurses who have a strong sense of their own spiritual well-being and/or a positive perspective [attitude, value, belief] about spiritual care are more inclined to provide spiritual care to their patients. However there is a scarcity of such studies among acute care nurses. This descriptive correlational study aimed to explore relationships between and among acute care nurses’ spiritual well-being (SWB), spiritual care perspectives (SCP), and their provision of spiritual …


Diabetes Self-Management Education In The Home, Diane Lavelle, Joanah Zeitoun, Marianne Stern, Elise Butkiewicz, Elfie Wegner, Courtney Reinisch Jul 2016

Diabetes Self-Management Education In The Home, Diane Lavelle, Joanah Zeitoun, Marianne Stern, Elise Butkiewicz, Elfie Wegner, Courtney Reinisch

School of Nursing Faculty Scholarship and Creative Works

Purpose: Diabetes self-management education and home visits have been found to improve clinical outcomes in individuals living with diabetes. The purpose of this pilot project was to evaluate the feasibility and effectiveness of conducting self-management education in patients' homes.

Methods: Baseline biometric data was collected from a cohort of adult patients with diabetes. Home visits to 19 patients were conducted by doctoral students from Rutgers University School of Nursing. The visits included knowledge assessment, review of foods in the home, diabetes self-management education, and teaching the proper use of monitoring tools such as the glucometer and blood pressure monitor. Biomarkers …


Aspiring And Inquiring Minds Want To Know: How To Incorporate Lean Methodologies Into Orientation Programs To Meet Organizational And Learner Needs, Jill Hinnershitz Msn, Rn, Tiffany C. Epting Jul 2016

Aspiring And Inquiring Minds Want To Know: How To Incorporate Lean Methodologies Into Orientation Programs To Meet Organizational And Learner Needs, Jill Hinnershitz Msn, Rn, Tiffany C. Epting

Department of Education

No abstract provided.


Simulation In Orientation: Increasing Nurses' Self-Confidence In Hospital Equipment, Policies, And Procedures, Haley Wilmoth Jul 2016

Simulation In Orientation: Increasing Nurses' Self-Confidence In Hospital Equipment, Policies, And Procedures, Haley Wilmoth

Nursing Theses and Capstone Projects

Simulation provides a safe environment for the nurse to practice and learn new skills in a safe and controlled manner. This allows a novice nurse to advance to an expert level without placing a patient at harm and increasing self-confidence at the bedside. The purpose of the Orientation Simulation Study is to evaluate the effectiveness of simulation on self-confidence on new hire nursing staff when learning how to use the hospital Heparin Nomogram and dose mode on the IV pump. The study was conducted over four months with 18 nurses surveyed using a pre- and post-Likert scale called the Confidence …


Nclex-Rn Success: Correlation Study Of Ati Comprehensive Predictor In An Associate Degree Nursing Program, Wanda L. Jenkins Jul 2016

Nclex-Rn Success: Correlation Study Of Ati Comprehensive Predictor In An Associate Degree Nursing Program, Wanda L. Jenkins

Nursing Theses and Capstone Projects

The purpose of this quantitative study was to determine the relationship between the ATI Comprehensive Predictor and NCLEX-RN success on first attempt for the ADN program at a consortium of three community colleges in the foothills of North Carolina. The population sample consisted of graduates from the associate degree consortium of three community colleges in the foothills of North Carolina in 2014-2015 that have made one attempt at NCLEX-RN. The total number of students included in the study was 111. The results were collected and analyzed utilizing the SPSS version 23 statistical system and a predictive spreadsheet to determine overall …


Examining Kaplan Nursing School Entrance Exam For Student Success And Attrition: A Retrospective Review, Delicia Mckoy Jul 2016

Examining Kaplan Nursing School Entrance Exam For Student Success And Attrition: A Retrospective Review, Delicia Mckoy

Nursing Theses and Capstone Projects

The purpose of this study is to determine what the relationship is between student performance on the Kaplan Nursing School Entrance Exam, academic success, and attrition. Nursing Undergraduate Retention and Success (NURS) Model by Marianne R. Jeffreys (2012) was the theoretical framework for a study. The population consisted of 94 BSN students at a southeast public university in North Carolina. An existing nursing student database was used to collect the data. The independent variables were Kaplan Nursing School Entrance Exam scores, including the composite score and subtest scores in math, science, reading, and writing. The dependent variable, academic success, was …


Outcomes Of Peer Mentoring At An Associate Degree Nursing Program, Melissa B. Harper Jul 2016

Outcomes Of Peer Mentoring At An Associate Degree Nursing Program, Melissa B. Harper

