Implementing a clinical checklist for pregnant patients with opioid use disorder.

BACKGROUND: Opioid use disorder (OUD) has been increasing in pregnant patients over the past two decades. Best practice guidelines that are available for these patients, must now be implemented by health care teams. Clinical checklists have been used for other complex patient cohorts with good success and are a potentially viable tool for ensuring best practices with this patient population as well. LOCAL PROBLEM: Maine has seen a dramatic increase in the number of pregnant patients with OUD. Many of these patients seemed to "fall through the cracks" in the traditional prenatal care model. The obstetrical care team expressed feeling overwhelmed by the complex care needs of these patients and unsure of how to improve their care. METHODS: To improve prenatal care delivery for patients with OUD, we implemented an evidence-based clinical checklist. This local, NP-led quality improvement project was done in partnership with a state-led initiative to improve perinatal care for patients with OUD. INTERVENTIONS: An evidence-based checklist provided by the state initiative was implemented for prenatal patients with diagnosed OUD. RESULTS: Use of a clinical checklist for patients with OUD increased the rate of several best practices during their prenatal care, including emergency naloxone prescription, tracking prescription monitoring reports, and contraceptive planning. Rates of completed prenatal screening for substance misuse, social determinants of health, and intimate partner violence also increased in our practice overall, as a result of this project. CONCLUSIONS: To further improve perinatal care coordination for patients with OUD, we recommend future evaluation of clinical checklists within various practice settings.

Qualitative Analysis of Men's Involvement in Family Planning in The Philippines: An Ecological Assessment.

While family planning (FP) programs have the capacity to empower women, support gender equality, and reduce poverty, male involvement is an influential factor for the uptake of FP that has been lacking. In the past decade, there have been more progressive FP policies and growing attention on male involvement in FP in the Philippines, providing an opportunity to develop evidence-based interventions to better integrate men into FP services by approaching care delivery from a family-focused perspective. This paper sought to understand the current role of men in FP services and explore how to strengthen facilitators and overcome barriers to optimize men's involvement in FP in the Philippines. Using the Ecological Model for Health Promotion, this qualitative study used convenience sampling to collect data through in-depth interviews and focus group discussions at all levels of the ecosystem. All data were collected in the Albay area, with the exception of some policy data collected in Manila. Qualitative analysis was guided by content analysis. The final sample included 66 participants across the ecosystem. Two primary themes emerged: (1) Resources and health care systems structure impact on male involvement in FP and (2) Education and training that support male involvement in FP. The findings of our qualitative study suggest that while men in the Philippines and their ecosystems support men's FP involvement, the inconsistent health care systems and protocols are not yet reaching men with information and education they need to help them make informed FP decisions with their female partners.

Incorporating a Patient Education Video With Provider Consultation to Improve Patient Satisfaction and Reduce Consultation Time Among New Patients Seeking Cosmetic Injections.

The field of aesthetics is expanding more rapidly than ever before, bringing with it an influx of new-to-aesthetics patients who lack industry knowledge. We investigated ways to bridge this gap in knowledge and provide patients with important procedural information and also increase their satisfaction and confidence. We implemented this project to improve the delivery of preprocedural patient education via the implementation of an educational video. We collected data over a 16-week period and analyzed the results of the pre- and post-video implementation. We found that implementing the educational video decreased the average time the provider spent consulting with new patients considering injectable neuromodulators or dermal fillers. We also found that using the video increased the patient's preprocedural confidence and postprocedural satisfaction. Based on the results of our quality improvement project, we concluded that implementing a patient education video before performing cosmetic injectable procedures improved patient confidence and satisfaction and decreased provider consultation times.

Psychobiological, clinical, and sociocultural factors that influence Black women seeking treatment for infertility: a mixed-methods study.

Objective: To provide a comprehensive and multidimensional description and conceptualization of the experiences of Black women seeking treatment for infertility. Design: Convergent parallel mixed-methods study combining retrospective chart review data and semistructured interview data. Setting: Private infertility clinic. Patients: African American/Black women between 18 and 44 years of age who presented for an initial infertility evaluation with a male partner between January 2015 and September 2019 at an infertility clinic in the metropolitan Washington D.C. area. Interventions: None. Main Outcomes: Treatment seeking. Measures: Psychobiological, clinical, and sociocultural factors. Results: Along with the psychobiological, clinical, and sociocultural domains, we understood that Black women who sought treatment for infertility were older and overweight, had complex gynecological diagnoses, and experienced infertility for long periods of time. The delay in seeking treatment was possibly because of a low perceived risk of infertility, poor understanding of treatment options, inadequate referral patterns of primary care providers, and limited social support. Further, Black women experienced delays in seeking treatment because they attempted lifestyle-based self-interventions before considering medical interventions. Facilitators to care included psychological distress, complex gynecological medical history, and finding culturally competent providers. Conclusions: The study findings show that Black women in the United States are vulnerable to disparities in healthcare delivery, especially within reproductive endocrinology. Our findings highlight areas where Black women are experiencing missed opportunities for teaching, early identification, and early referrals for infertility-related concerns. Future studies should seek to reduce barriers to infertility treatment at the clinical and policy levels.

