'We are suffering. Nothing is changing.' Black mother's experiences, communication, and support in the neonatal intensive care unit in the United States: A Qualitative Study.

OBJECTIVES: Black mothers experience markedly disproportionate maternal morbidity and mortality in the United States, with racism often cited as the root cause manifesting through several pathways. The study examined Black mothers' perceived provider communication, support needs, and overall experiences in the neonatal intensive care unit (NICU). DESIGN: This study used grounded theory embedded in the Black feminist theoretical (BFT) framework to generate new ideas grounded in the data. Data was collected through semi-structured interviews using videoconferencing, with questions related to the mother's overall NICU experiences, communication within the NICU, and perceived support needs. Data were analyzed using thematic analysis. RESULTS: Twelve mothers participated in the study; most were married (n = 10), had a cesarean birth, had a previous pregnancy complication (e.g., diabetes, hypertension), had attained a graduate degree or more (n = 9), earned an annual household income of $75,000 or more, and were between 35-44 years of age (n = 7). Three broad domains with several accompanying themes and sub-themes were identified, explicating the mother's experiences in the NICU. Specifically, factors influencing NICU hospitalization for mothers included maternal care/nursing experiences, interactions in the NICU, and the perceived support need that might attenuate negative care and birthing experiences. . CONCLUSION: The study adds to the growing literature championing Black maternal health equity and multilevel quality improvement strategies to foster equitable maternal health. Our study reinforces the need for racially congruent interventions and policy reformations to protect Black birthing people regardless of socioeconomic factors and social class using life course, holistic approaches, and intersectionality mindset. Importantly, using the BFT, this study calls for culturally sensitive research to capture the nuances associated with the multiplicity of experiences of Black people.

Patient-Centered Care Through Nurse Practitioner-Led Integrated Behavioral Health: A Case Study.

Integrated behavioral health can improve primary care and mental health outcomes. Access to behavioral health and primary care services in Texas is in crisis because of high uninsurance rates, regulatory restrictions, and lack of workforce. To address gaps in access to care, a partnership formed among a large local mental health authority in central Texas, a federally designated rural health clinic, and the Texas A&M University School of Nursing to create an interprofessional team-based health care delivery model led by nurse practitioners in rural and medically underserved areas of central Texas. Academic-practice partners identified 5 clinics for an integrated behavioral health care delivery model. From July 1, 2020, through December 31, 2021, a total of 3183 patient visits were completed. Patients were predominantly female (n = 1719, 54%) and Hispanic (n = 1750, 55%); 1050 (33%) were living at or below the federal poverty level; and 1400 (44%) were uninsured. The purpose of this case study was to describe the first year of implementation of the integrated health care delivery model, barriers to implementation, challenges to sustainability, and successes. We analyzed data from multiple sources, including meeting minutes and agendas, grant reports, direct observations of clinic flow, and interviews with clinic staff, and identified common qualitative themes (eg, challenges to integration, sustainability of integration, outcome successes). Results revealed implementation challenges with the electronic health record, service integration, low staffing levels during a global pandemic, and effective communication. We also examined 2 patient cases to illustrate the success of integrated behavioral health and highlighted lessons learned from the implementation process, including the need for a robust electronic health record and organizational flexibility.

Religiosity and Health: A Holistic Biopsychosocial Perspective.

The resurgence of interest in the influence of religion and spirituality on health is examined within the context of the holistic paradigm and historical connection between nursing and spirituality. While nursing and spirituality often intersect with end-of-life considerations, this article presents findings from studies that demonstrate that religious involvement favors health and longevity across the life course. Examples include protective associations with stress, depression, self-rated health, and infant birth weight. Theoretical and empirical explanations for this relationship are offered, such as social and psychological resources and healthy behaviors. The effects of religion on biological functioning, including allostatic load and telomere length, are also discussed, although this area is understudied. Considerations for the "dark-side" of religious involvement are also offered. Suggestions for nurses wishing to protect and promote the health of their patients using a holistic approach include expanding knowledge of research on religion and health and advocating for patients' spiritual needs by conducting a comprehensive spiritual assessment in primary, secondary, and tertiary clinical settings.

Acculturation in Mexican immigrants: a concept analysis.

The concept of acculturation in Mexican immigrants was analyzed using the concept analysis technique developed by Walker and Avant. The related concepts for acculturation are assimilation, separation, and marginalization. The defining attributes identified for acculturation are original cultural identity, exposure to a culture different from one's own, and changes in the behavioral, affective, and/or cognitive domains of one's functioning after exposure to a new culture. An antecedent for acculturation is that identification with one's culture of origin must be well established. Another antecedent is the willingness to modify one's original cultural identity. Transition is identified as a consequence of acculturation. Acculturation is a complex, multifaceted concept and cannot be adequately captured by measures that use language preference alone. Other factors such as social class, employment, education, and income should also be considered when acculturation is a factor in nursing practice and research.