Doctoral graduates' attitudes toward scholarly work and Institutional Review Board and Quality Improvement Committee education and submission processes: A pilot study.

BACKGROUND: Educators are challenged to find better ways to prepare doctoral nursing students to conduct scholarly work involving human subjects. PURPOSE: To better understand doctoral nursing students' attitudes toward programmatic scholarly work and Institutional Review Board (IRB)/Quality Improvement Committee (QIC) education and submission processes. METHODS: Recent Doctor of Nursing Practice (DNP) and Philosophy of Nursing (PhD) graduates were recruited using convenience sampling techniques to participate in this cross-sectional, descriptive, mixed-methods pilot study. Data were collected using two researcher-developed instruments. DISCUSSION: Nineteen doctoral nursing students participated in this study. Students most often used a quantitative approach with health care providers to complete their scholarly work requirements. Both PhD and DNP participants were overall satisfied with the IRB/QIC content in the curricula and the submission process. Four themes were identified: (a) Efficiency, (b) Collaboration, (c) Faculty Mentorship, and (d) Areas for Improvement. CONCLUSION: Findings from this pilot study may be used to enhance IRB/QIC processes through revision of administrative processes and student education.

Healthcare providers' perceived barriers and facilitators to screening for intimate partner violence in pregnant women attending prenatal clinics.

AIM: To examine healthcare providers' extent of and perceived barriers and facilitators to screening for intimate partner violence in pregnant women attending prenatal clinics. DESIGN: Cross-sectional descriptive design was used to collect data from 130 healthcare providers. METHODS: Seventeen healthcare providers from 17 prenatal clinics in Kanungu district, Uganda, were recruited via convenience sampling to participate in an online survey implementing a modified Normalization Measure Development instrument. Data were collected between February 2023 and March 2023 (02/8/2023 to 03/12/2023) and analysed using descriptive and Mann-Whitney U test and chi-square tests. RESULTS: Slightly more than half (56%) of healthcare providers report screening pregnant women for intimate partner violence. There was a statistically significant relationship between healthcare providers screening for intimate partner violence and having previous training on intimate partner violence screening. The only barrier to screening identified was a lack of understanding of how intimate partner violence screening affects the nature of participant's own work. There were numerous potential facilitators identified for healthcare providers' intimate partner violence screening. CONCLUSION: Although higher-than-expected number of healthcare providers reported screening of pregnant women for intimate partner violence, the extent of screening is still suboptimal. The barrier to screening identified needs to be addressed and facilitators promoted. Receiving training among healthcare providers on intimate partner violence screening was associated with higher levels of screening; thus, this needs to be enhanced to optimize screening rates. Future studies should assess screening practices objectively and implement interventions to improve healthcare providers' intimate partner violence screening rates. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE: Screening for intimate partner violence should be part of standard care provided by healthcare providers to all pregnant women during prenatal clinic visits. The study supports the need for more training for healthcare providers in aspects related to intimate partner violence screening in order to ensure prompt diagnosis and treatment of those affected, identify those at risk and increase awareness. There is a need to enhance healthcare providers' capacity for intimate partner violence screening through education by integrating intimate partner violence screening pre- and post-registration courses and preparation programs or curriculum. IMPACT: Intimate partner violence (IPV) in pregnancy is a global health problem. Screening for IPV by healthcare providers is suboptimal. This study found that only 56% of healthcare providers were routinely screening for IPV in Ugandan prenatal clinics. This study identified the main facilitators and one barrier to IPV screening. REPORTING METHOD: This study has adhered to the relevant EQUATOR guidelines for quantitative studies. PATIENT AND PUBLIC CONTRIBUTION: No patient was involved in this study.

Family experiences reported by healthcare worker parents during the COVID-19 pandemic.

