Women's and Nurses' Perceptions of Visitor Restrictions After Childbirth During the COVID-19 Pandemic.

OBJECTIVE: To examine the perceptions of labor and delivery (L&D) nurses and childbearing women in the postpartum period regarding a restricted visitor policy during the COVID-19 pandemic. DESIGN: Descriptive mixed-methods survey and open-ended questions. SETTING/LOCAL PROBLEM: One hospital in the southwestern United States. There is limited evidence regarding recently imposed visitor restrictions related to COVID-19. PARTICIPANTS: Individuals who were pregnant and self-identified as women who gave birth during October 2020 through March 2021 (n = 674) and L&D nurses (n = 47). INTERVENTION/MEASUREMENTS: Participants who had given birth with visitor restrictions completed an online survey, and L&D nurses completed a paper survey. RESULTS: Childbearing women had positive and negative views; they valued a more intimate familial bonding and recovery without visitors and appreciated decreased pressure to accommodate family/friends. They were also disappointed with sibling restrictions and were sad and frustrated with visitor limitations, especially in special circumstances (e.g., NICU admission or extended stays). Nurses expressed that visitor restrictions allowed more time for higher-quality nursing care/patient teaching and decreased distractions in emergencies, leading to safer care. Women and nurses reported that visitor restrictions allowed women more rest and relaxation as well as less worry and strain from juggling family and friends who wanted to visit, but they also identified that there was decreased family support when it was needed. CONCLUSION: Women's responses were mixed, with some preferring support from many visitors, while others appreciated the intimate focus of just their partner. Most nurses preferred fewer visitors but could empathize with women.

Birth, Postpartum, and Home Experiences of Individuals With Lower Extremity Nerve Injury.

OBJECTIVE: To explore birth and at-home postpartum experiences of individuals with lower extremity nerve injury (LENI) related to childbirth. DESIGN: Mixed-methods, descriptive, cross-sectional survey with open-ended questions. SETTING: Closed Facebook support group. PARTICIPANTS: Two hundred-thirty individuals who experienced LENI during childbirth. MEASUREMENTS: Two research team members developed the online LENI survey that incorporated suggestions from LENI support group leaders. We used descriptive statistics, linear regression, and Kaplan-Meier survival curves to summarize the quantitative data and used content analysis for open-ended items. RESULTS: We described labor, birth, and postpartum characteristics in our sample, including immediate and long-term LENI symptoms. Falls resulting from LENI were common in the hospital (55.6%) and at home (75.6%). At discharge home, respondents reported low confidence in their ability to care for themselves and their infants as well as high levels of dependence on others. There was an 89.6% prevalence of depression in the first month at home. Approximately 80% of participants rated their degree of healing at 5 years as 80% to 100% healed. Content analysis yielded six themes: (a) Grieving Loss of Current and Future Life; (b) Caregiver Responses That Helped or Hindered; (c) Being in Danger; (d) Experiencing Emotional Turmoil; (e) Dealing With Family, Marital, and Financial Difficulties; and (f) Finding Strength, Overcoming Obstacles, and Experiencing Personal Growth. CONCLUSION: Participants in our sample reported a very high rate of falls, anxiety, and depression at home. Nurses should recognize LENI symptoms, take action to prevent falls, and offer accurate information and referrals.

Effect of an Obstetric Hemorrhage Bundle on Clinical Outcomes and Clinician Perceptions.

OBJECTIVE: To examine the effect of an obstetric hemorrhage (OBH) safety bundle on health outcomes and to explore nurses' and physicians' perceptions of using the bundle. DESIGN: Descriptive longitudinal study, including review of electronic health records for 79,509 births, and clinician surveys. SETTING: Nine hospitals in the southwestern United States. PARTICIPANTS: 685 maternity nurses and 210 obstetricians. INTERVENTIONS/MEASUREMENTS: Retrospective and prospective data collection over 3.5 years to examine selected health outcomes before and after implementing an OBH bundle. A 10-item questionnaire was used to survey clinicians for their perceptions of bundle use. The Hospital Survey on Patient Safety Culture was used to explore nurses' views of the safety climate before and after bundle implementation. RESULTS: Statistically significant decreases in mean documented blood loss were observed with bundle use. Blood loss rates of less than 500 ml and greater than 1,000 ml increased, and blood loss rates of 500 to 1,000 ml decreased. Use of postpartum hemorrhage medications increased. When adjusted for multiple tests, there was no statistically significant difference in the rates of postpartum hysterectomies or ICU admissions or in length of stay. Clinicians' perceptions of bundle use were positive, with scores ranging from 6 to 8 on a scale of 1 to 10. However, Hospital Survey on Patient Safety Culture results indicated a decrease in nurses' perceptions of safety after bundle implementation. CONCLUSION: OBH bundles provide tools and guidance to improve perinatal care and outcomes. Our findings of lower mean blood loss, increased use of postpartum hemorrhage medications, and positive perceptions of the bundle differed from findings of previous studies. Nurses' perceptions of safety decreased, yet clinicians reported that care was safer with the OBH bundle. Nurses' commitment and collaboration are vital to the success of bundle implementation.

