Women's and Nurses' Perceptions of Visitor Restrictions After Childbirth During the COVID-19 Pandemic.

OBJECTIVE: To examine the perceptions of labor and delivery (L&D) nurses and childbearing women in the postpartum period regarding a restricted visitor policy during the COVID-19 pandemic. DESIGN: Descriptive mixed-methods survey and open-ended questions. SETTING/LOCAL PROBLEM: One hospital in the southwestern United States. There is limited evidence regarding recently imposed visitor restrictions related to COVID-19. PARTICIPANTS: Individuals who were pregnant and self-identified as women who gave birth during October 2020 through March 2021 (n = 674) and L&D nurses (n = 47). INTERVENTION/MEASUREMENTS: Participants who had given birth with visitor restrictions completed an online survey, and L&D nurses completed a paper survey. RESULTS: Childbearing women had positive and negative views; they valued a more intimate familial bonding and recovery without visitors and appreciated decreased pressure to accommodate family/friends. They were also disappointed with sibling restrictions and were sad and frustrated with visitor limitations, especially in special circumstances (e.g., NICU admission or extended stays). Nurses expressed that visitor restrictions allowed more time for higher-quality nursing care/patient teaching and decreased distractions in emergencies, leading to safer care. Women and nurses reported that visitor restrictions allowed women more rest and relaxation as well as less worry and strain from juggling family and friends who wanted to visit, but they also identified that there was decreased family support when it was needed. CONCLUSION: Women's responses were mixed, with some preferring support from many visitors, while others appreciated the intimate focus of just their partner. Most nurses preferred fewer visitors but could empathize with women.

Birth, Postpartum, and Home Experiences of Individuals With Lower Extremity Nerve Injury.

OBJECTIVE: To explore birth and at-home postpartum experiences of individuals with lower extremity nerve injury (LENI) related to childbirth. DESIGN: Mixed-methods, descriptive, cross-sectional survey with open-ended questions. SETTING: Closed Facebook support group. PARTICIPANTS: Two hundred-thirty individuals who experienced LENI during childbirth. MEASUREMENTS: Two research team members developed the online LENI survey that incorporated suggestions from LENI support group leaders. We used descriptive statistics, linear regression, and Kaplan-Meier survival curves to summarize the quantitative data and used content analysis for open-ended items. RESULTS: We described labor, birth, and postpartum characteristics in our sample, including immediate and long-term LENI symptoms. Falls resulting from LENI were common in the hospital (55.6%) and at home (75.6%). At discharge home, respondents reported low confidence in their ability to care for themselves and their infants as well as high levels of dependence on others. There was an 89.6% prevalence of depression in the first month at home. Approximately 80% of participants rated their degree of healing at 5 years as 80% to 100% healed. Content analysis yielded six themes: (a) Grieving Loss of Current and Future Life; (b) Caregiver Responses That Helped or Hindered; (c) Being in Danger; (d) Experiencing Emotional Turmoil; (e) Dealing With Family, Marital, and Financial Difficulties; and (f) Finding Strength, Overcoming Obstacles, and Experiencing Personal Growth. CONCLUSION: Participants in our sample reported a very high rate of falls, anxiety, and depression at home. Nurses should recognize LENI symptoms, take action to prevent falls, and offer accurate information and referrals.

Effect of an Obstetric Hemorrhage Bundle on Clinical Outcomes and Clinician Perceptions.

OBJECTIVE: To examine the effect of an obstetric hemorrhage (OBH) safety bundle on health outcomes and to explore nurses' and physicians' perceptions of using the bundle. DESIGN: Descriptive longitudinal study, including review of electronic health records for 79,509 births, and clinician surveys. SETTING: Nine hospitals in the southwestern United States. PARTICIPANTS: 685 maternity nurses and 210 obstetricians. INTERVENTIONS/MEASUREMENTS: Retrospective and prospective data collection over 3.5 years to examine selected health outcomes before and after implementing an OBH bundle. A 10-item questionnaire was used to survey clinicians for their perceptions of bundle use. The Hospital Survey on Patient Safety Culture was used to explore nurses' views of the safety climate before and after bundle implementation. RESULTS: Statistically significant decreases in mean documented blood loss were observed with bundle use. Blood loss rates of less than 500 ml and greater than 1,000 ml increased, and blood loss rates of 500 to 1,000 ml decreased. Use of postpartum hemorrhage medications increased. When adjusted for multiple tests, there was no statistically significant difference in the rates of postpartum hysterectomies or ICU admissions or in length of stay. Clinicians' perceptions of bundle use were positive, with scores ranging from 6 to 8 on a scale of 1 to 10. However, Hospital Survey on Patient Safety Culture results indicated a decrease in nurses' perceptions of safety after bundle implementation. CONCLUSION: OBH bundles provide tools and guidance to improve perinatal care and outcomes. Our findings of lower mean blood loss, increased use of postpartum hemorrhage medications, and positive perceptions of the bundle differed from findings of previous studies. Nurses' perceptions of safety decreased, yet clinicians reported that care was safer with the OBH bundle. Nurses' commitment and collaboration are vital to the success of bundle implementation.

