Common dyadic coping and its congruence in couples facing breast cancer: The impact on couples' psychological distress.

OBJECTIVE: Psychological distress is prevalent in couples facing breast cancer. Couples often deal with breast cancer as a unit instead of as individuals. Couple's dyadic coping is important for their adjustment to breast cancer; however, little is known about how couple's coping congruence influences their distress. This study examined how common dyadic coping (CDC) and coping congruence impact psychological distress in couples facing breast cancer. METHODS: Baseline data were analyzed from 343 women with recently diagnosed early-stage breast cancer and their partners who participated in a randomized clinical trial. Psychological distress was indicated by depressed mood and state anxiety. Common dyadic coping was measured by a self-report scale. Coping congruence was assessed by the absolute difference between a woman's and her partner's CDC scores. RESULTS: Higher CDC scores were associated with lower psychological distress in both women and partners. In the CDC subscales, women who suffered less scored higher on open communication, sharing a positive outlook, and lower on avoidance coping. Partners who suffered less scored higher on open communication, sharing a positive outlook, spending time talking, and lower on avoidance coping. Greater congruence in CDC was associated with lower psychological distress in women and their partners. Congruence in sharing a positive outlook benefited both members of the dyad; congruence in avoidance coping significantly benefited patients; congruence in open communication significantly benefited partners. CONCLUSIONS: CDC and its congruence in specific areas have potential benefit to couple's psychological distress when facing breast cancer. Health care providers could consider enhancing couple's CDC and coping congruence to improve their adjustment.

Development of a common dyadic coping scale in couples facing breast cancer: the importance of open communication.

OBJECTIVE: Couples' joint coping is important in managing the impact of breast cancer. However, measures assessing couples' communication as a way of coping are insufficient. This study aimed to generate a self-report valid and reliable measure of couples' coping with a particular focus on communication. METHOD: We used baseline data of 343 couple dyads who participated in a randomized clinical trial targeting marital communication. Women were diagnosed with early-stage breast cancer in the past eight months; couples were married or in an intimate relationship for at least six months, could read and write English, and lived within 100 miles of the study center. An expert panel selected items with conceptual fit from the Mutuality and Interpersonal Sensitivity Scale (MIS) that was originally designed to evaluate marital communication about breast cancer. RESULTS: Exploratory and confirmatory factor analyses supported a 12-item measurement model with four factors: Keeping the communication open with each other about breast cancer (4 items), Sharing a positive outlook on breast cancer (2 items), Avoiding discussion of negative thoughts and feelings about breast cancer (3 items), and Spending sufficient time together talking about breast cancer (3 items). Reliability ranged from 0.76 to 0.87 for women and 0.70 to 0.83 for spouses. CONCLUSION: This new measure has potential application in clinical practice and future research to assess couple's joint coping efforts especially through communication.

Transformative justice to support truth and reconciliation within nurse-midwifery education.

Nursing education holds a history framed in white supremacy and whiteness. Efforts to employ antiracist strategies have been hindered, largely due to an inability for faculty to acknowledge and hold accountability for racialized harms that occur within nursing educational structures. A nurse-midwifery program in the Pacific Northwest United States uncovered harm that impacted students and identified a need to respond and hold accountability. Guided by the framework of Transformative Justice, a truth and reconciliation process was implemented as a first step to better address racism within nursing and nurse-midwifery education. This paper describes the process to support other institutions in their work to address harms within nursing education.

Losing Connection: Experiences of Virtual Pregnancy and Postpartum Care During the COVID-19 Pandemic.

INTRODUCTION: The rapid uptake of telehealth for perinatal care during the coronavirus disease-2019 (COVID-19) pandemic has led to mixed evidence as to its effectiveness, with limited research demonstrating satisfaction and appropriateness for communities at risk for poor birth outcomes. The purpose of this article is to describe the experiences of virtual care during pregnancy and postpartum among a diverse group of pregnant/birthing people in Washington State during the COVID-19 pandemic. METHODS: We conducted a thematic analysis study exploring experiences of care during the COVID-19 pandemic for 15 pregnant and birthing people in Washington State. This secondary analysis utilized data specific to experiences receiving care via telehealth. RESULTS: Three dominant themes were identified: loss of connection and relationships with providers; need for hands-on interactions for reassurance; and virtual care is good for some things but not all-desire for immediate, accessible care when appropriate. The majority of participants felt that it was subpar to in-person care due to a lack of connection and the inability to receive necessary tests and hands-on reassurance. DISCUSSION/CONCLUSIONS: Our study findings encourage very judicious use of virtual care for communities that are at high risk for birth disparities to avoid impacting relationship building between patient and provider.

