Stair-Related Injuries Among Pregnant Women Treated in United States Emergency Departments.

OBJECTIVES: Falls are one of the leading causes of trauma during pregnancy, and most falls occur on stairs. The purpose of this study was to describe stair-related falls among pregnant women who were treated in United States emergency departments during a 10-year period. METHODS: This study utilized a cross-sectional analysis of National Electronic Injury Surveillance System (NEISS) data, 2008-2017. Emergency department visits by pregnant women aged 12 years and older were identified using case narratives. RESULTS: From 2008 to 2017, 1466 cases of pregnant women who had sustained stair-related falls were reported to NEISS, equating to a national estimate of 57,512 over the 10-year study period. Variables examined included age, body part injured, location of injury, discharge disposition, gestation, mechanism of injury, and other fall-associated hazards and symptoms. Most injuries involved contusions or abrasions, other injuries commonly reported were sprains/strains and contusions/abrasions. Wet/icy conditions represented hazards associated with 4.1% of all injuries. Severe obstetric symptoms, such as decreased fetal movement and vaginal bleeding, were described in study narratives. CONCLUSIONS: Falls are a leading cause of injury among women of childbearing age and stair-related falls comprise a large proportion of maternal falls. Physiological changes associated with pregnancy can put gravid women at greater risk for falls. Healthcare providers can provide women anticipatory guidance that may reduce their risk for falls as they progress in pregnancy.

Contextualizing Instructional Technology to the Demands of Nursing Education.

This article reviews current technologies in nursing education and the impact of technology on learning. The integration of technology into nursing curricula is thought to improve efficiency and enhance student experiences through active learning and interactive learning designs. The following focused questions are explored: (1) What are the current technologies used by university students and faculty in nursing programs? (2) How does that technology influence student learning? The primary themes were student-centered technology, with five subthemes, and faculty-centered technology. Consumers of healthcare (patients) demand quality care and expect highly skilled, compassionate, ethical practitioners; to this end, training and education of future nurses by skilled, qualified nurse educators who are comfortable with technological demands of all aspects of healthcare are fundamental. While it is essential that nurses and nurse educators continue to publish as a mechanism for open discussion and transparency in our teaching and learning approaches, we need higher levels of evidence to strengthen the argument that technology improves the learning environment and student outcomes and has a positive impact on clinical settings and patient care.

Compassion fatigue and satisfaction: a cross-sectional survey among US healthcare workers.

Professional quality of life among healthcare providers can impact the quality and safety of patient care. The purpose of this research was to investigate compassion satisfaction and compassion fatigue levels as measured by the Professional Quality of Life Scale self-report instrument in a community hospital in the United States. A cross-sectional survey study examined differences among 139 RNs, physicians, and nursing assistants. Relationships among individual and organizational variables were explored. Caregivers for critical patients scored significantly lower on the Professional Quality of Life subscale of burnout when compared with those working in a noncritical care unit. Linear regression results indicate that high sleep levels and employment in critical care areas are associated with less burnout. Identification of predictors can be used to design interventions that address modifiable risks.

Reported sleep health and viral respiratory illness in nurses.

PURPOSE: In this study, differences and relationships among variables in sleep quality/quantity and self-reported viral illness between day and non-day shift hospital nurses were examined. DESIGN AND METHODS: A descriptive, cross-sectional study used the 10-item Karolinska Sleep Questionnaire to measure quality of sleep in 131 direct-care nurses from a 246-bed community-owned hospital in the northwestern United States. FINDINGS: Non-day shift nurses used more techniques to stay awake while at work or aid in sleep at home. No differences were found between shifts in reported absenteeism for viral illness (m=2.9 days), or hours of reported sleep (m=7.5); significant differences were found in non-day shift quality of sleep compared to day shift nurses and between age groups. CONCLUSION: Sleep disturbances are present among nurses and differ depending on shift worked and nurse's age. No association was found between sleep and reported viral illness.

