PURPOSE: To examine the topic of breast reduction surgery and nursing implications. METHODS: The following databases were searched (Embase, PubMed, Scopus, and CINAHL) using the terms mammoplasty, breast milk, human milk...PURPOSE: To examine the topic of breast reduction surgery and nursing implications. METHODS: The following databases were searched (Embase, PubMed, Scopus, and CINAHL) using the terms mammoplasty, breast milk, human milk, breastfeeding, and lactation, as well as breast reduction and reduction mammoplasty for studies in English, where both breastfeeding and reduction were mentioned in abstract or title, with no restriction on date of publication. RESULTS: There were four systematic reviews, and four additional articles identified that were not cited in the systematic reviews. All the systematic reviews used different definitions of "successful" breastfeeding. None specifically addressed the milk-making capacity of the breast tissue after surgery or reported 24-hour milk production. Certain surgical techniques are reported to help with the preservation of milk supply; however, they have not been accurately studied for milk-making capacity of the breast. Breastfeeding after breast reduction surgery has not been a topic covered by nurse researchers. CLINICAL IMPLICATIONS: The word "success" is not a useful word in providing counseling to women who are considering breast reduction surgery. Patients considering breast reduction should be advised that surgery may affect the ability to achieve a complete milk supply. More research is needed on the milk-making capacity of the breast after various types of breast reduction surgery.
BACKGROUND: The United States lacks a comprehensive framework to describe how multidisciplinary efforts to support breastfeeding and lactation fit together. The purpose of this article is to assess the roles of perinatal...BACKGROUND: The United States lacks a comprehensive framework to describe how multidisciplinary efforts to support breastfeeding and lactation fit together. The purpose of this article is to assess the roles of perinatal health care professionals in providing breastfeeding and lactation support (BFLS) along the perinatal care continuum and to offer a preliminary conceptual framework. STUDY DESIGN: We conducted a scoping review to examine the breadth and depth of published position statements by perinatal care professional organizations about BFLS. METHODS: Methodology for scoping reviews outlined by Peters et al. (2020) was used. We identified nine professions as primarily implicated in provision of perinatal care in the United States, seven of which had national professional organizations. We searched PubMed and a generic web engine to identify position statements from those organizations. We used thematic analysis to create an adapted framework of the perinatal care continuum illustrating how BFLS from perinatal health care professionals can be mapped onto the care continuum. RESULTS: Some overlap in roles were noted as were some gaps regarding professional roles in different phases of the perinatal care continuum. Overall, most professional perinatal care organizations described specific BFLS roles for their practitioners and recommended collaboration with other perinatal care professions. CLINICAL IMPLICATIONS: The full spectrum of BFLS involves information sharing and anticipatory guidance which begins in the preconception period and lasts through 2 or more years postpartum. Interprofessional collaboration, such as through engagement with state-based perinatal quality collaboratives or other interprofessional perinatal partnerships, is essential to ensuring that families receive cohesive, comprehensive BFLS.
