Exploration of the Vaginal and Gut Microbiome in African American Women by Body Mass Index, Class of Obesity, and Gestational Weight Gain: A Pilot Study.

OBJECTIVE: This study determines the differences in the distal gut and vaginal microbiome in African American (AA) women by prepregnancy body mass index and gestational weight gain (GWG) comparing women with and without obesity and by obesity class. STUDY DESIGN: We prospectively sampled the vaginal and distal gut microbiome in pregnant AA women at two time points during pregnancy. Samples were analyzed using high-throughput sequencing of the V4 region of the 16S ribosomal ribonucleic acid gene. RESULTS: Distinct differences in vaginal and distal gut α-diversity were observed at time point 1 between women with and without obesity by total GWG. Significant differences in distal gut ß-diversity were also found at time point 1 in obese women by GWG. Within the Bacteroides genus, a significant association was observed by total GWG among obese women which was absent in nonobese women. Women with class III obesity who experienced low GWG had the lowest abundance of distal gut Bacteroides and appreciably higher relative abundance of a consortia of vaginal taxa including Atopobium, Gardnerella, Prevotella, and Sneathia. CONCLUSION: These results contribute new evidence showing that GWG in combination with obesity and obesity class is associated with an altered distal gut and vaginal composition early in pregnancy among AA women.

Experience of neonatal intensive care unit nurses in providing developmentally-supportive care: A qualitative study.

Many challenges have been noted in the implementation of developmentally-supportive care principles in neonatal intensive care units, despite evidence that adhering to such care principles achieves positive results for the neonate. The aim of this study was to explore and describe compliance in adhering to developmentally-supportive care principles implemented in one neonatal intensive care unit in South Africa. An exploratory design was used in this qualitative study with purposive sampling to select eligible neonatal intensive care registered nurses (n = 14) as participants. Participants all worked in a 10 bed neonatal intensive care unit at a large tertiary care public hospital. Six audio-recorded interviews were conducted, with recordings subsequently transcribed and analyzed. Three main themes were identified: value of developmentally-supportive care, nature of developmentally-supportive care, and barriers to developmentally-supportive care. One of the main themes had subthemes, which substantiated the findings, and included parent involvement, nurse engagement, and holistic care. Study outcomes offer insight into the development or revision of policies and practices, which are crucial when implementing developmentally-supportive care, particularly in resource-poor settings where challenges are magnified.

Nature and scope of certified nurse-midwifery practice: A workforce study.

AIMS AND OBJECTIVES: To describe the nature and scope of nurse-midwifery practice in Texas and to determine legislative priorities and practice barriers. BACKGROUND: Across the globe, midwives are the largest group of maternity care providers despite little known about midwifery practice. With a looming shortage of midwives, there is a pressing need to understand midwives' work environment and scope of practice. DESIGN: Mixed methods research utilising prospective descriptive survey and interview. METHODS: An online survey was administered to nurse-midwives practicing in the state of Texas (N = 449) with a subset (n = 10) telephone interviewed. Descriptive and inferential statistics and content analysis was performed. RESULTS: The survey was completed by 141 midwives with eight interviewed. Most were older, Caucasian and held a master's degree. A majority worked full-time, were in clinical practice in larger urban areas and were employed by a hospital or physician group. Care was most commonly provided for Hispanic and White women; approximately a quarter could care for greater numbers of patients. Most did not clinically teach midwifery students. Physician practice agreements were believed unnecessary and prescriptive authority requirements restrictive. Legislative issues were typically followed through the professional organisation or social media sites; most felt a lack of competence to influence health policy decisions. While most were satisfied with current clinical practice, a majority planned a change in the next 3 to 5 years. CONCLUSIONS: An ageing midwifery workforce, not representative of the race/ethnicity of the populations served, is underutilised with practice requirements that limit provision of services. Health policy changes are needed to ensure unrestricted practice. RELEVANCE TO CLINICAL PRACTICE: Robust midwifery workforce data are needed as well as a midwifery board which tracks availability and accessibility of midwives. Educators should consider training models promoting long-term service in underserved areas, and development of skills crucial for impacting health policy change.

