Understanding the role and impact of electronic health records in labor and delivery nursing practice: A scoping review protocol.

Background: Electronic health records have a significant impact on nursing practice, particularly in specializations such as labor and delivery, or acute care maternity nursing practice. Although primary studies on the use of electronic health records in labor and delivery have been done, no reviews on this topic exist. Moreover, the topic of labor and delivery nurses' organizing work in the electronic health record-enabled context has not been addressed. Objective: To (a) synthesize research on electronic health record use in labor and delivery nursing and (b) map how labor and delivery nursing organizing work is transformed by the electronic health record (as described in the reviewed studies). Methods: The scoping review will be guided by a modified methodology based on selected recommendations from the Joanna Briggs Institute and the Preferred Reporting Items for Systematic reviews and Meta-Analyses Extension for Scoping Reviews. A comprehensive search will be conducted in the following databases: CINAHL Complete, MEDLINE, Academic Search Complete, Web of Science, Scopus and Dissertations and Theses Abstracts and Indexes. Included sources will be primary research, dissertations, or theses that address the use of electronic health records in labor and delivery nursing practice in countries with high levels of electronic health record adoption. Data extracted from included sources will be analyzed thematically. Further analysis will theorize labor and delivery nurses' organizing work in the context of electronic health record use by utilizing concepts from Davina Allen's Translational Mobilization Theory. Findings will be presented in tabular and descriptive formats. Conclusion: The findings of this review will help understand transformations of nursing practice in the electronic health record-enabled labor and delivery context and identify areas of future research. We will propose an extension of the Translational Mobilization Theory and theorize nurses' organizing work involving the use of the electronic health record.

Missed care and equitable breastfeeding support: An integrative review of exposure to in-hospital care by patient characteristics and breastfeeding outcomes.

AIM: To synthesize the literature on breastfeeding outcomes associated with exposure to internationally recognized best practices, such as the Baby-Friendly Hospital Initiative, for patients in the United States during the postpartum period, contextualized within the Missed Care Model. DESIGN: The authors employed Whittemore and Knafl's integrative review framework and the 2020 PRISMA guidelines for data extraction, synthesis, reporting and assessment. METHODS: Five electronic databases were searched for articles published between 2007 and 2023. Eligible articles reported on exposure to breastfeeding best practices and outcomes or the experiences, views, perceptions and attitudes of parents, nurses or lactation consultants regarding hospital breastfeeding support. Extracted data were compared to identify in-hospital exposure to breastfeeding best practices and breastfeeding outcomes, and differences in exposure and outcomes based on patient and provider characteristics. RESULTS: Twenty-one quantitative, qualitative and mixed methods articles met inclusion criteria. A higher reported adherence to best practices was associated with greater odds of breastfeeding; some practices demonstrated greater effects overall or for specific groups. Higher exposures to best practices and higher breastfeeding rates were found for non-Hispanic white patients, and those with more education, private insurance and who live in urban areas. Disparities in support and outcomes were related to patients' race/ethnicity, language, weight and age. Qualitative findings reflected missed care concepts, such as internal processes related to habits and group norms, relevant to breastfeeding support. CONCLUSION: Review findings also include an adapted Missed Care Model specific to breastfeeding support, which can inform future research related to providers' internal processes that may influence breastfeeding or equitable breastfeeding care. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE: Missed care can be influenced by a variety of factors, including providers' internal values and beliefs. Study findings suggest the existence of inequities in breastfeeding care and underscore the need to address and eliminate breastfeeding disparities. IMPACT: This study addressed how patient exposure to best practices in breastfeeding support relates to breastfeeding outcomes and whether exposure and outcomes differ by patient or provider characteristics, connecting this to the Missed Care in Breastfeeding Support Model. The main findings were that higher reported exposure to best practices in breastfeeding support related to improved breastfeeding outcomes; inequities exist in exposure to best practices; and patients and providers identify the importance of providers' internal processes in the delivery of breastfeeding support, which aligns with the Missed Care in Breastfeeding Support Model. Study findings will have the potential to impact how nurses, lactation consultants and other providers who deliver breastfeeding support in the postpartum hospital setting. REPORTING METHOD: The authors adhered to relevant 2020 PRISMA reporting guidelines. PATIENT OR PUBLIC CONTRIBUTION: No patient or public contribution.

