Examining Women's and Men's Ideal Criteria Before Forming Families.

In the United States, family formation decision-making is more complex than the predominant models that have been used to capture this phenomenon. Understanding the context in which a pregnancy occurs requires a more nuanced examination. In-depth interviews were conducted with 60 men and women, aged 18-35, who had children or were pregnant. Using grounded theory analysis, themes emerged that revealed participants' ideal criteria desired before pregnancy. We stratified by those who met and did not meet these criteria. Almost universally, participants shared ideal criteria: to graduate, gain financial stability, establish a relationship, and then become pregnant. Many participants did not accomplish these goals. Those who had not met their criteria had experienced traumatic childhoods and suffered economic concerns. For this group, having children prompted positive changes within their control, but financial stability remained limited. Efforts should focus on improving circumstances for all individuals to fulfill their criteria before pregnancy.

Ambulatory Care Nurse-Sensitive Indicators Series: Patient Engagement as a Nurse-Sensitive Indicator In Ambulatory Care.

Ambulatory care registered nurses (RNs) have a pivotal role in educating, encouraging, motivating, and supporting patients to be engaged in their care and achieve their health care goals. To improve health outcomes, patients need to be engaged in attaining these goals. RNs are instrumental in this process and well-controlled studies will demonstrate their impact on helping patient's engage in their care.

2009 H1N1 vaccination by pregnant women during the 2009-10 H1N1 influenza pandemic.

OBJECTIVE: Pregnant women were identified at greater risk and given priority for 2009 H1N1 vaccination during the 2009 through 2010 H1N1 pandemic. We identified factors associated with acceptance or refusal of 2009 H1N1 vaccination during pregnancy. STUDY DESIGN: We conducted an in-person survey of postpartum women on the labor and delivery service from June 17 through Aug. 13, 2010, at 4 New York hospitals. RESULTS: Of 1325 survey respondents, 34.2% received 2009 H1N1 vaccination during pregnancy. A provider recommendation was most strongly associated with vaccine acceptance (odds ratio [OR], 19.4; 95% confidence interval [CI], 12.7-31.1). Also more likely to take vaccine were women indicating the vaccine was safe for the fetus (OR, 12.4; 95% CI, 8.3-19.0) and those who previously took seasonal flu vaccination (OR, 7.9; 95% CI, 5.8-10.7). Race, education, income, and age were less important in accepting vaccine. CONCLUSION: Greater emphasis on vaccine safety and provider recommendation is needed to increase the number of women vaccinated during pregnancy.

Understanding diagnostic safety in emergency medicine: A case-by-case review of closed ED malpractice claims.

The report Improving Diagnosis in Health Care calls for collaboration between professional liability insurance carriers and health care providers to identify opportunities to improve diagnostic performance. We used this collaborative approach and involved risk management/patient safety professionals and emergency medicine physician reviewers to analyze diagnosis-related emergency medicine closed claims from a large malpractice insurer. Our aim was to identify opportunities for risk reduction and to develop an approach for improving at-risk processes. Analysis of these cases revealed several missed opportunities in the diagnostic process. A collaborative approach offered greater insight into diagnosis process failures that may not have been evident if cases were reviewed in silos. Focused review findings led to a multidisciplinary improvement collaborative to develop clinical guidelines for improving at-risk practices and informed a simulation-based training initiative.