Trans Youth Talk Back: A Foucauldian Discourse Analysis of Transgender Minors' Accounts of Healthcare Access.

Contemporary transgender youth in the U.S. today face increasing stigmatization as extraordinary legislative attacks intensify discrimination and exclusion of these young people in healthcare, recreation, and school life. These attacks reflect broader political, religious, and cultural ideologies embedded in systems of power that regulate the provision of healthcare for American transgender youth. We apply Foucauldian discourse analysis and a theory-driven conceptual framework for structural analysis of transgender health inequities-Intersectionality Research for Transgender Health Justice-to identify discourses youth encounter within healthcare practice. We analyzed data from interviews conducted in Western Washington State with youth ages 13-17 (n =11) and asked how transgender subjectivity was constructed in their accounts and in what ways youth made use of the discursive resources available to them when navigating systems of care. Three sets of discourses-discourses of normativity, discourses of temporality, and discourse of access-characterized participants' narratives. We discuss how participants negotiated discursively situated systems of power in order to ensure their safety and access to care.

Exploring Perinatal Nursing Care for Opioid Use Disorder: Knowledge, Stigma, and Compassion.

The opioid epidemic has greatly increased the number of pregnant women with opioid use and newborns exposed to opioids in utero. Mothers with opioid use disorder can face stigma by nurses in perinatal care settings, contributing to negative care experiences. A survey was distributed to nurses caring for mothers and newborns exposed to opioids in a large urban hospital in the Pacific Northwest United States (n = 89) from March to July 2019. Survey measures included participant characteristics, attitude toward substance use in pregnancy and postpartum (stigma, compassion satisfaction, comfort, and knowledge), and open-ended questions. Relationships among variables and questionnaire items were examined using Pearson's correlations, 2-sample t tests, and simultaneous multiple linear regression. Qualitative description was used to analyze open-ended questions. Nurses' stigma was negatively correlated with compassion satisfaction (r = -0.63), feeling knowledgeable (r = -0.36), and comfortable in providing care to this population (r = -0.44). Nurses identified defensiveness, lack of trust, and inadequate social support as key challenges in this patient population. Nurses suggested more support for mothers and nurses, increased nursing education, and clinical guidelines to improve clinical practice and foster therapeutic relationships. Findings highlight potential strategies to improve nursing care for chemically dependent mothers and their infants. These strategies may offer practical approaches to reduce stigma, develop therapeutic relationships, and improve patient outcomes.

The impact of COVID-19 visitor policy restrictions on birthing communities of colour.

AIMS: To explore the experiences of care for pregnant and birthing people, and the nurses who cared for them, during the COVID-19 pandemic, with special emphasis on the impact of visitor restrictions policies. DESIGN: Qualitative study using critical thematic analysis. METHODS: We conducted semi-structured interviews with 15 community members who were pregnant and/or gave birth and 14 nurses who worked in the perinatal setting between April and August 2020. Participants were recruited via purposive and snowball sampling, and interviews were conducted virtually via the Zoom platform. The research team used critical thematic analysis methods informed by other interpretive methodologies to arrive at resultant themes. RESULTS: Participants described experiences pertaining to how visitor restriction policies are not equitable and disproportionately impact Black, Indigenous, and People of Color (BIPOC) families, and the direct impacts of not having support people, and also provided recommendations for how to adapt current policies to be more equitable. CONCLUSIONS: Visitor restriction policies have had a disproportionately harmful effect on BIPOC patients and families, leading some patients to make decisions that increase their physical risks to alleviate their risk of labouring and birthing without desired support. IMPACT: While this pandemic is nearing the end, these results can guide structuring of policy not only for the next pandemic, but also for universal policy development. Mitigating the effects of racism in policies, by including diverse stakeholders in decision-making, should be an inherent part of hospital administration procedures.

