Use of an Evidence-Based Approach to Improve Influenza Vaccination Uptake in Pregnancy.

INTRODUCTION: Influenza can be a significant health threat for any affected individual. Pregnant women are a high-risk population because of the likelihood of developing severe disease. Although the influenza vaccine has been recommended for use by pregnant women since 2004, current vaccination rates among pregnant women are lower than the general population and other high-risk groups. PROCESS: A quality improvement project was undertaken during the 2019-to-2020 influenza season to increase the uptake of the influenza vaccine by women who were pregnant. The primary objective of the project was to increase the influenza vaccination rate compared with the rate in the previous season. The project had a secondary objective of standardizing documentation of the patient's vaccination status in the health record to capture data for performance measures. Interventions directed at patients, health care providers, and the health care system were simultaneously implemented as recommended by the Community Preventive Services Task Force. OUTCOMES: Data were collected from 2967 records with 1480 from the 2018-to-2019 season and 1487 from the 2019-to-2020 season. Compared with records from the 2018-to-2019 season, the rate of those associated with a documented influenza vaccine was higher in the 2019-to-2020 season (63% vs 59%; P = .01). The rate of records without vaccination status codes was significantly less in the 2019-to-2020 season compared with the 2018-to-2019 season (14% vs 23%; P < .001). DISCUSSION: Although interventions were effective in improving influenza vaccination uptake among pregnant women, vaccination rates still remain below the 80% goal set by the US Department of Health and Human Services. Bundled interventions have proven to be more effective than individual interventions, although which interventions are most effective remains unclear.

Influenza and Influenza Vaccine: A Review.

Influenza is a highly contagious, deadly virus, killing nearly half a million people yearly worldwide. The classic symptoms of influenza are fever, fatigue, cough, and body aches. In the outpatient setting, diagnosis can be made by clinical presentation with optional confirmatory diagnostic testing. Antiviral medications should be initiated as soon as possible, preferably within 24 hours of initiation of symptoms. The primary preventive measure against influenza is vaccination, which is recommended for all people 6 months of age or older, including pregnant and postpartum women, unless the individual has a contraindication. Vaccination should occur at the beginning of flu season, which typically begins in October. It takes approximately 14 days after vaccination for a healthy adult to reach peak antibody protection. There are challenges associated with vaccine composition and vaccine uptake. It takes approximately 6 to 8 months to identify and predict which influenza strains to include in the upcoming season's vaccine. During this time, the influenza virus may undergo antigenic drift, that is, mutating to avoid a host immune response. Antigenic drift makes the vaccine less effective in some seasons. The influenza virus occasionally undergoes antigenic shift, in which it changes to a novel virus, creating potential for a pandemic. There are also barriers to vaccine uptake, including lack of or limited access to care and misconceptions about receiving the vaccine. Interventions that improve access to and uptake of the influenza vaccine must be initiated, targeting multiple levels, including health care policy, patients, health care systems, and the health care team. This article reviews information about influenza identification, management, and prevention.

Management of Bartholin Duct Cysts and Gland Abscesses.

Bartholin duct cysts and gland abscesses can affect a woman's day-to-day functioning and be challenging to manage. Many Bartholin duct cysts that are not infected remain asymptomatic and resolve spontaneously without intervention. However, an infected Bartholin duct cyst or glandular abscess should be drained when larger than 2 cm because such cysts or abscesses do not tend to resolve spontaneously and can recur. Management options fall under 3 broad categories: expectant, medical, or surgical. With special training, midwives and women's health nurse practitioners can manage many women who present with Bartholin duct cysts or gland abscesses. Rarely, a woman with a severe or recurrent infection will need referral to a surgeon. Knowing which management option to choose may be challenging at first; this article is aimed at providing evidence-based knowledge about Bartholin duct cysts and gland abscesses for clinicians so that they can make the diagnosis and management plan with confidence. A clinical case is used to illustrate the identification, diagnosis, and management of Bartholin duct cysts and gland abscesses. The range of interventions, from expectant management with comfort measures to surgical intervention, is be explored to assist the clinician in choosing the correct management approach.

