Hats Off for Full-Term Healthy Newborns: No Benefits for Thermoregulation.

BACKGROUND: Hyperthermia is a known risk for sudden unexpected infant death. The practice of hat placement at birth to prevent transient hypothermia may not be necessary and sets an early standard for clothing infants that may lead to hyperthermia postnatally. OBJECTIVE: To examine the elimination of hats on thermoregulation (eg, hypothermia, <97.6°F) in full-term newborns with no abnormalities within 24 hours of birth. METHODS: In 2018, an institution guideline discontinued the use of hats at birth. Subsequently, newborn body temperatures were respectively extracted from electronic health records and data were compared from 482 infants (>38 weeks' gestation and newborn birth weight >2500 g) prior to ( n = 257) and following ( n = 225) the practice change. Body temperatures prior to and after the practice change to eliminate hats use were compared. RESULTS: No statistically significant difference was observed: (1) in the proportion of infants experiencing hypothermia with or without hat use, respectively, 23.7% compared with 31.1% ( P = .09) and (2) in the odds of an infant experiencing hypothermia when adjusting for relevant covariates (odds ratio = 1.44; 95% confidence interval 0.89-2.32; P = .14). CONCLUSIONS: Our findings demonstrate that the use of hats on infants at birth had no measurable impact on newborn thermoregulation.

The Perspectives of Volunteer Counselors of Korean Immigrant Women Experiencing Intimate Partner Violence.

This study investigates what needs to be considered in our current health services to appropriately respond to abused Korean immigrant women. Using a community-based participatory approach, this qualitative interpretive description analyzed counseling documents and semi-structured interviews. Data analyses suggested that intimate partner violence (IPV) screening for ethnic minority women in health care settings can be improved by informing patients about the role of health care providers in addressing IPV, establishing rapport before IPV screening, assuring confidentiality is maintained, respecting Korean immigrant women's unique perspectives and response toward IPV, providing translation services, and collaborating with ethnic minority women's community organizations.

Bridging nursing practice and education through a strategic global partnership.

To forge strong relationships among nurse scholars from the University of Pennsylvania School of Nursing, Philadelphia, PA (USA); University of Botswana School of Nursing, Gaborone, Botswana; the Hospital of the University of Pennsylvania, Philadelphia; Princess Marina Hospital (PMH), Gaborone; and the Ministry of Health of Botswana, a strategic global partnership was created to bridge nursing practice and education. This partnership focused on changing practice at PMH through the translation of new knowledge and evidence-based practice. Guided by the National Institutes of Health team science field guide, the conceptual implementation of this highly successful practice change initiative is described in detail, highlighting our strategies, challenges and continued collaboration for nurses to be leaders in improving health in Botswana.

Subject Matter Expert Nurses in Safe Sleep Program Implementation.

BACKGROUND: Pennsylvania sudden unexpected infant death rates rank among the highest nationally. A nursing team developed, implemented, evaluated, and disseminated an evidence-based quality improvement (QI) program at birthing hospitals in Pennsylvania to address this issue. To facilitate implementation, clinical nurses were educated as Subject Matter Experts (SMEs) to empower them to transform and sustain outcomes-driven QI for infant safe sleep nursing practice. METHODS: This descriptive study examined outcomes from 268 nurses who received comprehensive education on infant safe sleep and the SME role. Likert-type scale surveys measured knowledge gained and progress made in practice following education. A programmatic dashboard tracked program implementation. Descriptive statistics were used to report findings. INTERVENTION: SME nurses ( N = 268) completed two interactive learning modules addressing safe sleep guidelines and teaching strategies and attended a workshop to acquire skills for program implementation. Key competencies included data collection and dissemination, policy development, and communication techniques. RESULTS: Immediate posteducation surveys completed by SMEs indicated that over 98% of respondents strongly agreed or agreed they were able to effectively demonstrate communication strategies, identify SME role components, provide environment surveillance, and demonstrate best practices in infant safe sleep. To allow time for assimilation of the of SME role, a survey was initiated at 6 months to capture progress made. Seventy-eight SMEs responded to the survey and reported exceptional or substantial progress in 10 areas for SME responsibilities. CONCLUSION: Use of the SME role for program implementation led to highly favorable SME-reported outcomes in leading a hospital-based QI program.

The health of women and girls determines the health and well-being of our modern world: A white paper from the International Council on Women's Health Issues.

