Nursing Midwifery Commons^™

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 …

Challenges Experienced By Newly Qualified Nurse-Midwives Transitioning To Practice In Selected Midwifery Settings In Northern Malawi, Mathews Brave Mtegha, Elizabeth Chodzaza, Ellen Chirwa, Fatch Welcome Kalembo, Maggie Zgambo

Research outputs 2022 to 2026

Background: Literature shows that newly qualified nurse-midwives face challenges integrating into the workforce during their transition period from education to practice. However, little is known about the needs and challenges of Malawian nurse-midwives during their transition from education to practice. The aim of the study was to explore the transition experiences of newly qualified nurse-midwives working in selected midwifery units in Northern Malawi. Methodology: A qualitative descriptive approach was used. Data were collected through in-depth interviews using semi-structured interview guides from a purposive sample of 19 participants (13 newly qualified nurse-midwives and 6 key informants). The researchers developed two interview …

Determinants Of Reproductive Freedom Among Israeli Women Ages 18-50: A Mixed Methods Study, Abby Kra-Friedman

Electronic Theses and Dissertations

Introduction: Reproductive freedom is a social determinant of health (SDOH) that reduces health disparities and increases health equity. Through the National Health Insurance Plan, Israeli women can access a range of contraceptive methods. Scant data on Israeli women limits development of policies and interventions to meet international benchmarks for reproductive freedom. The purpose of this dissertation study is to synthesize current international multidisciplinary literature using the capability approach for reproductive freedom, explore determinants of reproductive freedom among Israeli women ages 18-50 using Nussbaum's capability approach, and make recommendations for nursing research, practice, and theory.

Methodology: Using Whittemore 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 …

Quantification Of Obstetric Hemorrhage, Alma Garcia

Student Scholarly Projects

Practice Problem: The practice problem identified involved the inconsistent measurement of blood loss during the postpartum period due to the standard practice of estimating blood loss. Estimates are subjective measures that can have variable results based on interpretation and thus provide minimal meaningful data.

PICOT: The question that guided this project was structured in the following PICOT format. In postpartum women (P), how does the implementation of quantitative blood loss measurements (I), compared to estimated blood loss measurement (C), affect the early identification of severe hemorrhage (O), during the recovery period (T)?

Evidence: Obstetric hemorrhage is a preventable event that …

Saliva Cortisol Diurnal Variation And Stress Responses In Term And Preterm Infants, David Q. Stoye, James P. Boardman, Clive Osmond, Gemma Sullivan, Gillian Lamb, Gill S. Black, Natalie Z. M. Homer, Nina Nelson, Elvar Theodorsson, Evalotte Mörelius, Rebecca M. Reynolds

Research outputs 2022 to 2026

Objective:

To determine if preterm birth is associated with adaptation of the hypothalamic–pituitary–adrenal (HPA) axis and whether HPA axis programming relates to the degree of prematurity (defined as extremely preterm birth at < 28 weeks or very preterm birth at 28–32 weeks gestation).

Design:

This study reports findings from a prospective birth cohort. Saliva cortisol concentrations were measured prevaccination and postvaccination, and in the morning and evening, at 4 months chronological age.

Setting:

Infants born at a single Scottish hospital.

Participants:

45 term-born, 42 very preterm and 16 extremely preterm infants.

Outcomes:

Cortisol stress response to vaccination (postvaccination minus prevaccination cortisol concentrations), diurnal slope (log-transformed morning minus log-transformed evening cortisol values) …

Care Ethics Framework For Midwifery Practice: A Scoping Review, Kate Buchanan, Elizabeth Newnham, Deborah Ireson, Clare Davison, Sadie Geraghty

Research outputs 2022 to 2026

Background:

As a normative theory, care ethics has become widely theorized and accepted. However, there remains a lack of clarity in relation to its use in practice, and a care ethics framework for practice. Maternity care is fraught with ethical issues and care ethics may provide an avenue to enhance ethical sensitivity.

Aim:

The purpose of this scoping review is to determine how care ethics is used amongst health professions, and to collate the information in data charts to create a care ethics framework and definition for midwifery practice.