A Qualitative Study of Parents' Experiences in the Pediatric Intensive Care Unit: Riding a Roller Coaster.

PURPOSE: Post-traumatic stress disorder rates in parents following PICU admission ranged between 12.2% and 42%. Despite the numbers affected and the magnitude of parents' distress, little is known about parents' experience in the PICU that could be a source of their stress. This study sought to describe parents' experience of the PICU during their child's stay, including their perceived stressors. DESIGN AND METHODS: Single occasion interviews with 15 parents of children with complex medical conditions admitted for 48 or more hours to a tertiary PICU in the USA. Interviews were inductively coded using methods adapted from Grounded Theory. RESULTS: Riding a Roller Coaster was the core construct that explained parents' experiences. Analyses revealed four domains: Being in a New Stressful World, My Brain Is Burning All the Time, Going through a Hurricane of Emotions, and Being in a Safe Place with Great People. CONCLUSION: Despite outstanding medical services, parents were traumatized by seeing their child in a life-threatening situation and were buffeted by a tidal wave of emotions. Parents lived in a constant state of uncertainty, helplessness and fear, not knowing if their child would survive or have devastating outcomes or permanent disabilities. PRACTICE IMPLICATIONS: Supporting parents during their emotional roller coaster ride requires targeted services throughout the child's illness trajectory, including ways to interpret what is happening in the PICU, helping parents self-regulate their stress, and offering services around parents' fears, concerns, and strategies to manage their uncertainty and feelings of helplessness.

Metaphors of Distress: Photo-Elicitation Enhances a Discourse Analysis of Parents' Accounts.

In research on sensitive topics, photo-elicitation can be a profound aid to data collection and interpretation processes. Photo-elicitation methods were used in this manner in a discourse analysis of parents' distress at least 6 months after preterm birth. After an initial interview, participants were asked to take digital photographs representing their distress and to return for a second interview to discuss the photographs. The elicited photo representations supported participants' engagement with their current or past distress and generated new meanings from the reappraisal of old photographs. Photo-elicitation demonstrated the embodiment of parents' distress in the child and the placement of distress in specific locations. Photographs of documents showed the power of the written word in generating and maintaining distress. Participants used existing photographs from their child's photo history to generate rich metaphors for their distress as parents. These findings have implications for enhancing interpretive health research by incorporating photo-elicitation methods.

Internet confessions of postpartum depression.

Women with postpartum depression may suffer in silence due to the stigma of depression and failed motherhood. It is important to consider how mothers are able to talk about postpartum depression and what strategies they use. Foucault's idea that confession is a widespread technique for producing truth in Western societies was tested through discourse analysis of posts on an Internet forum for women with postpartum depression. The Internet forum showed women's use of confessionary language and self-judgments as well as their sense of disconnected mothering, shame, and disembodiment. Discourses of depression included the good mother, biomedical illness, and social dysfunction. Findings have implications for creating safe spaces for helping mothers with postpartum depression.

Preliminary Evaluation of the Effectiveness of Perinatal Mindfulness-Based Well-Being and Parenting Programs for Low-Income New Mothers.

Objectives: This study examined specificity in the effects of three perinatal mindfulness-based prevention programs that differed in their timing (prenatal, postpartum) and target (maternal well-being, parenting). Effects on maternal mental health (depression, anxiety, resilience), mindfulness, and observed parenting, as well as observed, physiological, and mother-report indicators of infant self-regulation, were examined. Methods: The programs were evaluated in a racially and ethnically diverse sample of first-time mothers (n = 188) living in low-income contexts using intention-to-treat analysis. Mothers were assigned to a prenatal well-being, postpartum well-being, parenting, or book control group. Multi-method assessments that included questionnaire, observational, and physiological measures were conducted at four time points: during pregnancy (T1) and when infants were 2-4 months (T2), 4-6 months (T3), and 10-12 months. Results: Compared to the postpartum intervention and control groups, the 6-week prenatal well-being intervention was related to decreases in depressive symptoms during pregnancy but not postpartum, higher maternal baseline respiratory sinus arrhythmia (RSA), fewer intrusive control behaviors, and lower infant cortisol levels in the early postpartum period. Compared to all other groups, the postpartum parenting intervention was related to decreases in maternal anxiety and increases in responsive parenting. Some differential effects across programs might be due to differences in attendance rates in the prenatal (62%) vs. postpartum (35%) groups. Conclusions: The findings suggest that brief mindfulness-based well-being and parenting preventive interventions can promote maternal and infant mental health in families living in low-income, high-stress settings, particularly if accessibility can be enhanced. Preregistration: This study is not preregistered.