Is oral consumption of dates (Phoenix dactylifera L. fruit) in the peripartum period effective and safe integrative care to facilitate childbirth and improve perinatal outcomes: a comprehensive revised systematic review and dose-response meta-analysis.

BACKGROUND: Recent reviews have reported inconclusive results regarding the usefulness of consuming dates (Phoenix dactylifera L. fruit) in the peripartum period. Hence, this updated systematic review with meta-analysis sought to investigate the efficacy and safety of this integrated intervention in facilitating childbirth and improving perinatal outcomes. METHODS: Eight data sources were searched comprehensively from their inception until April 30, 2023. Parallel-group randomized and non-randomized controlled trials published in any language were included if conducted during peripartum (i.e., third trimester of pregnancy, late pregnancy, labor, or postpartum) to assess standard care plus oral consumption of dates versus standard care alone or combined with other alternative interventions. The Cochrane Collaboration's Risk of Bias (RoB) assessment tools and the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) were employed to evaluate the potential RoB and the overall quality of the evidence, respectively. Sufficient data were pooled by a random-effect approach utilizing Stata software. RESULTS: Of 2,460 records in the initial search, 48 studies reported in 55 publications were included. Data were insufficient for meta-analysis regarding fetal, neonatal, or infant outcomes; nonetheless, most outcomes were not substantially different between dates consumer and standard care groups. However, meta-analyses revealed that dates consumption in late pregnancy significantly shortened the length of gestation and labor, except for the second labor stage; declined the need for labor induction; accelerated spontaneity of delivery; raised cervical dilatation (CD) upon admission, Bishop score, and frequency of spontaneous vaginal delivery. The dates intake in labor also significantly reduced labor duration, except for the third labor stage, and increased CD two hours post-intervention. Moreover, the intervention during postpartum significantly boosted the breast milk quantity and reduced post-delivery hemorrhage. Likewise, dates supplementation in the third trimester of pregnancy significantly increased maternal hemoglobin levels. The overall evidence quality was also unacceptable, and RoB was high in most studies. Furthermore, the intervention's safety was recorded only in four trials. CONCLUSION: More well-designed investigations are required to robustly support consuming dates during peripartum as effective and safe integrated care. TRIAL REGISTRATION: PROSPERO Registration No: CRD42023399626.

Development of the Conversational Health Literacy Assessment Tool for maternity care (CHAT-maternity-care): participatory action research.

BACKGROUND: Limited health literacy in (expectant) parents is associated with adverse health outcomes. Maternity care providers often experience difficulties assessing (expectant) parents' level of health literacy. The aim was to develop, evaluate, and iteratively adapt a conversational tool that supports maternity care providers in estimating (expectant) parents' health literacy. METHODS: In this participatory action research study, we developed a conversational tool for estimating the health literacy of (expectant) parents based on the Conversational Health Literacy Assessment Tool for general care, which in turn was based on the Health Literacy Questionnaire. We used a thorough iterative process including different maternity care providers, (expectant) parents, and a panel of experts. This expert panel comprised representatives from knowledge institutions, professional associations, and care providers with whom midwives and maternity care assistants work closely. Testing, evaluation and adjustment took place in consecutive rounds and was conducted in the Netherlands between 2019 and 2022. RESULTS: The conversational tool 'CHAT-maternity-care' covers four key domains: (1) supportive relationship with care providers; (2) supportive relationship within parents' personal network; (3) health information access and comprehension; (4) current health behaviour and health promotion. Each domain contains multiple example questions and example observations. Participants contributed to make the example questions and example observations accessible and usable for daily practice. The CHAT-maternity-care supports maternity care providers in estimating (expectant) parents' health literacy during routine conversations with them, increased maternity care providers' awareness of health literacy and helped them to identify where attention is necessary regarding (expectant) parents' health literacy. CONCLUSIONS: The CHAT-maternity-care is a promising conversational tool to estimate (expectant) parents' health literacy. It covers the relevant constructs of health literacy from both the Conversational Health Literacy Assessment Tool and Health Literacy Questionnaire, applied to maternity care. A preliminary evaluation of the use revealed positive feedback. Further testing and evaluation of the CHAT-maternity-care is required with a larger and more diverse population, including more (expectant) parents, to determine the effectiveness, perceived barriers, and perceived facilitators for implementation.

Essential Nursing Actions to Reduce Inequities for Black Women in the Perinatal Period.