Men's Involvement in Sexual and Reproductive Health Care and Decision Making in the Philippines: A Systematic Review of the Literature.

Sexual and reproductive health care (SRH) and family planning (FP) services have been primarily female centered. In recent decades, international groups have advocated for men's involvement in SRH and FP, yet related research remains limited and implementation not fully realized in many countries. This systematic review of literature seeks to summarize the barriers and facilitators to men's involvement in SRH/FP services in the Philippines. It is limited to publications in English from 1994 to 2021 regarding studies conducted in the Philippines whose research questions focused on men's involvement in SRH/FP. Eligible studies were assessed for methodological quality using the Johns Hopkins Nursing Evidence-Based Practice (JHNEBP) Evidence Rating Scale. The Ecological Model for Health Promotion was used as the guiding theoretical framework for analysis and to report findings. Barriers and facilitators were identified at every ecological level except that of policy. The most common barrier identified was men's deficit in knowledge about SRH/FP; the most common facilitator was the positive influence of their social network on men's attitudes, beliefs, and practices pertaining to SRH/FP. A range of factors from the individual to the community level influenced men's involvement, including religious beliefs, economic means, and cultural gender roles. More studies are needed to provide a fuller understanding of the multilevel ecological factors influencing men's involvement in SRH/FP and inform interventions with men that can positively affect their behavior related to SRH/FP decision making.

Men's perception and understanding of male-factor infertility in the UK.

Male-factor infertility is a common but stigmatised issue, and men often do not receive the emotional support and the information they need. This study sought to understand awareness of male fertility issues compared to female fertility among the UK general male public, and also what were perceived as being the optimum methods for providing support for affected men, emotionally and through information. Men feel that male infertility is not discussed by the public as much as female infertility. Lifestyle issues that affect male fertility are not well understood, and men affected by infertility desire more support, including online, from health professionals and through peer support. Health professionals, including those in public health, could offer evidence-based programmes to reduce stigma and increase public knowledge about infertility, as well as offer emotional support to men with infertility problems.

Knowledge and decision making about future fertility and oocyte cryopreservation among young women.

The objective was to examine what young graduate student women know about preserving fertility/oocyte cryopreservation, and which reproductive resources they use. A prospective, cross-sectional design was used and the study was conducted at a University on the East Coast of the United States. The participants were 278 female graduate students. Participants completed a survey with questions about demographics, fertility knowledge, oocyte cryopreservation, and sources of fertility information. Descriptive statistics were calculated for all variables. Participants had average knowledge about fertility (64% items correct). The most used fertility information source was formal education (87.1%), information to help make fertility decisions was gynaecologists (85.3%), and oocyte cryopreservation was media (63.4%). Only 26.6% reported being well informed about fertility. Although 93.9% had heard of oocyte cryopreservation, only 7.2% had considered its use. Most (74.9%) ranked fertility as important, though 83% would consider postponing family until career (85.2%) and relationship (85.2%) were established. Half felt that there was a social stigma surrounding oocyte cryopreservation, and 70.1% believed that the media gives the impression that motherhood is viable after 40 years old. Professionally motivated women receive the most information about fertility from formal, accuracy-driven sources (i.e. education, healthcare providers), but information about fertility preservation from media. They lack knowledge about fertility planning.

Stress and Anxiety in Couples Who Conceive via In Vitro Fertilization Compared With Those Who Conceive Spontaneously.