Midwifery in the Time of COVID-19: An Exploratory Study from the Perspectives of Community Midwives.

INTRODUCTION: An increasing number of people in the United States are choosing to give birth in a community setting. There is anecdotal evidence that interest in community birth further increased during the COVID-19 pandemic. The purpose of this study was to explore the needs, barriers, and successes of community midwifery during COVID-19 and how these experiences can inform future efforts to support and sustain community-based midwifery. METHODS: This qualitative study used semi-structured interviews conducted online with 11 community midwives from the greater Seattle area who were practicing during the COVID-19 pandemic. Interviews were transcribed verbatim from audio recordings. Transcripts were analyzed using deductive and inductive coding. RESULTS: Participants all reported challenges navigating COVID-19-related changes, such as implementing personal protective equipment, using telehealth, and limiting support people at births. Although participants saw an increased interest in their services, the increase in uncompensated labor contributed to burnout. Many participants described regularly encountering stigma and misperceptions about community midwifery when their patients transferred to hospitals, which occurred more often among clients who chose midwifery primarily because of COVID-19 concerns. Community midwives expressed a desire to increase interprofessional collaboration with hospitals to sustain the future of community midwifery. CONCLUSIONS: The experiences of community midwives practicing during the COVID-19 pandemic indicate strategies to reduce burnout and support community midwifery during the pandemic, natural disasters, and beyond. These strategies include improved interprofessional collaboration and higher reimbursement rates.

Health Care Experiences During Pregnancy and Parenting with an Opioid Use Disorder.

PURPOSE: The purpose of this study was to describe the experience of individuals with opioid use disorder (OUD) during the perinatal period. STUDY DESIGN AND METHODS: We convened focus groups of patients with OUD who had been pregnant and were parenting. Participants who were 18 and older, English-speaking, self-identified as pregnant or parenting, and actively using opioids or in recovery from OUD were recruited using snowball and convenience sampling in resident treatment facilities and outpatient settings. Data were recorded, transcribed, and analyzed for themes. RESULTS: Twenty-four participants were recruited, 10 of whom were actively receiving residential recovery services. Most participants had been pregnant from 4 weeks to 2 years prior to our focus group session; none reported being currently pregnant. Nineteen participants had custody of some, or all, of their children. They identified four key themes related to their care: (1) disrespectful care, (2) fear of accessing services, (3) inconsistencies in care received, and (4) limited health and social services. CLINICAL IMPLICATIONS: Participants reported overall negative interactions across different health care settings and lack of social resources to promote ongoing recovery and successful parenting. Nurses should be aware of the lasting impressions they have on their patients. Recognition of their own biases, person-first language, and partnership building skills with patients can help attenuate OUD stigma, promote positive nurse-patient relationships, and support new parents in recovery and infant bonding.

Instrument Development and Psychometric Validation Using Confirmatory Factor Analysis of the Breastfeeding Relationship Scale.

Background and Purpose: The Breastfeeding Relationship Scale (BFRS) was developed to measure mother-infant mutual responsiveness during breastfeeding. The purpose of this study was to develop and test the psychometric properties of the BFRS. Methods: Construct validity of a 16-item three-factor model (Mother-Infant Breastfeeding Interaction, Perceived Adequate Milk Supply, and Breastfeeding Synchronicity) was assessed using confirmatory factor analysis (CFA) and reliability (Cronbach's alpha) across two independent samples. Results: CFA of the hypothesized three-factor model demonstrated good fit in both samples (comparative fit index >.90, root mean square error of approximation <.06, square root mean residual < .061). Cronbach's alpha for the constructs ranged between .73 and .83. Conclusion: The BFRS is a valid measure of breastfeeding relations between mother and infant. Reliability was acceptable for all constructs in both samples.

