Narrative Sense-Making During COVID-19: Using Stories to Understand Birth in a Global Pandemic.

Women who gave birth in the spring and summer of 2020 contended with a host of challenging factors. In addition to facing pregnancy, labor, and delivery during an emerging global pandemic, women grappled with health care restrictions that altered their birth experience. To explore how women made sense of their birth during COVID-19, we analyzed written narratives from 71 women who gave birth in the United States from March to July 2020. Based on tenets of communicated narrative sense-making, the themes that emerged from our data suggest that women framed the role of the pandemic as either completely overshadowing their birth experience or as an inconvenience. Women also wrote about threats to their agency as patients, mothers, and caregivers, as well as the evolving emotional toll of the pandemic that often prompted feelings of fear and sadness, along with self-identified anxiety and depression. We discuss these findings in light of the literature on birth stories as essential sites of narrative sense-making for women and their families.

Expectancy violations and boundary management when giving birth during a pandemic: implications for supporting women.

BACKGROUND: Few life events are as profound as the birth of a child. Yet for those who gave birth during the COVID-19 pandemic, the birth experience and the care of their newborn child were altered in significant ways. METHOD: In this study, we examined the stories of women who gave birth during the COVID-19 pandemic using expectations violations theory and communication privacy management theory. RESULTS: Based on focus group interviews with 65 women from 19 states across the U.S., we found that policies imposed by institutions and visitation rules negotiated by women were prominent in women's birth stories. Policies that affect territorial access to mothers and babies shaped communication to manage health and safety, resulted in intense emotional responses, and affected relationships with women's partners and families. CONCLUSIONS: Our findings offer practical implications for both health care systems and health care providers. Systems must communicate proactively to offer compassionate patient care, and physicians should offer guidance to help new parents manage visitors.

"I'm Not Comfortable With COVID, But ": Dilemmas and Decision-Making to Mitigate Risks Among Mothers Who Gave Birth During the COVID-19 Pandemic.

Individuals have faced unprecedented uncertainty and risk surrounding the COVID-19 pandemic, and decision-making dilemmas have been complicated by quickly evolving and often contradictory recommendations for staying healthy. Using tenets of problematic integration theory and risk orders theory, we analyzed interview data from 50 mothers who gave birth during the pandemic to understand how uncertainty and risk perceptions shaped their decision-making about keeping themselves and their infants healthy in the first year after birth. Results describe how some mothers in our sample made sense of their decision-making to prioritize first-order risks to their own and their family's physical health, and other mothers prioritized second-order risks to their relationships and identities. We also discuss the social nature of mitigating risk during the COVID-19 pandemic and the catalysts for shifting risk perceptions. Theoretical and practical implications include improving public health messaging and clinical conversations to enable individuals to effectively manage social and identity needs alongside serious threats to physical health.

"There's no time limit on grief:" Women's perspectives on a novel reproductive grief screening tool.

Objective: Women who have experienced reproductive loss (i.e., miscarriage, stillbirth, abortion) evaluated the usefulness of a novel screening tool, Reproductive Grief Screen (RGS), to identify patients struggling with ongoing, complicated grief. Methods: This mixed-methods study involved U.S. women who had experienced reproductive loss. Online data collection resulted in 27 interviews and 282 surveys completed. Perceptions of and preferences about RGS were thematically analyzed. Chi square analyses assessed relationships between demographics and tool preferences. Results: RGS validated women's experiences with grief after reproductive loss. Women noted their providers may be unaware of their loss(es). Participants requested periodic screening using RGS beginning shortly after a loss (or during new patient intake) and occurring regularly (e.g., annually). Overall, women preferred completing RGS online before an appointment, though preferences varied by demographics (i.e., age, time since loss). Participants want providers to compassionately discuss RGS results with them and offer appropriate resources. Conclusion: The RGS can help identify largely ignored grief after reproductive loss. Innovation: Findings from group and individual interviews and a survey of women who have coped with reproductive loss suggest that use of a brief RGS tool could reshape clinical practice to aid women who might be facing complicated grief. Moreover, women expressed clear preferences for how to implement use of the RGS in clinical contexts.

Validation of a Brief Measure for Complicated Grief Specific to Reproductive Loss.

