MCN : The American Journal of Maternal/Child Nursing

Includes bibliographical references.

249 Editorial -- 296 Hot topics in maternity nursing -- 297 Hot topics in pediatric nursing -- 298 Nutrition for the family -- 299 Global health and nursing -- 300 Toward evidence based practice -- 304 Perinatal patient safety.

[Article Title: Maternal Mortality in the United States / Kathleen Rice Simpson, p. 249] Abstract: Maternal mortality rates in the United States compare very unfavorably with other high-income countries. The Centers for Disease Control and Prevention estimate that about 700 women die of pregnancy-related causes in the United States each year. A summary of their May 2019 report is presented. Nurses must continue to take a leadership role in efforts to reduce the unacceptably high maternal mortality in the United States.;[Article Title: A Quality Improvement Initiative to Reduce Opioid Consumption after Cesarean Birth / Adriane Burgess, Amy Harris, Julia Wheeling and Roni Dermo, p. 250-259] Abstract: Background: One in 300 opioid naïve women become addicted to opiates after cesarean birth. After cesarean, women are often prescribed more opiates at discharge than necessary, resulting in increased opportunity for diversion. Purpose: To improve use of comfort strategies and nonopioid medications to decrease the amount of opioids required postoperatively and prescribed at discharge, in women who gave birth via cesarean. Methods: An interdisciplinary workgroup was convened to assess data on opioid use, prescribing practices at discharge, and nurses' use of alternative comfort strategies from January to March 2018. A comfort bundle was designed to include standardized use of preoperative acetaminophen, postoperative comfort education, simethicone, postoperative gum chewing, and abdominal binders. Nurses and healthcare providers were educated on the initiative. Data were reevaluated and compared with preintervention data assessing for improvement and adherence to the bundle components. Results: There was a 61% reduction in morphine milliequivalents given to women after cesarean birth between the first quarter in 2018 and the fourth quarter in 2018. Comparing March with December, 2018 data, adherence to each bundle component improved. The percentage of women receiving less than 20 tabs of oxycodone at discharge increased from 26.3% to 96.7%. Implications for nursing practice: Nurses should evaluate comfort options provided after cesarean birth and educate women about use of nonopioid pain relief strategies. A standardized process to address pain and comfort after cesarean birth may decrease exposure to opioids while maintaining comfort. ;[Article Title: Clinicians' Perspectives on Admission of Pregnant Women: A Triad / Rachel Blankstein Breman, Stacey Iobst, Julie Paul and Lisa Kane Low, p. 260-268 Abstract: Purpose: Reducing primary cesarean births is a national priority in the United States. Recommendations include delaying admission of low-risk pregnant women to the hospital until they are in active labor, considered to be 6 cm cervical dilatation. How this recommendation affects decision-making during triage requires further exploration. The purpose of this study was to explore the clinician's perspective on the triage process and deferral of hospital admission for low-risk pregnant women who were not yet in active labor. Methods: A qualitative descriptive approach was used via semistructured interviews with physicians, midwives, and nurses. Data analysis used an inductive approach and identified codes, a theme and subthemes. Results: Twenty-five clinicians participated. A triad of decision-making occurred between three main stakeholders: the low-risk pregnant woman, the triage nurse, and the physician or midwife. One theme and four subthemes related to this triad were identified. The theme Admission of Low-Risk Pregnant Women Depends on Many Factors provides context to the maternity care triage process. There are many factors clinicians consider prior to admitting women, including situational and clinical factors. Subthemes related to the woman are her expectation and knowledge about birth and her ability to cope with labor. Subthemes associated with the provider and triage nurse are care variation and concern for maternal and fetal safety. Clinical implications: From the clinician's perspective, triage is a complex, dynamic process, even for low-risk pregnant women. There is an interplay of different factors affecting clinical decision-making, thus the decision-making triad provides a possible framework for shared decision-making.;[Article Title: Implementation of the Fetal Monitor Safety Nurse Role: Lessons Learned / Kellie M Griggs and Elizabeth K Woodard, p. 269-276] Abstract: Background: The fetal monitor safety nurse role was created as a supplemental support for nurses assessing fetal heart rate tracings in response to an adverse event. An experienced labor and delivery nurse without a patient care assignment was designated to continuously assess all active fetal monitoring tracings, via an electronic display away from the main nurses' station, as an adjunct to the care and assessment of the nurse with primary responsibility for the patient. Purpose: The purpose of this project was to evaluate the views of nurses who served as fetal monitor safety nurses about various aspects of the role. Methods: Nurses who served as fetal monitor safety nurses were invited to attend a small group session where they completed a survey about the role and then received information on the importance of fetal monitoring safety. Two weeks later, they were asked to take the survey again to evaluate potential changes in viewpoints. Results: Thirty nurses attended small group sessions and completed the survey. Of those, 22 nurses completed the post survey 2 weeks later. There was minimal change in nurses' views of the fetal monitor safety nurse role after attending the small group sessions. Nurses expressed comfort in notifying peers about concerns related to the fetal heart rate tracing and perceived overall safety benefits; however, they felt that safe staffing measures were not in place to support the role. Concerns were expressed about a nurse being in a nondirect patient care position during times of high census and acuity. Clinical implications: The fetal monitoring safety nurse may be an innovative potential solution to minimize risk of adverse events during labor that are related to accurate assessment of electronic fetal monitoring data and timely and appropriate interventions. More data are needed on improvements in fetal outcomes and adverse events potentially related to the fetal monitor safety nurse role. Budgetary support and adequate nurse staffing are required to make the role operationally feasible and safe. Valuing and seeking nurses' input as bedside experts about perinatal safety initiatives should be a part of implementing new practices.;[Article Title: Bedside Music Therapy for Women during Antepartum and Postpartum Hospitalization / Kristen Corey, Ronit Fallek and Maya Benattar, p. 277-283] Abstract: Purpose: Stress and anxiety are prevalent during pregnancy and postpartum with adverse effects on mothers and newborns, yet women's psychological and emotional needs are often given a lower priority than their physical wellbeing. The purpose of this study was to assess feasibility of implementing a bedside music therapy intervention to alleviate stress and anxiety, provide emotional support, and facilitate mother-baby bonding for women during antepartum and postpartum hospitalization at a large urban medical center. Study Design and Methods: Over 15 months, women on three units who were hospitalized during antepartum or postpartum were referred for music therapy and received a single bedside session from a credentialed music therapist (MT-BC), including tailored interventions and education in relaxation techniques. A retrospective analysis of postintervention feedback questionnaires and process notes was conducted to assess participant receptivity and satisfaction, and the feasibility of implementing the program on the units. Results: Music therapy was provided to 223 postpartum and 97 antepartum patients. The program was found to be feasible and well received, including high satisfaction, positive effects on participants' relaxation and sense of connection with their baby, and enthusiastic reception from providers and staff. Qualitative feedback revealed salient themes including the effect of the intervention on mothers' mental, emotional and physical states, and the soothing effect of music on their newborns.