The International Council on Women's Health Issues (ICOWHI) is an international nonprofit association dedicated to the goal of promoting health, health care, and well-being of women and girls throughout the world through participation, empowerment, advocacy, education, and research. We are a multidisciplinary network of women's health providers, planners, and advocates from all over the globe. We constitute an international professional and lay network of those committed to improving women and girl's health and quality of life. This document provides a description of our organization mission, vision, and commitment to improving the health and well-being of women and girls globally.

Maternal Sleepiness and Risk of Infant Drops in the Postpartum Period.

BACKGROUND: An increase in infant drops on a postpartum unit prompted a quality improvement project to examine causes and formulate risk reduction strategies. Review of health records revealed that infant drops occurred more frequently when mothers fell asleep holding infants. METHODS: A prospective descriptive study was conducted with a convenience sample of 101 postpartum mother-infant dyads. Hourly assessments of maternal sleepiness using the Stanford Sleepiness Scale (SSS) and surveillance of patient rooms were performed during hospitalizations (N = 4,550 observations). RESULTS: Mothers slept on average 3.7 hours/day (median = 5.0). Sleepiness followed an expected nighttime routine on postpartum day 1 regardless of when mothers arrived on the unit. Peak sleepiness was observed at 04:00 (mean SSS score = 5.3; standard deviation [SD] = 2.6), and mothers were most awake until 18:00 (mean SSS score = 1.9; SD = 1.7). No infant drops occurred during the project; however, 50 participants required at least one intervention or corrective action to address unsafe sleep. Of 1,718 observations of mothers in bed with their infant, there were 35 instances (2.0%) where nurses observed mothers asleep holding their infant. CONCLUSION: Frequent observations of maternal sleepiness and infant environments may prevent infant drops and provide opportunities for intervening with risk reduction strategies, including education on safe sleep for infants.

Symptoms described by African American women evaluated for preterm labor.

OBJECTIVE: To describe symptoms, self-care for symptoms, and lay consultations of African American women later diagnosed with a likelihood of preterm labor (PTL). DESIGN: Qualitative descriptive study. SETTING: Two sites within the United States, one urban and one suburban high-risk maternity referral center. PARTICIPANTS: Twenty-five African American women presenting for emergent care and subsequently diagnosed as "rule out PTL." Five of the women later delivered before 37 weeks gestation, of whom 4 had a preterm low-birthweight infant (

Usability and Acceptability of Everhealthier Women, a Mobile Application to Enhance Informed Health Choices.

OBJECTIVE: To explore women's use and acceptance of Everhealthier Women, a mobile health (mHealth) application (app) designed to provide women with easy access to preventive health information and to promote adherence to life-saving clinical screenings and disease prevention behaviors. DESIGN: Qualitative descriptive study. SETTING: A Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) office in a large Northeastern U.S. city. PARTICIPANTS: Fifteen low-income women ages 18 to 30 years who used WIC services. METHODS: Participants completed a baseline survey regarding their use of technology to obtain health information. Next, they received an introductory session to Everhealthier Women on a mobile device by a study staff member and individually explored the app. Afterward, they completed a questionnaire in the waiting room to assess their initial views on the acceptability and usefulness of the app. Participants were then contacted over a period of 3 weeks to elicit feedback about their app use through a series of open-ended questions. Descriptive statistics were calculated, and content analysis was performed. RESULTS: Fourteen of the 15 participants reported using the Internet to search for health information in the past. Seven participants had used mHealth apps, and 14 believed that Everhealthier Women was easy to navigate and beneficial for women of all ages. They reported being more likely to use the app if it was recommended by a friend or health care provider. The app was mainly used to search for health information and set appointment reminders. CONCLUSION: mHealth apps can be powerful public health tools; however, evidence should inform their development. Research about specific apps, such as Everhealthier Women, advances our knowledge about the benefits of mHealth and implementation challenges and could inform stakeholders of the optimal level of investment in new technologies. Consideration of financial, time, and personal constraints is needed to evaluate the use of mHealth apps by economically disadvantaged populations.

New guidelines for maternal and neonatal resuscitation.

New evidence has prompted changes in our national cardiopulmonary resuscitation guidelines for both neonates and adult patients. The purpose of this article is to provide an overview of the changes recommended by the American Heart Association, Academy of American Pediatrics, and the American College of Obstetrics and Gynecology. In addition, a strategy for implementing these guidelines into practice is suggested.

Obesity and the association with maternal mental health symptoms.

