Maternal, Child Health and Neonatal Nursing Commons^™

The Unspoken Grief Of Multiple Stillbirths In Rural Pakistan: An Interpretative Phenomenological Study, Muhammad Asim, Sehrish Karim, Hajra Khwaja, Waqas Hameed, Sarah Saleem

Community Health Sciences

Background: Pakistan has the highest rate of stillbirth (30.6 stillbirths per 1000 total births) as compared to other South Asian countries. The psychological impact of stillbirths on bereaved women is well documented; however, there is a dearth of literature on lived experiences of women with multiple stillbirths in Pakistan.
Objective: The purpose of this research is to understand the lived experiences of women who had multiple stillbirths in Thatta, Pakistan.
Methods: An interpretative phenomenological study was conducted in district Thatta with eight women who experienced more than one stillbirth. A semi-structured in-depth interview guide was used for data collection. The …

Knowledge, Attitude And Practices Of Pregnant Women Related To Covid-19 Infection: A Cross-Sectional Survey In Seven Countries From The Global Network For Women's And Children's Health, Farnaz Naqvi, Seemab Naqvi, Sk Masum Billah, Sarah Saleem, Elizabeth Fogleman, Nalini Peres Da-Silva, Lester Figueroa, Manolo Mazariegos, Ana L. Garces, Sana Yousaf

Community Health Sciences

Objective: We sought to understand knowledge, attitudes and practices (KAP) regarding COVID-19 in pregnant women in seven low and middle-income countries (LMIC).
Design: Population-based prospective, observational study.
Settings: Study sites in DRC, Kenya, Zambia, Bangladesh, India (two sites), Pakistan and Guatemala.
Population and sample: Pregnant women in the Global Network's Maternal and Neonatal Health Registry (MNHR).
Methods: A KAP questionnaire was administered in face-to-face interviews with pregnant women from September 2020 through October 2021 in the MNHR.
Main outcome measures: KAP regarding COVID-19 during pregnancy.
Results: In all, 25 260 women completed the survey. Overall, 56.8% of women named ≥3 …

Individual, Social And Institutional Vulnerabilities In The Premature Infant Care At Home, Claudia Silveira Viera Ms, Leticia Pancieri Ms, Rosane Meire Munhak Da Silva Ms, Monika Wernet Ms, Maria Aparecida Munhoz Gaiva Ms, Debora Falleiros De Mello Ms

The Qualitative Report

The prematurity carries some difficulties for families during the preterm infant hospitalization, as well as, after hospital discharge. In this context, is required a specific knowledge about the preterm biological characteristics, family’s life conditions, health care, and social context. This study aims to analyze parent’s experiences on daily home care for preterm infants focusing on individual, social and institutional vulnerabilities. Descriptive qualitative study was developed through the hermeneutic perspective approach, in South of Brazil with six families, who had babies discharged from Neonatal Intensive Care Unit. Non-structured interviews were recorded in the home visit with 12 participants (parents) and genogram …

Compounding Inequalities: Adolescent Psychosocial Wellbeing And Resilience Among Refugee And Host Communities In Jordan During The Covid-19 Pandemic, Nicola Jones, Sarah Baird, Bassam Abu Hamad, Zulfiqar Ahmed Bhutta, Erin Oakley, Manisha Shah, Jude Sajdi, Kathryn M. Yount

Department of Paediatrics and Child Health

Purpose: The COVID-19 pandemic and associated risk-mitigation strategies have altered the social contexts in which adolescents in low- and middle-income countries live. Little is known, however, about the impacts of the pandemic on displaced populations, and how those impacts differ by gender and life stage. We investigate the extent to which the pandemic has compounded pre-existing social inequalities among adolescents in Jordan, and the role support structures play in promoting resilience.
Methods: Our analysis leverages longitudinal quantitative survey data and in-depth qualitative interviews, collected before and after the onset of COVID-19, with over 3,000 Syrian refugees, stateless Palestinians and vulnerable …

