Nursing Midwifery Commons^™

The Efficacy Of Transversus Abdominis Plane Block As An Adjunct To Spinal Anesthesia For Cesarean Delivery: An Evidence Synthesis And Implementation Toolkit, Alyssa Hebert, Alex Potts, Gabriela Robertson

Graduate Theses, Dissertations, and Capstones

Postoperative pain hinders cesarean delivery recovery and overall patient experience. Although spinal anesthesia with intrathecal opioids remains the standard of practice, associated side effects and concerns regarding opioid exposure highlight the need for effective opioid-sparing strategies. Anesthesia providers play a critical role in advancing postoperative pain management through evidence-based protocol development, provider education, and interdisciplinary collaboration to optimize maternal outcomes. The transversus abdominis plane (TAP) block provides somatic analgesia to the anterior abdominal wall by targeting the thoracolumbar nerves (T6–L1) and has increasingly been incorporated into multimodal postoperative pain management strategies for abdominal surgery. Nevertheless, a gap remains in obstetric …

Breastfeeding Promotion For Infants With Neonatal Abstinence Syndrome (Nas), Olivia Czerwonka

Evidence-Based Practice Project Reports

Neonatal abstinence syndrome (NAS) is the exposure in utero to drugs with the incidence in the United States increasing from 4 to 6.3 per 1000 births (Wei et al., 2023). The purpose of this quality improvement project was to implement a breastfeeding support intervention to increase breastfeeding frequency and reduce hospital length of stay of newborns with NAS. A tailored multicomponent guideline based upon the current Ten Steps to Successful Breastfeeding as established by WHO and UNICEF (2017) was implemented. Mothers of infants diagnosed with NAS were recruited using convenience sampling from a Northwest Indiana Hospital. Key stakeholders within the …

Clinical Pathway For Rhogam Administration In The Emergency Department, Lauren Kyzar, Amy Bigham

Appalachian Student Healthcare Research Review

Background: Clinical pathways in emergency departments (ED) are designed to standardize patient care and reduce variability in clinical practice. In a rural hospital setting, the ED management of RhoGAM administration in pregnant patients with vaginal bleeding varied by provider with no standard of care achieved. This approach raised concerns about potential patient safety issues.

Methods: In response, the local emergency department medical director, in conjunction with local perinatal providers developed a clinical pathway to standardize care and optimize RhoGAM administration. The clinical pathway was implemented to the local ED providers over a three-month period. Retrospective chart review for Type and …

Comparing Nurse-Led Holistic Pain Relief Strategies And Sole Pharmacological Use In Enhancing Maternal Satisfaction, Reducing Pain, And Lowering Obstetric Interventions During Childbirth, Jessica C. Moore

Nursing | Senior Theses

Background: Childbirth has become heavily reliant on pharmacological management and obstetric interventions such as epidural use, labor induction, and cesarean deliveries (C-sections) even among low-risk pregnancies. While necessary in some cases, excessive reliance on pharmacological interventions can negatively impact the experience of birthing as a whole. Non-pharmacological interventions (NPIs) such as breathing techniques, positioning, hydrotherapy, massage, aromatherapy and continuous support have shown to be effective in reducing pain and supporting physiologic labor. The gaps in education and lack of standard implementation result in inconsistent application in practice. Purpose: This research proposal aims to evaluate the effectiveness of nurse-led NPIs compared …

The Knowledge, Experiences, And Attitudes Of Nurses Regarding Trauma-Informed Care For Sexually Abused Intrapartum Patients, Kayleigh Mcgraw

Honors Undergraduate Theses

Labor and delivery nurses care for women from diverse backgrounds who are preparing for a life-changing event, often marked by fear, excitement, sadness, and joy. However, 1 in 5 women in the United States have experienced rape or attempted rape, and for these survivors, labor can become re-traumatizing. Many report flashbacks, dissociation, and a sense of “being back in the rape” during childbirth. Research further links prior sexual assault to unplanned cesareans, traumatic births, and childbirth-related PTSD. Trauma-informed care (TIC) provides a framework to reduce these risks by encouraging providers to understand trauma, recognize signs of distress, and act to …

Implementing A Pap Smear Tracking Tool For Increased Compliance, Meghan Marie Madea Msn, Cnm, Whnp-Bc, Katherine Ferrell Fouquier Phd, Cnm, Facnm, Bobby Bellflower Dnsc, Nnp-Bc, Faan, Faanp, Fnap

Doctor of Nursing Practice Projects

Purpose/Background

The Papanicolaou “pap” smear screens for cervical cancer in women ages 21-65 with a cervix. Inconsistent locations for lab results lead to a decrease in provider efficiency, and patients are unaware of results or recommended follow-up. This quality improvement project implemented a tracking tool within the electronic medical record (EMR) in a busy midwifery clinic. The outcomes are the identification of patients overdue for pap smears, scheduling the procedure, recording of results, and patient notification with recommended follow-up.