Nursing Theses and Capstone Projects

Nursing students have described clinical experiences as being stressful, yet the application of classroom knowledge to the clinical health care setting is a requirement. The purpose of this mixed-method study is to compare students’ perceptions of the peer mentoring leadership experience (PMLE) and the student charge nurse experience (SCNE). The PMLE was piloted at a southeastern community college’s associate degree nursing (ADN) program. Hand-selected PMLE second-year nursing students (n=5) were paired with hand-selected PMLE first-year nursing students (n=5) for medical/surgical clinical rotations. The ADN program’s purpose for these clinical rotations was to provide a mutually beneficial mentoring experience. The remaining …


Developing Therapeutic Communication Skills: Integration Of Standardized Client Simulation In An Associate Degree Nursing Program, Kristine Weber, Timothy Farrell May 2016

Developing Therapeutic Communication Skills: Integration Of Standardized Client Simulation In An Associate Degree Nursing Program, Kristine Weber, Timothy Farrell

UNLV Theses, Dissertations, Professional Papers, and Capstones

By the year 2020, it is projected that there will be a shortage of 300,000 to one million registered nurses in the United States (Juraschek, Zhang, Ranganathan & Lin, 2012). Therapeutic communication skills are a fundamental and integral part of any registered nurse’s practice. Despite the importance of therapeutic communication, evidence suggests that the lack of skill development in nursing programs is having an adverse effect on the NCLEX-RN pass rate of graduating registered nurses. Identifying and addressing shortfalls in effective communication offers an opportunity to improve this pass rate. Learning to effectively communicate in a simulated situation will provide …


Building The Foundation: Utilizing Concept Maps To Enhance Critical Thinking In First Semester Nursing Students, Lisa S. Smith May 2016

Building The Foundation: Utilizing Concept Maps To Enhance Critical Thinking In First Semester Nursing Students, Lisa S. Smith

Nursing Theses and Capstone Projects

Critical thinking and clinical decision making are essential components of the knowledge and skills necessary for all nurses in order to make complex decisions that improve patient outcomes, safety, and quality of nursing care. Promoting student competence in critical thinking skills is imperative for nurse educators. Concept mapping is an active teaching strategy that can assist nurse educators in preparing nursing students to think critically in today’s complex health care environment. The purpose of this project was to implement concept maps as an additional instructional activity with first semester Associate Degree Nursing (ADN) students to promote confidence in basic critical …


Transitioning Novice Nurses To Expert Nurses In Progressive Telemetry Care, Timothy E. Fraley May 2016

Transitioning Novice Nurses To Expert Nurses In Progressive Telemetry Care, Timothy E. Fraley

Nursing Theses and Capstone Projects

New nurses do not possess the clinical skills necessary to thrive in a fast-paced, rapidly changing telemetry unit. The study explores the idea that nurses with less than two years’ experience may not have the self-confidence or experience to begin a career on a telemetry unit. A search of the literature was performed to identify the skills needed to be successful in a critical care telemetry unit. Established orientation programs, nurse internships, and nursing experience were the keywords researched. Patricia Benner’s Theory: From Novice to Expert Excellence and Power in Clinical Nursing Practice (1984) serves as the foundation for this …


Lateral Violence Among New Graduate Nurses, Megan Russell May 2016

Lateral Violence Among New Graduate Nurses, Megan Russell

Nursing Theses and Capstone Projects

Lateral violence is an act of aggression that is committed against one nurse by another. There are many names for lateral violence, some of these include: horizontal violence, bullying, aggression, horizontal hostility, verbal abuse, or nurses eating their young. Lateral violence occurs when nurses covertly or overtly direct the dissatisfaction they are feeling inward toward each other. The effects of lateral violence on new graduate nurses and the organizations in which they work can be detrimental. An extensive literature review was undertaken to understand the significance and prevalence of lateral violence against new graduate nurses. The purpose of this study …


Orientation Program For Psychiatric Clinical Experience, Kathy C. Williams May 2016

Orientation Program For Psychiatric Clinical Experience, Kathy C. Williams

Nursing Theses and Capstone Projects

Student nurses often experience anxiety prior to their psychiatric clinical experience and this anxiety can adversely affect their learning experience and ability to provide optimal nursing care to clients who have psychiatric illnesses. A formal Orientation Program for the Psychiatric Clinical Experience (OP-PCE) was developed to reduce student nurses’ anxiety prior to their psychiatric clinical experience. The OP-PCE was implemented as a component of the routine psychiatric curriculum in a pre-licensure registered nursing program at a university in Southeastern United States of America. Thirty-four student nurses participated in the OP-PCE. The content of the OP-PCE included general orientation information such …


A Flipped Classroom In Nursing: The Effects Of Peer-Led Simulation On Cognitive Learning And Critical Thinking, Shannon A. Matthews May 2016

A Flipped Classroom In Nursing: The Effects Of Peer-Led Simulation On Cognitive Learning And Critical Thinking, Shannon A. Matthews