Clinical Implications: Hospitals are in a unique position to provide support services and self-care education for women during their antepartum and postpartum hospitalization. Music therapy can be integrated successfully into inpatient care as a nurturing and patient-centered form of psychosocial support.;[Article Title: Substance Abuse Disorder: Prenatal, Intrapartum and Postpartum Care / Kathleen Mahoney, Wendy Reich and Susan Urbanek, p. 284-288] Abstract: The growing opioid crisis in the United States affects childbearing women and their infants at an alarming rate. Substance use disorders in pregnancy have transitioned from a topic barely addressed to one that has become mainstream in the issue of pregnancy management. Opioid use can include appropriate use of a prescribed medication, the misuse of street drugs, and maintenance on an opioid agonist treatment such as methadone. Identifying this population of childbearing women is critical to be able to organize the appropriate resources and to provide a comprehensive multidisciplinary evidence-based plan of care. All clinicians need to be educated in identifying and caring for the growing population of women with substance use disorders. Each component of the continuum from prenatal care, labor and birth, and postpartum has challenges and issues that can have a positive or negative impact on the outcome of the pregnancy and the mother-infant relationship. Risk assessment, medication-assisted treatment, pain management, and fostering maternal-infant bonding are important considerations in the care of the woman with substance use disorder. Unbiased empathetic nurses are well positioned to strongly advocate and intervene on behalf of women with substance use disorder, which in turn will help to create positive outcomes for the mother and her baby.;[Article Title: Perspectives on Barriers and Facilitators in Caring for Women with Gestational Diabetes in Rural Appalachia / Ilana R Azulay Chertok, Jennifer J Silk and Kathryn A Kulasa, p. 289-295] Abstract: Purpose: The purpose of this study was to explore perspectives of healthcare providers in rural Appalachia who care for pregnant women with gestational diabetes, including management facilitators and barriers. Study design and methods: Qualitative study with interviews and thematic analysis. Thematic analysis was conducted using the sort and sift method after inductive content analysis with open coding, identifying categories, and abstraction. Results: Twenty-one advanced practice nurses and 10 physicians participated in the study. Three themes were identified: rural healthcare challenges including limited resources and lack of adherence to recommendations, cultural influences including normalization of diabetes and food culture, and collaborative care including accessible resources and patient motivation. Clinical implications: The themes provide insight into the perceived barriers and facilitators of healthcare providers caring for women with gestational diabetes in rural Appalachia. Consistent, evidence-based communication with cultural consideration supports effective education and care of women with gestational diabetes. Healthcare providers' knowledge of local resources, accessible electronic medical records, and communication among the various team members enhance collaboration in diabetic management in the rural setting.;[Article Title: Sexual Assault: What do Perinatal Nurses Need to Know? / Kirsten Wisner, p. 296] Abstract: Many women in the United States have experienced sexual violence. In a recent survey, nearly half of women have reported some type of contact sexual violence in their lifetime, and approximately one in five women reported an attempted or completed rape. Our maternity nursing expert, Dr. Wisner, offers advice on how to support women who have experienced sexual assault using trauma-informed care. ;[Article Title: An End to Sugary Drinks: The American Academy of Pediatrics and American Heart Association Speak Out / Judy A Beal, p. 297] Abstract: In March 2019, the American Academy of Pediatrics (AAP) and the American Hearth Association (AHA) release a public health policy recommendations designed to reduce childrens' consumptions of surgary drinks.;[Article Title: Assessing Corporate Influence on Dietary Advice / Denise Snow, p. 298] Abstract: Poor nutrition is a risk factor for chronic illness. The role of the clinician is to promote health and to guide patients toward healthy dietary choices from birth through the life span based on recommendations from government resources, professional organizations, and peer-reviewed journals.;[Article Title: The POWHER School: Transforming Care Provided by Guatemalan Traditional Birth Attendants / Lynn Clark Callister, p. 299] Abstract: Our global health and nursing expert, Dr. Callister, discusses the School of POWHER (Providing Outreach in Women's Health and Educational Resources) that was founded in Sololá in the western highlands of Guatemala in 2011 to help train traditional birth attendants for safe maternity care. Respect for culture and local customs are important aspects of this successful program.