Nutritional Status And Dietary Intake Of School-Age Children And Early Adolescents: Systematic Review In A Developing Country And Lessons For The Global Perspective, Durray Shahwar Abid Khan, Jai K. Das, Shagufta Zareen, Zohra S. Lassi, Afsah Salman, Muhammad Raashid, Aftab A. Dero, Aijaz Khanzada, Zulfiqar Ahmed Bhutta

Department of Paediatrics and Child Health

Background: The prevalence of double burden of malnutrition (DBM) is high in low- and middle-income countries (LMICs). Data on malnutrition trends is present for children age, however the data for school-going children and adolescents aged 5-15 years is scarce.
Objective: This systematic review presents the pooled prevalence of nutritional status and dietary intake among school-going children and adolescents (5-15 years of age) in an LMIC of Pakistan and the perspective for broader global nutrition in this age group.
Methods: An electronic search of databases was run on Pubmed and Medline (via Ovid) along with gray literature and archives of local …

Nursing And Interprofessional Relationships On A Labor And Delivery Unit: Ethnography, Tricia A. Lewis

Dissertations, Theses, and Capstone Projects

Research regarding interprofessional relationships on a labor and delivery unit is overwhelmingly quantitative, most of it relying on descriptors of the concepts “team” and “teamwork.” However, there is a scarcity of studies that explore the actual interactions that occur among professionals while they provide care to a laboring mother. In a labor and delivery unit at a suburban hospital, over a 14-month period, data was collected through participant observation, casual conversation, extensive field notes, informal interviews, and unstructured, in-depth interviews with 12 healthcare professionals until saturation of emerging themes was achieved. Field notes and transcribed interviews were continuously examined and …

Contact Dermatitis Due To Personal Protective Equipment Use And Hygiene Practices During The Covid-19 Pandemic: A Systematic Review Of Case Reports, Zouina Sarfraz, Azza Sarfraz, Muzna Sarfraz, Miguel Felix, Jonathan A. Bernstein, Luz Fonacier, Ivan Cherrez-Ojeda

Department of Paediatrics and Child Health

Background: Prolonged use of personal protective equipment (PPE) may lead to contact dermatitis during the coronavirus disease 19 (COVID-19) pandemic. This paper aims to identify the causative factors of contact dermatitis from PPE and hygiene practices.
Methods: The search was conducted adhering to PRISMA 2020 guidelines. A Delphi process was employed to ensure that the aims of this study were met. PubMed and Web of Science databases were systematically searched through September 12, 2021, using search terms: Contact dermatitis, case report, covid-19. The findings were tabulated as author/year, gender, age, presentation, cause, dermatological diagnosis, testing modality, provided treatment, symptom resolution …

Quality Of Care Assessment For Small And Sick Newborns And Young Infants In Pakistan: Findings From A Cross-Sectional Study, Nousheen Pradhan, Sumera Aziz Ali, Sana Roujani, Ammarah Ali, Syed Shujaat Hussain, Samia Rizwan, Shabina Ariff, Sarah Saleem, Sameen Siddiqi

Community Health Sciences

Introduction: Pakistan is facing a challenging situation in terms of high newborn mortality rate. Securing pregnancy and delivery care may not bring a substantial reduction in neonatal mortality, unless coupled with the provision of quality inpatient care for small and sick newborns and young infants (NYIs). We undertook this study to assess the availability and quality of newborn care services provided and the readiness of inpatient care for NYIs in Pakistan.
Methods: We conducted a cross-sectional study across Pakistan from February to June 2019, using a purposive sample of 61% (23) of the 38 sick newborn care units at public …

Rural Pregnant Women’S Experiences With Substance Use Disorder: A Qualitative Study, Cami Weber

Dissertations

Rural pregnant women with substance use disorder (SUD) are an understudied vulnerable population that often experiences poor pregnancy outcomes (Higgins et al., 2019; Jumah, 2016; Kramlich et al., 2018; Shaw et al., 2015). Despite the high prevalence and high burden associated with SUD, rural women are less likely than non-pregnant women to seek addiction treatment and complete an outpatient treatment program during pregnancy (Shaw et al., 2015). This study aimed to give voice to rural Missouri women with SUD. The research questions explored the life experiences and motivations for seeking treatment using a qualitative, descriptive research design with grounded theory …