The value of community-focused interprofessional care in peru for developing cultural competency in health professions students.

International immersion experiences for health-care students have increased over the past 10 years. Students and faculty expect these experiences to increase cultural competency; however, research on outcomes of these programs has lacked rigor. Over a 4-year period, groups of nursing and other health professions students spent 3 weeks in Peru providing primary care and health education. Students attended pre-departure seminars addressing personal travel health and safety, culture and health care in Peru, working with interpreters, and ethics of international health care. Student participants (N=77) completed an instrument assessing self-perceived cultural competency before and after the experience. Results of pre- and post-immersion scores showed significant increases in perceived cultural competency and increased self-efficacy in cultural knowledge, skills, and attitudes for four groups of students. Implications and future directions are discussed and recommended.

Changes in Air Force fitness measurements pre- and post-childbirth.

U.S. Air Force (USAF) personnel are required to take periodic fitness assessments with minimum requirements to earn satisfactory performance evaluations. Active duty women are exempt from fitness testing during pregnancy and until 6 months postpartum. Although there is evidence that many women do not achieve prepregnancy fitness levels by 6 months postpartum, no published studies were found that evaluated changes in fitness measurements and assessment pass rates in active duty USAF women after childbirth. The purpose of this study was to compare USAF fitness assessment component measurements and overall pass rates at 6 months postpartum to prepregnancy measurements. A paired t-test analysis of fitness component measurements of 107 active duty women showed significantly larger abdominal circumferences, fewer push-up repetitions, and longer run times at 6 months postpartum when compared to prepregnancy assessments. No significant difference was found in sit-up measurements. Secondly, there was a significantly lower pass rate at 6-months postpartum compared to the prepregnancy time frame. Results from this study indicate that women may struggle to achieve prepregnant fitness levels and pass their fitness test by 6 months postpartum. More research is needed to discover which factors impact women's ability to successfully meet fitness standards postpartum.

Factors Associated With Exclusive Direct Breastfeeding in the First 3 Months.

OBJECTIVE: To identify factors associated with exclusive direct breastfeeding in the first 3 months among mother and infant dyads living in the United States. DESIGN: A secondary analysis of data collected using a cross-sectional online survey completed over a 4-month period in late 2019. PARTICIPANTS: We recruited a convenience sample of 370 mothers with healthy full-term singleton infants between 1 and 12 weeks of age whose feeding methods consisted of direct breastfeeding at least once a day. Mothers had not returned to work/school at the time of the survey completion. MEASUREMENTS: The questionnaire consisted of 34 questions about maternal and infant factors that influence decisions about infant feeding, professional support, and parental preferences. RESULTS: Mothers who practiced feeding on demand (adjusted OR [aOR] = 35.76, 95% confidence interval [CI] [2.04, 500.00]) and mothers of infants 1 to 4 weeks of age (aOR = 2.74, 95% CI [1.54, 4.85]) were more likely to use exclusive direct breastfeeding. The odds of exclusive direct breastfeeding decreased with mothers who breastfed with a nipple shield while in the hospital/birth center/home (aOR = 0.13, 95% CI [0.05, 0.35]), used pacifiers (aOR = 0.31, 95% CI [0.21, 0.65]), or had perceptions of insufficient milk (aOR = 0.11, 95% CI [0.04, 0.26]). CONCLUSION: Demand feeding and an infant's age of 1 to 4 weeks contributed to exclusive direct breastfeeding. Lower rates of exclusive direct breastfeeding were associated with the use of nipple shields immediately after birth, pacifier use, and perceptions of insufficient milk. Further investigation is warranted to fully differentiate exclusive direct breastfeeding from exclusive breastfeeding.

Health Care Professionals' Perceptions of Caring for Patients with Substance Use Disorders during Pregnancy.