BACKGROUND: This integrative review used Whittemore and Knafl's (2005) framework to critique the available quantitative evidence examining multiple types, prevalence, and impact of psychological trauma in labor and deliv...BACKGROUND: This integrative review used Whittemore and Knafl's (2005) framework to critique the available quantitative evidence examining multiple types, prevalence, and impact of psychological trauma in labor and delivery nurses. This review synthesizes the quantitative evidence on multiple types of trauma in this population. METHODS: Inclusion criteria were quantitative and mixed-methods studies of labor and delivery nurses examining types of trauma as defined by Foli's Middle-Range Theory of Nurses' Psychological Trauma. Studies on patient trauma from nursing care were excluded. CINAHL, Scopus, Medline, PubMed, and Web of Science databases were searched for studies electronically available through April 8, 2024. The Joanna Briggs Institute critical appraisal tools facilitated quality and bias assessments. A conceptual model based on Foli's theory contextualizes the findings. RESULTS: Nine studies (five cross-sectional descriptive, one longitudinal, and three mixed-methods) are included in this review. Across all studies, unique aspects of the labor and birth nurse role were found to contribute to trauma, including exposure to perinatal death and fetal demise, high rates of patient trauma, an increasingly medicalized birth environment, and emotional burnout. Labor and birth nurses experienced psychosomatic symptoms, negative effects on their relationships and quality of life, and increased rates of attrition, although nurses also identified specific system supports to decrease these effects. DISCUSSION: Limited research exists on the types of and impact of trauma experienced by labor and delivery nurses. This integrative review aims to address this gap in knowledge, while also suggesting implications for future research and policy. There is emerging evidence that post-traumatic growth is possible in this population with system support, yet many nurses are unaware of or have inadequate access to such resources. More research is needed to fully understand the magnitude of this population's psychological trauma and provide effective support strategies.
Amniotic fluid embolism (AFE) is a life-threatening complication occurring during pregnancy, labor, or birth and is characterized by sudden cardio-respiratory collapse and disseminated intravascular coagulopathy. Amnioti...Amniotic fluid embolism (AFE) is a life-threatening complication occurring during pregnancy, labor, or birth and is characterized by sudden cardio-respiratory collapse and disseminated intravascular coagulopathy. Amniotic fluid embolism is unpredictable, sudden, and complex. Amniotic fluid embolism is one of the causes of peripartum maternal mortality and morbidity in the United States. Nurses and other health care professionals responding to severe maternal events, such as an AFE, may experience trauma, which can lead to reduced executive functions, and challenges with memory, organization, prioritization, and emotional regulation. Amniotic fluid embolism patients and families also experience shock and trauma and may have a difficult time receiving and understanding information conveyed after the event. Communication frameworks commonly used in oncology and trauma settings have been successful in helping plan and guide the delivery of bad news while increasing patient and family understanding. Existing communication frameworks do not address the impact of perinatal nurse and health care professional trauma on their ability to communicate with their patients effectively. Based on feedback from the AFE survivors and clinicians, the AFE Foundation developed the AFE Effective Communication Guide. The Guide acknowledges and validates the impact of perinatal nurse and health care professional trauma and assists them in the planning and execution of effective, trauma-informed communication with patients and families after an AFE or other severe maternal events.
BACKGROUND: Current education and evaluation methods to support safe monitoring and interpretation of electronic fetal monitoring (EFM) tracings lack rigor. The purpose of this scoping review was to assess the state of E...BACKGROUND: Current education and evaluation methods to support safe monitoring and interpretation of electronic fetal monitoring (EFM) tracings lack rigor. The purpose of this scoping review was to assess the state of EFM education and competence evaluation. METHODS: A systematic search was conducted of peer-reviewed articles between January 2011 and December 2023 using CINAHL, PubMed, and Web of Science. The publications reviewed included findings on EFM education and competence evaluation. Data were synthesized into identified themes. RESULTS: The search produced 192 initial publications, and after review and analysis, nine were included in the final analysis. The themes identified included educational and evaluation methods and the curricular design. The type of competence evaluation used and the inclusion of essential EFM interpretation components were noted. Processes for the development of curricula and the use of an educational theory were also highlighted. The definition of competence, the effectiveness of educational interventions and evaluation measures, and the inclusion of intra- and interrater consistencies of interpretations were identified as key themes. Of the interventional studies, most used e-learning or a hybrid method including e-learning. An evaluation tool measured effectiveness in most studies; however, many did not set a passing standard. Some operationalized rigorous tools, but few measured the essential components of EFM interpretations or considered interrater consistencies of participants' EFM interpretations. CLINICAL IMPLICATIONS: There is need to improve education and evaluation of EFM tracing interpretation skills after participating in initial fetal monitoring courses, including integrating evidence-based educational design practices and rigorous learner evaluation to ensure safe and accurate EFM interpretations.