Compassion fatigue in nurses: A metasynthesis.

AIMS AND OBJECTIVES: To interpret the body of qualitative work focusing on compassion fatigue to distil a common understanding that could then be applied to nursing care. BACKGROUND: Complex demands place extraordinary stress on nurses struggling to work in overburdened healthcare systems. The result can be the inability to care well for others, leading to compassion fatigue, burnout and increased numbers leaving the profession. Metasynthesis offers a means of more fully illuminating compassion fatigue and further understanding of practices which might reduce its negative consequences. DESIGN: Metasynthesis. METHOD: As a method designed to facilitate knowledge development, metasynthesis allowed for integration of qualitative study findings conducted between 1992-2016 using defined search terms. Six databases were searched for articles published in English. Nine papers met the criteria for review and metasynthesis was conducted using the meta-ethnographic approach detailed by Noblit and Hare. RESULTS: Four themes related to compassion fatigue were found by consensus discussion. The themes included: physical ("just plain worn out") and emotional symptoms ("walking on a tightrope"), triggering factors ("an unbearable weight on shoulders" and "alone in a crowded room"), and measures to overcome/prevent ("who has my back?"). CONCLUSIONS: Compassion fatigue is a concept of documented relevance to those in nursing and represents a basic inability to nurture others and engenders a temporal component. Synthesis of studies provides evidence of the veracity of the concept for application to clinical practice and research related to nursing care. RELEVANCE TO CLINICAL PRACTICE: Findings provide insight into the clinical milieu needed to prevent compassion fatigue. A theoretical model is presented which can be used to guide future research, as well as the creation of clinical practice policies which might mitigate the development of compassion fatigue and its potential consequences.

Selecting An Open Access Journal for Publication: Be Cautious

Nurse scholars and clinicians seek to publish their research and scholarly findings to strengthen both nursing science and clinical practice. Traditionally subscription-based publications have been the mainstay of knowledge dissemination. However, subscription costs have tended to restrict access to many journals to a small, specialized, academic community, a limitation that has contributed to the development of open access (OA) publications. OA journals have a powerful appeal as they allow greater access to scholars and consumers on a global level. However, many OA journals depend on an author-pays model that may lead to unintended and undesirable consequences for authors. Today, it is easier than ever to share scholarly findings, but authors need to be vigilant when selecting a journal in which to publish. In this article, we discuss the background of open access journals and describe key consideration to distinguish between reputable publications and those that may lead authors astray. We conclude that despite controversy and concerns related to publishing in OA journals, these journals do provide opportunities for researchers and clinicians to raise the profile of their work and ensure a robust, scholarly communication system.

Trends in Practice Patterns and Perspectives of Colorado Certified Nurse-Midwives.

Healthcare resources are stretched perilously thin and the demand for primary healthcare services has never been greater. Despite this demand for service, relatively little is known about the practice environment of primary healthcare providers, particularly certified nurse-midwives (CNMs), where workforce surveys frequently include these specialists within the broader nurse practitioner category. A distinct professional discipline, nurse-midwives are one type of primary care provider recommended to enhance access to services. The objective of this study was to understand the nature of the nurse-midwifery practice environment in the state of Colorado. Online survey of Colorado CNMs (N = 328) found little ethnic/racial diversity and an aging workforce, with most providing care in an urban, hospital/medical center environment. Several key legislative issues were identified though respondents felt ill prepared to engage in legislative change. Overall, CNMs were optimistic about the future of midwifery and were largely satisfied with their practice.

Fordyce happiness training program on the competence of mothers of premature infants admitted to the NICU from Middle East: A quasi-experimental study.