An Exploration of New Graduate Nurses' Transition to Specialty Practice.

New graduates' adjustment to high-acuity specialty areas was evaluated using qualitative methods in a hospital system that uses the Versant New Graduate Residency Program. Subjects were interviewed at baseline in person, answered interview questions at 6 months via computer, and were interviewed at 12 months in person. Twelve themes emerged from the interviews, reflecting intrinsic and extrinsic factors affecting new graduate nurse adjustment. Study results were used to evaluate the program and improve the program implementation.

Integrative Review of Lower Extremity Nerve Injury During Vaginal Birth.

OBJECTIVE: To describe the incidence, health effects, risk factors, and practice implications of lower extremity nerve injury (LENI) related to vaginal births. DATA SOURCES: We searched MEDLINE, CINAHL, and PubMed from 2000 to 2020 for peer-reviewed published case reports and research studies of LENI related to vaginal births. STUDY SELECTION: We identified 188 potential records, and 20 met inclusion criteria (six research studies and 14 case studies). DATA EXTRACTION: Three independent reviewers extracted details of injuries and births into an Excel spreadsheet and analyzed data using SPSS. DATA SYNTHESIS: Using birth data from each case study and from four of the six research articles, we found the incidence of LENI in vaginal births was 0.3% to 1.8%. The description of health effects includes affected nerves and the location, description, and duration of symptoms. Analyses of risk factors were limited by missing birth data (length of second stage, birth weight, etc). Vaginal births with LENI were 76% spontaneous, 77% with neuraxial anesthesia, and 64% first vaginal birth. Practice implications focused on prevention through specific positioning strategies. Despite nurses being the primary caregivers during labor, LENI was reported most often in anesthesia journals with virtually no reports in nursing journals. CONCLUSION: LENI is a potential complication of vaginal birth, and little published research is available on prevention and prognosis. While obstetric and anesthesia factors can cause or contribute to nerve injury, LENI is usually caused by positioning and is considered preventable. Care recommendations include the following: avoid prolonged hyperflexion of women's thighs and knees; minimize time in lithotomy, squatting, or kneeling positions; prevent hand or other deep pressure on lateral knee and posterior thigh areas; avoid motor-blocking neuraxial (epidural) anesthesia; and implement frequent repositioning. The paucity of literature contributes to the lack of awareness of LENI among clinicians.

Are genetics/genomics competencies essential for all clinical nurses?

In 2006, the American Nurses Association created a set of essential genetics and genomics (G/G) competencies for all RNs, regardless of academic preparation, practice setting, or specialty. However, more than half of the RNs practicing today received no prelicensure education on these G/G competencies. This study describes the current use of G/G nursing competencies in acute care hospitals and how nurses perceive them.

Response to a National Issue: Moving Beyond "Back to Sleep" at Three Hospitals.

PURPOSE: To measure changes in registered nurse (RN) knowledge/beliefs and practices, parents' recall of infant safe sleep (ISS) teaching, and inpatient infant sleep environments and safety after implementing an ISS initiative. DESIGN AND METHODS: This longitudinal quasi-experimental study took place in three hospitals in the United States. An existing infant safe sleep tool was revised and updated to align with current recommendations on sleep environments. A bundled intervention included educating nurses, changing unit processes and implementing crib cards and room signs. Paired questionnaires surveyed 62 nurses before and 2 months after the intervention. Audits of 462 cribs/sleep environments with parent conversations assessed infant sleep conditions and parents' recall of RN teaching before and after the intervention. RESULTS: After Bonferroni correction, eight of 19 items for RN knowledge/beliefs and self-reported practice showed statistically significant improvements with moderate effect sizes. All 11 items for parents' recall of RN teaching showed statistically significant improvements, with odds ratios ranging from 7 to 76. Five of six real-time sleep safety conditions (from crib/sleep environment audits) had statistically significant improvements. Odds ratios ranged from eight to 83. CONCLUSION: An updated educational tool improved nurses' and parents' knowledge and practices related to current and updated safety factors for infant sleep conditions. Inpatient adherence to infant sleep safety recommendations improved. PRACTICE IMPLICATIONS: A two-hour investment of nurses' time yielded statistically significant improvements. Factors critical to the success of the ISS project roll-out are reported. Improvements in parents' recall of teaching and actual sleep environments suggest potential for long-term changes in infant safety at home.