Methods

A one-month chart review was performed of fifty gynecology patients within a midwifery clinic. Results of pap smears were located …

Small And Sick Newborn Care: Changes In Service Readiness Scoring Between Baseline And 2023 For 65 Neonatal Units Implementing With Nest360 In Kenya, Malawi, Nigeria, And Tanzania, Rebecca E. Penzias, Morris Ondieki Ogero, Robert Tillya, Irabi Kassim, Olabisi Dosunmu, Opeyemi Odedere, Hannah Mwaniki, Vincent Ochieng, Dolphine Mochache, William Macharia

Paediatrics and Child Health, East Africa

Health Facility Assessments (HFAs) are important for measuring and tracking service readiness for small and sick newborn care (SSNC). NEST360 Alliance aims to reduce neonatal mortality in four countries (Kenya, Malawi, Nigeria, Tanzania). NEST360 and UNICEF facilitated HFA tool design with ministries of health in four African countries and developed two complimentary approaches to summarize readiness. Using the NEST360/UNICEF HFA tool, we collected data, developed two service readiness scoring approaches for SSNC (standards-based scoring by adapted World Health Organization (WHO) health system building blocks (HSBBs) and assessing service readiness across the health system, and level-2+ scoring by WHO clinical interventions), …

Evaluating Referral Rates For Positive Postpartum Depression Screenings At Telehealth And Well-Child Visits: A Scoping Review, Rachel Macklin Barber, Mph, Bsn, Rn, Damaris Amber Brooks, Bsn, Rn, Ashli-Emeria Gary, Bsn, Rn, Margaret Harvey, Phd, Acnp-Bc, Chfn, Kate Fouquier Phd, Aprn, Cnm, Pmh-C, Facnm

Doctor of Nursing Practice Projects

Purpose/Background

Postpartum depression (PPD) affects one in nine women. It has distressing impacts, including behavioral and attachment issues and toveruse of healthcare services. PPD occurs within 4 weeks to 12 months postpartum. A scoping review was conducted to compare referral rates to mental health providers after PPD screenings were conducted via telehealth versus those completed at well-child visits.

Methods

Peer-reviewed articles published within five years before the initial search, beginning September 2022 and ending November 2024, were selected. Articles were sourced from several publications using an online library database with various MeSH terms and Boolean operators. Search results were narrowed …

Assessing The Efficacy Of Tranexamic Acid In Adjunct To Oxytocin In Reducing Blood Loss During Cesarean Deliveries: A Scoping Review, Hilary Clair Ray Bsn, Rn, Shelbie Freeman Hendrix Bsn, Rn, Lauren Elizabeth Hubbard Bsn, Rn, Helen Maisen Conley Bsn, Rn, Dwayne Accardo Dnp, Ccrn, Faana

Doctor of Nursing Practice Projects

Purpose/Background

Globally, postpartum hemorrhage (PPH) is the leading cause of morbidity and mortality during the peripartum and postpartum period in delivering people. Emerging evidence suggests that combining second-line uterotonics with tranexamic acid (TXA) improves maternal outcomes, reduces blood loss, and lowers morbidity and mortality related to PPH (Jones et al., 2023; Al-dardery et al., 2023). TXA, an antifibrinolytic, enhances clotting, reduces blood loss, transfusion needs, hemoglobin drop, and the use of additional uterotonics (Bellos & Pergialiotis, 2021). This review highlights the benefits of TXA.

Methods

A scoping review required a literature search conducted from August 2023 to February 2024 using …

The Impact Of The Utilization Of Shared Decision-Making Tools In Contraceptive Counseling On Patient Satisfaction In Adolescents: A Scoping Review, Akaninyene Ruffin Msn,Fnp-C, Judith Tunney Bsn, Rn, Mary Katherine Fouquier Phd, Aprn, Cnm, Facnm, Margaret Harvey Phd, Aprn, Acnp-Bc

Doctor of Nursing Practice Projects

Purpose/Background

Robust adolescent contraceptive counseling requires deep understanding of the specific context in which adolescents are receiving reproductive health care. As teen pregnancy rates rise, particularly in places across the Deep South, providers must find ways to engage their adolescent patients about their sexual and reproductive health. Professional organizations like the American College of Obstetricians and Gyencologists and the American Academy of Pediatrics both offirm the need for robust contraceptive counseling for adolescents. The purpose of this is to ascertain the impact of utilizing shared-decision making aids during contraceptive counseling on patient satisfaction in adolescent populations.