PURPOSE: Pregnant patients with substance use disorders (SUDs) may experience stigma and implicit and explicit bias from health care professionals when seeking prenatal care. This study explored the perceptions of health care professionals caring for pregnant women with SUDs and examined changes in their perceptions over time following attendance at an educational conference about SUDs. STUDY DESIGN AND METHODS: Evidence-based education was presented to health care professionals at a conference to reinforce the complex needs of pregnant women with SUDs. An adapted version of the Attitudes of Healthcare Providers Survey (AHPS) was administered at three intervals and assessed health care professionals' perceptions of pregnant women with SUDs. Data from the three time points were analyzed using repeated measures ANOVA. RESULTS: There was a significant decrease in mean AHPS scores between T1 (38.24 ± 8.93) and T2 (32.71 ± 7.77), p < .05, and then a significant increase in mean AHPS score between T2 and T3 (37.08 ± 8.45), p < .05. High mean scores on health care professionals' knowledge and competence were noted after the educational intervention but were not sustained over time. CLINICAL IMPLICATIONS: Education cannot change health care professional perceptions of pregnant individuals with SUD. Health care professionals need access to additional clinical and community resources. Nurse leaders must continue to advocate for institutional and community resources to meet referral, treatment, and follow-up needs during pregnancy. Reducing perceptions of stigma and acknowledging the impact of implicit bias toward pregnant women with SUD may reduce barriers and improve their care.

Deliberate practice of motor skills in nursing education: CPR as exemplar.

Our study explored the effects of deliberate practice on the retention ofcardiopulmonary resuscitation (CPR) psychomotor skills among nursing students. The practice sessions were short, six minutes a session one time a month. Differences in performance between students who had deliberate practice and a control group, with no practice beyond the initial training, were compared every three months for one year. The intervention group performed better than the control over the 12 months. There is a need in nursing education for deliberate practice of relevant and high-use skills for students to improve their performance and gradually develop their expertise.

Examination of Factors That Contribute to Breastfeeding Disparities and Inequities for Black Women in the US.

Breastmilk is considered the optimal nutrition for newborns. US Black women continue to have the lowest breastfeeding initiation and duration rates. This Perspective examines factors associated with breastfeeding disparities and inequities among Black women through the lens of critical race theory and the social-ecological model. Recommendations to increase breastfeeding rates in this population include increased communication and educational strategies by health care professionals, education to recognize implicit bias and systemic racism in our health care system, early prenatal and ongoing postpartum breastfeeding support, increased community support, and breastfeeding groups developed by and for Black women. In addition, equity policies such as paid maternity leave and work policies that support milk expression would provide needed institutional support for women in the workplace.

Factors Associated with Perceived Insufficient Milk in the First Three Months of Breastfeeding.

PURPOSE: Perceived insufficient milk is the predominant risk factor for early breastfeeding discontinuation globally. The purpose of this study was to explore the association between perceived insufficient milk in the first 3 months and infant factors, maternal factors, professional support, parenting decisions, and breastfeeding concerns. Sixty-nine mothers who had perceived insufficient milk and 301 mothers who did not were included. STUDY DESIGN AND METHODS: A cross-sectional online survey design was used in a convenience sample of 370 U.S. mothers with a healthy singleton infant between 1 and 12 weeks who were breastfeeding directly on the breast as part of their feeding methods. RESULTS: Using stratified multivariable logistic regression, we found that among 102 mothers of infants < 4 weeks of age, planned breastfeeding duration < 6 months (OR = 13.17; 95% CI [1.42, 122.48], p = .024), and concerns about infant crying or fussing (OR = 4.72; 95% CI [1.10, 20.00], p = .03) were associated with perceived insufficient milk. Among 256 mothers of infants 4 to 12 weeks of age, concerns about frequent feedings (OR = 4.05; 95% CI [1.95, 8.40], p = .000) and latching difficulty (OR = 2.95; 95% CI [1.33, 6.54], p = .008) were associated with perceived insufficient milk. CLINICAL IMPLICATIONS: Association between factors and perceived insufficient milk differed based on infant age. Maternal perceptions of crying or fussing, frequent feedings, and latching difficulty need to be assessed because of its attribution to perceived insufficient milk.