PURPOSE: Parents, who were working as essential frontline healthcare workers experienced unique stressors during the COVID-19 pandemic including disruption of regular routines, long lapses away from family, extreme work stress and subsequent difficulty in compartmentalizing work-related concerns when at home. The purpose of this study was to assess COVID-19 exposure and impact of frontline healthcare workers who are parents. DESIGN & METHODS: This study quantitatively assessed the COVID-19 exposure and impact and qualitatively explored perceptions of parents of children 9 to 17 years of age, who were also frontline healthcare workers. RESULTS: Participants (N = 79) using the COVID-19 Exposure and Family Impact Survey (CEFIS) reported exposure mean scores of 10.03 (SD = 2.63); and impact scores mean scores of 3.18 (SD = 0.46). Thematic analysis identified four themes, each with 2 subthemes: 1) family stressors increased (e.g., concerns about health and safety, losses of lifestyle patterns); 2) changes in children's health and well-being (e.g., isolation from family and friends, mental health problems); 3) virtual school difficulties (e.g., parent and student challenges, home school option); 4) skill building opportunities (e.g., enhanced emotional connections, increased family activities). CONCLUSION: The CHAMPS Family Health Study suggests that families of essential workers are especially vulnerable to the effect of COVID-19, as are those families of essential workers who include child/ren with special health care needs. PRACTICE IMPLICATIONS: Preparation for future emergencies requires strategies to mitigate consequences and promote well-being. These results highlight the need for supportive approaches to decrease the negative consequences of stress and to augment skills for family connection and cooperation.

"Yes, I can bond." Reflections of autistic women's mothering experiences in the early postpartum period.

BACKGROUND: Autism is a neurodevelopmental condition affecting communication and social interaction. Much of the research regarding childbirth and motherhood is focused on non-autistic women. Autistic mothers may experience challenges communicating their needs to health care professionals and find aspects of the hospital environment distressing, indicating a need for more informed practice. OBJECTIVE: To describe the experiences of autistic women bonding with their newborns after delivery in an acute care setting. DESIGN: The study used a qualitative interpretative description design with data analysis using the method described by Knafl and Webster. The study explored the women's childbirth experiences in the early postpartum period. METHOD: Interviews were conducted using a semi-structured interview guide. The women were interviewed in a setting of their choosing and included in person meetings, meetings over Skype, over the telephone, or via Facebook messenger. Twenty-four women ages 29-65 years participated in the study. The women were from the United States, the United Kingdom, and Australia. All women gave birth to a healthy term newborn in an acute care setting. RESULTS: Three major themes emerged from the data: having difficulty communicating, feeling stressed in an uncertain environment, and being an autistic mother. CONCLUSION: The autistic mothers in the study expressed love and concern for their babies. Some women described needing more time to recover physically and emotionally before assuming care of the newborn. The stress of childbirth left them exhausted and the demands of caring for a newborn could be overwhelming for some women. Miscommunication during labor affected some of the women's ability to trust the nurses caring for them and, in two cases, left the women feeling judged as mothers.

Empowering Community Leadership: Perspectives of Peer Mentors Facilitating a Food Pantry-Based Nutrition Education Program.

Peer Mentors (PMs) are valuable health educators within food-insecure communities; however, little is known about PMs' perspectives and experiences after serving in their peer mentor role. Therefore, this qualitative study explored PMs' (n = 10) perceptions and analyzed data using thematic analysis based on descriptive phenomenology. Four themes emerged: (1) Successes and Struggles in Sharing Nutrition Knowledge; (2) Establishing a Conducive Learning Environment; (3) The Peer Mentor and Mentee Connection: Impact of Shared Experiences; (4) Empowerment of the Peer Mentor Experience. PMs have many advantages; however, more research is needed to evaluate the sustainability and efficacy of PMs within food-insecure communities.

Achieving a healthy home food environment: perspectives on parents' nutrition education needs when living with food insecurity.

Purpose: The familial food environment is influenced by many factors, including food insecurity, food accessibility, and foods accepted by the family. These factors can facilitate or hinder caregivers' ability to support a healthy home food environment. The aim of this research was to explore the barriers to, perspectives on, and nutrition education needs identified by food-insecure parents which would then inform a community-based nutrition education program. Methods: A qualitative study used focus group data that were recorded, transcribed verbatim, and analyzed using a constant comparison approach to categorize the emerging themes. Results: Emergent themes: (1) Cooking confidence deficit; (2) Healthy meal preparation barriers; (3) Healthy meal acceptance barriers; (4) Meal planning, management, and adaptability. These themes suggest that supporting a healthy home food environment is connected to both food knowledge and competencies, known as food literacy. Conclusion: Food literacy competency should be assessed before nutrition education program implementation within community settings.