Method:

The scoping review was conducted according to the Preferred Reporting …

Factors Influencing Utilisation Of Services Provided By Community Midwives And Their Non-Retention In District Thatta, Pakistan: A Qualitative Study Protocol, Bakhtawar M Hanif Khowaja, Anam Shahil Feroz, Sarah Saleem

Department of Obstetrics & Gynaecology

Introduction: Drawing on the well-acknowledged evidence of community midwives services to address the issue of high maternal mortality, the Government of Pakistan initiated the Community Midwifery (CMW) programme in 2006 to provide skilled birth attendance to pregnant women living in rural areas. Despite a large investment in CMW programme, the availability of community midwives in rural areas following their training is a constant struggle. The concerns related to the training, support and acceptability of community midwives need to be studied in order to identify gaps in the provision of skilled maternal and newborn healthcare. Therefore, this study aims to explore …

Implicit Bias Training For Perinatal Nursing, Racheal Lakine-Harden

Dissertations

Problem: Maternal and fetal morbidity and mortality is a rising health care crisis in the United States. Black women are disproportionately affected. Clinician implicit bias and medical racism have been named as factors in this crisis. Recommendations to address this public health peril include; educating and raising awareness among front-line perinatal nursing staff on implicit bias and its consequences for Black women. The purpose of this project is to evaluate the impact of implicit bias training on nurses’ awareness of implicit bias, attitudes, and beliefs about disparities, and the likelihood to engage in behaviors to reduce or address racial bias …

Implementation Of Quantitative Blood Loss Tool To Detect Postpartum Hemorrhage After Vaginal Delivery, Rachael Williams

Dissertations

Problem Maternal deaths and comorbidities related to postpartum hemorrhage (PPH) continue to be high despite being quite preventable. The delay in recognition and treatment of PPH due to the use of imprecise estimated blood loss (EBL) instead of precise measurement using quantitative blood loss (QBL) attributes to this issue.

Methods For this quality improvement (QI) project, a descriptive, observational design was used to gather quantitative data regarding QBL implementation instead of EBL as well as the number of PPH’s identified. A pilot cohort of staff nurses participated by documenting QBL two hours after each delivery. The nurses were given an …

The Effects Of Early Lactation Support On Breastfeeding Exclusivity Rates, Alexa Fleming

Dissertations

Abstract

Problem Breastfeeding exclusively for the first 6 months of a child’s life is the recommendation across medical professionals. Unfortunately, exclusive breastfeeding rates are on the decline due to insufficient support, lack of self-efficacy and inadequate hospital interventions.

Methods For this quality improvement (QI) project, a descriptive observational study design was used to identify appropriate participants who were planning to have a full-term, healthy, exclusively breastfed newborn. Within one hour after delivery, a lactation specialist provided the mother with breastfeeding education and assistance with the initial latching process. At the time of discharge, data was collected to examine if the …

Prenatal Education For Black Mothers And Their Support Persons As An Intervention For Improving Initiation Of Breastfeeding, Sandra King

Doctor of Nursing Practice Projects

Background: The benefits of breastfeeding are commonly known; however, the rates of exclusive breastfeeding among the Black community are less than those of other ethnic groups. Providing breastmilk or formula to an infant is an individual decision. Influential factors such as cultural background, employment status, socioeconomic status, level of education, and availability of support from family members and health care providers correlate with the method a mother chooses to feed her infant. Increasing breastfeeding initiation immediately after birth is a necessary precedent for uptake in the exclusivity of breastfeeding.

Purpose: This Doctor of Nursing Practice project aims to improve prenatal …

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 …

Midwives’ Associations’ Dual Role In Supporting Members And Driving The Profession Forward: A Qualitative Interview Study From Bangladesh, Mosammat Ratna Mon, Most Nargis Parvin, Joy Kemp, Sharmin Shobnum Joya, Christina Pedersen, Ulrika Byrskog, Kerstin Erlandsson

Journal of Asian Midwives (JAM)

Background: Professional midwives are being introduced as a long-term solution to improve maternal and newborn health in Bangladesh and to contribute to Universal Health Coverage. Professional midwives’ associations are a core element of a strong midwifery profession according to the International Confederation of Midwives (ICM). The Bangladesh Midwifery Society (BMS) was formed in 2010 to advocate for the introduction of professional midwifery in Bangladesh. Since 2017 BMS has benefitted from an international twinning partnership with the Royal College of Midwives (RCM) UK and has undergone significant organizational development.