Objective Complicated grief reactions follow some pregnancy outcomes, like miscarriage, stillbirth, neonatal death, infant death, selective reduction, or termination of pregnancy. Stigma can delay treatment and worsen outcomes. Screening tools such as the Edinburgh Postnatal Depression Scale detect complicated grief poorly, and specific tools for prolonged or complicated grief after a reproductive loss are cumbersome. In this study, a five-item questionnaire to detect complicated grief after reproductive loss of any type was designed and preliminary validated. Methods A questionnaire patterned after the extensively validated Brief Grief Questionnaire (BGQ) was created by a group of physicians and lay advocates to employ non-traumatic but specific language related to grief after miscarriage, stillbirth, neonatal death, infant death, selective reduction, or termination of pregnancy. One hundred and forty women at a large academic center were recruited in person and via social media to validate the questionnaire with well-studied instruments for anxiety (7-item Panic Disorder Severity Scale, PDSS), trauma (22-item Impact of Events Scale), and reproductive grief and depressive symptoms (33-item Perinatal Grief Scale [PGS]). Results The response rate was 74.9%. Of the 140 participants, 18 (12.8%) experienced their loss during high-risk pregnancies, and 65 (46.4%) were recruited via social media. Seventy-one (51%) respondents had a score > 4, a positive screen for the BGQ. On average, women experienced their loss 2 years prior to participation (IQR 1-5 years). Cronbach's alpha was 0.77 (95% CI: 0.69-0.83). The goodness of fit indices of the model met Fornell and Larker criteria (RMSEA = 0.167, CFI = 0.89, SRMR = 0.06). The AVE was 0.42 and the CR 0.78. Conclusions This investigator-created screening tool is internally consistent and meets preliminary criteria for discriminant validity. This tool can be refined prior to testing for sensitivity and specificity in screening for complicated grief after a reproductive loss.

"It made all the difference": a qualitative study of parental experiences with pediatric obstructive sleep apnea detection.

STUDY OBJECTIVES: To assess parental experience of their child's obstructive sleep apnea (OSA) detection process and inform the development of interventions and health communication strategies to improve OSA detection. METHODS: Semistructured interviews were conducted with 30 parents of children (ages 3-14) who snored and were referred for an overnight polysomnogram (PSG). Parents (60.0% Black race, 93.3% mothers) described how their child was referred for PSG and their perceptions and feelings throughout the detection process. Parents also completed an OSA knowledge measure. Interview data were analyzed using a descriptive approach and thematic analysis was conducted using the NVivo 12 software system. RESULTS: Twenty-one themes were identified across 5 categories (first steps; PSG facilitators and barriers; health information; health care experiences; parent experiences). Respondents experienced multiple pathways to OSA detection, with more than half of referrals initiated by parental concerns (vs. screening efforts). Parents reported a willingness to take any necessary steps to help their child. Both barriers and facilitators to completing a PSG were described. Parents observed both nighttime and daytime symptoms related to OSA in their child but often did not connect the symptoms to each other until later in the process. Participants had varying degrees of OSA knowledge, with a mean knowledge score of 56% correct (range 10%-90% correct). CONCLUSIONS: Parental experiences highlight aspects of the health care system that are both effective and ineffective in detecting children with OSA. Implications include a need for strategies to promote timely detection and to provide parents with accurate information about pediatric OSA. CITATION: Honaker SM, Gopalkrishnan A, Brann M, Wiehe S, Clark AA, Chung A. "It made all the difference": a qualitative study of parental experiences ith pediatric obstructive sleep apnea detection. J Clin Sleep Med. 2022;18(8):1921-1931.

Breaking Bad News: A Randomized Trial Assessing Resident Performance After Novel Video Instruction.

Introduction Delivering bad news to patients is an essential skill for physicians, which is often developed through patient encounters. Residents in our program participate in objective structured clinical examinations (OSCEs) on an annual basis to evaluate their skills in these scenarios. Our objectives were to develop an educational video and determine if an educational video provided to residents prior to OSCEs would improve performance. Methods Previous OSCEs were reviewed to identify best practices and to create a four-minute video highlighting the "do's and don'ts" of delivering bad news. Residents in two post-graduate year (PGY) classes were randomized to watch the video prior to or after a standardized patient encounter. Three masked reviewers assessed resident empathy, attention, and understanding on 10 five-point Likert scales and assigned a total score (scale: 0-50). Hedges' g was used to assess mean scores and effect size. Results A total of 17 residents participated in the evaluation: nine in the pre-OSCE video group and eight in the control group. Residents randomized to the video prior to the patient encounter had a mean score of 37.01 (SD=3.6). Residents randomized to the control group had a mean score of 35.38 (SD=4.85). Hedges' g was 0.37 (95% CI: -0.59 to 1.33). Conclusion Residents randomized to the video group had a small increase in OSCE performance, which was not statistically significant. The novel video was helpful and addresses the need for a quick pre-assessment educational tool, though interns and graduating medical students may be a more appropriate target audience for instruction.

