Current Resources for Evidence-Based Practice, January/February 2017

Abstract

Published simultaneously in the Journal of Midwifery & Women's Health, 62(1). Often I have conversations with nursing and midwifery students about why they should consider careers as researchers. One of the things I always share in these conversations is the connection between research and practice. We need researchers who conduct research that addresses the fundamental concerns of nursing science: maintaining health, addressing complex health conditions, enhancing quality of life, and improving health care systems (DeVon et al., 2016DeVon H.A. Rice M. Pickler R.H. Krause-Parello C.A. Richmond T.S. Setting nursing science priorities to meet contemporary health care needs.Nursing Outlook. 2016; 64: 399-401http://dx.doi.org/10.1016/j.outlook.2016.05.007Abstract Full Text Full Text PDF PubMed Scopus (10) Google Scholar). Otherwise, nurses and midwives are left to follow evidence-based practice guidelines based on the research priorities of investigators from other professions. Moreover, without research by nurses and midwives, un-investigated practices commonly used by these types of providers tend to be devalued in our health care systems, by our collaborators, and by our patients. In a November 2016 commentary in The Lancet, Kennedy et al. suggested 11 top research priorities to improve the quality of care for women and children. In light of persistently high rates of many adverse perinatal outcomes, the authors inquired if researchers are asking the right questions “to inform better ways of providing sustainable, high quality care” (p. e77). To arrive at the ranked list of research priorities, the team assembled a panel of maternal and newborn health research experts from The Lancet series on midwifery (Renfrew et al., 2014Renfrew M.J. McFadden A. Bastos M.H. Campbell J. Channon A.A. Cheung N.F. Declercq E. Midwifery and quality care: Findings from a new evidence-informed framework for maternal and newborn care.Lancet. 2014; 384: 1129-1145https://doi.org/10.1016/S0140-6736(14)60789-3Abstract Full Text Full Text PDF PubMed Scopus (697) Google Scholar), the World Health Organization, the United Nations Population Fund, the International Confederation of Midwives, and representatives of service users. This panel formulated a master list of 30 research topics based on evidence gaps identified in the Lancet series (Kennedy et al., 2016Kennedy H.P. Yoshida S. Costello A. Declercq E. Dias M.A. Duff E. Renfrew M.J. Asking different questions: Research priorities to improve the quality of care for every woman, every child.The Lancet Global Health. 2016; 4: e777-e779https://doi.org/10.1016/S2214-109X(16)30183-8Abstract Full Text Full Text PDF PubMed Scopus (45) Google Scholar). These topics were then distributed to 1191 representatives from the global Partnership for Maternal, Newborn, and Child Health and from all WHO regions for prioritization. The final ranked list of research priorities is provided in Table 1 (Kennedy et al., 2016Kennedy H.P. Yoshida S. Costello A. Declercq E. Dias M.A. Duff E. Renfrew M.J. Asking different questions: Research priorities to improve the quality of care for every woman, every child.The Lancet Global Health. 2016; 4: e777-e779https://doi.org/10.1016/S2214-109X(16)30183-8Abstract Full Text Full Text PDF PubMed Scopus (45) Google Scholar) with congruent priorities from the research agenda of the American College of Nurse-Midwives, 2016American College of Nurse-MidwivesACNM research agenda.2016http://www.midwife.org/ACNM-Research-AgendaGoogle Scholar and the research priorities of the Association of Women's Health and Obstetric and Neonatal Nurses, 2016Association of Women's HealthObstetric and Neonatal NursesAWHONN research priorities.2016https://www.awhonn.org/page/ResearchPrioritiesGoogle Scholar.Table 1Alignment of Maternal–Infant Research Priorities From Kennedy et al. (2016), the American College of Nurse-Midwives (ACNM), and the Association of Women's Health, Obstetric and Neonatal Nurses (AWHONN)Research Priorities of Kennedy et al. (2016)Research Priorities of ACNMResearch Priorities of AWHONNEvaluate the effectiveness of midwifery care across the continuum in increasing access to and acceptability of family planning services for women.Evaluate the effectiveness of midwife-led care compared to other models of care across various settings, particularly on rates of fetal and infant death, preterm birth, and low birthweight.Research linkages between midwifery care practices and specific maternal and neonatal outcomes, e.g., out of hospital birth.Normal birthDetermine which indicators are most valuable in assessing quality maternal and newborn care.Inequities and disparities in women’s health.Identify and describe aspects of care that optimize and those that disturb the biological and physiologic processes for healthy childbearing women, fetuses, newborns, infants, and those who experience complications.Grow the evidence base on the midwifery model of care and translate it into specific practices.Normal birthDescribe and evaluate the effectiveness of midwives working with others (such as other health professionals, community health workers, traditional birth attendants) in achieving quality maternal and newborn care including•Timely transfer of women to appropriate level/site of care•Management of emergency situations•Maximal use of skills and competencies•Shared decision making and accountabilityThe outcomes of care when midwives have full practice autonomy.Study and disseminate successful interprofessional collaborations, including research on productive teams, to enhance financial efficiency.Assess the views and preferences of women and families across a variety of settings about their experiences of maternal and newborn care including but not limited to care providers and sites of care.Women's decision-making processes on choice of providers during pregnancy and birth.Women's decision-making processes about health care procedures and interventions.Normal birthDevelop setting-specific benchmarks to assess measurable progress on implementation of quality maternal and newborn care.ACNM needs to take lead in research on women’s health and maternity care.Identify and describe aspects of maternal and newborn care that strengthen or weaken women’s psychosocial well-being and mental health.Mental healthAssess whether new measures of morbidity are needed to more effectively evaluate outcomes of maternal and newborn care.