The purpose of this study was to determine the effect of the Fordyce Happiness Training Program on the parental competence of mothers of premature infants admitted to the neonatal intensive care unit (NICU). This quasi-experimental study was performed on 80 mothers of premature infants who were admitted to a NICU in Iran. Mean Parenting Sense of Competence Scale (PSOC) scores of participants in the intervention group before and after training were 61.32 ± 6.44 and 68.52 ± 2.52. Mean PSOC scores for those in the control group before and after the intervention were 64.47 ± 11.08 and 65.30 ± 6.90, respectively. The two groups showed significant differences in terms of parental competence after the happiness training program (p = 0.0001). NICU admission of a premature baby not only has a negative effect on the mother's emotional state but it can also adversely affect the parental sense of competence. Therefore, considering the psychological needs of mothers of premature infants, it is worth considering implementation of programs such as Fordyce Happiness Training, to promote and maintain the mental health of mothers.

Midwives, labour induction and the Wooden Spoon award Part 2.

Rates of labour induction without clear medical indication have risen exponentially. This trend has not been without consequence of increased perinatal mortality and morbidity. Midwives must understand the importance of educating pregnant women and other obstetrical providers, about the risks associated with labour induction. Maternal-child health policy that minimises unnecessary interventions is urgently needed and prevention strategies are described in the second part of this article. Midwives are challenged to consider their role in reducing unnecessary labour inductions in a rapidly changing birth culture reflecting high intervention.

Midwives, labour induction and the Wooden Spoon award part I.

Labour induction rates have rocketed, largely due to consumer demands and provider convenience. This increase has been a significant factor in rapidly increasing caesarean birth rates and adverse perinatal outcomes. It is important that midwives understand the risks associated with labour induction. The article overviews those factors contributing to increasing induction rates and the associated risks. Midwives are challenged to consider the evidence for an intervention contributing to a cascade of birth interventions.

Effect of Rubus idaeus L. Consumption During Pregnancy on Maternal Mice and Their Offspring.

The trigger for human labor is a scientific mystery. This research examined Rubus idaeus (RI), commonly referred to as red raspberry, which is widely purported to be efficacious in promoting parturition processes and favorable birth outcomes. This randomized controlled trial sought to determine the influence of RI consumption during gestation on C57BL/6N Tac mice and their offspring. The aims of this study were to (1) determine differences in the length of gestation, gestational weight gain, and litter size where RI is consumed daily at varied strengths and (2) determine differences in offspring characteristics and behavior where maternal RI consumption occurred. Once paired, mice were randomly assigned to one of three groups: placebo (n = 10) receiving plain water, RI aqueous extract fluid of 1.78 mg/mL (n = 10), or RI aqueous extract fluid of 2.66 mg/mL (n = 10). All received the same standardized diet throughout gestation. Pregnant mice were weighed with chow intake and fluid consumption determined daily. Gestation length and litter size were recorded at the time of birth. Differences in offspring characteristics were also determined and included physical characteristics (weight, physical development) and neuromotor reflexes and behaviors (locomotive abilities, geotaxis reflex, cliff avoidance reflex, and swimming development). When compared with controls, high-dose RI ingestion resulted in shorter length of gestation and smaller litter size (P ≤ .05). There was also an increase in fluid consumption and a decrease in pup weights on postnatal day 4 and 5 with RI treatment (P ≤ .05). Altogether, results suggest that RI influences parturition and fecundity processes with transplacental exposure impacting offspring characteristics.

A concept analysis of self-leadership: The "bleeding edge" in nursing leadership.

AIM: To explore the concept of self-leadership in nursing. Self-leadership, while frequently referenced, has not been clearly defined in either the literature or within nursing. DESIGN: Common language sources were reviewed, along with literature searched from 2017 to 2019 using seven electronic databases: CINAHL, EbscoHost, Sabinet, ScienceDirect, ProQuest, Nexus, and Academic Complete. Database searches yielded 10 articles. REVIEW METHODS: Walker and Avant's method of concept analysis was modified, as suggested by Risjord. RESULTS: Reviews of the broad literature demonstrated that self-leadership is the creation of a space for the individual with self-awareness to live a better self through reflective consciousness. The multidimensionality of work and blurring of boundaries between work and living has prompted the individual to understand their own qualities or abilities. The individual has a true sense of who they are and what they think and feel. This shift in leadership refocuses on a more desirable way of living and envelopes being a master of one's own destiny. CONCLUSION: Analytic work provides support for a middle-range explanatory theory that engenders self-awareness, taking the lead, and personal satisfaction. Explication of the concept and the relevance to professional nursing gives direction for future research.