Qualitative Assessment of Bad News Delivery Practices during Miscarriage Diagnosis.

Miscarriage is one of the most common pregnancy complications health care providers discuss with patients. Previous research suggests that women's distress is compounded by ineffective communication with providers, who are usually not trained to deliver bad news using patient-centered dialogue. The purpose of this study was to use a patient-centered approach to examine women's experiences with and perspectives of communication during a miscarriage to assist in the development of communication training tools for health care providers. During focus groups, 22 women who had experienced miscarriage discussed video-recorded standardized patient-provider interactions and recalled communication during their own miscarriages. Results of a pragmatic iterative analysis of the transcripts suggest training techniques and communication behaviors that should guide education for providers to deliver the diagnosis of and treatment options for early pregnancy loss, such as demonstrating empathy, creating space for processing, checking for understanding, and avoiding medical jargon and emotionally charged language.

Tensions and Contradictions in Interns' Communication about Unexpected Pregnancy Loss.

Early miscarriage is an unexpected pregnancy complication that affects up to 25% of pregnant women. Physicians are often tasked with delivering the bad news of a pregnancy loss to asymptomatic women while also helping them make an informed decision about managing the miscarriage. Assessing the communicative responses, particularly the discursive tensions embedded within providers' speech, offers insight into the (in)effective communication used in the delivery of bad news and the management of a potentially traumatic medical event. We observed and analyzed transcripts from 40 standardized patient encounters using Baxter's relational dialectics theory 2.0. Results indicated that interns invoked two primary distal already-spoken discourses: discourses of medicalization of miscarriage and discourses of rationality and informed consent. We contend that tensions and contradictions could affect how women respond to the news of an impending miscarriage and offer practical implications for communication skills training.

Communicating to promote informed decisions in the context of early pregnancy loss.

OBJECTIVE: To evaluate residents' ability to engage standardized patients in informed decision making during a pregnancy loss scenario. METHODS: Forty patient encounters between interns and standardized patients were coded to assess informed decision-making practices, exploration of unexpressed concerns, and support provision. RESULTS: Interns engaged in minimum informed decision making but did not address all of the communicative elements necessary for informed decisions, and most elements were only partially addressed. Patients in this study did not receive information about all management options, their concerns were not addressed, and there was limited support communicated for their decision. CONCLUSION: This study offers an initial assessment of a communicative approach to evaluate and improve decision making during early pregnancy loss. A comprehensive approach to making informed decisions must include discussion of all management options, exploration of patient preferences and concerns, and support for the patient's decision. PRACTICE IMPLICATIONS: Physicians could benefit from communication skills training to communicate more effectively with patients to help them make more informed decisions.

Nursing student evaluation of NIOSH workplace violence prevention for nurses online course.

INTRODUCTION: As primary targets of workplace violence in health care settings, nurses may suffer negative physical and psychological consequences. NIOSH created an online course to educate nurses about violence prevention techniques. METHOD: A mixed-methods approach assessed workplace violence awareness and knowledge among nursing students. A pre/post/post-test survey and focus group discussions evaluated participant awareness and knowledge, assessed course design, and solicited recommendations for increasing participation and strategies for improving message retention. RESULTS: The mean awareness scores differed significantly between pre-course and both post-course time points (Wilk's λ=0.319, F(2, 46)=49.01, p<0.001). Post hoc tests using the Bonferroni correction revealed that course participation increased awareness of workplace violence from pre-course scores (M=0.75, SD=0.438) to immediate post-course (M=2.13, SD=0.789) and four-week post-course (M=1.96, SD=0.771) scores on a 3-item measure. Similarly, mean knowledge scores increased between pre-course and both post-course time points (Wilk's λ=0.495, F(1.57, 73.66)=37.26, p<0.001). Post hoc tests using the Bonferroni correction revealed that course participation increased knowledge of workplace violence from pre-course scores (M=6.65, SD=1.45) to immediate post-course (M=8.56, SD=1.32) and four-week post-course (M=8.19, SD=1.42) scores on a 10-item measure. Qualitative data from the focus groups reinforced the quantitative findings. Participants citing benefits from the content strongly recommended including the course in nursing curriculums. Incorporating the course early in the nursing educational experience will better prepare students to deal with workplace violence when they enter health care professions. CONCLUSIONS: The results indicate that NIOSH and its partners created an effective online workplace violence awareness and prevention course. Practical applications: Nursing students and professionals can be effectively educated about workplace violence using an online format.

Making the message meaningful: a qualitative assessment of media promoting all-terrain vehicle safety.