The Promise Of Telemedicine In Pakistan: A Systematic Review, Syed Sarosh Mahdi, Raheel Allana, Gopi Battineni, Tamsal Khalid, Daniyal Agha, Mariam Khawaja, Francesco Amenta

Department of Paediatrics and Child Health

Background:
Telemedicine offers the possibility of provision of medical assistance to remote patients, and it has great potential in developing countries like Pakistan. Telemedicine solves logistical barriers, gives support to weak health systems, and helps to establish worldwide networks of healthcare professionals. Because of the high implementation costs, it is not possible yet to adopt telehealth systems for low- and middle-income nations.
Objective:
To present a revision of region-based telemedical services in Pakistan.
Methods:
Libraries such as PubMed (Medline), CINAHL (Cumulative Index to Nursing and Allied Health Literature), Scopus (EMBASE), and Google Scholar were used for document search. Newcastle-Ottawa Scale …

Understanding Perceptions And Practices For Designing An Appropriate Community-Based Kangaroo Mother Care Implementation Package: Qualitative Exploratory Study, Shabina Ariff, Ikram Maznani, Maria Asif Bhura, Zahid Memon, Tayyaba Arshad, Tariq Ahmed Samejo, Shujaat Zaidi, Muhammad Umer, Imran Ahmed, Muhammad Atif Habib, Sajid Bashir Soofi, Zulfiqar Ahmed Bhutta

Department of Paediatrics and Child Health

Background: Low birth weight (LBW) is a common outcome of preterm birth, which increases the risk of an infant's morbidity and mortality. Approximately 20 million infants are born with LBW globally per year. Since a significant number of births in Pakistan take place at home, it is important to focus on the use of kangaroo mother care (KMC), the practice of skin-to-skin contact, in communities to prevent neonatal mortality and morbidity.
Objective: We employed a formative research approach to understand the context of communities and facilities with regard to neonatal care and KMC practice. The broader aims were to inform …

Do Empowered Women Receive Better Quality Antenatal Care In Pakistan? An Analysis Of Demographic And Health Survey Data, Muhammad Asim, Waqas Hameed, Sarah Saleem

Community Health Sciences

Introduction: Quality antenatal care is a window of opportunity for improving maternal and neonatal outcomes. Numerous studies have shown a positive effect of women empowerment on improved coverage of maternal and reproductive health services, including antenatal care (ANC). However, there is scarce evidence on the association between women's empowerment and improved ANC services both in terms of coverage and quality. Addressing this gap, this paper examines the relationship between multi-dimensional measures of women empowerment on utilization of quality ANC (service coverage and consultation) in Pakistan.
Methods: We used Pakistan Demographic and Health Survey 2017-18 (PDHS) data which comprises of 6,602 …

Industry 4.0 Technologies For The Manufacturing And Distribution Of Covid-19 Vaccines, Azza Sarfraz, Zouina Sarfraz, Muzna Sarfraz, Aminah Abdul Razzack, Shehar Bano, Sarabjot Singh Makkar, Sindhu Thevuthasan, Trissa Paul, Muhammad Khawar Sana, Nishwa Azeem

Department of Paediatrics and Child Health

Background: The evolutionary stages of manufacturing have led us to conceptualize the use of Industry 4.0 for COVID-19 (coronavirus disease 2019), powered by Industry 4.0 technologies. Using applications of integrated process optimizations reliant on digitized data, we propose novel intelligent networks along the vaccine value chain. Vaccine 4.0 may enable maintenance processes, streamline logistics, and enable optimal production of COVID-19 vaccines.
Vaccine 4.0 framework: The challenge in applying Vaccine 4.0 includes the requirement of large-scale technologies for digitally transforming manufacturing, producing, rolling-out, and distributing vaccines. With our framework, Vaccine 4.0 analytics will target process performance, process development, process stability, compliance, …

Cost-Effectiveness Analysis Of Implementing An Integrated Neonatal Care Kit To Reduce Neonatal Infection In Rural Pakistan, Fiona Muttalib, Karen Chung, Lisa Grace Pell, Shabina Ariff, Sajid Soofi, Shaun K. Morris, Beate Sander

