Benefits of Accreditation.

In this column, the editor of The Journal of Perinatal Education discussed the benefits of accreditation and what it means to the profession and to consumers. The editor also describes the contents of this issue, which offer a broad range of resources, research, and inspiration for childbirth educators in their efforts to promote, support, and protect natural, safe, and healthy birth.

Hospital Care Practices Associated With Exclusive Breastfeeding 3 and 6 Months After Discharge: A Multisite Study.

Maternity care practices influence breastfeeding outcomes long after women leave the birth setting. We conducted this study to describe, from mothers' perspective, maternity care practices associated with breastfeeding at 3 and 6 months. Mothers who recalled having skin-to-skin care (SSC) and rooming-in for 23 or more hours/day were more likely to report exclusive breastfeeding when surveyed at 3 months. Perception of not enough milk and difficulty latching explained more than 85% of supplementing and weaning at 3 months. Women also reported that returning to work influenced their decision to supplement or wean. Our multisite study supports implementing low cost and evidence-based interventions such as immediate and uninterrupted SSC and rooming in to improve breastfeeding exclusivity. Findings highlight the ongoing need to bridge the gap between hospital discharge and community breastfeeding support, including workplace accommodations.

Peer Review Ensures Quality.

In this column, the editor of The Journal of Perinatal Education (JPE) discusses the peer-review process utilized by JPE and why it is essential for quality. The editor also describes the contents of this issue, which offer a broad range of resources, research, and inspiration for childbirth educators in their efforts to promote, support, and protect natural, safe, and healthy birth.

Interprofessional Development of a Livestream Simulation Activity to Enhance an Undergraduate Nursing Research Course.

The article describes the development, implementation, and evaluation of an interactive simulation activity to enhance student engagement and comprehension of evidence-based practice principles. An interprofessional team of nurse educators, simulation experts, information technology specialists, and nursing informatics graduate students collaborated on the simulation design. The results of this project support the need to develop innovative learning strategies to facilitate nursing students' understanding of the relevance of evidence-based practice research to improve patient outcomes.

Predictors of nurses' experience of verbal abuse by nurse colleagues.

BACKGROUND: Between 45% and 94% of registered nurses (RNs) experience verbal abuse, which is associated with physical and psychological harm. Although several studies examined predictors of RNs' verbal abuse, none examined predictors of RNs' experiences of verbal abuse by RN colleagues. PURPOSE: To examine individual, workplace, dispositional, contextual, and interpersonal predictors of RNs' reported experiences of verbal abuse from RN colleagues. METHODS: In this secondary analysis, a cross-sectional design with multiple linear regression analysis was used to examine the effect of 23 predictors on verbal abuse by RN colleagues in a sample of 1,208 early career RNs. FINDING: Selected variables in the empirical intragroup conflict model explained 23.8% of variance in RNs' experiences of verbal abuse by RN colleagues. CONCLUSION: A number of previously unstudied factors were identified that organizational leaders can monitor and develop or modify policies to prevent early career RNs' experiences of verbal abuse by RN colleagues.

Birth Photos: #No Filter!

In this column, the editor of The Journal of Perinatal Education (JPE) shares a letter to the editor from a reader commenting on photos selected for the cover of JPE. The editor also describes the contents of this issue, which offer a broad range of resources, research, and inspiration for childbirth educators in their efforts to promote, support, and protect natural, safe, and healthy birth.

A case study on building capacity to improve clinical mentoring and maternal child health in rural Tanzania: the path to implementation.

BACKGROUND: Tanzania is a low income, East African country with a severe shortage of human resources for health or health workers. This shortage threatens any gains the country is making in improving maternal health outcomes. This paper describes a partnership between Touch Foundation and NYU Rory Meyers College of Nursing - Global, aimed at improving clinical mentorship and capacity among nurses and midwives at two rural hospitals in the Tanzanian Lake Zone Region. Clinical mentoring capacity building and supportive supervision of staff has been shown to be a facilitator of retaining nurses and would be possible to acquire and implement quickly, even in a context of low resources and limited technology. METHODS: A case study approach structures this program implementation analysis. The NYU Meyers team conducted a 6-day needs assessment at the two selected hospitals. A SWOT analysis was performed to identify needs and potential areas for improvement. After the assessment, a weeklong training, tailored to each hospitals' specific needs, was designed and facilitated by two NYU Meyers nursing and midwifery education specialists. The program was created to build on the clinical skills of expert nurse and midwife clinicians and suggested strategies for incorporating mentoring and preceptorship as a means to enhance clinical safety and promote professional communication, problem solving and crisis management. RESULTS: Nineteen participants from both hospitals attended the training. Fourteen of 19 participants completed a post training, open ended questionnaire for a 74% response rate. Fifty-seven percent of participants were able to demonstrate and provide examples of the concepts of mentorship and supervision 4 and 11 months' post training. Participants indicated that while confidence in skills was not lacking, barriers to quality care lay mostly in understaffing. Implementation also offered multiple insights into contextual factors affecting sustainable program implementation. CONCLUSIONS: Three recommendations from this training include: 1) A pre-program assessment should be conducted to ascertain contextual relevance to curriculum development; 2) flexibility and creativity in teaching methods are essential to engage students; and 3) access to participants a priori to program implementation may facilitate a more tailored approach and lead to greater participant engagement.