Methods

A systematic literature …

Evaluating The Efficacy Of The Implementation Of A Food Insecurity Screening Tool In Identifying Risk Amongst Nicu Families, Jessica Daniels Bsn, Rn, Sahtiah Williams Bsn, Rn, Bobby Bellflower Dnsc, Nnp-Bc, Faanp

Doctor of Nursing Practice Projects

Purpose/Background

Infants admitted to the Neonatal Intensive Care Unit (NICU) are critically ill and at risk of increased infections, developmental delays, and higher readmission rates after discharging due to complex health needs when compared to healthy term newborns. Nutrition has been widely recognized as an important predictor of readmission and developmental delay. However, current practice often does not provide any screening for food insecurity (FI) in NICU families, which assumes security and displays a gap in care surrounding discharge planning. This quality improvement project implements the use of an FI screening tool for NICU families to help practitioners identify FI …

Scoping Review Of Algorithms For Electronic Fetal Monitoring, Katherine Sabatier, Kate Fouquier Cnm, Phd, Facnm

Doctor of Nursing Practice Projects

Purpose/Background

The purpose of this scoping review is to review the use of an algorithm in evaluating continuous external fetal heart rate (FHR) monitoring in labor as opposed to clinician judgment for improved fetal outcomes, including earlier recognition of abnormal tracings (Clark et al., 2017). FHR monitoring was created to evaluate for fetal hypoxia in labor and has become standard practice (Gyllencreutz et al., 2018). One of the goals of the use of cardiotocography is to decrease hypoxia-induced fetal metabolic acidemia and neurologic injury. There are multiple options for individual or computer-based algorithms in evaluating FHR to reduce fetal acidemia …

Perinatal Mood And Anxiety Disorders (Pmads): A Scoping Review, Christina Willis Bsn, Rn, Nia Wells Bsn, Rn, Miranda Smith Bsn, Rn, Kate Fouquier Cnm, Phd, Facnm

Doctor of Nursing Practice Projects

Purpose/Background Perinatal Mood and Anxiety Disorders (PMADs), including postpartum depression, anxiety, and psychosis, significantly impact maternal and infant health. This scoping review consolidates current literature on PMADs, emphasizing prevalence, risk factors, screening, and treatment. The primary aim is to identify research gaps and inform clinical guidelines to enhance perinatal care.

Methods A literature search followed PRISMA guidelines from August 2022 to November 2024. Databases searched included PubMed, CINAHL, Scopus, and Google Scholar, using terms such as "perinatal mood disorders" and "maternal mental health." Inclusion criteria were English-language studies from the past decade addressing PMADs during pregnancy and up to one …

Implementation Of The Modified Early Obstetric Warning System (Meows) In Obstetric Patients Within A Level Iv Maternal Care Facility, Mei M. Stalder

Student Scholarly Projects

Practice Problem: Incidences of increasing maternal morbidity and mortality are often preceded by a period of unrecognized deterioration. The lack of an obstetric early warning system in a high-risk Level IV Maternal Care Facility further contributed to delayed identification and intervention of deteriorating mothers.

PICOT: The PICOT question that guided this DNP project was, in obstetric patients, 18-years or older (P), does the Modified Early Obstetric Warning System (MEOWS) (I), compared to current standard practice (C), affect the number of patients transferred to the ICU (O) within a six-week time frame (T)?

Evidence: Nine evidence-based articles were included in this …

Birth Planning, Audrey K. Gill, Kacie J. Easley

Student Scholarship & Creative Works

This is an informative presentation completed using evidence based practice regarding the importance of birth planning and the use of birth plans. It is used as a tool to educate nurses and healthcare providers about the benefits of implementing birth plan education into their patients portfolio. The birth plan is a written document that involves the collaborative efforts between nurses/healthcare providers and future mothers. It is used in order to personalize and improve the birthing experience for patients. This presentation uses qualitative research, quantitative research, and theoretical framework in order to deem positive results with the implementation of birth plans.