Department of Paediatrics and Child Health

Objective:
To evaluate the cost-effectiveness of distribution of the integrated neonatal care kit (iNCK) by community health workers from the healthcare payer perspective in Rahimyar Khan, Pakistan.
Setting:
Rahimyar Khan, Pakistan.
Participants:
N/A.
Intervention:
Cost-utility analysis using a Markov model based on cluster randomised controlled trial (cRCT: NCT02130856) data and a literature review. We compared distribution of the iNCK to pregnant mothers to local standard of care and followed infants over a lifetime horizon.
Primary and secondary outcome measures:
The primary outcome was incremental net monetary benefit (INMB, at a cost-effectiveness threshold of US$15.50), discounted at 3%. Secondary outcomes …

Early Labor Management: A Quality Improvement Project, Amy Dempsey

Regis University Student Publications (comprehensive collection)

Objective

The purpose of this quality improvement project is to safely reduce early labor admission rates through the implementation of evidence-based nursing triage management protocol focused on patient education and labor support for spontaneous early labor management in a community hospital setting. This initiative is part of a bundle of care intended to safely reduce primary cesarean birth rates.

Methods

A paired sample t-test was used to compare the following: early admission rates of NTSV patients before and after the study intervention: a pre and post knowledge survey taken by labor and delivery nurses; pre and post ELEQ survey results …

Prenatal Perception Of Wic Breastfeeding Recommendation Predicts Breastfeeding Outcomes In Infant's First Year, Joanne Guthrie, Qi Zhang, Kelin Li, Kathryn Wouk, Rajan Lamichhane

Community & Environmental Health Faculty Publications

Objectives

Promoting breastfeeding (BF) is a priority of the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC). Prior research found that pregnant mothers who believed WIC recommends BF only (versus BF and formula equally OK) were more likely to initiate BF and continue through 1 month postpartum. We examine whether such mothers are more likely to continue to exclusively BF through 5 months and BF at all through the infant's first year. Methods

Data are from the WIC Infant and Toddler Feeding Practices Study-2 (ITFPS-2), a longitudinal study that includes 2,649 mothers who completed prenatal interviews. Four BF …

Improving Antibiotic Administration Timing In Neonatal Early-Onset Sepsis, Donia B. Bass

Regis University Student Publications (comprehensive collection)

Abstract

Neonatal early onset sepsis (EOS) remains one of the most common causes of neonatal morbidity and mortality. Neonates requiring evaluation and treatment for suspected EOS inconsistently receive antibiotics within one hour of decision to treat as recommended in the 2012 neonatal sepsis guidelines by the National Institutes for Health and Care Excellence (NICE). A mixed method quality improvement initiative was employed in a level three NICU, applying a standardized admission process to mitigate systems flaws impacting delay of first dose antibiotic. A nursing sepsis education module was provided, and the novel SAM admission prioritization tool was developed to guide …

Risk Factors Contributing To Urinary Tract Infections (Uti) In Neonates, Jennifer V. Harshman

Honors Undergraduate Theses

Urinary tract infections (UTI) in neonates are caused by many types of risk factors such as increased length of maternal labor, physiologic maternal conditions, prematurity, and decreased birth weight. Identification of potential risk factors for UTI in neonates can lead to rapid assessment and early interventions to treat urinary infection in the neonate before it transitions to a severe or life-threatening condition, such as a kidney infection or septicemia.

The primary purpose of this literature review was to examine risk factors predisposing neonates to UTI. The secondary purpose was to identify if length of time to drug therapy used to …

The Effects Of Delayed Initial Bathing In Newborns, Danielle Nitzachon

Honors Undergraduate Theses

Delayed bathing of the newborn infant for twenty-four hours after birth can decrease potential newborn complications such as hypoglycemia, hypothermia, and improve the infants skin integrity and breastfeeding rates. The primary purpose of this literature review was to examine the health benefits of delaying initial bathing in newborns for twenty-four hours. A comprehensive review of the literature was performed using peer-reviewed, research articles from multiple databases focusing on delayed infant bathing after birth and health benefits. 15 articles met the inclusion criteria and answered the research questions. Two studies showed the effects of vernix caseosa on improved skin integrity and …

