INTRODUCTION: Lactation support services can improve exclusive breastfeeding rates among infants in the neonatal intensive care unit (NICU). There are limited data on how many NICUs offer these services. OBJECTIVE: To as...INTRODUCTION: Lactation support services can improve exclusive breastfeeding rates among infants in the neonatal intensive care unit (NICU). There are limited data on how many NICUs offer these services. OBJECTIVE: To assess prevalence and type of lactation services provided in level III Canadian NICUs. METHODS: A nationwide comprehensive point-prevalence study was undertaken via a telephone survey of level III NICUs in Canada. Availability of lactation consultants, type of services offered, infrastructure such as centralized milk labs, private space for expressing milk, and refrigerators to store breast milk, and follow-up support programs were assessed. RESULTS: There are 31 level III NICUs in Canada. Nineteen of the 31 NICUs participated in the survey, representing a 61% response rate. Of these, 79% (n = 15) offered lactation consultant services. Most (n = 13, 68%) noted they had International Board-Certified Lactation Consultants (IBCLCs). The types of lactation services offered were either a reactive care model, a proactive care model, or a combination of both. Seven (37%) units, both with and without LCs, offered alternate lactation assistance, such as helping mothers at the bedside with breastfeeds. Several units had available infrastructure (n = 10, 53%) and offered follow-up lactation support (n = 10, 53%). CONCLUSION: Most of the surveyed level III NICUs in Canada provided lactation support services; however, there was variation in type. More research is needed to identify barriers that NICUs face in offering lactation services for mothers of NICU babies.
BACKGROUND: Maternal morbidity and mortality in the United States are higher than peer countries. These adverse events disproportionally affect Black women. LOCAL PROBLEM: Rates of maternal morbidity and mortality among...BACKGROUND: Maternal morbidity and mortality in the United States are higher than peer countries. These adverse events disproportionally affect Black women. LOCAL PROBLEM: Rates of maternal morbidity and mortality among Black childbearing women in West Louisville, Kentucky are higher than rates in Kentucky and the United States. METHODS: We conducted a quality improvement project to evaluate the effectiveness of adding doulas to the health care teams at the Norton downtown hospital to address health disparities and other challenges identified by Black childbearing women related to communication and health care system barriers. INTERVENTION: Three culturally congruent doulas were hired and integrated into the health care teams in one large health care organization. RESULTS: Participants in the doula program had lower no-show rates for postpartum visits compared with non-participants. No-show rates for prenatal visits were the same for both groups. Rates of diagnosed preeclampsia, hypertension, and chronic hypertension were similar among doula program participants and those who did not participate. Narrative data indicated that program participants and health professionals were generally pleased with the doula program and there was positive feedback from the community. CONCLUSIONS: Integrating culturally congruent doulas into the health care system maximized their impact to address health and other challenges experienced by Black childbearing women.
PURPOSE: The purpose of this study was to describe labor and delivery nurses' experiences in caring for patients during the COVID-19 pandemic. METHODS: We used a descriptive phenomenological design and purposeful samplin...PURPOSE: The purpose of this study was to describe labor and delivery nurses' experiences in caring for patients during the COVID-19 pandemic. METHODS: We used a descriptive phenomenological design and purposeful sampling to recruit experienced labor and delivery nurses for flexible semi-structured face-to-face audiotaped interviews. Constant comparison was used to analyze data. RESULTS: Ten nurses employed in a labor and delivery unit in two acute care hospitals in southern Texas participated and were interviewed from June through August 2022. The mean age of nurse participants was 36.5 years. Seven had over 5 years' experience as a labor and delivery nurse before the pandemic. Five distinct themes were identified: Psychological stress during COVID-19; Feelings of satisfaction and gratitude; Resilience and readiness for positive change; Patient-centered care; and Interprofessional collaboration. CLINICAL IMPLICATIONS: These findings build on our understanding of key determinants contributing to labor and delivery nurses' ability to adjust to the unprecedented and chaotic working conditions during the COVID-19 pandemic and highlighted several factors that could influence nurses' resilience and job satisfaction.
PURPOSE: To describe the relationship between experiencing traumatic childbirth events and burnout. STUDY DESIGNS AND METHODS: This descriptive cross-sectional study used an anonymous online survey to assess traumatic ch...PURPOSE: To describe the relationship between experiencing traumatic childbirth events and burnout. STUDY DESIGNS AND METHODS: This descriptive cross-sectional study used an anonymous online survey to assess traumatic childbirth event exposure and the three independent constructs of burnout: emotional exhaustion, depersonalization, and personal accomplishment. Participants were a convenience sample of registered nurses, obstetric residents, family medicine residents, and attending obstetricians across five hospitals from December 2020 through June 2021. The traumatic childbirth event questionnaire measured the frequency of traumatic childbirth event exposure, perception of severity, and perceived influence on the participant's professional practice and personal life. RESULTS: Data were analyzed from 150 participants. Registered nurses represented the largest percentage of participants (66%). Components of burnout varied according to race and occupation. Asian/Pacific Islanders had significantly higher mean depersonalization scores at 10.1 (SD = 6.0). Resident physicians had the highest emotional exhaustion scores (M = 34.6, SD = 8.8). Traumatic childbirth events perceived influence on practice correlates with personal accomplishments. Yet, no relationship was observed between traumatic childbirth events, emotional exhaustion, and depersonalization. Linear mixed analysis revealed that hospitals account for 7.5% of the variance in emotional exhaustion scores, 11.1% in depersonalization scores, and 1.3% in personal accomplishments scores. CLINICAL IMPLICATIONS: Maternity clinicians experience burnout at similar rates to those in other specialties. Although traumatic childbirth events are infrequent and not strongly correlated with emotional exhaustion and depersonalization, hospitals should implement effective strategies to support clinicians after such events. Educational interventions can enhance knowledge and resilience, whereas specialized training effectively alleviates burnout. Development of evidence-based strategies that prioritize the wellbeing of clinicians and patients is crucial.