OBJECTIVE: To evaluate the association between maternal obesity and mood disorders including depression, anxiety, stress, and pregnancy-specific stress during pregnancy. STUDY DESIGN: This was a planned secondary analysis of a prospective cohort study investigating factors associated with preterm delivery. The cohort included women who initiated prenatal care before 20 weeks with a singleton pregnancy. Maternal mental health was assessed using four standard psychosocial behavioral measures to screen for depression, pregnancy-specific stress, anxiety, and stress. Screen positive scores for each tool were established based on previously published "high" scores. RESULTS: Of the 1010 women included in the cohort, 355 (35.1%) were obese. There was no significant difference in the number of obese women with stress (64.2% versus 68.4%, p = 0.18), pregnancy-specific stress (26.2% versus 22.1%, p = 0.15), or anxiety (38.6% versus 41.2%, p = 0.42); however, a greater number of obese women did report symptoms consistent with major depression when compared to women with BMIs <30 (30.4% versus 21.2%, p < 0.01). CONCLUSION: Obese women had higher rates of depression in early pregnancy compared to nonobese women. As many of the health behavior interventions for obese women during pregnancy have proven ineffective, incorporating depression screening and treatment into prenatal care may improve perinatal outcomes.

Acceptance of hepatitis B vaccination by pregnant adolescents.

PURPOSE: To determine (1) the rate of prenatal hepatitis B virus (HBV) vaccine acceptance in HBV nonimmune pregnant adolescents, (2) if postulated behavioral and attitudinal factors are associated with HBV vaccine, and (3) the rate of actual receipt of HBV vaccine postpartum in eligible subjects. DESIGN AND METHODS: During 1999-2000, at an inner-city tertiary-care center prenatal clinic, 160 HBV nonimmune adolescents <18 years who were receiving prenatal and delivery care at the center were identified. The research nurse provided an HBV information pamphlet and offered immediate in-hospital postpartum HBV vaccination. Risk factors for nonacceptance of the vaccine were measured with structured questionnaires and medical record review documenting care attendance. Subsequently, all subjects, irrespective of prenatal acceptance of vaccine, were offered vaccine before postpartum discharge, and the rate of actual acceptance was determined. RESULTS: In these predominantly African American (95%) adolescents, the rate of vaccine acceptance was 91%. Actual vaccination rate was 86%, but it was not associated with prior acceptance of vaccination or behavioral or attitudinal factors. CLINICAL IMPLICATIONS: Acceptance of vaccination and actual vaccination were high in this population of high-risk adolescents. The authors found that reoffering vaccine was a successful intervention, even with adolescents who had less-than-optimal attendance at prenatal visits. Given the high rate of acceptance and vaccination in this setting, the authors would encourage public health programs to implement vaccination programs in adolescent prenatal clinics and to offer vaccination postpartum to those who do not receive it prenatally.

The cost of prenatal care attendance and pregnancy outcomes in low-income working women.

OBJECTIVE: To examine personal costs (dollar costs and time spent) associated with prenatal care (PNC) attendance and outcomes (gestation length, PNC adequacy, and birth weight) for low-income, working women (N = 165). DESIGN: Prospective, descriptive study. SETTING: Participants were recruited from a pre-natal clinic located at an inner city tertiary care center. PARTICIPANTS: A convenience sample of 165 low-income, working women. MAIN OUTCOME MEASURES: Personal costs were measured as dollar costs and time spent associated with PNC attendance. Perinatal outcomes were measured as gestation length, PNC adequacy, and birth weight. RESULTS: Per visit, the mean cost associated with PNC was 33.31 dollars (range 1-125.60 dollars, SD = 32.33 dollars) and the time needed to attend care was 228 min (20-720, SD = 205). Women delivered at 37.8 (18-42) weeks; 17.6% of the women received inadequate PNC, and 17.0% of the women delivered low-birth-weight newborns. CONCLUSIONS: The findings indicated that personal costs associated with PNC attendance were not associated with inadequate care attendance.

Limited obstetric ultrasound examinations: competency and cost.

OBJECTIVE: To determine both the actual dollar cost and the amount of time required per nurse to establish competency in limited obstetric ultrasonography (LOBU). DESIGN: Descriptive. SETTING: A tertiary care setting. PARTICIPANTS: Registered nurses who were taught in LOBU. RESULTS: Nurses who attained competency in LOBU completed 12 hours of didactic education and a clinical practicum consisting of 6 to 9 hours and approximating 15 ultrasound scans. For five nurses to concurrently attain competency in LOBU, the cost per nurse was $1,037.55 (includes salaries and employee benefits). CONCLUSION: Registered nurses are able to acquire competency in LOBU at a reasonable cost, thus enhancing the ability of the professional nurse to deliver a fuller scope of services in an obstetric setting. For institutions that have limited access to individuals with this skill, nurses trained in LOBU may present a high-quality, cost-efficient solution to providing needed obstetric services.