Objective: The study aimed to describe the experiences, knowledge and attitudes of …

Midwife-Led Community Transformation (Milcot) Nursing Now Challenge In Uganda, Harriet Nayika, Cliff Aliga, Lisa Bayliss-Pratt, Robert Kagwire, Grace Edwards

School of Nursing & Midwifery, East Africa

Summary

This paper describes the journey of a young African midwife utilising the Nursing Now Nightingale Challenge framework to undertake a gap analysis and a mapping exercise to provide high-quality continuous professional development education for midwives working in isolation in a deprived suburb in Uganda. The project was completed in three stages:

• Stage one mapped out the services available within Nansana, Uganda
• Stage two identified the gaps in education for midwives and nurses within the area
• Stage three developed and offered educational study days for nurses, midwives and adolescents based on the gap analysis.

Jam – Summer 2022: One Crisis After Another…., Rafat Jan, Edwin Van Teijlingen, Kiran Mubeen

Journal of Asian Midwives (JAM)

No abstract provided.

Swot Analysis Of Community Midwifery Program In Pakistan, Bakhtawar Muhammad Hanif Khowaja, Anam Feroz, Farina Abrejo, Sarah Saleem

Journal of Asian Midwives (JAM)

The community midwifery program was launched in 2006 by the Government of Pakistan as a major initiative to provide skill birth attendance to women living in rural areas of Pakistan. The main purpose of the program is to extend maternal and newborn services to the communities, through the selection and training of community midwives (CMWs) from rural areas, and to deliver services to their local communities. However, there is a substantial difference between the number of CMWs trained and those working at their birthing stations. Therefore, this paper uses a SWOT (Strengths, Weaknesses, Opportunities, Threats) analysis to evaluate the different …

The Psychological Toll Of Covid-19 Pandemic On Private Practice Midwives In Indonesia And Its Relation With Perceived Knowledge And Individual Adaptability, Amelia Citra Kirana, Gracia Ivonika, Dewa Ayu Mirah Ardrini, Maria Stephani Dwitya, Ratih Ibrahim, Ray Wagiu Basrowi

Journal of Asian Midwives (JAM)

COVID-19 had serious impacts on the lives and health of people across the globe. Due to the high-risk nature of their work midwives frequently report personal/professional adverse psychological impacts. However, there is a lack of studies examining the psychological impacts of the COVID-19 pandemic on private practice midwives in Indonesia and beyond. This study examines the psychological impacts of the pandemic on private practice midwives in Indonesia, as well as its association with individual adaptability and perceived knowledge about COVID-19. A total of 423 private practice midwives, who were active practitioners during the pandemic, completed an online survey, comprising five …

Hidden Relationships: Perspectives On Leadership And Management In Afghan Maternity Services - An Ethnographic Exploration, Rachel Arnold, Edwin Van Teijlingen, Kath Ryan, Immy Holloway

Journal of Asian Midwives (JAM)

Introduction: Health system leaders have a vital role to play in ensuring the delivery of high-quality care. Improving the quality of healthcare, particularly in low-income countries often focuses on the performance of healthcare providers and the availability, acceptability, and uptake of services. The role that health service leaders play in facilitating effective care has received less attention in the literature. This study explored the perspectives of Afghan maternity care providers, managers and other stakeholders on leadership and the provision of quality maternity care.
Methods: This ethnographic study used semi-structured interviews, participant observation, and background interviews for data collection. …

Knowledge, Attitudes, And Preparedness For Managing Pregnant And Postpartum Women With Covid-19 Among Nurse-Midwives In Kenya, Rose Maina, Rachel Kimani, James Orwa, Bernard Mutwiri, Carolyne K. Nyariki, Sheila Shaibu, Valerie Fleming

School of Nursing & Midwifery, East Africa

Introduction: Globally, maternal morbidity and mortality have increased during the COVID-19 pandemic. Given the high burden of maternal and neonatal mortality in Kenya prior to COVID-19, front line health workers, including nurse-midwives, must be competent to ensure continued quality maternal services. Knowledge and awareness of COVID-19 transmission influence nurse-midwives risk perception and ability to implement prevention strategies.

