Decolonizing nursing education and research to address racial disparities in maternal health.

PURPOSE: In this paper, we discuss the need to move beyond theoretical explorations of social determinants of health (SDoH) to addressing systemic racism and its effect on Black maternal health outcomes. We also address the importance of connecting nursing research, education and practice and offer suggestions on how to transform the teaching, research and clinical practice specific to Black maternal health. KNOWLEDGE DEVELOPMENT: A critical analysis of current Black maternal health teaching and research practices in nursing informed by the authors' experience in Black/African diasporic maternal health and reproductive justice. DISCUSSION: There is a need for nursing to be more intentional in addressing the effects of systemic racism on Black maternal health outcomes. In particular, there is still a substantial focus on race rather than racism as a risk factor. The focus on racial and cultural differences rather than systems of oppression continues to pathologize racialized groups while failing to address the impact of systemic racism on the health outcomes of Black women. CONCLUSION: Using a social determinant of health framework to examine maternal health disparities is useful; however, focusing on SDoH without challenging systems of oppression producing these disparities does not produce substantial changes. We suggest adding frameworks grounded in intersectionality, reproductive and racial justice and moving beyond biological assumptions about race that pathologize Black women. We also recommend a deliberate commitment to reshaping nursing research and education to centre anti-racist and anti-colonial practices that value community knowledge and practices. NO PATIENT OR PUBLIC CONTRIBUTION: The discussion in this paper is based on the author's expertise.

Algorithmic bias in artificial intelligence is a problem-And the root issue is power.

BACKGROUND: Artificial intelligence (AI) in health care continues to expand at a rapid rate, impacting both nurses and communities we accompany in care. PURPOSE: We argue algorithmic bias is but a symptom of a more systemic and longstanding problem: power imbalances related to the creation, development, and use of health care technologies. METHODS: This commentary responds to Drs. O'Connor and Booth's 2022 article, "Algorithmic bias in health care: Opportunities for nurses to improve equality in the age of artificial intelligence." DISCUSSION: Nurses need not 'reinvent the wheel' when it comes to AI policy, curricula, or ethics. We can and should follow the lead of communities already working 'from the margins' who provide ample guidance. CONCLUSION: Its neither feasible nor just to expect individual nurses to counter systemic injustice in health care through individual actions, more technocentric curricula, or industry partnerships. We need disciplinary supports for collective action to renegotiate power for AI tech.

A reflection on the decolonization discourse in nursing.

Colonialism, in its many forms and stages is often imposed as being central to the narratives of colonizedpeople and their cultures, as well as the genesis of their knowledge. In colonial discourse, lands and the occupants of these lands were 'discovered', further implying that colonized people did not have their own ways of knowing (nor even existence) before colonization. This narrative has been embedded within Euro-American fields of study, including nursing, in which caring and healing practices that exist outside of a colonial lens are dismissed and complicity with colonialism is downplayed or sanitized. This paper is a reflection on the current discourse on decolonizing nursing shaped by postcolonial, critical and Black feminist philosophies. After examining the decolonization discourse in nursing, I argue that current calls to decolonize nursing lack a clear description of the goals and process of doing so, making it unfeasible to hold those in the process of decolonizing accountable. In addition, the lack of intentionality in reckoning with past and current forms of colonialism embedded in nursing hinders the ability to engage with lessons that could shape the future. I conclude this discourse by discussing practical steps toward centrering diverse ways of knowing, and ensuring this process prioritizes communities and nurse scholars who have historically been silenced.

What nurses of color want from nursing philosophers.

Scholars of color have been instrumental in advancing nursing knowledge development but find limited spaces where one can authentically share their philosophical perspective. Although there is a call for antiracism in nursing and making way for more diverse and inclusive theories and philosophies, our voices remain at the margins of nursing theory and philosophy. In nursing philosophy, there continues to be a lack of racial diversity in those who are given the platform to share their scholarship. Five nurse scholars of color attended the International Nursing Philosophy Conference in August 2022. We established a collective system of support by sharing our experiences as researchers, scholars, and educators with each other. The theory of emancipatory nursing praxis informed this process. In this dialogue, we reflected on what it is like to present at and attend predominantly white nursing conferences. We shared our experiences of how we exist as nurse scholars, our philosophical views, and our thoughts on how we create spaces where scholars of color can feel welcomed and acknowledged for their contributions to advancing nursing knowledge.