HeartCode BLS with voice assisted manikin for teaching nursing students: preliminary results.

The purpose of this study was to evaluate the effectiveness of HeartCode BLS, a self-directed, computer-based course for obtaining basic life support (BLS) certification. For part 2 of the course, students learned and practiced their cardiopulmonary resuscitation (CPR) psychomotor skills on a voice assisted manikin (VAM). Students from 10 schools of nursing were randomly assigned to two types of CPR training: HeartCode BLS with VAM or the standard, instructor-led (IL) course with manikins that were not voice assisted; 264 students trained using HeartCode BLS and 339 had an IL course. When students passed their respective courses and were certified in BLS, their CPR skills were tested using the Laerdal PC SkillReporting System. Students who trained using HeartCode BLS and practiced their CPR skills on VAMs were significantly more accurate in their ventilations, compressions, and single-rescuer CPR than students who had the standard, IL course with regular manikins.

Creating a path: American Indian/Alaska Native high school students pursuing college and a career in nursing.

The purpose of this quantitative descriptive pre- and post-survey study was to analyze four years of data documenting differences in pre- and post-test responses by American Indian/Alaska Native high school students attending a weeklong residency program. The program was designed to provide information and role models to motivate students to go to college and pursue a career in nursing. The survey measured student perceptions of college and nursing. In addition, the analysis included comparisons of responses between students who lived on reservations and those who did not. Results demonstrated that students changed their views of nursing as a profession, how they would be perceived by their tribe, and the financial security they could gain. Students living on their reservations were concerned that college might be too far from home. Recommendations include the need to provide indigenous students with role models and accurate information as well as mentors to support them.

Outcomes of teaching baccalaureate nursing students about mastitis utilizing a multimodal teaching tool.

Annually, 10-33% of U.S. lactating women develop mastitis. Often underreported, mastitis has acute and chronic sequelae with rare documented cases of invasive breast surgery due to pervasive infection. Evidenced-based prevention, early recognition, and treatment of mastitis are not emphasized in the undergraduate nursing profession textbooks or academic settings. Using current evidence-based research on postpartum mastitis, and concepts of maximizing cognition, this pre and post test study examines the knowledge acquired and retained utilizing traditional teaching methods compared to a multimodal teaching video on mastitis with a baccalaureate nursing student population. A significant difference in knowledge acquisition was noted between pre and post tests results. Furthermore, using Benner's novice to expert criteria, baccalaureate student nurses improved their ability to articulate lay and professional descriptions of and treatment for mastitis. These results emphasize the significance of lactation curricula in undergraduate nursing programs and the importance of utilizing multimodal delivery methods.

Exploratory Factor Analysis of the Caffrey Cultural Competency in Health Care Scale.

BACKGROUND AND PURPOSE: The purpose of this study was to psychometrically analyze the Caffrey Cultural Competence in Healthcare Scale (CCCHS), a scale that measures self-assessed cultural competency of nursing students participating in international immersion experiences during their nursing curriculum. METHODS: A sample of 105 health professions students completed the CCCHS. Inter-item correlations, exploratory factor analysis (EFA), and Cronbach's α were used to examine validity and reliability. RESULTS: Results indicated that items were positively related. A 1-factor model of the CCCHS was found in which all items loaded onto a single factor at > .30, except two items dealing with national policy, which may not be a component of cultural competence. CONCLUSION: The CCCHS was internally consistent (α = .93) and is a valid and reliable scale consisting of a unidimensional factor.

Mobility Programs for the Hospitalized Older Adult: A Scoping Review.

