A Time to Speak: When Incivility Injures Patients.

ABSTRACT: Incivility continues to create challenging work environments for healthcare workers. Nurses who experience incivility related to patient concerns or treatment often must confront power differentials and the fear of consequences if they speak up on behalf of the patient. This case report of a family's labor and delivery experience demonstrates the potential of harm to patients and long-term consequences of workplace incivility for the patient and the nurse. Moral courage and biblical insights to strengthen nurses' commitment to speak up for patients are discussed.

Experiences of African American Mothers Following the Death of Their Infants.

OBJECTIVE: To explore the lived experiences of African American mothers after the death of their infants. DESIGN: Qualitative, interpretive phenomenologic study. SETTING: Northeast Louisiana. PARTICIPANTS: Seven self-identified African American women whose infants died during the first year of life; the women's ages ranged from 18 to 38 years at the time of the infant's death. METHODS: Heidegger's interpretive phenomenologic approach guided the data collection and analysis. The women were interviewed using in-depth questioning to determine the meaning of the infant loss experience and their subsequent efforts to cope. RESULTS: Six themes represented the experiences of loss for the mothers: Shattered Dreams, Questioning God, Dissociation, Paralyzing Fear, Left in the Dark, and Uniqueness of Grieving. Three themes affected the women's efforts to cope after their loss: Authentic Presence, Spiritual Empowerment, and Disconnectedness. CONCLUSION: African American women who experienced infant death described intense feelings of loss, guilt, and isolation. These negative emotions can potentially affect their physical and psychological health. These findings may help health care providers develop culturally sensitive understanding of African American mothers' experiences of loss and equip providers to provide holistic assessment, appropriate support, and treatment for these vulnerable women.

COVID-19: Planning and Postpandemic Partnerships.

The emergence of coronavirus disease 2019 (COVID-19) has highlighted the need for strong partnerships between educators and healthcare professionals to facilitate the reopening of schools. School nurses are uniquely positioned to bridge this gap because of their role as a healthcare professional in the educational setting. Past research identifies the effectiveness of collaborative efforts to serve students by community partners, school system personnel, and school nurses. However, partnerships have been episodic and reactive rather than ongoing and proactive. The circumstances of COVID-19 present an opportunity for school nurses to promote collaboration and planning as an ongoing practice. Recommendations for school nurses to form ongoing public health and school system partnerships, as well as with teachers, parents, and school nursing colleagues, are presented.

A Case of Perceived Lack of Prenatal Caring.

This qualitative case study tells the story of one woman's experience of prenatal care through her own words and those of her mother, who is a nurse. Frequent sonograms, referral to a maternal-fetal medicine physician, and the unexpected recommendation to schedule an induction made this woman anxious about the well-being of her fetus, influenced her experience of pregnancy, and affected her developing identity as a mother. She felt neither cared for nor included as a partner in her own prenatal care. Although she reported feeling strong and capable in every other aspect of her life, she felt powerless to self-advocate with regard to her prenatal care experience. Ultimately, she asked her mother to accompany her to a prenatal appointment to advocate on her behalf.

A case study of maternal response to the implied antepartum diagnosis of inevitable labor dystocia.

Two pregnant women, one obese and one of extremely small stature, received antepartum recommendations from their health care providers to schedule cesarean births. In response, both women sought providers who would support their desire to attempt vaginal birth. The women's perspectives on their birth experiences along with the pertinent medical record data from their pregnancies and births provide a reminder about the inherent normalcy of birth amid the current culture of interventive obstetrical practices.

Early term birth: the impact of practice patterns on rates and outcomes.

The American College of Obstetricians and Gynecologists guidelines discourage elective deliveries before 39 weeks gestation, but clinicians continue to schedule elective inductions and cesareans resulting in births at 37 0/7 to 38 6/7 weeks gestation. These "early term" (ET) infants incur more morbidity and mortality than their 39-to-41-week counterparts. Using the Quality Health Outcomes Model, four hypotheses were tested: Among hospitals in one southwestern U.S. county, there are different rates of ET births, ET births preceded by elective labor induction, ET births preceded by elective cesarean section, and Neonatal Intensive Care Unit (NICU) admissions of ET infants. Analyses of 75,625 birth certificates involved 26,199 ET and 49,426 full term births in 16 hospitals. Chi-square analyses revealed significant differences in rates among hospitals for ET births, ET births preceded by elective labor induction, and ET births preceded by elective cesarean section, but no significant differences in NICU admissions. Wide variance across hospitals demonstrated practice patterns amenable to improvements.