Obstetrical Nursing Care And Cesarean Section Delivery Rates In Laboring Women: An Integrative Review Of Literature, Ayana Cornelius

Honors Undergraduate Theses

Background: There is a documented overuse of C-sections (CS) in the United States. The majority of research surrounding CS overuse focuses on the physician’s role, location (state, city, hospital), hospital policies, and the reason why the CS is being performed. Little research focuses on the nurse’s influence on CS outcomes, although nurses spend the longest amount of time with the patient. Methods: Data for this literature review examined 13 research articles between 1992 to present, exploring factors relating to the overuse of CS, specifically, data relating to the correlation between CS and the nurse’s role. Results: Recent research has shown …

Cesarean Skin-To-Skin Contact: Who Gets The Experience In The Operating Room?, Jessica S. Junk-Wilson

Graduate Theses/Dissertations

For the past decade, skin-to-skin contact immediately after birth has been the general recommendation for all births, as there is evidence that it provides many benefits for mothers and infants. Yet, research has shown that immediate skin-to-skin contact is not the standard practice after most Cesarean births. This study assessed access, incidence, and circumstances surrounding Cesarean skin-to-skin contact (CSSC) in the operating room and examined influencing maternal characteristics of age, education, race, and number of births via a survey of 2327 people. Women who experienced a Cesarean section birth in the past 10 years were recruited through Facebook groups for …

Risk Factors And Compliance Of Surviving Sepsis Campaign: A Retrospective Cohort Study At Tertiary Care Hospital, Farheen Yousuf, Ayesha Malik, Ayesha Saba, Sana Sheikh

Department of Obstetrics & Gynaecology

Background and objective: Sepsis is one of the leading causes of direct maternal mortality in Pakistan. It is recommended that the first three hours after the presentation are crucial. During this time implementation of surviving sepsis campaign resuscitation bundles reduces maternal mortality. Our objective was to assess the factors contributing to puerperal sepsis and the compliance of "surviving sepsis campaign resuscitation bundles in puerperal sepsis" for the management of puerperal sepsis.
Methods: This was a retrospective record review for five years from January 2011-December 2015. All women who fulfilled the inclusion criteria of puerperal sepsis were included and data from …

Splanchnic Oxygenation And Feeding Intolerance In The Very Low Birthweight Infant, Melissa C. Dollings

Theses and Dissertations

SPLANCHNIC OXYGENATION AND FEEDING INTOLERANCE IN THE VERY LOW BIRTHWEIGHT INFANT

By Melissa C. Dollings, Ph.D.

A dissertation submitted in partial fulfillment of the requirements for the degree of Doctor of Philosophy at Virginia Commonwealth University

Virginia Commonwealth University, 2022

Major Director: Lisa F. Brown, Ph.D., RN, School of Nursing

Background. Feeding intolerance is common in preterm infants but can be an ominous precursor of necrotizing enterocolitis, a life-threatening gastrointestinal disease. The definition and management of feeding intolerance vary widely. This research examined the relationship

between feeding intolerance, intrauterine factors, extrauterine factors, and intestinal immaturity and circulatory immaturity in the …

Comparing The Effectiveness Of Methods Meant To Reduce Perineal Laceration Rates, Danielle E Horovitz

Nursing | Senior Theses

Background

Perineal lacerations are a common occurrence in childbirth- with tears occurring in 53-79% of women. Trauma to the perineum is classified into 4 categories, with each class increasing in severity. Severe perineal lacerations have long term consequences for the women who experience them.

Objectives

To compare the effectiveness of methods which aim to reduce the rate and severity of perineal lacerations, including: hands on vs hands off technique, slow and controlled birth, use of lubrication, perineal massage, etc.

Summary of Findings

The literature review suggests that it is critical to employ methods to reduce laceration incidence and severity as …

Best Practices For The Prevention And Treatment Of Microcytic Hypochromic Anemia In Infancy, Janelle Paredes

Nursing | Senior Theses

Background: Microcytic hypochromic anemia is the most common nutritional deficiency in the world. This type of anemia is commonly found during infancy due to the lack of iron-fortified foods after six months of age. The effects linked to this deficiency can cause developmental delays and behavioral disturbances in infants if not treated immediately. Therefore, it is important for nurses to find the best practices to prevent microcytic hypochromic anemia to decrease its prevalence in infancy.