Dietary transition among Sub-Saharan Africa women post-immigration and during pregnancy.

BACKGROUND: Black immigrant women experience high risks for maternal complications, and some of these complications are related to dietary outcomes. This study aimed to explore Sub-Saharan African (SSA) pregnant women's dietary patterns and dietary transition post-immigration and during pregnancy. METHODS: We used a narrative design with a Photovoice approach and collected data through semi-structured interviews, digital food diaries, and Photovoice interviews. We recruited eleven participants (n = 11) through community gatekeepers and analyzed data using a constructivist grounded theory approach with constant comparative methods. RESULTS: The changes in food processes and participants' reactions to these changes generated a dietary transition model with three stages: perplexity, deliberation, and acceptance. (1) Perplexity was caused by different food characteristics such as taste, texture, and options. (2) Participants described deliberation as a process of deciding the kind of foods/cooking styles that would be an integral part of their regular diet. All participants opted for what they referred to as the 'African diet.' (3) Acceptance was characterized by participants' resolve to figure out how to make their chosen types of food and eating habits 'work' for themselves and their families. CONCLUSION: This study emphasizes the importance of having a sense of self-efficacy, a positive attitude, and community support in enabling migrant women to navigate dietary transition until they are satisfied with newly constructed eating habits. This determination, along with community support and persistent connection to their home culture, might help immigrants resist dietary acculturation and maintain healthy cultural eating habits, which is particularly important during pregnancy, given the impact of diet on maternal and neonatal outcomes. These findings underscore the need for collaborating with migrants from SSA to develop culturally tailored dietary interventions focused on each stage of dietary transition. Future studies should include focus group discussions to leverage women's shared experiences and create knowledge/information exchange opportunities.

The Preliminary Efficacy of a Sleep Self-management Intervention Using a Personalized Health Monitoring Device during Pregnancy.

Background: Sleep disturbances are common during pregnancy and are associated with the development of adverse pregnancy outcomes. Personal health monitors (PHM) can facilitate change in health behaviors, though few studies have examined their use in improving sleep during pregnancy. This pilot study aimed to characterize sleep changes during pregnancy in women participating in a self-management intervention using a PHM.Participants/Methods: Participants with low risk, singleton pregnancies from Western Massachusetts were randomized at 24 weeks gestation to receive sleep education only (n = 12) or sleep education, and PHM intervention (n = 12). The single-session sleep education was given at baseline by a registered nurse. Sleep quality, duration, efficiency, disturbances, daytime sleepiness, and fatigue were assessed at baseline and 12 weeks follow-up using questionnaires. We described mean ± standard deviation within and between-group changes in each sleep outcome from baseline to 12 weeks follow-up.Results: The PHM arm experienced larger sleep quality improvements and daytime sleepiness than the sleep-education only arm, but the differences were not statistically significant. In the PHM arm, the Pittsburgh Sleep Quality Index (PSQI) score decreased (i.e., sleep quality increased) 1.22 ± 2.39 (p = .16), and the Epworth Sleepiness Scale (ESS) score decreased (i.e., daytime sleepiness decreased) 1.11 ± 2.08 (p = .15). In the sleep-education arm PSQI decreased 0.57 ± 2.37 (p = .55) and ESS decreased 1.29 ± 2.93 (p = .29). Neither group experienced statistically significant changes in sleep duration, efficiency, disturbances, or fatigue.Conclusion: Sleep education with PHM may improve or prevent decreases in sleep outcomes during pregnancy. Further investigation in larger trials is warranted.

Healthy Diet Perceptions of Pregnant Women from Sub-Saharan Africa Residing in the U.S.

Several consumers lack a clear understanding of what makes a healthy diet. This uncertainty may be worsened by immigration due to socio-cultural differences. The purpose of this study was to explore Sub-Saharan African (SSA) pregnant women's perceptions of a healthy diet and the sources of dietary information available to them in the context of immigration. We used narrative interviews and photo-food diaries, followed by photo-elucidated interviews to obtain data. Participants defined and illustrated a healthy diet as having four characteristics: (a) Familiar, (b) balanced, (c) made of fresh and organically grown ingredients, and (d) able to build the consumer's body. Participants indicated that the overwhelming nature of dietary information made it difficult to navigate. Participants trusted dietary recommendations offered by family and peers the most, while those offered by health care providers were reported to be difficult to understand or incorporate due to not being culturally specific. This paper highlights the importance of considering consumers' socio-cultural backgrounds and building partnerships between health care providers and the communities they serve to design culturally relevant dietary education.