Nursing Theses and Capstone Projects

This aim of this project was to implement a flipped classroom model of instruction using a peer-led in-class simulation in a nursing course. The student-centered learning environment fosters self-paced class preparation and provides interactive application of concepts in the classroom to improve critical thinking and cognitive learning in first level nursing students. The faculty introduced new content by using video lectures and online material assigned as homework with a peer-led simulation used during class to apply the concepts in a hands-on, interactive, learning experience. The effect the flipped classroom using a peer-led simulation had on cognitive learning, critical thinking, and …


The Effects Of Congestive Heart Failure On Quality Of Life: As Evaluated By The Minnesota Living With Heart Failure Questionnaire, Diana G. Gonzalez May 2016

The Effects Of Congestive Heart Failure On Quality Of Life: As Evaluated By The Minnesota Living With Heart Failure Questionnaire, Diana G. Gonzalez

The Eleanor Mann School of Nursing Undergraduate Honors Theses

Abstract

Congestive heart failure (CHF) is a chronic disease that impairs the quality of life (QoL) of patients and is associated with both high hospital readmission rates and healthcare resource utilization such as emergency services. This study proposed use a student led transitional care program in providing home care to NYHA functional class II and III CHF patients. It evaluated the impact of the program on their quality of life as measured by the Minnesota Living with Heart Failure Questionnaire© (MLWHFQ), the percentage of patients requiring readmission to the hospital within 30 days of initial hospitalization, and healthcare utilization. Thirty-six …


The Effects Of Patient Education And Knowledge Of Chf Patients As Evaluated By The Paksac Survey, Nabil Tovar May 2016

The Effects Of Patient Education And Knowledge Of Chf Patients As Evaluated By The Paksac Survey, Nabil Tovar

The Eleanor Mann School of Nursing Undergraduate Honors Theses

After diagnosis, management of congestive heart failure (CHF) can pose quite a struggle to many patients, since it requires that lifestyle changes be implemented into their daily life. Patients require the sufficient knowledge and education in order to best manage symptoms and improve their quality of life after being diagnosed. Use of Patient Knowledge of Self-care activities in Congestive Heart Failure© (PaKSAC) survey in transitional care programs could identify patient gaps in knowledge, as well as decreasing acute care service use. The purpose of this research study was to investigate the knowledge level of CHF patients at the time …


Implementing A Good Catch Program In Nursing Homes, Leigh Raposo May 2016

Implementing A Good Catch Program In Nursing Homes, Leigh Raposo

Muskie School Capstones and Dissertations

Rationale and processes for reporting near misses and evidence-based tools were collected by a literature search, seminal works by Sidney Dekker and James Reason, and websites for the Agency for Healthcare Research and Quality (AHRQ), the Institute for Healthcare Improvement (IHI), and the Centers for Medicare and Medicaid Services (CMS). Tools, information, and strategies found in this research were evaluated for implementation in Maine nursing homes. The tools provide a communication vehicle for nursing home staff to safely report to management near misses, or mistakes that do not harm residents. To emphasize a positive approach, the project replaces the term …


Patient Perceptions Of An Aidet And Hourly Rounding Program In A Community Hospital: Results Of A Qualitative Study, Tosha Allen, Tyne Rieck, Stacie Salsbury Apr 2016

Patient Perceptions Of An Aidet And Hourly Rounding Program In A Community Hospital: Results Of A Qualitative Study, Tosha Allen, Tyne Rieck, Stacie Salsbury

Patient Experience Journal

Quantitative evidence links patient satisfaction scores to the use of communication strategies such as AIDET (Acknowledge, Introduce, Duration, Explanation, and Thank you) and Hourly Rounding. However, little is known about patient perceptions of these tools in regards to their hospital experience. Qualitative interviews were conducted with a convenience sample of 14 adult medical/surgical inpatients in one mid-sized, community hospital, following hospital discharge. The interview data was transcribed and opened coded, utilizing constant comparison to identify common themes. Themes emerged in four topical areas: (a) patient experience of hospitalization, (b) AIDET, (c) Hourly Rounding, and (d) unexpected findings. Patients placed significant …


Educating Providers: A Pilot Study On The Impact Of Standard Days Method Education In Northern Haiti, Jennifer Quigley Apr 2016

Educating Providers: A Pilot Study On The Impact Of Standard Days Method Education In Northern Haiti, Jennifer Quigley

DNP Projects

Preventing unintended pregnancy is a topic of global and domestic importance. In 2013, almost 290,000 maternal deaths occurred due to complications of pregnancy or child-birth; 99% of these deaths were in developing countries (World Health Organizations, 2014). Additionally, more than 4 million infants died before reaching their first birthday, a large number being attributed to multiple factors related to unhealthy timing of pregnancy (World Health Organization, 2012). The World Health Organization (2012) asserts the ability of women to adequately control the timing and spacing of pregnancy can dramatically decrease maternal mortality due to pregnancy complications and unsafe abortions, decrease infant …