Experience of midwives in providing care to labouring women in varied healthcare settings: A qualitative study.

BACKGROUND: Midwives are essential to timely, effective, family-centred care. In South Africa, patients have often expressed dissatisfaction with the quality of midwifery care. Negative interpersonal relationships with caregivers, lack of information, neglect and abandonment were consistent complaints. Less is known about how midwives experience providing care. AIM: This research explored and described the experiences of midwives in providing care to labouring women in varied healthcare settings. SETTING: Midwives practicing in the Gauteng province, South Africa, in one of three settings: private hospitals, public hospitals or independent maternity hospital. METHODS: A convenience sample of midwives (N = 10) were interviewed. An exploratory and descriptive design, with individual semi-structured interviews conducted, asked a primary question: 'How is it for you to be a midwife in South Africa?' Transcribed interviews were analysed using thematic coding. RESULTS: Five themes were found: proud to be a midwife, regulations and independent function, resource availability, work burden and image of the midwife. CONCLUSION: Midwives struggle within systems that fail to allow independent functioning, disallowing a voice in making decisions and creating change. Regardless of practice setting, midwives expressed frustration with policies that prevented utilisation consistent with scope of practice, as well as an inability to practice the midwifery model of care. Those in public settings expressed concern with restricted resource appropriation. Similarly, there is clear need to upscale midwifery education and to establish care competencies to be met in providing clinical services. CONTRIBUTION: This research provides evidence of the midwifery experience with implications for needed health policy change.

Sterilization decision making among medically at-risk obese pregnant women.

In this article, we describe a study using a qualitative, naturalistic grounded theory design to explore sterilization decision making by pregnant obese women. Semistructured interviews of women who intended to undergo sterilization at the time of delivery were conducted in the third trimester of pregnancy (n = 15) and again postpartum (n = 11). The decision for sterilization was based on personal criteria for family composition and the nature of each woman's relationship with her partner. The process of decision making began with developing a personal comfort with cessation of childbearing, followed by social confirmation, informing the provider, and then awaiting the procedure. Sterilization was seen as reversible, despite a desire for "something permanent." Obesity was rarely viewed as related to any part of the decision for or against sterilization, and was rarely discussed by providers. Participants made sterilization decisions in their personal and social contexts, and then shared the decision with their providers, whom they often perceived as challenging that decision.

Interprofessional Communication and Collaboration During Emergent Birth Center Transfers: A Quality Improvement Project.

INTRODUCTION: Midwifery care in the birth center setting has proven to be a safe and ideal option for some low-risk women. Although rare, perinatal complications that require emergent transfer to a higher level of care can occur in community birth settings. Optimal perinatal outcomes during emergent transfers depend on excellent interprofessional communication and collaboration. The purpose of this quality improvement project was to implement interprofessional emergent birth center transfer mock drills in order to improve communication and collaboration among birth center midwives, local paramedics, and receiving hospital staff during emergent birth center transfers. PROCESS: Birth center midwives and hospital staff provided education sessions on perinatal emergencies and the scope of practice for midwives for local paramedics. Paramedics' knowledge level was assessed with pretests and posttests, before and after the education sessions, respectively. An interprofessional, collaborative mock drill was then organized and included birth center, paramedic, and hospital staff. All participants received a questionnaire after the drill. OUTCOMES: Mean test scores after paramedic education sessions increased by 43.5% (n = 95, P <.001). The Likert-type scale questionnaire given to mock drill participants after drill completion revealed that 97% indicated probable support for the sustainability of future mock drills in the birth center setting (n = 10). DISCUSSION: Health care providers can help improve perinatal outcomes during emergent transfers from the community setting by having clearly outlined guidelines and procedures and communicating efficiently with interprofessional members of the health care team. Both interprofessional education sessions and collaborative mock drills are effective methods to increase knowledge of perinatal emergencies, thus improving interprofessional communication and collaboration during emergent birth center transfers.