Perinatal nurses play a critical role in the care of, advocacy for, and research with Black women in the perinatal period. Despite awareness of inequities in the perinatal health care system that stem from racism in the United States, many nurses report feeling detached from the crisis. In this critical commentary, we provide a five-step nursing action guide to address this health disparity that is aligned with the Future of Nursing report and the American Nurses Association Code of Ethics. We recommend nursing activities in each step: understand drivers of health inequities among Black women, reflect on implicit bias, use respectful care frameworks with Black women, conduct ethical research, and advocate for change. The article includes a sharable and printable action sheet that can be used in the work environment to remind nurses of their roles in enacting change.

The 300 versus 300 Study-Low Volume versus High Volume Single Balloon Catheter for Induction of Labor: A Retrospective Case-Control Study.

The use of a Foley catheter is one of the oldest known methods of labor induction. Therefore, protocols using different volumes of Foley catheter balloons have been developed and tested to accurately determine their effectiveness. In this study, it was decided to retrospectively evaluate two induction of labor (IOL) protocols. The last 300 eligible patients who met the criteria and underwent the low-volume balloon protocol (40-60 mL) IOL were selected. Then next, 300 patients who met the criteria and underwent high-volume balloon (80-100 mL) IOL were selected. Outcomes included time to delivery and parturition type, oxytocin augmentation, operative deliveries and application of intrapartum anesthesia. Overall, the majority of patients delivered within 24 h. Patients who received a high-volume Foley catheter had statistically significantly more vaginal deliveries. The mean-time to delivery in the high-volume catheter group was statistically significantly shorter than in the low-volume catheter group. Patients who received a high-volume Foley catheter required statistically significantly less oxytocin augmentation during induction of labor compared to patients with a low-volume Foley catheter. Regardless of the balloon volume used, the percentage of operative deliveries remained at a similar, low level (8.36% and 2.14%). Regardless of the catheter volume used, the majority of patients chose epidural over intravenous anesthesia. In conclusion, a high-volume balloon Foley catheter IOL is characterized by an increased percentage of vaginal deliveries, shortened time to delivery regardless of the type of delivery, and lower need for oxytocin augmentation.

Knowledge of Postbirth Warning Signs and Postpartum Education Among Women in Ghana.

OBJECTIVE: To assess the relationship between postpartum education and knowledge of postbirth warning signs among women in Ghana. DESIGN: Cross-sectional survey. SETTING: Tamale West Hospital in Tamale Metropolitan Area, Ghana. PARTICIPANTS: Women (N = 151) who gave birth to healthy newborns and were admitted to the postnatal ward. METHODS: We collected data from surveys distributed in the hospital. The survey included items for sociodemographic characteristics, obstetric history, postpartum education provided, and knowledge of nine common postbirth warning signs. We used descriptive statistics and multivariate logistic regression models to analyze the data. RESULTS: Participants reported knowing an average of 5.2 of 9 (SD = 2.84) postbirth warning signs. Severe bleeding (94.70%, n = 143), fever (82.12%, n = 124), and severe headache (72.19%, n = 109) were the postbirth warning signs most frequently identified by participants. Swelling in the leg (37.09%, n = 56) and thoughts of hurting oneself (33.11%, n = 50) were the postbirth warning signs least frequently identified by participants. Knowledge about postbirth warning signs was positively associated with reports of receiving educational handouts on the postnatal ward (adjusted OR = 4.64, 95% confidence interval [1.27, 17.04]) and reports that four or more postpartum complications were taught before hospital discharge (adjusted OR = 27.97, 95% confidence interval [7.55, 103.57]) compared to zero to three postpartum complications. CONCLUSION: All women need comprehensive discharge education on the warning signs of complications after birth. Promoting knowledge of postbirth warning signs can decrease delays in seeking care and contribute to the reduction of maternal mortality in Ghana.

'You have a little human being kicking inside you and an unbearable pain of knowing there will be a void at the end': A meta-ethnography exploring the experience of parents whose baby is diagnosed antenatally with a life limiting or life-threatening condition.