Pain assessment and intervention for term newborns.

A baseline assessment of pain should occur as part of a newborn's health assessment within the first few hours of life. Validation and assessment of pain in the term newborn is important for providing care because newborns may experience pain from a multitude of procedures, ranging from heel sticks to circumcisions. Current assessment tools evaluate both behavioral and physiologic parameters. In addition, providing individualized care requires a knowledge base of the interventions available to reduce or eliminate pain, such as breastfeeding, non-nutritive suck, skin-to-skin contact, and sucrose pacifiers. This article describes three newborn pain assessment tools, the use of valid assessment tools, and evidence-based interventions that are recommended to effectively manage newborn pain.

Nursing care of the patient with preterm premature rupture of membranes.

Preterm premature rupture of the membranes (PPROM) is diagnosed when rupture of the amniotic membranes occurs prior to the completion of the 36th week of gestation. PPROM accounts for 25% of all cases of premature rupture of the membranes and is responsible for 30%-40% of all preterm deliveries. In mothers diagnosed with PPROM without evidence of infection, active labor, or fetal compromise, the current standard of care is expectant management. The goal of expectant management is the prolongation of the pregnancy to increase fetal gestational age thus potentially decreasing the effects of prematurity. Expectant management consists of ongoing observation for signs and symptoms of infection, active labor, and/or nonreassuring fetal status. This article provides clinical nursing guidelines for the mother diagnosed with PPROM who is managed expectantly. Eight targeted areas for nursing assessment and intervention are described: preterm labor, side effects of tocolytic therapy, maternal/fetal infection, fetal compromise, side effects of extended bed rest, maternal stress, educational needs, and routine prenatal care.

Technology in the birthing room.

The use of technology is not benign. As with any health care intervention, there are associated risks and benefits. The practitioner needs to constantly consider the benefits of the technology versus the naturalistic birth experience. The use of technology should optimize birth outcomes while maintaining a balance that provides for the best possible human birth experience. Technology, however, does have merit in the birth setting, regardless of location, but its use should be evaluated on an individual, as needed, basis. The most common technological advances currently available for assessment and maternal/fetal care during birth include electronic fetal monitoring, ultrasonography, blood pressure screening, maternal/fetal pulse oximetry, and infusion pumps. All obstetrical care providers must be familiar with the forms of technology currently available and be aware of emerging technologies for use during the birthing process.

Response to homeless childbearing women's health care learning needs.

The study findings showed that homeless childbearing women are at greatest risk for cancer, violence, poor nutrition, sexually transmitted infections, unplanned pregnancy, and adverse pregnancy outcomes. Collaborating with personnel at a women's shelter, the authors studied homeless childbearing women's knowledge, attitudes, and beliefs about general health promotion, healthy pregnancy promotion, and preterm labor prevention. Guided by the Integrative Model of Behavioral Prediction and Change, 45 homeless women participated in focus groups. They were 28.7 years old (range 18-44 years), and approximately 87% of these women had custody of their children. Three themes identified included things you do to stay healthy during pregnancy, where you learned about staying healthy, and women's knowledge about preterm labor and general health promotion. These findings informed an 8-week educational session (1 hr/week). During the past year, four 8-week sessions were conducted with attendance between 8 and 14 participants. Each week a different health topic was discussed incorporating the associated unique challenges of homelessness.

Determining a threshold for amniotic fluid as a predictor of perinatal outcome at term.

OBJECTIVE: To determine a threshold level of amniotic fluid in low-risk term pregnancies predictive of adverse perinatal outcome. METHODS: Prospective cohort study of low-risk patients at term undergoing amniotic fluid volume measurement. Amniotic fluid index (AFI) remained blinded unless ≤ 1 cm or ≥ 25 cm. Primary outcome was a positive fetal vulnerability index (FVI). The last AFI was evaluated as predictor of a +FVI. We estimated that we needed to perform ultrasounds on 620 women. RESULTS: Patients were enrolled through 2004-2008. There were 24 (7.8%) patients delivering a neonate with +FVI. An AFI < 8 cm increased the risk of a +FVI (risk ratio 2.70 [95% CI 1.2, 6.0]; p = 0.01); however, the area under the receiver operating characteristics curve was 0.60. Enrollment was stopped at 308 patients due to enrollment challenges. CONCLUSIONS: An AFI cutoff <8 cm was associated with an increase in FVI outcomes but had a low positive predictive value for a +FVI. Isolated incidentally found low fluid in uncomplicated pregnancies may not be an indication for immediate intervention.