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” …

An Evaluation Of The Effectiveness Of An Updated Pre-Service Midwifery Curriculum Integrated With Emergency Obstetric And Newborn Care In Kenya: A Cluster Randomised Controlled Trial, Duncan N. Shikuku, Catherine Mwaura, Peter Nandikove, Alphonce Uyara, Helen Allott, Lucy Waweru, Lucy Nyaga, Edna Tallam, Issak Bashir, Eunice Ndirangu

School of Nursing & Midwifery, East Africa

Introduction Quality midwifery education is central to improving midwifery service delivery and maternal and newborn health outcomes. In many settings, midwifery educators insufciently prepared for their teaching role and defcient curriculum compared to international standards afect the quality of healthcare provided by the midwifery graduates. This study assessed the efectiveness of an EmONC enhanced midwifery curriculum delivered by trained and mentored midwifery educators on the quality of education and student performance in Kenya.

Methods A cluster randomised controlled trial in 20 midwifery colleges (12 intervention, 8 control colleges). Educators in both arms received training in teaching/EmONC skills to deliver the …

Assessing Association Between Socio-Demographic Variables And Contraceptive Usage In Married Men Residing In Korangi District, Karachi, Pakistan, Fahmida Khawaja, Gloria Noble Khan, Alia Nasir, Kiran Khowaja

Journal of Asian Midwives (JAM)

Background: Population growth remains an alarming concern for Pakistan as it not only exhausts scarce resources but further impedes socioeconomic development. One potential solution is to advance modern Family Planning (FP), which in the Pakistani context requires specific and rigorous attention towards male contraception in conjunction with female family planning usage. This study aims to determine the association between socio demographic factors and contraceptive use in married men of squatter settlement of Korangi Karachi.
Methods and Materials: A cross-sectional study was carried out from March, 2017 to June 2017, using a non-probability convenience sampling technique to select married men …

The Effect Of Cotton Dust Exposure As A Longterm Impact On Lung Function Changes: A Short Narrative Review, Naureen Akber Ali, Noshaba Akber, Adeel Khoja

School of Nursing & Midwifery

No abstract provided.

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 …

School-Based Study To Assess The Nutritional Status (Bmi Based) Of Adolescents Of Gojra City Of District Toba Tek Singh, Punjab, Pakistan, Shagufta Perveen, Rozina Karmaliani, Rubina Barolia, Rozina Mistry

School of Nursing & Midwifery

Adolescence is the make-or-break stage of life. Major physical, mental, and psychological growth takes place at this age. Adequate and balanced nutrition is a vital requirement to support this phase. Adolescents living in developing and low-income countries are more likely to face nutritional challenges. Poor nutritional status during adolescence is an important determinant of health outcomes.
Objective: To analyze the nutritional status (BMI based) of school-going adolescents in Gojra city, Punjab, Pakistan.
Methods: A school-based cross-sectional survey was carried out covering 635 (6-8 grade) school-going adolescents (boys and girls) from public schools in Gojra city. Data were collected through anthropometric …

Erac (Enhanced Recovery After Cesarean): A Safer And More Efficient Recovery Protocol, Allison Deluca

Senior Honors Projects

No abstract provided.

Virtual Visits In Routine Prenatal Care, Katrina K. Wu

MUSC Theses and Dissertations

Problem

One million pregnant persons in the United States do not receive early prenatal care or the recommended number of prenatal visits each year, and this gap in care access disproportionately affects people of color, those with lower incomes, and those living in rural communities. Telemedicine was widely utilized in prenatal care during the COVID-19 pandemic, and optimizing prenatal telemedicine has the potential to improve prenatal care access beyond the pandemic.

Purpose

This dissertation focused on examining the integration of virtual visits in routine prenatal care during the COVID-19 pandemic. The purpose of this dissertation was to:

Aim 1. Explore …

Does The Anastatica Hierochuntica Plant Shorten The Duration Of Labour? A Prospective Observational Study, Filiz Okumuş, Halime Öncü-Çelik, Nevin Şahin

Journal of Asian Midwives (JAM)

Objective: This study aims to investigate the effect of Anastatica Hierochuntica L. on the duration of labour in primiparous women.
Methods: A prospective, case-controlled study with an intervention (n=28) and control (n=29) group. Participants were not randomized; their preferences related to the use of the A. Hierochuntica L. determined the group in which they would be included. In the intervention group, Anastatica Hierochuntica L. was used by all women. Standard care continued for both the intervention and control group. The duration of the first and second stage of labour were evaluated and compared between groups.
Results: Participants’ mean of age …

Postpartum Depression For Mothers With Early Fetal Death Or Stillbirths, Callie Goldman