Objective: We examined nurse-midwives’ knowledge, attitudes, and preparedness in managing pregnant and postpartum women with COVID-19 in Kenya.

Methods: A cross-sectional online survey was conducted among 118 nurse-midwives between July 2020 and November 2020. A 31-item survey comprising 15 knowledge, …

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 …

Every Milliliter Matters: Quantitative Blood Loss In Postpartum, Iana Vatsenko

Master's Projects and Capstones

Postpartum hemorrhage remains a leading cause of maternal mortality in the United States. Postpartum hemorrhage occurs when mothers are bleeding excessively, have uterine atony, or the placenta has failed to come out completely. Research has shown that quantitative methods of blood loss estimation revealed a higher incidence of PPH than visual estimation. That is why using quantitative methods on time is essential for diagnosing PPH. Quantification of blood loss should be replaced by estimated blood loss since it is more accurate. The project's main focus was implementing quantification of blood loss and using the Triton Scale, a smart system to …

Utilizing Training And Educational Materials To Increase Hand Hygiene Compliance Of Healthcare Providers Participating In Cesarean Sections, Christopher Natividad

Master's Projects and Capstones

Surgical site infections (SSIs) are one of the most common complications of Cesarean section (C-section) procedures. The incidence of SSIs after C-section procedures at Hospital X has increased in each of the past three years. The Labor and Delivery (L&D) unit at Hospital X performs approximately 4,500 C-sections each year. Observation of these procedures illustrated a lack of adhesion to hand hygiene policies and protocols. This quality improvement project involved informing staff members of the poor hand hygiene compliance rates, and re-educating them regarding proper hand hygiene behavior using flyers, emails, and addressing them at shift change. Data collection focused …

Counting Every Drop: Preventing Maternal Mortality With Quantifying Blood Loss Through Triton Scale, Summer Le

Master's Projects and Capstones

Postpartum (PP) hemorrhage is one of the leading causes of maternal mortality (AWHONN, 2021). In each of the past three years, the percentage of PP hemorrhage has increased at Hospital X. The PP unit at Hospital X performs around 4,500 total deliveries each year. While the standard of care for PP blood loss is to specifically measure blood in milliliters as Quantifying Blood Loss (QBL) for Labor and Delivery (L&D), it is not yet the standard of care in the 24 hours postpartum after delivery (ACOG, 2019). This quality improvement project involved educating nurses about measuring blood loss – specifically …

Save Lives And Sanitize: Prevention Of Surgical Site Infections Post-Cesarean Section Through Increased Hand Hygiene Compliance, Lindsay N. Nance

Master's Projects and Capstones

Problem: Surgical site infections (SSIs) occur in 3-15% of cesarean sections, making SSIs one of the most common hospital-acquired infections (HAIs). Surgical site infections (SSIs) have increased within a Labor & Delivery (L&D) unit in a large California teaching hospital for the past three years, affecting reimbursement and creating a range of adverse outcomes for patients. Performance of consistent and thorough hand hygiene practices is key to preventing infection, yet the unit’s hand hygiene compliance of 66.7% is well below the facility’s target goal of 90%. Based on recommendations from the organization’s Infection Prevention & Control (IPC) specialist, the …

Midwifery Care's Potential To Improve Birth Outcomes And Experiences For Black Women And Infants, Neville Wintergerst-Burch

Undergraduate Theses

Black women and infants experience higher morbidity and mortality rates compared to white women and infants in the United States. Forces of systemic racism and poverty often lead to inadequate access to prenatal care for Black women, and care received is often compromised by implicit bias or barriers related to insurance coverage, impersonal provider-patient relationships, and poor healthcare literacy. Despite the rich history of Black Granny midwives in the United States, most Black women began using physicians for obstetric care in the 20th and 21st centuries. This integrative review explores how improving access to midwifery care for Black women could …