Nurses' Priorities for Improving Pregnancy and Birth Care for Individuals with Opioid use Disorder.

INTRODUCTION: The motivation to seek treatment for opioid use disorder (OUD) can increase during the perinatal period. However, several identified barriers, such as poor access to services, lack of trained providers, stigma, and legal ramifications of OUD, limit the ability for individuals with OUD to receive safe and supportive care during pregnancy and birth. During the birth hospital stay in particular, nurses provide the majority of care for pregnant and birthing families. We aimed to engage nurses, with experience caring for pregnant and postpartum individuals with OUD, in priority setting as a way to identify areas of need in the current health care systems. METHODS: Using community-engaged priority setting methods, we recruited a sample of 47 nurses (phase 1) and 20 nurses (phase 2), including nurse-midwives and other advanced practice nurses, at a statewide nursing conference, who reported regularly providing care for pregnant and postpartum individuals with OUD. We invited participants to submit questions and concerns regarding the provision of care for individuals with OUD (phase 1). A selection of those who submitted questions attended a focus group to rank and prioritize submitted questions into a set of priorities for research, policy, and care improvement (phase 2). RESULTS: In phase 1, participants submitted a total of 165 questions and concerns. In phase 2, participants prioritized the following: funding to support improvements in OUD care in the perinatal period, increased access to services, supportive housing for individuals in recovery, standardization of care for individuals with OUD, and efforts to destigmatize care. DISCUSSION: Nurses who work with pregnant and postpartum individuals with OUD have a unique insight as to how health care providers, including midwives, can better support this community and should be engaged setting priorities for research, changes to policy, and improvement in care.

Community-led Priority Setting for Opioid Use Disorder in Pregnancy and Parenting.

OBJECTIVES: To engage community members with opioid use disorder (OUD) and case managers working with pregnant and parenting individuals with OUD in a priority setting process to identify the key priorities for research, policy, and care improvement during pregnancy, birth, and postpartum. METHODS: We conducted focus groups across Washington State with pregnant and parenting people with OUD and with case managers working with this community as part of research priority setting using the validated Research Prioritization by Affected Communities protocol. Priorities for research, policy, and service improvement were developed during each focus group by the participants. RESULTS: Three focus groups with pregnant and parenting people with OUD and 2 focus groups with case managers were conducted (total N = 24 and 16, respectively). Both prioritized topics such as stigma and bias, housing, access to treatment, and steps toward successful recovery. The community and case manager groups shared similar, complementary strategies for each priority, with differences reflecting their perspectives in relation to OUD. CONCLUSIONS: Community-engaged priority setting among those with OUD was an effective and meaningful way to guide future research, policy, and care improvement efforts.

Addressing Positionality Within Case-Based Learning to Mitigate Systemic Racism in Health Care.

BACKGROUND: Case-based learning has historically focused on the individual patient; however, there is often little consideration within this teaching method of how social determinants of health, such as structural racism and its adverse health effects, bear upon patients' health status and consequent patient outcomes. PROBLEM: Implementing case studies necessitates taking into account the positionality of patients, as well as health care providers, to counter the racial oppression and discrimination embedded in existing health care and educational systems. APPROACH: We describe a process for creating an inclusive, antiracist environment for case-based learning within nursing education, outlining steps for preparing students to more effectively examine case studies through social determinants of health framing and lens to mitigate harmful impacts from systemic racism and racial discrimination in clinical care. CONCLUSIONS: Addressing positionality in case-based learning is one antiracist strategy to begin rectifying health disparities and moving health care toward equity.

Where the System Failed: The COVID-19 Pandemic's Impact on Pregnancy and Birth Care.

The COVID-19 pandemic created a massive shift in health care systems, including within pregnancy and birth care. To explore how experiences of pregnancy and birth were impacted, 15 patient participants and 14 nurse participants were interviewed and transcripts analyzed using critical thematic analysis. Patients highlighted how adaptations to care were inadequate to meet their needs, a desire for support in response to stress, and the impact of COVID on patients' experiences. Nurses identified how inconsistencies in policies impacted nurses' ability to care for patients, the impact on nurses from hospital actions, and the impact on patients from hospital actions. Both groups discussed how system changes had disparate impacts on marginalized communities, leading to racially-biased care. This pandemic will continue to have lasting impact on pregnant and birthing families, and the nurses who care for them, and it is imperative that hospitals examine their role and any potential impacts.