Feasibility of a pilot, randomized controlled trial using a personalized health monitoring device with pregnant women for behavioral sleep research.

Sleep disruptions are common in pregnancy and can have significant maternal and infant health consequences. Management of sleep using a personal health monitoring (PHM) device may be effective in promoting behavior change and contribute to improved pregnancy-related sleep. The purpose of this pilot, randomized controlled trial was to determine the feasibility of recruitment (i.e., recruiting a 20% minority sample, most successful recruitment methods), retention, adherence, and data collection methods with a sample of pregnant women (n = 24) at 24 weeks gestation for a 12-week intervention using a PHM device. Of 24 enrolled participants, 20 (83%) were retained through the 12-week intervention and the follow-up at 2-4 weeks postpartum. The majority of participants had a four-year education and identified as White. Ninety-one percent (n = 11) wore the device for at least ten weeks. Pregnant women may be willing engage in sleep intervention research and wear a PHM to self-monitor sleep during pregnancy. Future research should consider recruitment methods tailored to recruit diverse populations of pregnant women.

Food taboos during pregnancy.

Observing food taboos during pregnancy might have impacts on maternal and neonatal health outcomes. The author's purpose in this review was to explore the most common food taboos during pregnancy and potential health implications. PubMed, CINAHL, and Web of Science were searched. We identified more than 50 types of tabooed food during pregnancy with examples such as fresh meat, eggs, and different varieties of fruits and vegetables. While observing food taboos may predispose women to poor nutrition outcomes, some taboos could potentially protect women against unhealthy eating habits. Our findings highlight the need to understand the dual impact of food taboos to develop effective, culturally sensitive, community-based nutrition programs.

Pregnancy loss among Muslim women: A narrative review.

Background: Diversity in spirituality, religion, and cultural norms among women leads to varying attitudes, grieving processes, and coping mechanisms after a pregnancy loss. Despite this, there is a limited understanding of grief, coping mechanisms, and mental health outcomes following pregnancy loss among Muslim women. Objectives: This study aims to examine the impact of religion, spirituality, and faith communities on the psychological health of Muslim women during pregnancy loss. Method: We systematically searched six databases with the key concepts, 'pregnancy loss' and 'Muslim women,' in PubMed, CINAHL, Embase, Web of Science, APA PsycINFO, and Academic Search. The search strategy was developed in line with the PCOT framework: Population - Muslim Women with "pregnancy loss," "miscarriage," "stillbirth, Context - "religion," faith, "spirituality," "faith communities," Outcome - "religious practices," perception, coping mechanism, "psychological health."Studies were screened, their quality appraised, and narratively sized in line with the review aim. The review protocol was registered at Open Science Framework (OSF): https://doi.org/10.17605/OSF.IO/52QTA. Result: Findings from the reviewed articles addressed the following themes: (a) Overwhelming Grief and Loss, (b) social isolation and stigmatization, (c) impact on mental health, and (d) trust in divine destiny. Islamic beliefs were strongly featured in how Muslim women processed pregnancy loss. Concepts such as tawakkul and yaqeen (trusting and certainty) were used to interpret pregnancy loss, with many women acknowledging that their Islamic faith eased the sorrow of pregnancy loss, facilitated acceptance, and strengthened their Islamic belief system. Conclusion: This review revealed that there is limited information on Muslim women's experience of pregnancy loss. Professionals helping Muslim women dealing with the grief of pregnancy loss need to be aware that spirituality and faith communities play a major role in shaping their coping mechanisms. Future studies on the development of culturally congruent bereavement care models and supportive interventions for Muslim women facing pregnancy loss.

A remotely accessible plant-based culinary intervention for Latina/o/x adults at risk for diabetes: lessons learned.