An uncertain time: Clinical nurses' first impressions during the COVID-19 pandemic.

The COVID-19 pandemic overwhelmed the US healthcare system and healthcare providers. Nurses, who comprise one of the most affected groups because they are the largest group of healthcare providers, were in a unique position to speak about their perspectives. As a result of the COVID-19 pandemic, nurses have experienced ongoing physical and psychological challenges while displaying strength and perseverance during uncertain times. In this study, we explored the perceptions and experiences of nurses in clinical practice caring for patients diagnosed with COVID-19 during the pandemic. Researchers conducted a qualitative descriptive study with 20 clinical nurses most of whom were enrolled in a graduate program while working in healthcare settings. Semi-structured interviews conducted through Zoom occurred between August 2020 and December 2020. Thematic analysis was used to analyze the transcripts. Five themes emerged: navigating uncertainty, managing death and loss, acknowledging emotional responses, learning opportunities, and facing community undercurrents. Lack of clinical practice guidelines, and inconsistent access to personal protective equipment when providing care to patients with COVID-19 caused emotional strain for nurses and highlighted future learning opportunities. Providing support to dying patients was devastating to nurses. Concern about community misunderstandings of the pandemic created challenges. Evolving teamwork provided invaluable support to study participants. Nurses shared essential information for revising and creating clinical practice guidelines. Nursing interventions and strategies were used to produce humane and positive patient outcomes and provide a foundation for nurse-driven care in possible future pandemics.

Qualitative Descriptive Study of Childbirth Educators' Perspectives on Prenatal Education for Women With Physical Disability.

OBJECTIVE: To explore the knowledge, experiences, and perceptions of childbirth educators about providing childbirth education to women with physical disability. DESIGN: Qualitative descriptive design. SETTING: Telephone interviews. PARTICIPANTS: Seventeen childbirth educators. METHODS: We used a semistructured interview guide to explore participants' knowledge, experiences, and perceptions of providing childbirth education to women with physical disability. We audio recorded, transcribed, and analyzed the interviews using content analysis. RESULTS: We identified four themes: Importance of Childbirth Education for All Women, Inadequate Knowledge About Physical Disability, Willingness to Learn About Physical Disability, and Misconceptions and Assumptions About Women With Physical Disability. CONCLUSION: Participants reported little knowledge about the needs of pregnant women with physical disability and limited experience with them in childbirth education classes. They reported eagerness to learn about disability and its effect on pregnancy to help provide meaningful education to women with physical disability. Childbirth educators need to develop and implement innovative approaches to reach women with physical disability, provide information relevant to their needs, and address the misconceptions and assumptions they may have about women with physical disability and pregnancy.

Relationships Among Neighborhood Poverty, Access to Healthy Food, and Diabetes Self-Management in Women Who Received Perinatal Nurse Home Visits.

OBJECTIVE: To examine the relationships among neighborhood poverty, access to healthy food, and diabetes self-management in pregnant women in an urban setting who received perinatal nurse home visits. DESIGN: Exploratory descriptive secondary analysis of existing individual-level and neighborhood-level data. SETTING: Philadelphia, Pennsylvania, United States. PARTICIPANTS: Women who were pregnant, had diabetes, and were enrolled in the citywide perinatal nurse home visiting program because of their diabetes (N = 264). METHODS: We retrieved neighborhood-level aggregated data on poverty and access to healthy food from PolicyMap, a geographic information system. We retrieved individual-level data from a clinical research database. Access to healthy food was operationalized at the individual level by reported use of the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC). We operationalized diabetes self-management as good or poor glycemic control. We conducted descriptive and logistic regression analyses. RESULTS: We found no relationship between neighborhood-level poverty and neighborhood-level access to healthy food with women's glycemic control. However, at the individual level, use of the WIC program was associated with glycemic control (p = .034). Participants who reported not using this program were two times more likely to have poor glycemic control than those who did (OR = 2.045, 95% confidence interval [1.003, 2.045]). CONCLUSION: It is important to understand how the complex interplay between neighborhoods and individual factors of poverty and access to healthy food influences health outcomes among pregnant women. The WIC program may mediate neighborhood influence on diabetes self-management. Future research is warranted on how this program and nurse home visiting services can optimize maternal health outcomes among women who have diabetes during pregnancy.