Tools of the trade: Improving nurses' ability to access and evaluate research.

AIM: To evaluate the effect of a manager-required RN competency on staff nurses' perceived knowledge, ability and frequency of information-seeking activities. BACKGROUND: Basing clinical practice on research and standards of care is essential to delivering appropriate care with optimal outcomes. Nurses' information-seeking abilities are critical for acquiring evidence-based answers to aid clinical decision-making, yet nurses under-utilize library resources and report barriers. A unit manager sought to test the effect of an innovative competency for acquiring and appraising evidence for practice. METHODS: This longitudinal descriptive study evaluated 28 nurses before and after a 1-hr class, as well as 5 months later. The class covered library information services and the basics of critiquing research articles. RESULTS: Nurses had statistically significant improvements in four of five items measuring knowledge/ability and four of five items measuring frequency of information-seeking activities. At 5 months, most knowledge/ability items increased. There was no effect of nurse characteristics on outcomes. CONCLUSIONS: A required competency improved nurses' knowledge, ability and frequency of acquiring and appraising evidence with a single 1-hr class and a hands-on practice activity. Unit managers can have great impact on nurses' use of evidence for practice.

First in the Nation: One Unit's Journey to Achieving Fragility Fracture Certification.

Osteoporosis is related to more than 2 million fractures and $19 billion in healthcare costs each year (). A fragility fracture (FF) is a low-energy fracture of the distal radius, proximal humerus, ankle, or proximal femur (hip) from minimal trauma such as a fall from a standing height. In addition to cost, FFs often result in the loss of independence and productivity (). In 2015, our orthopaedic unit received the first certification ever awarded for FFs. Fragility fracture certification is a new certification demonstrating that a healthcare facility complies with national patient care standards and uses evidence-based practice guidelines to deliver quality outcomes. Orthopaedic nurses have a critical role in optimizing future bone health and fracture prevention. Our story describes the process and challenges faced becoming the first organization in the nation to be successfully surveyed for The Joint Commission's Fragility Fracture Certification.

Preventing Tumor Lysis Syndrome: Two Case Studies of Unexpected Outcomes.

BACKGROUND: Tumor lysis syndrome (TLS) is a potentially fatal complication in patients with large, rapidly proliferating tumor cell cancers that may occur after chemotherapy. Patients with TLS are complicated to treat and often have an unpredictable trajectory. OBJECTIVES: The purpose of this article is to report two cases with unusual clinical manifestations and unexpected outcomes during cancer treatment and to share best practices for this situation. METHODS: The authors described details from two unusual cases and outlined lessons learned. The authors described a newly developed clinical order set (protocol) to support optimal care for patients at risk for TLS. FINDINGS: Implementing best practices, the order set prompts early identification of TLS risk and provides step-by-step guidance to eliminate or control TLS.

Developing and Testing a Vaginal Delivery Safety Checklist.

Communication failures are the most common root causes of perinatal deaths and injuries. We designed and tested a Vaginal Delivery Safety Checklist to improve communication and assist delivery teams' risk assessments and plans for potential complications of vaginal birth. Delivery teams found the checklist easy, convenient, and helpful. Teams completed the checklist within 2 to 3 minutes and showed improved teamwork, communication, and decision making.

Psychometric Testing of the Health Care Evidence-Based Practice Assessment Tool.

BACKGROUND AND PURPOSE: Evidence-based practice (EBP) is essential to optimal health care outcomes. Interventions to improve use of evidence depend on accurate assessments from reliable, valid, and user-friendly tools. This study reports psychometric analyses from a modified version of a widely used EBP questionnaire, the information literacy for nursing practice (ILNP). METHODS: After content validity assessments by nurse researchers, a convenience sample of 2,439 nurses completed the revised 23-item questionnaire. We examined internal consistency and used factor analyses to assess the factor structure. RESULTS: A modified 4-factor model demonstrated adequate fit to the data. Cronbach's alpha was .80-.92 for the subscales. CONCLUSIONS: The shortened ILNP (renamed Healthcare EBP Assessment Tool or HEAT) demonstrated adequate content validity, construct validity, and reliability.

Empowering nurses with evidence-based practice environments: surveying Magnet®, Pathway to Excellence®, and non-magnet facilities in one healthcare system.