Objectives: This scoping review (a) describes programs to improve mobility in hospitalized adults and (b) determines the methods used to measure mobility. Method: The Joanna Briggs Institute Methodology for Scoping Reviews was used to conduct this review. Results: Our findings suggest that using a multidisciplinary approach may be the most effective way to promote mobility in hospitalized older adults. Most studies did not articulate how physical activity was measured, indicating that more research is needed. Discussion: The literature shows that implementation of protocols designed to improve the early and regular implementation of physical mobility activities improves the health outcomes of hospitalized older people. Costs associated with healthcare utilization are also reduced, including hospital length of stay. Mobility programs that quantified mobility through validated measurement tools or accelerometers are the most promising as they provide feedback that reinforces progress of the patient and the expected benefits of early mobility.

Modifiable Factors that Support Political Participation by Nurses.

Political participation is an opportunity for individuals to give their time and energy in such a way that it benefits others and advances relevant agendas. Political participation is a key issue for nurses because they are familiar with clinical issues that directly impact health care policies instituted at the local, state, and federal levels. Collectively, nurses also represent the largest number of health care providers in the United States and are among the most trusted health professionals. However, there are many obstacles that prevent nurses from taking a more active role in politics, creating a gap in how nurses pursue and respond to political participation, or civic engagement. The purpose of this exploratory review is to identify modifiable factors that support political participation among nurses. A review of the extant literature revealed three primary factors that promote civic engagement among nurses: (a) integration of political education in the nursing curriculum; (b) value of active psychological engagement, including a personal interest in political knowledge and information; and (c) value of collective influence such as membership in professional organizations.

Training for the Air Force fitness assessment: the experience of postpartum women.

Active duty personnel in the U.S. Air Force (USAF) are required to pass periodic fitness assessments in order to facilitate and evaluate physical readiness. Pregnant women are exempt from testing but must take the fitness test 6 months after childbirth. However, evidence from prior research indicates that in the first 6 months postpartum, women may not achieve prepregnancy fitness levels and may be more vulnerable to mental and physical health problems. It is important for health care clinicians to understand how training for the USAF fitness test after childbirth may impact health and well-being. The purpose of this study was to develop a deep understanding of the experiences of postpartum USAF women as they train for their fitness assessment. Understanding was sought through a phenomenological study by interpreting the meaning of the lived experiences of 17 active duty women at two USAF bases. Two overarching patterns emerged from this analysis: "Striving to Perform under Pressure through Profound Life Transitions of Childbirth" and "Seeking Understanding from Others." These results provide insight into the challenges postpartum women encounter while training for their fitness assessments, and they can inform practices that facilitate efforts of women in returning to optimal fitness and well-being.

Grand Multiparous Women's Perceptions of Birthing, Nursing Care, and Childbirth Technology.

This qualitative descriptive study explored grand multiparous women's perceptions of the evolving changes in birthing, nursing care, and technology. A purposive sample of grand multiparous women (N = 13) from rural, eastern Washington State were interviewed as they shared their 105 birth stories. Eight themes were identified: (1) providing welcome care, (2) offering choices, (3) following birth plans, (4) establishing trust and rapport, (5) being an advocate, (6) providing reassurance and support, (7) relying on electronic fetal monitors and assessments versus nursing presence, and (8) having epidurals coupled with loss of bodily cues. Results from this study may be used to educate women, intrapartum nurses, and childbirth educators on nursing care and on the evolving use of technology to better manage intrapartum care in hospitals. The results can also add to the extant knowledge of childbirth nursing practices.

Preparing parents for NICU discharge: an evidence-based teaching tool.

Preparation for discharge and transition to parents' care of infants hospitalized in the neonatal intensive care unit (NICU) is a process that begins on admission. Identifying parents' educational needs requires thoughtful assessment by experienced nurses. Caring for these infants can be daunting to parents, and participating in a discharge class can be very helpful in easing the transition to home. This article describes a NICU discharge informational DVD/video that was developed to deliver parent education and promote informed and safe transition from hospital to home.