OBJECTIVE: To determine the feasibility of recruitment and explore whether women and their partners who conceive via in vitro fertilization (IVF) experience greater levels of stress and anxiety during pregnancy compared to each other and compared to couples who conceive spontaneously. DESIGN: Longitudinal, descriptive, pilot study. SETTING: Recruitment was conducted at three sites in the United States (two fertility clinics and one well-woman clinic). PARTICIPANTS: Informed consent was obtained from 48 women and their partners (22 IVF couples and 26 spontaneous conception [SC] couples). METHODS: During each trimester, participants completed the Perceived Stress Scale, the State-Trait Anxiety Inventory, and the Pregnancy-Related Anxiety Measure to assess their levels of stress and anxiety. We used hierarchical linear mixed-effects models for repeated measures adjusting for woman and partner nesting effects to conduct trajectory analyses to test for group differences in stress and anxiety levels. RESULTS: Recruitment goals were met (31 IVF and 27 SC couples gave informed consent and 22 IVF and 26 SC couples completed questionnaires). We found no significant group main or group by time interaction effects on anxiety and stress. However, pregnant women had significantly higher mean state and pregnancy-related anxiety scores than their male partners. Of interest, the women showed a gradual reduction in state and pregnancy-related anxiety across trimesters, whereas pregnancy-related anxiety of their partners gradually increased. CONCLUSION: Among our participants, IVF did not increase risk for stress, state anxiety, or pregnancy-related anxiety, which provides reassurance during patient counseling. Although pregnant women overall experienced greater state and pregnancy-related anxiety than men, we found that levels in women decreased closer to birth, which may contribute to successful emotional transition to parenthood. Men's experiences with anxiety require additional investigation given the recent attention to male postpartum depression.

Applying the Adaptive Leadership Framework for Chronic Illness to understand how American and British men navigate the infertility process.

In this article, we sought to understand the adaptive challenges and work faced by men with male factor infertility. Using a prospective qualitative study in private (the United States) and academic (the United Kingdom) urology clinics, we recruited seven American and five British men with primary infertility after their urology consultation for male factor infertility between December 2015 and April 2017. Individual in-depth qualitative interviews were conducted shortly after male factor infertility urology consultation and then two additional interviews at about 3 and 6 months. We found three themes related to adaptive challenges faced during fertility treatment: avoidance (not disclosing, avoided social network), uncertainty (about ability to have a child, fertility-related information, and male factor infertility status), and affective symptoms (sadness, shock, disbelief, denial, about not achieving fatherhood, and poor outcomes). Four themes about adaptive work included focusing on goal (having clear, actionable steps; knowledge received from urologist; exhausted all options; focus on parenthood), support from partner (relationship and communication), support from health care team (provision of emotional support, increased comfort with staff over time, disclosure of knowing others with same condition), and acquired information (understanding issue, support from urologist, seeking information). We concluded that men with male factor infertility face adaptive challenges including avoidance, uncertainty, and affective symptoms. To manage during the treatment process, they use adaptive work including focusing on the goal, receiving support from their partner and health care team, and acquiring information. Although qualitative results cannot be generalized to larger populations, they might be applicable to men with male factor infertility during infertility treatment.

Unexpected Influences-A Maternity Nursing Career and the Next Generation.

A nurse reflects on what her daughters have picked up from her career in maternity nursing, education, and research.

Are There Differences in Marital-Role Quality between Women and Their Male Partners Who Conceived Via IVF and Those Who Did Not?

OBJECTIVES: Marital-role quality (MRQ) is a predictor of mental well-being, sexual intimacy, and maternal attachment. Data on differences in MRQ during pregnancy between women and their male partners who conceived spontaneously or via IVF are inconclusive. This study compared MRQ across pregnancy in these two groups. METHODS: The sample's two groups: (a) 26 women and 26 male partners who conceived via IVF; and (b) 25 women and 20 male partners who conceived spontaneously. All 97 participants completed a MRQ scale during each trimester of pregnancy. Trajectory analyses were conducted to test for between-group differences in the changes in subscales across pregnancy within dyads. RESULTS: Scores did not reveal any significant differences in subscales in those who conceived via IVF compared to non-IVF groups across the three trimesters in each dyad. The observed effect sizes were small, with exception that males in the non-IVF comparison group had greater concerns during the first trimester than did males in the IVF group (Cohen d= 0.51, moderate effect size). CONCLUSIONS: Though the IVF population perceives pregnancy differently and experiences more anxiety than those who conceive spontaneously, their marital-role quality during pregnancy does not seem to be affected. Their perceptions before conception and in early parenting are worthy of investigation.

Long-acting reversible contraception: Assessment of knowledge and interest among college females.

Objective: To implement the Long-Acting Reversible Contraception Quality Improvement (LARC QI) project using evidence-based contraceptive counseling techniques to improve knowledge and intent to use among college females. Participants: The project, conducted from April through September 2017, involved 41 female students, from a 4-year public college in North Carolina. Methods: Students participated in group educational sessions on all methods of birth control with an emphasis on LARC. Surveys were administered to group participants and descriptive statistics were used to determine the difference in knowledge scores and intent to use. Descriptive and qualitative analysis described usage of LARC methods. Results: LARC knowledge scores significantly improved. Intention to use also increased compared to reported actual use. The final chart review demonstrated an increase usage of the subdermal implant, but no change for intrauterine device. Conclusions: The college setting offers a unique opportunity to use evidence-based contraceptive counseling techniques to guide use of LARC.