BACKGROUND: Nurses have an essential role in implementing evidence-based practices (EBP) that contribute to high-quality outcomes. It remains unknown how healthcare facilities can increase nurse engagement in EBP. PURPOSE: To determine whether individual or organizational qualities could be identified that were related to registered nurses' (RNs') readiness for EBP as measured by their reported EBP barriers, ability, desire, and frequency of behaviors. METHODS: A descriptive cross-sectional survey was used in which a convenience sample of 2,441 nurses within one United States healthcare system completed a modified version of the Information Literacy for Evidence-Based Nursing questionnaire. Descriptive statistics, t tests, one-way ANOVA, and regression modeling were used to analyze the data. RESULTS: RNs employed by facilities designated by the American Nurses Credentialing Center (ANCC) as Magnet® or Pathway to Excellence® reported significantly fewer barriers to EBP than those RNs employed by non designated facilities. RNs in Magnet organizations had higher desire for EBP than Pathway to Excellence or non designated facilities. RNs educated at the baccalaureate level or higher reported significantly fewer barriers to EBP than nurses with less education; they also had higher EBP ability, desire, and frequency of behaviors. A predictive model found higher EBP readiness scores among RNs who participated in research, had specialty certifications, and engaged in a clinical career development program. LINKING EVIDENCE TO ACTION: Education, research, and certification standards promoted by the Magnet program may provide a nursing workforce that is better prepared for EBP. Organizations should continue structural supports that increase professional development and research opportunities so nurses are empowered to practice at their full capacity.

Breastfeeding during military deployment: a soldier's story.

Thousands of women of childbearing age are serving and being deployed in the United States military. U.S. Department of Defense policies related to breastfeeding and deployment are inconsistent among the different branches of the military and sometimes conflict with evidence-based guidelines about optimal breastfeeding practices. This is the story of an active duty soldier who was deployed while breastfeeding and the obstacles she encountered trying to send breast milk home to her son. The article explores policy, health and professional practice implications.

Nurses' views of factors that help and hinder their intrapartum care.

OBJECTIVE: To explore labor and delivery nurses' views of intrapartum care, particularly factors that help or hinder their efforts to provide professional labor support. DESIGN: Content analysis of narrative comments that nurses wrote on questionnaires during a two-part research study on professional labor support in 2001. PARTICIPANTS: Intrapartum registered nurses. RESULTS: Six themes emerged under the category of factors that hinder nurses' intrapartum care: (a) hastening, controlling, and mechanizing birth; (b) facility culture and resources; (c) mothers' knowledge, language, and medical status; (d) outdated practices; (e) conflict; and (f) professional/ethical decline. Under the category of factors that help nurses' intrapartum care, four themes emerged: (a) teamwork and collaboration, (b) philosophy of birth as a natural process, (c) facility culture and resources, and (d) nursing impact, experience, and autonomy. CONCLUSIONS: Nurses conveyed a spectrum of feelings from intense pride and pleasure to disillusionment, dissatisfaction, and distress based on barriers and facilitators to their ability to provide effective optimal care. They felt strongly that medical interventions often hindered their care and prevented them from providing labor support. Nurses offered blunt, often scathing criticism and also glowing praise for their colleagues in nursing, nurse-midwifery, and medicine regarding the quality of their care.

Intrapartum nursing: integrating Rubin's framework with social support theory.

Numerous studies and articles on labor support have focused on the potential for improved labor and birth outcomes from supportive care during labor. Despite increased attention to labor support research, surprisingly little has been written about the theoretical underpinnings for intrapartum nursing care. This article explores Reva Rubin's framework and social support theory as a foundation for intrapartum nursing care. The most common features of social support provided the structure into which Rubin's descriptions of nursing care during labor and birth could be evaluated. Social support theory fit remarkably well, both with Rubin's views of the role of the perinatal nurse and with Rubin's observations of mothers' needs and feelings during childbirth. Combining these theoretical frameworks provides a perspective of intrapartum nursing practice that has not been previously considered in the published literature.

Development and testing of the Labor Support Scale.

Nurses use interventions and supportive strategies to help mothers throughout labor, yet little research examines intrapartum nurses' labor support techniques. The purpose of the study was to develop and test a self-report instrument, the Labor Support Scale (LSS), to describe the frequency with which nurses perform interventions and nurses' perceptions of the helpfulness of interventions. Steps for instrument development were item generation, content validity testing, piloting, refining, and administering the questionnaire in two studies (n = 307, n = 472). Internal consistency reliability was .90 and .92 for the frequency and helpfulness portions of the instrument (respectively). Exploratory factor analysis, known groups technique, content analysis, and discriminant analysis evaluated validity. In both phases, instrument psychometrics provided evidence of content, construct, and discriminant validity.