Successes and challenges of using a peer Mentor model for nutrition education within a food pantry: a qualitative study.

BACKGROUND: Delivering nutrition education within an emergency food pantry (EFP) provides an opportunity to reach many food insecure households and underserved populations. However, little is known about using a peer mentor model, "Community Cooks," as a modality to deliver nutrition education within this setting. This research aimed to identify the successes and challenges of using a peer mentor model within an EFP to better understand the best approaches to deliver nutrition education among community residents. METHODS: In spring 2018, semi-structured interviews were conducted with 11 peer mentors after they delivered a series of nutrition workshops to community members of the EFP. Interviews were audio-recorded and transcribed verbatim. Qualitative content analysis was used to analyze the data. RESULTS: All peer mentors were women over 40 years-of-age, were recruited from the EFP community; most were high school graduates and currently received some form of federal nutrition assistance. All peer mentors reported that the "Community Cooks" nutrition education program offered many benefits. Key successes of the program included serving in the role as a peer mentor was an empowering experience which gave them a sense of community, purpose, and camaraderie; 2) the nutrition education was appropriately tailored towards those living with food insecurity; 3) the recipes required minimal cooking skills and included low-cost easily accessible foods available at the EFP. Key challenges of the program were the lack of community member engagement in the nutrition education workshops. CONCLUSION: Challenges continue to exist when delivering nutrition education within a community EFP setting. While the use of peer mentors to deliver nutrition education messages is promising, more research is needed to quantify the impact of using a peer mentor model in underserved and food insecure communities.

Barriers to Healthy Eating in a Community That Relies on an Emergency Food Pantry.

OBJECTIVE: To explore perceived barriers to healthy eating within a food-insecure community that relies on an emergency food pantry. METHODS: A qualitative descriptive study was conducted using focus groups within an emergency food pantry located in southeastern Pennsylvania. Eleven female participants were recruited from the food pantry to serve as focus group participants and key community informants. Focus group transcripts were transcribed, coded, and analyzed using a constant comparative method. RESULTS: Four themes regarding perceived barriers to healthy eating were identified: (1) knowledge, (2) resources, (3) special dietary needs, and (4) culture and family influences. CONCLUSIONS AND IMPLICATIONS: Emergent themes from the focus groups identified the perceived barriers to healthy eating within a food-insecure community. These findings may be essential for informing the development of future nutrition education programs and for promoting health in low-income communities.

A Practice-Based Research Database to Study Perinatal Nurse Home Visiting to Pregnant Women With Diabetes.

BACKGROUND AND AIMS: Accumulation of real-world evidence from practice-based perinatal nurse home visits to pregnant women with diabetes prompted this translational perinatal health disparities research. Given the global diabetes epidemic, this academic-community partnered research team is studying the utilization, processes, and outcomes of this understudied model of perinatal nurse home visiting that provide home-based enhanced diabetes care to pregnant women. Because the nursing records provide the rich source of data for the study, our aim is to provide an in-depth description of the Philadelphia Pregnancy and Diabetes Home Visiting (PPD-HV) research database developed from data in the longitudinal nursing records. METHODS: This descriptive study uses retrospective data abstracted from paper-based perinatal nurse home visiting clinical records to create the PPD-HV, a HIPAA compliant, secure REDCap electronic research database. The sample includes 248 urban, pregnant women with diabetes who received a total of 1,644 home visits during the year 2012. The setting was Philadelphia, a large metropolitan city in the northeastern part of the United States. The PPD-HV database followed the information fields of the paper-based clinical nursing forms, which were originally designed by following the Omaha System to guide documenting the nursing process used in caring for patients in their homes. RESULTS: Using REDCap, the PPD-HV research database is robust with 239 variables and captures longitudinal clinical nursing data. Among the pregnant women with diabetes receiving nurse home visits, the mean age was 30.7 years, most were single, and had given birth to other children. LINKING EVIDENCE TO ACTION: Real-world clinical nursing practice data provide a rich source of research data to advance understandings about this model of enhanced diabetes care and the pregnant women with diabetes receiving the care. Considering the global epidemic of diabetes, this is a perinatal nurse home visiting model to replicate and evaluate.