Objective: To find the best nursing practices for the prevention and treatment of microcytic hypochromic anemia in infancy.

Methods: This research will utilize …

A Comparison Of Perceptions Of Labor Support Before And During The Covid-19 Pandemic, Sarah Grace Krein

Honors Theses and Capstones

Satisfaction with the experience of birth has been shown to be affected by the quality of support received by the birthing individual and how closely the experience aligns with their expectations. This is important because the hospital and societal restrictions put in place during the COVID-19 pandemic may have altered individuals’ experiences of birth during this time. This is further concerning as there is a known correlation between a negative birth experience and the risk for postpartum depression. This study aimed to identify birthing parents’ perceptions of support during birth and how the COVID-19 pandemic impacted support practices. A survey …

Perinatal Patient Education On Substance Use Risk Factors In The Age Of The Opioid Crisis, Rebecca Ane Leary, Alyssa O'Brien

Honors Theses and Capstones

From 2014 to 2016, NH ranked first for fentanyl and all opioid-related overdose deaths per capita in the United States (Moore et al., 2021). In 2016 the New Hampshire Department of Health and Human Services (NH DHHS) found that there are many repercussions of this opioid crisis including overdose deaths, child and elder abuse, and newborns experiencing withdrawal. In utero substance exposure places a child at a higher risk for developmental, behavioral, and physical health concerns. To address this gap, a secondary data analysis using NH Pregnancy Risk Assessment Monitoring System (PRAMS) data from 2013 to 2020 was conducted. PRAMS …

Nurses’ Perceptions Of Their Role Utilizing Eat, Sleep, Console, In The Management Of Neonatal Abstinence Syndrome, Cerys Eldred

Honors Theses and Capstones

Background: There is a rising prominence of infants being born and diagnosed with Neonatal Abstinence Syndrome (NAS) in the United States. In recent years, a new non-pharmacological method of managing these infants called Eat, Sleep, Console (ESC) has emerged. While there is mounting evidence demonstrating the positive outcomes for infants treated with this method, there is limited research regarding nurses’ perceptions of this new intervention. This study seeks to understand the nurse’s experience and role during caring for infants with NAS utilizing the ESC method in comparison to the past practices.

Methods: This study used a qualitative descriptive design to …

Still Birth Classification: Application Of Relevant Condition At Death (Recode) Classification System In A Tertiary Care Hospital Of Pakistan, Urooj Kashif, Shelina Bhamani, Asma Patel, Zaheena Shamsul Islam

Department of Obstetrics & Gynaecology

Objectives: To determine the cause of stillbirth after application of relevant condition at death (ReCoDe) classification system.
Methods: This was a retrospective cross sectional study of 207 women diagnosed with stillbirth after 24 completed weeks of pregnancy at the Aga Khan University Hospital (AKUH), Karachi between 1st January 2015 and 31st December 2019. The primary objective was to find the cause of stillbirth according to the new classification of relevant condition at death (ReCoDe).
Results: There were a total of 32413 live births and 207 stillbirths during the study period thus stillbirth rate of 6 per 1000 live births. In …

Promoting Postpartum Knowledge And Support Through The Provision Of Educational And Support Resources During The Postpartum Admission Stay: A Quality Improvement Project, Danielle Woodman

Master's Theses and Capstones

BACKGROUND: The postpartum period is often imbued with heightened emotions, unfamiliar challenges, and an abundance of uncertainty. Postpartum depression and anxiety are well discussed in literature, yet postpartum mothers may lack knowledge of these conditions and their associated risk factors, signs, and symptoms as well as the support resources which are available to them. Improved postpartum support and awareness may alleviate the prevalence, severity, and progression of these conditions into more severe cases.

LOCAL PROBLEM: Within the given microsystem, a gap in postpartum educational and support resources exists due to a lack of resource awareness and ease of accessibility.

METHODS: …