BACKGROUND: Millions of all-terrain vehicles (ATV) are used around the world for recreation by both adults and youth. This increase in use has led to a substantial increase in the number of injuries and fatalities each year. Effective strategies for reducing this incidence are clearly needed; however, minimal research exists regarding effective educational interventions. OBJECTIVE: This study was designed to assess rural ATV riders' preferences for and assessment of safety messages. METHODS: 13 focus group discussions with youth and adult ATV riders were conducted. 88 formative research participants provided feedback on existing ATV safety materials, which was used to develop more useful ATV safety messages. 60 evaluative focus group participants critiqued the materials developed for this project. RESULTS: Existing ATV safety materials have limited effectiveness, in part because they may not address the content or design needs of the target population. ATV riders want educational and action-oriented safety messages that inform youth and adult riders about their responsibilities to learn, educate and implement safety behaviours (eg, appropriate-sized ATV, safety gear, solo riding, speed limits, riding locations). In addition, messages should be clear, realistic, visually appealing and easily accessible. Newly designed ATV safety materials using the acronym TRIPSS (training, ride off-road, impairment, plan ahead, safety gear, single rider) meet ATV riders' safety messaging needs. CONCLUSIONS: To reach a target population, it is crucial to include them in the development and assessment of safety messages. Germane to this particular study, ATV riders provided essential information for creating useful ATV safety materials.

Dialectical tensions in stroke survivor relationships.

Stroke is an unpredictable and life-altering medical occurrence that causes immediate change in survivors' relationships. This study unearthed dialectical tensions expressed by spouses of stroke survivors and examined how those dialectical tensions compare to those experienced by stroke survivors themselves. Sixteen spouses of stroke survivors participated in interviews, and four tensions ultimately emerged: self-orientation-partner-orientation, realism-idealism, uncertainty-acceptance, and emotional release-emotional reservation. Three dialectical tensions (i.e., uncertainty-acceptance, realism-idealism, self-orientation-partner-orientation) were similar to those communicated by stroke survivors. Recognizing dialectical tensions experienced and shared can open communication lines and ultimately improve the health of individuals and their relationships.

WV Walks: replication with expanded reach.

BACKGROUND: WV Walks replicated the Wheeling Walks community-wide campaign methodology to promote physical activity. METHODS: A social marketing intervention promoted walking among insufficiently active 40- to 65-year-olds throughout the television media market in north-central West Virginia. The intervention included participatory planning, an 8-week mass media-based campaign, and policy and environmental activities. Pre and post random-digit-dial cohort telephone surveys were conducted at baseline and immediately postcampaign in intervention and comparison regions. RESULTS: The campaign resulted in maximal message awareness in north-central WV and demonstrated a significant increase in walking behavior represented by an absolute shift of 12% of the target population from insufficiently active to active (> or = 30 minutes, 5 days per week), versus the comparison community (adjusted odds ratio 1.82, CI: 1.05-3.17). Policy and environmental changes were also evident. CONCLUSIONS: This replication study increases our confidence that the initial effects observed in the Wheeling Walks intervention are generalizable to other similar rural communities.

Toward a typology of confidentiality breaches in health care communication: an ethic of care analysis of provider practices and patient perceptions.

Confidentiality should be a fundamental right of patients in a health care setting. However, health care providers who take an oath to uphold confidentiality often neglect this basic patient right. Breaching confidential health information is a serious ethical problem and a communication issue that, historically, has received limited empirical, theoretical, or practical attention. The goals of this project were to frame this issue from an ethic of care perspective, define the concept of a confidentiality breach, identify the types of confidentiality breaches being communicated in health care organizations, and understand how patients perceive these breaches. Based on interviews with 51 patients and observations of health care providers, a definition and typology of confidentiality breaches emerged. Theoretical and practical implications also became evident.

E-medicine and health care consumers: recognizing current problems and possible resolutions for a safer environment.

Millions of Americans access the Internet for health information, which is changing the way patients seek information about, and often treat, certain medical conditions. It is estimated that there may be as many as 100,000 health-related Web sites. The availability of so much health information permits consumers to assume more responsibility for their own health care. At the same time, it raises a number of issues that need to be addressed. The health information available to Internet users may be inaccurate or out-of-date. Potential conflicts of interest result from the blurring of the distinction between advertising and professional health information. Also, potential threats to privacy may result from data mining. Health care consumers need to be able to evaluate the quality of the information provided on the Internet. Various evaluative mechanisms such as codes of ethics, rating systems, and seals of approval have been developed to aid in this process. The effectiveness of these solutions is evaluated in this paper. Finally, the paper addresses the importance of including patients in developing standardized quality assurance systems for online health information.