PURPOSE: To explore the effects of anxiety on the birth experience among Hispanic adolescents 13 to 19 years of age without comorbid major depression, along with selected obstetric and demographic variables. STUDY DESIGN...PURPOSE: To explore the effects of anxiety on the birth experience among Hispanic adolescents 13 to 19 years of age without comorbid major depression, along with selected obstetric and demographic variables. STUDY DESIGN AND METHODS: Cross-sectional study with a secondary analysis design using demographic information, a subjective rating of the birth experience and anxiety level, and an objective anxiety score using the Edinburg Postnatal Depression Inventory-A (EPDS-A) from 127 Hispanic adolescents. RESULTS: We found two variables to affect the birth experience: self-reported anxiety (p = .001) and type of birth (p = .001). Three additional variables neared significance indicating potential promise of importance: stress (p = .06), parity (p = .06), and unplanned pregnancy (p = .055). Remaining variables including objective measure of anxiety (p = .504), age (p = .144), and infant complications (p = .153) did not affect the birth experience. CLINICAL IMPLICATIONS: Our findings encourage attention by nurses and other clinicians to the effects of self-reported anxiety, stress, type of birth, parity, and unplanned pregnancy on the adolescent's birth experience and highlight the importance of an assessment of the birth experience in early postpartum. Prior research on an association between negative birth experiences and potential mental health consequences supports postpartum follow-up for at-risk adolescents.
PURPOSE: To examine whether hospital variation in the nurse work environment during labor and birth is associated with variation in the rate of exclusive breast milk feeding during the birth hospitalization. STUDY DESIGN...PURPOSE: To examine whether hospital variation in the nurse work environment during labor and birth is associated with variation in the rate of exclusive breast milk feeding during the birth hospitalization. STUDY DESIGN AND METHODS: Cross-sectional analysis of nurse survey, hospital, and exclusive breast milk feeding outcome data in a sample of 258 hospitals in five states. Sequential multivariate linear regression models were used to model the relationship between the outcome of exclusive breast milk feeding and the nurse work environment. RESULTS: A good or mixed nurse work environment is significantly ssociated with higher hospital-level exclusive breast milk feeding rates in unadjusted and adjusted regression models. A hospital's Baby-Friendly status was not significantly associated with exclusive breast milk feeding rates. CLINICAL IMPLICATIONS: Improvements to nurses' work environments can potentially increase hospital-level exclusive breast milk feeding rates.
PURPOSE: As valuable members of the care team, medical assistants are well-positioned to assist breastfeeding families. The purpose of this study was to identify ways in which medical assistants in the pediatric primary...PURPOSE: As valuable members of the care team, medical assistants are well-positioned to assist breastfeeding families. The purpose of this study was to identify ways in which medical assistants in the pediatric primary care setting may be empowered to improve care and support for breastfeeding families. STUDY DESIGN: A cross-sectional mixed-methods study was conducted using a one-time REDCap® survey including three open-ended prompts administered to medical assistants employed in primary care sites at Children's Hospital of Philadelphia from August 2022 through May 2023. METHODS: Descriptive statistics were used to summarize the background, training, and experience of respondents. Qualitative content analysis was used to identify themes in open-ended responses. RESULTS: Among the 78 medical assistants employed within Children's Hospital of Philadelphia's primary care network sites at the time of this study, 58 responded to the survey resulting in a response rate of 74%. Twenty-one locations were represented from Children's Hospital of Philadelphia's 31 pediatric primary care sites. Most medical assistants surveyed were providing informal breastfeeding support in the pediatric primary care setting and many were interested in learning more about breastfeeding and willing to offer more breastfeeding support to families. CLINICAL IMPLICATIONS: Medical assistants are a valuable part of the primary care team and have the potential to partner with nurses to make important contributions to the care and support of breastfeeding families.