Correlates of Postpartum Maternal Functioning in a Low-Income Obstetric Population.

BACKGROUND: Perinatal mental health has been characterized primarily via depression evaluation. However, there may be advantages to complementary assessment of postpartum functional status. OBJECTIVE: The purpose of this study was to examine sociodemographic and clinical factors associated with maternal functioning in low-income obstetrics patients. DESIGN: One hundred and twenty-eight women receiving postpartum obstetrical care at a large medical center in medically underserved, Middle Georgia were screened for depressive symptoms with the Edinburgh Postnatal Depression Scale. The women also completed the Barkin Index of Maternal Functioning and a sociodemographic survey. Multivariate analysis was performed to elucidate factors independently associated with maternal functioning. RESULTS: Higher Edinburgh Postnatal Depression Scale scores ( p < .0001) and being married ( p = .043) were associated with decreased maternal functioning. CONCLUSIONS: Health care providers should be cognizant of the relationship between postnatal depression and maternal functioning and its potential implications for family health.

Perinatal Nurse Home Visiting Referral Patterns Among Women With Diabetes and Hypertension in Philadelphia.

OBJECTIVE: To examine access to perinatal nurse home visiting services for high-risk pregnant women who have diabetes or hypertension. DESIGN: Secondary data analysis. SETTING: Philadelphia, PA. PARTICIPANTS: Pregnant women who had a live birth during 2012 and those referred to a community-based agency for perinatal nurse home visiting because of their diagnosis of diabetes or hypertension. METHODS: Access to services was measured by examining referral information (dosage, diagnosis, gestational age at time of referral, and insurance type) retrieved from administrative logs of the community-based organization that provides perinatal home visiting to high-risk pregnant women. The population-based prevalence rates of hypertension and diabetes were calculated from birth record data provided by the Philadelphia Department of Public Health. RESULTS: During 2012, 595 pregnant women were referred for perinatal nurse home visiting services. The mean gestational age when referred for services was 24.9 weeks (standard deviation = 8.5) with a mean number of 8.8 authorized visits (standard deviation = 8). Associated with more authorized visits was having Medicaid as the insurance type and medical diagnoses that included hypertension (p < .01). Philadelphia prevalence rates for diabetes and hypertension varied by race and ethnicity (p < .001); Asian mothers had the greatest rates for diabetes and Black mothers the greatest rates for hypertension. CONCLUSION: Various models of home visiting programs exist to improve maternal and child health outcomes. Because maternal morbidity and mortality rates are rising in the United States, further research about perinatal nurse home visiting programs for pregnant women with diabetes and hypertension is warranted.

Assessment and Care of Childbearing Women With Severe and Persistent Mental Illness.

Severe and persistent mental illness (SPMI) refers to complex mood disorders that include major depressive disorder with or without psychosis; severe anxiety disorders resistant to treatment; affective psychotic disorders including bipolar affective disorder, schizophrenia, and schizoaffective disorder; and other nonaffective subtypes of schizophrenia. SPMIs affect 1 in 17 people and are among the leading causes of disability and impaired health-related quality of life in the United States. Caring for childbearing women with preexisting SPMI can be challenging for maternal-child health clinicians. This article provides an overview of SPMI during pregnancy and challenges for clinicians, including early identification, accuracy of diagnoses, and appropriate management through care coordination among an interdisciplinary team that includes obstetric providers, psychiatrists, nurses, and others.

Human papillomavirus vaccination uptake and completion as a preventive health measure among female adolescents.