Making Comfort Count: Using Quality Improvement to Promote Pediatric Procedural Pain Management.

BACKGROUND AND OBJECTIVES: Pediatric procedural pain management (PPPM) is best practice but was inconsistent in our large multisite general academic medical center. We hypothesized that quality improvement (QI) methods would improve and standardize PPPM in our health system within inpatient pediatric units. We aimed to increase topical anesthetic use from 10% to 40%, improve nursing pediatric pain knowledge, and increase parent satisfaction around procedures for children admitted to a general tertiary academic medical center. METHODS: We used QI methods including needs assessment, self-identified champions, small tests of change, leadership accountability, data transparency, and a train-the-peer-trainer approach to implement PPPM. We measured inpatient use of topical anesthetic (goal of 40% of admissions), nursing pain knowledge, and parent satisfaction with child comfort during procedures. We used statistical process control and basic statistics to analyze data in this interrupted time series design. RESULTS: Over 18 months, use of topical lidocaine rose from 10% to 36.5% for all inpatient admissions, resulting in a centerline shift. Nursing pain knowledge scores increased 7%. Mean parent satisfaction around procedural comfort increased from 83% to 88%. CONCLUSIONS: A child-focused QI initiative around PPPM can succeed in a multisite general academic medical center. Key success factors for this effort included accountability, multidisciplinary core leadership, housewide training in a novel educational evidence-based framework, and use of data and champions to promote nurse and physician engagement. Future work will focus on sustaining and monitoring change.

A Task Force to Address Bullying.

Bullying in the workplace can create a dysfunctional environment that is associated with serious physical and psychological harm to the person being bullied. Nurses' experience with bullying has gained considerable attention in recent years, and warrants further discussion. Nurse leaders need to develop and implement effective bullying prevention initiatives that will foster the functioning of a professional and productive staff in a healthy work environment. The aim of this article is to review workplace bullying as experienced by nurses, and describe how nurses at a Magnet-designated academic medical center developed and implemented a bullying task force to address the problem.

Optimal Topical Agent for Radiation Dermatitis During Breast Radiotherapy: A Pilot Study.

BACKGROUND: Women receiving radiation to the breast will likely be recommended to use a topical cream to minimize and delay the development of radiation dermatitis. Although many topical products are commercially available and have been tested for safety and efficacy, few studies have compared various products to one another for superiority and cost effectiveness. OBJECTIVES: The purpose of this pilot study was to compare three commonly used skin care products prospectively to one other in a homogenously controlled group of women undergoing whole breast irradiation to assess superiority in minimizing the common toxicity criteria grade of radiation dermatitis, effect on quality of life, and cost. METHODS: The authors conducted a systematic review to determine the three types of skin care products with the strongest evidence of minimizing radiation dermatitis. Patients were voluntarily enrolled and randomized to one of three possible skin care topical regimens. Patients completed a quality-of-life survey to assess their preference in topical skin care regimen. The cost of each arm's topical product was assessed at the completion of patient participation. FINDINGS: No statistical difference was noted in the severity or occurrence of radiation dermatitis among the groups. In addition, no statistical difference was found among the three treatment arms in quality-of-life score changes, and no patients required a treatment interruption in their radiation or in the skin care product during treatment. A cost difference among the treatment arms was noted.

Choosing Wisely for Birth.

In this column, the editor of The Journal of Perinatal Education describes the American Academy of Nursing's engagement in the national Choosing Wisely campaign and how it has implications for promoting normal birth. The editor also describes the contents of this issue, which offer a broad range of resources, research, and inspiration for childbirth educators in their efforts to promote, support, and protect natural, safe, and healthy birth.

Midwifery-Led Maternity Care: Back to Basics.

In this column, the editor of The Journal of Perinatal Education discusses Britain's National Health Service's updated evidence-based guidelines stating that women with uncomplicated pregnancies are better off in the hands of midwives than hospital physicians during birth. The editor also describes the contents of this issue, which offer a broad range of resources, research, and inspiration for childbirth educators in their efforts to promote, support, and protect natural, safe, and healthy birth. Women with uncomplicated pregnancies are better off in the hands of midwives than hospital physicians during birth.

Evaluating implementation of a baby friendly hospital initiative.

PURPOSE: The study evaluates the implementation of a United Nations Children's Fund (UNICEF)/WHO Baby-Friendly Hospital Initiative (BFHI) in a large urban hospital in New York City that serves primarily poor, minority women. STUDY DESIGN AND METHODS: A descriptive qualitative evaluation study that included focus groups, key informant interviews, and observations of the clinical environment was conducted using a community-based participatory research approach with healthcare providers. RESULTS: Findings revealed strengths and challenges in the implementation process at the system, provider, and patient levels. Strategies for enhancing program implementation and outcomes include expansion of provider education, development of additional patient interventions, enhancement of environmental structural supports, and continuation and expansion of program evaluation activities. CLINICAL IMPLICATIONS: Evaluation of program implementation at multiple levels of the organization in collaboration with providers is critical to understanding program outcomes.