Symposium of Student Scholars

Background: Many times, prevention of early fetus death and stillbirths is possible; however, some mortality events are spontaneous or unavoidable. While existing research reveals the likelihood of postpartum depression for mothers following birth, few studies address the potential for postpartum depression of mothers of stillbirth or demised fetuses. The purpose of this study is to determine how mothers can be better prepared for the hardship of losing a baby during childbirth, while going through common difficulties, such as postpartum depression, following birth. Methods: A mixed method approach will be conducted to gather qualitative (interview) and quantitative (Edinburgh Postnatal Depression Scale …

Resilience And Prenatal Mental Health In Pakistan: A Qualitative Inquiry, Shireen Shehzad, David Arthur, An-Sofie Van Parys, Nicole Letourneau, Gail Wagnild, Shahirose Sadrudin Premji, Nargis Asad, Olivier Degomme

School of Nursing & Midwifery

Background: Women in Pakistan suffer from a high rate of depression. The stress of low-income, illiteracy, exposure to violence and living in a patriarchal society are predisposing vulnerabilities for depression, particularly during and following pregnancy. The resilience of an individual plays a significant role in promoting prenatal mental health, but this has yet to be thoroughly researched. In this article, our objective is to identify the core characteristics of resilience among pregnant women, which will then help us in developing an intervention.
Methods: The exploratory-descriptive study was conducted over 6 months in five different antenatal hospitals in Sindh, Pakistan. A …

Prevalence, Distribution, And Histopathological Features Of Malignant Tumors Reported At Tertiary Level In Afghanistan: A 3-Year Study, Haider Ali Malakzai, Ahmed Maseh Haidary, Saleema A. Gulzar, Mujtaba Haidari, Abdul Sami Ibrahimkhil, Ramin Saadaat, Ahmadullah Hakimi, Sayed Murtaza Sadat Hofiani, Soma Rahmani, Jamshid Abdul Ghafar

School of Nursing & Midwifery

Purpose: Cancer is one of the leading causes of mortality and morbidity, and therefore, tremendous research work is continuously being done around the world with consideration of etiopathogenesis as well as identification of therapeutic targets. Decades of continuous war in Afghanistan has left the medical infrastructure of the country in a miserable situation. There is a serious deficiency in research work in the fields of pathology and oncology at the moment with minimal data available to elaborate about the demographic characteristics of various malignant disorders in the country, which would be indispensable to pave the way for further research and …

No One Should Have To Give Birth Alone: An Analysis Of The Efficacy Of Community-Based Doula Programs Serving Ethnic Minorities In San Francisco, Maria Margaret Nelson

Master's Projects and Capstones

Adverse birth outcomes for both the parent and the child disproportionately affect people of color. Evidence demonstrates that one of the ways to mitigate these negative consequences is through the utilization of a doula, a trained birth companion that is not a medical provider but whose role it is to physically and emotionally support the patient through pregnancy, birth, and postpartum. Community-based doula programs, where the doula is of the same cultural background as the client, are particularly effective in improving birth outcomes in communities of color by providing culturally competent care and helping to navigate a healthcare system that …

A Qualitative Inquiry On Smokers’ Perceptions Of Smoking Cessation During Covid-19, Sajid Iqbal, Rubina Barolia, Kiran Iftikhar, Pammla Petrucka, Jeniefer Anastasi, Faris Farooq Saeed Khan, Naheed Feroz Ali

School of Nursing & Midwifery

Background: This qualitative exploratory study explores smokers’ perspectives regarding smoking cessation processes amid the COVID-19 pandemic.
Methods: Purposive sampling was employed to conduct semi-structured interviews with cigarette smokers visiting cardiac and pulmonary clinics at a tertiary care hospital in Karachi, Pakistan. Thematic analysis was performed to identify themes from the participants’ responses.
Results: Three themes emerged from the thematic analysis. These were smoking cessation facilitators, smoking cessation barriers, and COVID-19 impacts on smoking cessation. Awareness and education, threat of acquiring health problems, religious beliefs and family or support system behave as smoking cessation facilitators. While, role modeling, associating smoking to …

Remifentanil Patient Controlled Analgesia Use In Laboring Women: A Feasibility And Acceptability Study, Joshua Carr

Dissertations

Background/Purpose: Interest in remifentanil patient controlled analgesia (RPCA) as a treatment for labor pain has increased due to its unique pharmacodynamics and effectiveness on pain control among parturients. Despite its promise, RPCA remains infrequently used in the US. The purpose of this study was to 1) examine the implementation and acceptability of a new RPCA protocol in the labor and delivery ward of a mid-sized hospital, and 2) identify the attitudes and beliefs of healthcare workers in a real-world clinical setting.

Theoretical/Conceptual Framework: The holistic nature of Comfort Theory can account for the proposed mechanisms contributing to the …