A Survey of Midwives' Attitudes Toward Men in Midwifery.

INTRODUCTION: The midwifery profession in the United States demonstrates a significant lack of diversity. The critical need to address the lack of racial and ethnic diversity in the midwifery workforce is well recognized; little attention, however, has been given to gender diversity. This study focused on gender diversity within midwifery, specifically with regard to men who are midwives. Nearly 99% of midwives in the United States are women. No research has previously explored the attitudes of the predominantly female midwifery workforce toward its male members. METHODS: An invitation to an internet survey was sent to the American College of Nurse-Midwives (ACNM) membership. Quantitative and open-ended questions assessed attitudes toward and experiences with male midwives, whether members thought men belong in the profession, whether gender impacts quality of care, if ACNM should facilitate gender diversification, and whether exposure to male midwives impacts attitudes toward gender diversification. Data analysis of qualitative responses used a qualitative description methodology to identify common themes. RESULTS: Six thousand, nine hundred sixty-five surveys were distributed, and 864 participants completed the survey. Respondents reported beliefs that men belong in midwifery (71.4%), that gender does not affect quality of care (74%), and that ACNM should support gender diversity (72%). Respondents' perspectives revealed 3 dichotomous themes pertaining to the core nature of midwifery and how men fit within the profession: 1) inclusion versus exclusion, 2) empowerment versus protection, and 3) sharing with versus taking from. Often, the same respondent expressed both aspects of the dichotomy simultaneously. DISCUSSION: This study contributes new information about midwives' attitudes and beliefs toward gender diversity in midwifery in the United States. The values of professionalism, tradition, feminism, protection, and diversification inform participant responses. Findings support efforts toward gender diversification and have implications for implementation in education and practice.

Online prenatal trial in mindfulness sleep management (OPTIMISM): protocol for a pilot randomized controlled trial.

BACKGROUND: Sleep deficiency affects a majority of pregnant women with significant impact on daily function, mood, and pregnancy and birth outcomes. This ongoing study combines two evidence-based strategies for improving sleep and mood, mindfulness meditation and cognitive-behavioral therapy for insomnia (CBT-I), in a unique online format to address the particular needs of pregnant women. The purpose of this study is to test the feasibility and estimate the efficacy of this novel 6-week online mindfulness meditation intervention to help pregnant women in remission from depression self-manage insomnia. METHODS: This is a two-arm, parallel group randomized controlled trial. A total of 50 pregnant women between 12 and 28 weeks gestation will be recruited from the community and randomly assigned to a mindfulness or education-only control group in a 1:1 ratio. During the study, all participants will complete six weekly online modules, daily sleep diaries, and optional participation in a treatment-specific online discussion forum. Feasibility outcome measures will include study recruitment, retention, intervention adherence (number of online modules completed, number of meditation days per week), and intervention acceptability (8-item questionnaire). The primary clinical outcome measure will be sleep quality measured with the Pittsburgh Sleep Quality Index. Secondary outcome measures will include sleep measured with actigraphy and diaries (sleep efficiency, total sleep time, total wake time), Patient-Reported Outcomes Measurement Information System (PROMIS) measures (fatigue, sleep-related impairment, sleep disturbance); mood (depression, anxiety, positive affect, quality of life); and self-management and behavior change (potential self-efficacy, self-regulation, sleep problem acceptance, and trait mindfulness). Assessments will occur at baseline and post-intervention; an additional acceptability survey will be completed 4 weeks postpartum. Analyses will examine within-group differences in outcome change scores from baseline to post-intervention. Open-ended feedback will be analyzed using qualitative content analysis. DISCUSSION: This research is innovative in addressing sleep in pregnancy using a self-management research design and methods that can be accessible and cost-effective for large numbers of pregnant women. The results from this study will inform intervention refinement and efficacy testing of the intervention in a larger randomized controlled trial. TRIAL REGISTRATION: ClinicalTrials.gov, NCT04016428. Registered on 11 July 2019. Updated version registered on 26 July 2019.