Sustainability of improvements in perinatal teamwork and safety climate.

The purposes of this study were to describe changes in perinatal nurse (n = 70) and physician (n = 88) perceptions of teamwork and safety climate after implementing a 6-month Crew Resource Management training program and compare responses between nurses and physicians. The Teamwork and Safety Climate Survey was administered prior to and 1 year after the intervention. There were significant improvements in nurse and physician perceptions of teamwork and safety climate; however, physicians perceived teamwork more positive than nurses.

What to teach?

In this column, the editor of The Journal of Perinatal Education discusses why Lamaze International conducts a comprehensive job analysis of what childbirth educators are teaching and their beliefs of what is important for pregnant women and their partners to learn. The editor also describes the contents of this issue, which offer a broad range of resources, research, and inspiration for childbirth educators in their efforts to promote, support, and protect natural, safe, and healthy birth.

Knowledge and skills of the lamaze certified childbirth educator: results of a job task analysis.

Content validity of certification examinations is demonstrated over time with comprehensive job analyses conducted and analyzed by experts, with data gathered from stakeholders. In November 2011, the Lamaze International Certification Council conducted a job analysis update of the 2002 job analysis survey. This article presents the background, methodology, and findings of the job analysis. Changes in the test blueprint based on these findings are presented.

Developing a leadership laboratory for nurse managers based on lived experiences: a participatory action research model for leadership development.

OBJECTIVE: The aim of the pilot study was to design an innovative model of leadership development, Leadership Laboratory (LL), grounded in the lived experiences and peer best practices of 43 cross-disciplinary nurse managers. BACKGROUND: The Institute of Medicine/Robert Wood Johnson Foundation study, The Future of Nursing, reinforces the need to prepare nurses for leadership positions. METHODS: A 1-year participatory action research study was designed to develop 3 LLs involving nurse managers as participants, co-creators, and evaluators of the unique learning format. RESULTS: Analysis of qualitative and quantitative data revealed consistent and significantly positive results in leadership skill areas in all 3 LLs. Participants identified elements that distinguished LLs from traditional seminars and trainings sessions, including opportunities to gain from peer-to peer consultation, strategies, and support. CONCLUSIONS: Participants in the 1-year pilot demonstrated significant learning based on postsession and postproject assessments of the LLs. Data also described the unique attributes of a peer-driven approach to leadership development.

Verbal abuse from nurse colleagues and work environment of early career registered nurses.

PURPOSE: This study examined relationships between verbal abuse from nurse colleagues and demographic characteristics, work attributes, and work attitudes of early career registered nurses (RNs). DESIGN AND METHODS: Data are from the fourth wave of a national panel survey of early career RNs begun in 2006. The final analytic sample included 1,407 RNs. Descriptive statistics were used to describe the sample, analysis of variance to compare means, and chi square to compare categorical variables. FINDINGS: RNs reporting higher levels of verbal abuse from nurse colleagues were more likely to be unmarried, work in a hospital setting, or work in a non-magnet hospital. They also had lower job satisfaction, and less organizational commitment, autonomy, and intent to stay. Lastly, they perceived their work environments unfavorably. CONCLUSIONS: Data support the hypothesis that early career RNs are vulnerable to the effects of verbal abuse from nurse colleagues. Although more verbal abuse is seen in environments with unfavorable working conditions, and RNs working in such environments tend to have less favorable work attitudes, one cannot assume causality. It is unclear if poor working conditions create an environment where verbal abuse is tolerated or if verbal abuse creates an unfavorable work environment. CLINICAL RELEVANCE: There is a need to develop and test evidence-based interventions to deal with the problems inherent with verbal abuse from nurse colleagues.

Positive work environments of early-career registered nurses and the correlation with physician verbal abuse.

BACKGROUND: Verbal abuse in the workplace is experienced by registered nurses (RNs) worldwide; physicians are one of the main sources of verbal abuse. PURPOSE: To examine the relationship between levels of physician verbal abuse of early-career RNs and demographics, work attributes, and perceived work environment. METHOD: Fourth wave of a mailed national panel survey of early career RNs begun in 2006. DISCUSSION: RNs' perception of verbal abuse by physicians was significantly associated with poor workgroup cohesion, lower supervisory and mentor support, greater quantitative workload, organizational constraints, and nurse-colleague verbal abuse, as well as RNs' lower job satisfaction, organizational commitment, and intent to stay. CONCLUSION: RNs working in unfavorable work environments experience more physician abuse and have less favorable work attitudes. Causality is unclear: do poor working conditions create an environment in which physicians are more likely to be abusive, or does verbal abuse by physicians create an unfavorable work environment?