Traditional Chinese Medicine: A Qualitative Study for Reconsidering Nursing Care in the United States.

Purpose: Traditional Chinese medicine (TCM) proposes the world as a holistic unity of energy. With a long history of use, TCM is generally accepted in the Chinese health care system. Despite growing global interest and use, TCM has received a mixed response from Western health care systems. This study aimed to describe the underpinnings of TCM, compare TCM and Western medicine, and suggest how key modalities might be applied to strengthen holistic nursing care in the United States. Design: A qualitative, descriptive exploratory investigation employing a constructivist grounded theory. Method: Interview of TCM healers in Hong Kong (n = 5). Transcripts were reviewed to identify common themes and categories. Findings: Five themes were identified: improvement in energy flow and health, TCM as "a way of knowing," curing source versus symptoms of disease, declining TCM practice in Hong Kong, and need for interprofessional education. Conclusions: TCM is considered useful in chronic illnesses, whereas those with acute illnesses often seek Western medicine. Failing to address the holistic care needs and preferences of individuals results in less than optimal health outcomes. Nurses need explicit TCM content and would benefit from a restructuring of curricula and clinical experiences to foster integration into caring practices.

The lived experience of women with a high-risk pregnancy: A phenomenology investigation.

BACKGROUND: Pregnancy is a time of transformation, hope, expectation, and worry for women and their families - none more so than when the pregnancy is at-risk. The objective of this study was to describe the lived experience of women during high-risk pregnancy. METHODS: This qualitative investigation utilized a hermeneutic phenomenology study. The study was conducted in a public health center in a large urban area in southeast Iran. Purposive sampling of 20 women with a high-risk pregnancy. Participants included both nulligravid and multigravid women in the second and third trimesters of pregnancy with varied medical conditions. Data collection used face-to-face interview with transcribed data analyzed using Braun and Clarke's six stage thematic analysis approach. RESULTS: Four themes were extracted and included challenge of family in high-risk pregnancy, challenge of anticipation for motherhood, and challenges for future pregnancies, and challenge of adaptation. CONCLUSIONS: Findings demonstrate that women with a high-risk pregnancy struggle to adapt with burdens related to successful maternal role attainment and family functioning. Fears about pregnancy outcome and future pregnancies are dominant.

A profile of Colorado nurse--midwives: implications for health care.

Nurse-midwives provide significant health care to underserved and vulnerable women, yet there is limited information about the nature of nurse-midwifery practices and compensation for services. This study reports the results of a Colorado statewide survey of nurse-midwives (N = 217). Electronic survey was utilized to detail practice in seven areas: demographics, type of practice, compensation, leadership, legislative priorities,teaching involvement, and practice satisfaction. Responses (N = 114) were analyzed using SPSS 13.0. Results found wide variation in compensation and practice types. Respondents largely worked in urban settings, cared for low to moderate risk patients, and were generally older and White. Restriction from medical staff membership, prescriptive authority constraints, and liability issues were practice limitations. While teaching a wide variety of learners, nurse-midwives do limited mentoring of nurse-midwifery students, a finding which is concerning given the decreasing numbers of nurse-midwives. Findings are compared to known national data, with implications for the provision of health care services detailed.

Treatment patterns and outcomes in a low-risk nurse-midwifery practice.

Childbirth, which represents more than 20% of all hospitalizations for women, is often accompanied by technical intervention, and identifying best practices is crucial. This study analyzed data entered into the Nurse-Midwifery Clinical Data Set (ACNM, 1990) to ascertain treatment patterns and associated outcomes, using Kane's Model of Treatment and Outcomes (Kane, R. L. [1997]. Understanding health care outcomes research. Gaithersburg, MD: Aspen Publishers, Inc.). Low-risk women (N = 510) received prenatal care from nurse-midwives and delivered at a university facility. Significant relationships were found between patient characteristics (age) and clinical factors (parity, body mass index, number of prenatal visits, comorbidities) and between treatment interventions (activity, intake, invasive monitoring) and outcomes (infant Apgar scores, complications).