Preconception Care: Improving the Health of Women and Families.

Approximately 50% of the pregnancies in the United States are unintended. Most pregnancies are not diagnosed until after the period of organogenesis. Environmental exposures, chronic and acute illnesses, and ingestion of teratogens that can negatively affect the fetus may occur during these early weeks of pregnancy. Some chronic disease effects and lifestyle behaviors that affect the fetus can be adjusted prior to conception. Because of this, the health of a woman and her partner prior to pregnancy are of utmost importance. The Centers for Disease Control and Prevention and the Preconception Health and Health Care Initiative have established goals and evidence-based guidelines for preconception care. Preconception health care can be threaded into every visit with all women of reproductive age who are not pregnant. The guidelines focus on 3 main areas: screening, health promotion, and interventions. Screening is accomplished with women and couples via a thorough history and assessment of risks including a reproductive life plan; assessment of tobacco, alcohol and drug use; sexually transmitted infection (STI) testing and education; and assessment of environmental or teratogenic risk factors. Health promotion includes making sure the woman is current with regard to recommended vaccines, taking appropriate levels of folic acid, and maintaining a healthy weight and level of physical activity. The health care provider can intervene when indicated with management of chronic and acute illnesses, as well as provide assistance with tobacco, alcohol, and drug cessation as necessary. When a woman and her partner are healthy prior to pregnancy, unintended or planned, the woman and her fetus have a better chance at a healthy gestation and beyond. This article, via the use of case presentations, reviews how preconception health can be integrated into an office visit.

Using Community-Based Participatory Research to Investigate Meaningful Prenatal Care Among African American Women.

PURPOSE: In the United States, African American babies die more than twice as often as White babies. The cause for this difference remains elusive, yet is likely complex with one factor being inadequate cultural care of pregnant African American women. The purpose of this study was to explore African American women's perspectives of meaningful prenatal care. DESIGN: Community-based participatory research was employed for this study using photovoice. The sample included 11 African American mothers in an urban community in Midwestern United States. FINDINGS: Five themes were abstracted from the data: (1) Access to Care; (2) Soul Nourishment; (3) Companionship; (4) Help Me, Teach Me; and (5) The Future. DISCUSSION/CONCLUSION: Meaningful prenatal care is influenced by culture. African American women need physical, social, and soulful support to enhance meaningfulness of care during pregnancy. PRACTICE IMPLICATIONS: The findings support that meaningfulness of prenatal care for African American women may be enhanced by accessible and uniquely designed, culturally congruent models of prenatal care.

Innovative uses of technology in online midwifery education.

Women's health care in the United States is at a critical juncture. There is increased demand for primary care providers, including women's health specialists such as certified nurse-midwives/certified midwives, women's health nurse practitioners, and obstetrician-gynecologists, yet shortages in numbers of these providers are expected. This deficit in the number of women's health care providers could have adverse consequences for women and their newborns when women have to travel long distances to access maternity health care. Online education using innovative technologies and evidence-based teaching and learning strategies have the potential to increase the number of health care providers in several disciplines, including midwifery. This article reviews 3 innovative uses of online platforms for midwifery education: virtual classrooms, unfolding case studies, and online return demonstrations of clinical skills. These examples of innovative teaching strategies can promote critical and creative thinking and enhance competence in skills. Their use in online education can help enhance the student experience. More students, including those who live in rural and underserved regions and who otherwise might be unable to attend a traditional onsite campus, are provided the opportunity to complete quality midwifery education through online programs, which in turn may help expand the women's health care provider workforce. This article is part of a special series of articles that address midwifery innovations in clinical practice, education, interprofessional collaboration, health policy, and global health.

Nurse-midwifery: art and science.

The gap in the health of the nations' people seems to be widening and reflects existing social inequalities affecting the ongoing health of individuals. From a historical and practical perspective, certified nurse-midwives (CNMs) are one group of advanced practice registered nurses uniquely situated to address existing disparities related to maternal-child health. This article provides an overview of the historical development, current status, and use of CNMs in the United States health care system; the impact of CNMs on maternal-child health outcomes; and future trends in the education of CNMs.