Healthcare Providers' Experiences With A Clinical Mentorship Intervention To Improve Reproductive, Maternal And Newborn Care In Mwanza, Tanzania, Kahabi Isangula, Columba Mbekenga, Tumbwene Mwansisya, Loveluck Mwasha, Lucy Kisaka, Edna Selestine, David Siso, Thomas Rutachunzibwa, Secilia Mrema, Eunice Pallangyo

School of Nursing & Midwifery, East Africa

Introduction: There is increasing evidence suggesting that clinical mentorship (CM) involving on-the-job training is one of the critical resources—friendly entry points for strengthening the knowledge and skills of healthcare providers (HCPs), which in turn facilitate the delivery of effective reproductive, maternal, and newborn health (RMNH) care. The article explores the experiences of HCPs following participation in the CM program for RMNH in eight districts of Mwanza Region in Tanzania.

Materials and Methods: A qualitative descriptive design employing data from midterm project review meetings and Key Informant Interviews (KIIs) with purposefully selected HCPs (mentors and mentees) and District Medical Officers (DMOs) …

Perinatal Care In Western Uganda: Prevalence And Factors Associated With Appropriate Care Among Women Attending Three District Hospitals, Mercy Muwema, Dan K. Kaye, Grace Edwards, Gorrette Nalwadda, Joanita Nangendo, Jaffer Okiring, Wilson Mwanja, Elizabeth N. Ekong, Joan N. Kalyango, Joaniter I. Nankabirwa

School of Nursing & Midwifery, East Africa

Background: Perinatal mortality remains high globally and remains an important indicator of the quality of a health care system. To reduce this mortality, it is important to provide the recommended care during the perinatal period. We assessed the prevalence and factors associated with appropriate perinatal care (antenatal, intrapartum, and postpartum) in Bunyoro region, Uganda. Results from this study provide valuable information on the perinatal care services and highlight areas of improvement for better perinatal outcomes.

Methods: A cross sectional survey was conducted among postpartum mothers attending care at three district hospitals in Bunyoro. Following consent, a questionnaire was …

A Cohort Comparison Study On Women In Threatened Preterm Labor Given Nifedipine Or Nifedipine And Salbutamol Tocolysis In Air Medical Retrieval, Breeanna Spring Walsh, Fergus W. Gardiner, Dianne Bloxsome, David Ford, Brennen W. Mills, Simon M. Laws

Research outputs 2022 to 2026

Objective: Women with threatened preterm labor in remote Australia often require tocolysis in the prevention of in-flight birth during air medical retrieval. However, debate exists over the tocolytic choice. Methods: A retrospective analysis was undertaken on data containing women who required air medical retrieval for threatened preterm labor within Western Australia between the years 2013 and 2018. Results: A total number of 236 air medical retrievals were deemed suitable for inclusion; 141 received nifedipine, and 95 women received salbutamol + nifedipine. Tocolytic efficaciousness was reported in 151 cases, proportionally more (P < .05) from the women who received salbutamol + nifedipine (n = 68, 71.6%) compared with the women who received nifedipine only (n = 83, 58.9%). Those receiving salbutamol + nifedipine were more likely to suffer maternal tachycardia (n = 87 [91.6%] vs. n = 62 [44.0%]), fetal tachycardia (n = 26 [27.4%] vs. n = 13 [9.2%]), nausea (n = 17 [17.9] vs. n = 5 [3.55%]), and vomiting (n = 12 [12.6%] vs. n = 2 [1.4%]). Three women who received salbutamol + nifedipine had serious side effects including echocardiographic changes, chest pain, and metabolic and lactic acidosis. Conclusion: Salbutamol + nifedipine tocolysis was proven to be more effective than nifedipine only. Although salbutamol + nifedipine had increased temporary side effects, most were nonsevere and managed in-flight.

Associations Between State Regulations And Midwifery Workforce Access, Acacia Herndon

Undergraduate Research Symposium Podium Presentations

Background: U.S is worst in maternal care; Credible support for CNMs as a solution; Independent licensing has been ineffective; Other factors may influence access