BACKGROUND: Parents of babies diagnosed with life limiting conditions in the perinatal period face numerous challenges. Considerations include the remainder of the pregnancy, delivery of the baby and decisions around care in the neonatal period. AIM: To increase understanding of how parents experience the diagnosis of a life-limiting or life-threatening condition, during pregnancy and following the birth of their baby, by answering the question: 'what is known about the perinatal experiences of parents of babies with a life-limiting or life-threatening diagnosis?' DESIGN: A meta-ethnography was conducted to synthesise findings from existing qualitative evidence. DATA SOURCES: British Nursing Database, CINAHL, Medline, PsycINFO and Embase databases were searched in January 2023. FINDINGS: Relationships between parents and their families and friends, and with professionals influence the needs and experiences of parents, which oscillate between positive and negative experiences, throughout parents' perinatal palliative care journey. Parents highlighted the need for control and a sense of normality relating to their parenting experience. Validation was central to the experience of parents at all stages of parenthood. Relationships between the parent and the baby were unwavering, underpinned with unconditional love. CONCLUSION: Professionals, family members and friendship groups influence the experience, validating parents and their baby's identity and supporting parents in having a sense of control and normality by demonstrating empathy, and providing time and clear communication.

Aspectos da confortabilidade de mulheres hospitalizadas na unidade materno-infantil: perspectiva dos profissionais de enfermagem / Aspectos involucrados en la comodidad de mujeres hospitalizadas en la unidad materno infantil: perspectiva de profesionales de enfermería / Aspects involved in the comfort of women hospitalized in the maternal and child unit: perspective of nursing professionals

Objetivo: conhecer os aspectos implicados na confortabilidade das mulheres hospitalizadas na unidade materno-infantil, na perspectiva dos profissionais de enfermagem. Método: pesquisa qualitativa de caráter exploratório e descritivo realizada em uma unidade materno-infantil, com 21 profissionais de enfermagem. A coleta de dados ocorreu por entrevista semiestruturada e, posteriormente, os dados foram submetidos a análise temática. Resultados: dentre os aspectos que contribuem para a confortabilidade destacam-se: mobiliário, serviço de hotelaria, métodos não farmacológicos para alívio da dor, respeito às escolhas da parturiente, direito ao acompanhante e disponibilidade da equipe. Como aspectos que dificultam a confortabilidade evidenciou-se a necessidade de adequação da estrutura física com a adoção de quartos pré-parto, parto e pós-parto, e espaços que permitam a vivência do luto em situações de óbito fetal. Considerações finais: a confortabilidade não está relacionada somente aos aspectos estruturais, materiais ou arquitetônicos, mas envolve as relações e interações estabelecidas na unidade materno-infantil.

Objetivo: conocer los aspectos involucrados en el confort de la mujer hospitalizada en la unidad materno-infantil, desde la perspectiva de los profesionales de enfermería. Método: investigación cualitativa exploratoria y descriptiva; realizada en una unidad materno-infantil, con 21 profesionales de enfermería. La recolección de datos ocurrió a través de entrevistas semiestructuradas, y posteriormente los datos fueron sometidos al análisis temático. Resultados: entre los aspectos que contribuyen al confort, se destacan: mobiliario, servicio hotelero, métodos no farmacológicos para el alivio del dolor, respeto a las elecciones de la parturienta, derecho a acompañante y disponibilidad del equipo. Como aspectos que dificultan el confort, se evidenció la necesidad de adecuar la estructura física con la adopción de salas de preparto, parto y posparto, y espacios que permitan la vivencia del duelo en situaciones de muerte fetal. Consideraciones finales: el confort no sólo está relacionado con aspectos estructurales, materiales o arquitectónicos, sino que involucra las relaciones e interacciones que se establecen en la unidad materno-infantil.

Objective: to know the aspects involved in the comfortability of women hospitalized in the maternal and child unit, from the perspective of nursing professionals. Method: qualitative exploratory and descriptive research conducted in a maternal-child unit with 21 nursing professionals. Data collection occurred by semi-structured interview, and subsequently the data were submitted to thematic analysis. Results: among the aspects that contribute to comfortability stand out: furniture, hospitality service, non-pharmacological methods for pain relief, respect for the choices of the parturient, right to the companion and availability of the team. As aspects that hinder comfortability, it was evidenced the need to adapt the physical structure with the adoption of pre-delivery, delivery and post-delivery rooms, and spaces that allow the experience of grief in situations of fetal death. Final considerations: comfortability is not only related to structural, material or architectural aspects, but involves the relationships and interactions established in the maternal-child unit.