Oocyte Cryopreservation for Fertility Preservation in Healthy Women.

Advancements in methods of fertility preservation have resulted in more options available to women seeking to postpone reproduction. Preservation of unfertilized oocytes provides women with the possibility for reproduction even after age-related declines in fertility might make conceiving a child difficult to impossible. As oocyte cryopreservation rises in popularity among women, it is crucial for nurses and other clinicians to understand the background, process, ethical issues, and risks involved to help women make informed medical decisions.

Multidimensional Psychological Stress During Pregnancies in Women Who Conceived via In Vitro Fertilization.

PURPOSE: To explore relationships among the 3 psychological dimensions of stress, stimulus/environmental, perceptual, and emotional response, and then to develop a multidimensional composite measure of overall stress, and to determine demographic and clinical characteristics associated with stress in women who became pregnant via in vitro fertilization (IVF). METHODS: Cross-sectional design using self-report questionnaires during the second trimester. Multidimensional stress was assessed with the Prenatal Life Events Scale, Life Event Distress Scale, Perceived Stress Scale, State-Trait Anxiety Index-State, and the Pregnancy-Related Anxiety Measure. RESULTS: Participants (n = 144), aged 25-40 years, were enrolled June 2010-August 2011 from a private fertility clinic. Exploratory principal factor analysis was used to develop an overall stress score from the stress measures. Multiple stepwise regression analyses were conducted to determine characteristics related to the stress measures. White race tended to be associated with lower stress scores (p = .079). White participants also had lower perceived stress (p = .007), and those with a history of miscarriage had higher pregnancy-related anxiety (p = .035). CONCLUSIONS: White women had lower perceived stress. History of one or more miscarriage was associated with higher pregnancy-related anxiety. Additional research examining multidimensional stress is needed across the pregnancy trimesters as well as comparisons to women who conceived without IVF both in United States and internationally.

Implementation of a Modified Bedside Handoff for a Postpartum Unit.

The most frequent cause of sentinel events is poor communication during the nurse-to-nurse handoff process. Standardized methods of handoff do not fit in every patient care setting. The aims of this quality improvement project were to successfully implement a modified bedside handoff model, with some report outside and some inside the patient's room, in a postpartum unit. A structured educational module and champion nurses were used. The new model was evaluated based on the change in compliance, patient satisfaction, and nursing satisfaction. Two months after implementation, there was an increase in nursing compliance in completing all aspects of the model as well as an increase in both patient and staff satisfactions of the process. Replicating this project may help other specialty units adhere to safety recommendations for handoff report.

Male subfertility as a chronic illness: the role of adaptive challenges.

Male factor infertility (MFI) is extremely common, often with several associated chronic health conditions. Because a man's fertility assessment may be their first contact with health services, the health care team has a responsibility to act as male health advocates to ensure comprehensive care. The diagnosis of subfertility allows a broader view of these men as patients with a chronic illness who have complex health needs. Because of the associated complexity of care following evaluation, there needs to be new approach in how men affected by MFI should be managed long term. In this commentary, we propose that the Adaptive Leadership Framework model for Chronic Illness is a suitable vehicle to use for management of the MFI patient's journey towards optimized health.

Evidence-Based Care for Couples With Infertility.

When couples cannot achieve pregnancy, they often seek health care from medical and nursing specialists. The care the couple receives begins with a thorough assessment to determine the possible cause of infertility and to plan appropriate care to ensure the best chance for the couple to have a biological child. In this article, we provide an overview of the etiology and evaluation of infertility, the various treatment options available, and the appropriate clinical implications.

Pregnancy-Related Anxiety in Women Who Conceive Via In Vitro Fertilization: A Mixed Methods Approach.

The process of in vitro fertilization (IVF) causes anxiety, but it is unclear whether this anxiety continues into pregnancy and affects childbirth preparation. This study administered the pregnancy-related anxiety measure to 144 women during their second trimester. Anxiety scores were slightly higher among IVF compared to non-IVF pregnant women. Thirty-one participants provided narrative data about their pregnancy-specific anxiety. Themes emerged from qualitative analysis related to anxiety about the health of their babies, perception of maternal health and safety, and perception of their abilities to fulfill the role of mother. Because of their relationship with patients during pregnancy, nurses and perinatal educators play a critical role in identification of women with pregnancy-specific anxieties and providing relevant care to address these anxieties.