BACKGROUND: National coverage for the human papillomavirus (HPV) vaccine falls short of the targeted goals for Healthy People 2020 with disparities in completion rates noted in minority adolescent female populations. The purpose of this study was to provide a review of the literature on HPV vaccination uptake and completion rates among female minority adolescents as well as a discussion of the financial and policy dimensions of HPV vaccination with implications that impact uptake and completion rates. METHODS: By reviewing the literature, the authors show that the two human papillomavirus (HPV) vaccines, Gardasil and Cervarix, have presented unprecedented opportunities to prevent morbidity and mortality from cervical cancer. CONCLUSION: The authors recommend that nurses and advanced practice nurses take an active role at the point of care to educate families about HPV vaccination. Nursing interventions for practice changes are provided to improve vaccination initiation and completion rates in disadvantaged populations.

Growing up with juvenile idiopathic arthritis.

Juvenile idiopathic arthritis (JIA) is the most common chronic pediatric illness in the United States. The disease encompasses a group of heterogeneous chronic arthritis conditions that begin before age 16 years and persist for more than 6 weeks. Formerly termed juvenile rheumatoid arthritis (JRA), JIA now includes polyarticular, oligoarticular, psoriatic, enthesitis-related arthritis, systematic arthritis, and undifferentiated arthritis. Diagnosis is based on clinical and laboratory features. Treatment includes immunosuppressant therapy, non-steroidal anti-inflammatory drug (NSAIDS), and biologic therapies. This can affect all aspects of an adolescent's life including physiologic, psychosocial, and spiritual components; therefore, this article discusses a comprehensive approach to care management with transition of care as a critical feature in adolescent healthcare.

Cervical cancer screening in adolescents: an evidence-based internet education program for practice improvement among advanced practice nurses.

BACKGROUND: The literature reports great variation in the knowledge levels and application of the recent changes of cervical cancer screening guidelines into clinical practice. Evidence-based screening guidelines for the prevention and early detection of cervical cancer offers healthcare providers the opportunity to improve practice patterns among female adolescents by decreasing psychological distress as well as reducing healthcare costs and morbidities associated with over-screening. PURPOSE: The purpose of this pilot intervention study was to determine the effects of a Web-based continuing education unit (CEU) program on advanced practice nurses' (APNs) knowledge of current cervical cancer screening evidence-based recommendations and their application in practice. This paper presents a process improvement project as an example of a way to disseminate updated evidence-based practice guidelines among busy healthcare providers. METHODS: This Web-based CEU program was developed, piloted, and evaluated specifically for APNs. The program addressed their knowledge level of cervical cancer and its relationship with high-risk human papillomavirus. It also addressed the new cervical cancer screening guidelines and the application of those guidelines into clinical practice. FINDINGS: Results of the study indicated that knowledge gaps exist among APNs about cervical cancer screening in adolescents. However, when provided with a CEU educational intervention, APNs' knowledge levels increased and their self-reported clinical practice behaviors changed in accordance with the new cervical cancer screening guidelines. LINKING EVIDENCE TO PRACTICE: Providing convenient and readily accessible up-to-date electronic content that provides CEU enhances the adoption of clinical practice guidelines, thereby decreasing the potential of the morbidities associated with over-screening for cervical cancer in adolescents and young women.

Focusing on maternal health beyond breastfeeding and depression during the first year postpartum.

Nursing experts reviewed publications between 2003 and 2013 to identify practices for the care of women during the recovery year after childbirth. They focused on maternal transition, role and function, and psychosocial support. Findings indicated that clarification of the psychosocial meanings of childbirth and motherhood and family support systems that strengthen or hinder optimal wellness and functioning are needed. In addition, evidence is required to promote healthy transitions during this transition year.

The role of nurses in comprehensive care management of pregnant women with drug addiction.

Drug addiction during pregnancy is a complex health and social issue that requires an interdisciplinary health care team providing nonjudgmental, comprehensive care. Critical challenges include onset of and attendance at prenatal care, potential obstetric complications, transition to extrauterine life and potential neonatal abstinence syndrome for the neonate, newborn feeding issues, postpartum depression and risk of relapse for women.