Penner SB, Mercado NR, Bernstein S
… +3 more, Erickson E, DuBois MA, Dreisbach C
MCN Am J Matern Child Nurs
· 2025 Mar-Apr 01 · PMID 39724549
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Artificial intelligence (AI), defined as algorithms built to reproduce human behavior, has various applications in health care such as risk prediction, medical image classification, text analysis, and complex disease dia...Artificial intelligence (AI), defined as algorithms built to reproduce human behavior, has various applications in health care such as risk prediction, medical image classification, text analysis, and complex disease diagnosis. Due to the increasing availability and volume of data, especially from electronic health records, AI technology is expanding into all fields of nursing and medicine. As the health care system moves toward automation and computationally driven clinical decision-making, nurses play a vital role in bridging the gap between the technological output, the patient, and the health care team. We explore the nurses' role in translating AI-generated output to patients and identify considerations for ensuring informed consent and shared decision-making throughout the process. A brief review of AI technology and informed consent, an identification of power dynamics that underly informed consent, and descriptions of the role of the nurse in various relationships such as nurse-AI, nurse-patient, and patient-AI are covered. Ultimately, nurses and physicians bear the responsibility of upholding and safeguarding the right to informed choice, as it is a fundamental aspect of safe and ethical patient-centered health care.
BACKGROUND: The Agency for Healthcare Research and Quality recommends the use of safety huddles, in which clinicians are briefly gathered to review a patient's condition, including new or developing changes in acuity or...BACKGROUND: The Agency for Healthcare Research and Quality recommends the use of safety huddles, in which clinicians are briefly gathered to review a patient's condition, including new or developing changes in acuity or stability. The Joint Commission describes huddles as a "hallmark" of high-reliability organizations. Previous reviews have confirmed the general utility of huddles, including positive regard by clinicians, but there has not been work specifically looking at huddle use in hospital maternity care settings. Our objective was to identify the ways that huddles have been studied or reported in inpatient maternity settings and synthesize this information with recommendations from professional organizations to identify gaps in the literature published in the United States since 1999. METHODS: We used Arksey and O'Malley's framework to guide our scoping review. Using the time frame from 1999 to 2024, we searched the following databases: PubMed, CINAHL, SCOPUS, Embase, as well as gray literature and the reference lists and citing articles of the included manuscripts. RESULTS: We found 160 documents, of which 47 met inclusion criteria, including 11 care bundles, 10 quality improvement projects, and 4 research studies. The remaining 22 were a variety of editorials, position papers, and other gray literature. DISCUSSION: There is scant research on the use of huddles in hospital maternity care settings, and most literature does not define the participants, timing, or agenda of the huddle. Further research is needed to understand how huddles affect outcomes in maternity settings. Researchers should explicitly define the huddles they are studying. The review protocol was registered at Open Science Framework Registries.
Dreisbach C, Barcelona V, Turchioe MR
… +2 more, Bernstein S, Erickson E
MCN Am J Matern Child Nurs
· 2025 Mar-Apr 01 · PMID 39724545
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Predictive analytics has emerged as a promising approach for improving reproductive health care and patient outcomes. During pregnancy and birth, the ability to accurately predict risks and complications could enable ear...Predictive analytics has emerged as a promising approach for improving reproductive health care and patient outcomes. During pregnancy and birth, the ability to accurately predict risks and complications could enable earlier interventions and reduce adverse events. However, there are challenges and ethical considerations for implementing predictive models in perinatal care settings. We introduce major concepts in predictive analytics and describe application of predictive modeling to perinatal care topics such as fertility, preeclampsia, labor onset, vaginal birth after cesarean, uterine rupture, induction outcomes, postpartum hemorrhage, and postpartum mood disorders. Although some predictive models have achieved adequate accuracy (AUC 0.7-0.9), most require additional external validation across diverse populations and practice settings. Bias, particularly racial bias, remains a key limitation of current models. Nurses and advanced practice nurses, including nurse practitioners certified registered nurse anesthetists, and nurse-midwives, play a vital role in ensuring high-quality data collection and communicating predictive model outputs to clinicians and users of the health care system. Addressing the ethical challenges and limitations of predictive analytics is imperative to equitably translate these tools to support patient-centered perinatal care.