Response to a National Issue: Moving Beyond "Back to Sleep" at Three Hospitals.

PURPOSE: To measure changes in registered nurse (RN) knowledge/beliefs and practices, parents' recall of infant safe sleep (ISS) teaching, and inpatient infant sleep environments and safety after implementing an ISS initiative. DESIGN AND METHODS: This longitudinal quasi-experimental study took place in three hospitals in the United States. An existing infant safe sleep tool was revised and updated to align with current recommendations on sleep environments. A bundled intervention included educating nurses, changing unit processes and implementing crib cards and room signs. Paired questionnaires surveyed 62 nurses before and 2 months after the intervention. Audits of 462 cribs/sleep environments with parent conversations assessed infant sleep conditions and parents' recall of RN teaching before and after the intervention. RESULTS: After Bonferroni correction, eight of 19 items for RN knowledge/beliefs and self-reported practice showed statistically significant improvements with moderate effect sizes. All 11 items for parents' recall of RN teaching showed statistically significant improvements, with odds ratios ranging from 7 to 76. Five of six real-time sleep safety conditions (from crib/sleep environment audits) had statistically significant improvements. Odds ratios ranged from eight to 83. CONCLUSION: An updated educational tool improved nurses' and parents' knowledge and practices related to current and updated safety factors for infant sleep conditions. Inpatient adherence to infant sleep safety recommendations improved. PRACTICE IMPLICATIONS: A two-hour investment of nurses' time yielded statistically significant improvements. Factors critical to the success of the ISS project roll-out are reported. Improvements in parents' recall of teaching and actual sleep environments suggest potential for long-term changes in infant safety at home.

Breastfeeding during military deployment: a soldier's story.

Thousands of women of childbearing age are serving and being deployed in the United States military. U.S. Department of Defense policies related to breastfeeding and deployment are inconsistent among the different branches of the military and sometimes conflict with evidence-based guidelines about optimal breastfeeding practices. This is the story of an active duty soldier who was deployed while breastfeeding and the obstacles she encountered trying to send breast milk home to her son. The article explores policy, health and professional practice implications.

Intrapartum nursing: integrating Rubin's framework with social support theory.

Numerous studies and articles on labor support have focused on the potential for improved labor and birth outcomes from supportive care during labor. Despite increased attention to labor support research, surprisingly little has been written about the theoretical underpinnings for intrapartum nursing care. This article explores Reva Rubin's framework and social support theory as a foundation for intrapartum nursing care. The most common features of social support provided the structure into which Rubin's descriptions of nursing care during labor and birth could be evaluated. Social support theory fit remarkably well, both with Rubin's views of the role of the perinatal nurse and with Rubin's observations of mothers' needs and feelings during childbirth. Combining these theoretical frameworks provides a perspective of intrapartum nursing practice that has not been previously considered in the published literature.

Development and testing of the Labor Support Scale.

Nurses use interventions and supportive strategies to help mothers throughout labor, yet little research examines intrapartum nurses' labor support techniques. The purpose of the study was to develop and test a self-report instrument, the Labor Support Scale (LSS), to describe the frequency with which nurses perform interventions and nurses' perceptions of the helpfulness of interventions. Steps for instrument development were item generation, content validity testing, piloting, refining, and administering the questionnaire in two studies (n = 307, n = 472). Internal consistency reliability was .90 and .92 for the frequency and helpfulness portions of the instrument (respectively). Exploratory factor analysis, known groups technique, content analysis, and discriminant analysis evaluated validity. In both phases, instrument psychometrics provided evidence of content, construct, and discriminant validity.