Introduction: Little research has examined how community-engaged and -participatory dietary interventions adapted to remotely-accessible settings during the COVID-19 pandemic. Objectives: To identify lessons learned in design, implementation, and evaluation of a remotely-accessible, community-based, nurse-led approach of a culturally-tailored whole food plant-based culinary intervention for Latina/o/x adults to reduce type 2 diabetes risk, delivered during a pandemic. Methods: A mixed methods quasi-experimental design consisting of a pre-post evaluation comprised of questionnaires, culinary classes, biometrics, and focus groups. Lessons learned: Community partnerships are essential for successful recruitment/retention. To optimally deliver a remotely-accessible intervention, community leadership and study volunteers should be included in every decision (e.g., timeframes, goals). Recommendations include managing recruitment and supply chain disruption of intervention supplies. Conclusion: Future research should focus on increasing accessibility and engagement in minoritized and/or underserved communities, supply chain including quality assurance and delivery of services/goods, study design for sustainable, remotely-accessible interventions, and health promotion.

Rwandan nursing students' knowledge, attitudes and application of evidence-based practice.

BACKGROUND: Evidence-based practice (EBP) plays a key role in improving health outcomes of a country's population; however, the teaching of EBP is often theoretical and inconsistent, resulting in negative attitudes and limited application. OBJECTIVES: The aim of this study was to determine the knowledge, attitudes and application of EBP by nursing students at a school of nursing in Rwanda. METHOD: A total of 82 third- and fourth-year nursing students completed the survey. Univariate statistical analyses were performed to explore the distribution of data. Chi-square tests were utilised to examine the relation between knowledge, attitudes and application of EBP with the year of study. RESULTS: Most students reported being knowledgeable of the steps of EBP, with a range of 84% - 92%. However, 50% reported negative attitudes and only 12% reported daily searches for evidence. The main reported barriers to the application of EBP were lack of knowledge, lack of time and lack of examples or role models. CONCLUSION: Knowledge about EBP does not necessarily positively influence student attitudes. Evidence-based practice should be integrated into the theoretical and practical component of the nursing curriculum to promote the effective application of EBP by nursing students.

Feasibility of a Sleep Self-Management Intervention in Pregnancy Using a Personalized Health Monitoring Device: Protocol for a Pilot Randomized Controlled Trial.

BACKGROUND: Sleep disruptions are common during pregnancy and associated with increased risk of adverse maternal outcomes such as preeclampsia, gestational diabetes, prolonged labor, and cesarean birth. Given the morbidity associated with poor sleep, cost-effective approaches to improving sleep that can be disseminated in community or clinical settings are needed. Personal health monitor (PHM) devices offer an opportunity to promote behavior change, but their acceptability and efficacy at improving sleep in pregnant women are unknown. OBJECTIVE: The goal of the paper is to describe the protocol for an ongoing pilot randomized controlled trial that aims to establish the feasibility, acceptability, and preliminary efficacy of using a PHM device (Shine 2, Misfit) to promote sleep during pregnancy. METHODS: The proposed pilot study is a 12-week, parallel arm, randomized controlled trial. Pregnant women, at 24 weeks gestation, will be randomized at a 1:1 ratio to a 12-week sleep education plus PHM device group or a sleep education alone comparison group. The primary outcomes will be measures of feasibility (ie, recruitment, enrollment, adherence) and acceptability (ie, participant satisfaction). The secondary outcomes will be self-reported sleep quality and duration, excessive daytime sleepiness, fatigue, and depressive symptoms. RESULTS: Recruitment for this study began in September 2017 and ended in March 2018. Data collection for the primary and secondary aims was completed in August 2018. We anticipate that the data analysis for primary and secondary aims will be completed by December 2019. The results from this trial will inform the development of a larger National Institutes of Health grant application to test the efficacy of an enhanced version of the sleep intervention that we plan to submit in the year 2020. CONCLUSIONS: This study will be the first to apply a PHM device as a tool for promoting self-management of sleep among pregnant women. PHM devices have the potential to facilitate behavioral interventions because they include theory-driven, self-regulatory techniques such as behavioral self-monitoring. The results of the study will inform the development of a sleep health intervention for pregnant women. TRIAL REGISTRATION: ClinicalTrials.gov NCT03783663; https://clinicaltrials.gov/ct2/show/NCT03783663 (Archived by WebCite at http://www.webcitation.org/779Ou8hon). INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/12455.