•Midwives as primary care providers and integral to the Affordable Care Act•Midwifery education•Interprofessional education•Identify barriers to and opportunities for the development of a diverse midwifery workforce•Innovative ways to prepare more midwife providers especially from diverse and under-represented groups•A systematic approach to collecting clinical practice data across the membership•International maternal–child health issues such as safe motherhood•The work of midwives globally•Opportunities to collaborate on research with other professional organizations•Explore and develop policy research relevant to the goals of ACNM•Patient safety using nurse-sensitive outcomes•Nursing research and scholarship•Implementation science, translational research Open table in a new tab Most women's and maternal-infant health research priorities focus on the treatment of complications (Souza et al., 2014Souza J.P. Widmer M. Gülmezoglu A.M. Lawrie T.A. Adejuyigbe E.A. Carroli G. Temmerman M. Maternal and perinatal health research priorities beyond 2015: An international survey and prioritization exercise.Reproductive Health. 2014; 11: 61https://doi.org/10.1186/1742-4755-11-61Crossref PubMed Scopus (35) Google Scholar), which is in line with a diagnosis and treatment model of medical care (Kennedy et al., 2016Kennedy H.P. Yoshida S. Costello A. Declercq E. Dias M.A. Duff E. Renfrew M.J. Asking different questions: Research priorities to improve the quality of care for every woman, every child.The Lancet Global Health. 2016; 4: e777-e779https://doi.org/10.1016/S2214-109X(16)30183-8Abstract Full Text Full Text PDF PubMed Scopus (45) Google Scholar). By contrast, the research priorities presented by Kennedy and colleagues, the American College of Nurse-Midwives, 2016American College of Nurse-MidwivesACNM research agenda.2016http://www.midwife.org/ACNM-Research-AgendaGoogle Scholar, and the Association of Women's Health and Obstetric and Neonatal Nurses, 2016Association of Women's HealthObstetric and Neonatal NursesAWHONN research priorities.2016https://www.awhonn.org/page/ResearchPrioritiesGoogle Scholar focus on prevention. Although specific complications are mentioned, researchers are encouraged to consider ways to provide quality care that enhances the capability of women and infants to thrive. Thus, these research priorities are congruent with the focus of midwifery and nursing and potentially represent a new direction for maternal–infant health care priorities. Based on these priorities, how would research and quality improvement projects inform our systems of care for women and infants? How would the work of nurses, midwives, physicians, and other health care workers alter? We will not know these answers until clinicians and researchers adopt these priorities and conduct studies in these areas. •Antibiotic treatment for the sexual partners of women with bacterial vaginosis•Chinese herbal medicine for subfertile women with polycystic ovarian syndrome•Exercise for women receiving adjuvant therapy for breast cancer•Methods of milk expression for lactating women•Screening for genital chlamydia infection•Short-term and long-term effects of tibolone in postmenopausal women •Chewing gum for enhancing early recovery of bowel function after cesarean section•Dietary supplementation with myo-inositol in women during pregnancy for treating gestational diabetes •Avoidance of bottles during the establishment of breastfeeding in preterm infants•Baby-led compared with scheduled (or mixed) breastfeeding for successful breastfeeding•Non-nutritive sucking for increasing physiologic stability and nutrition in preterm infants•Oral stimulation for promoting oral feeding in preterm infants•Pain-relieving agents for infantile colic•Acetaminophen for prevention or treatment of pain in newborns•Synchronized mechanical ventilation for respiratory support in newborn infants•Vitamin A supplementation for the prevention of morbidity and mortality in infants one to six months of age •Postnatal rubella immunization Featured Review: Collins, C. T., Gillis, J., McPhee, A. J., Suganuma, H., & Makrides, M. (2016). Avoidance of bottles during the establishment of breast feeds in preterm infants. Cochrane Database of Systematic Reviews, 10, CD005252. http://dx.doi.org/10.1002/14651858.CD005252.pub4 In this updated Cochrane systematic review and meta-analysis, the reviewers considered seven trials (N = 1,153 preterm infants) to examine the effect of avoiding bottle feeding in preterm infants while establishing breastfeeding on the chances of breastfeeding success. Randomized and quasirandomized, controlled trials were included in which investigators compared avoidance of bottles with use of bottles for supplementary feedings in preterm infants whose mothers chose to breastfeed. Alternatives to bottle feeding included cup feeding (5 studies), tube feeding (1 study), and specially designed teat feeding (1 study). The reviewers found that preterm neonates exposed to these alternative feeding formats were more likely to breastfeed fully at the time of discharge to home (risk ratio [RR] 1.47, 95% confidence interval [CI] [1.19, 1.80]) or to be engaged in any breast feeding at hospital discharge (RR 1.11, 95% CI [1.06, 1.16]). In some of the studies, infants were followed up for 3 to 6 months after discharge. Analysis of this follow-up data showed that avoiding bottles during hospitalization increased the rate of exclusive breastfeeding and any breastfeeding at 3 and 6 months. Among alternative feeding methods, tube and cup feedings during hospitalization showed some benefit for breastfeeding several months after hospital discharge in infants born preterm. Unlike the previous review on this subject conducted in 2008 (Collins, Makrides, Gillis, & McPhee), the authors of this review found no evidence that alternative forms of supplementary feedings compared to bottle feeding in preterm neonates changed length of hospital stay. Comment: In preterm infants, using a cup or tube instead of a bottle during hospitalization increases the duration and extent of breastfeeding. Studies included in this review were of low to moderate quality, and future investigations, including larger trials with attention to attrition bias and follow-up of infants into the first year of life, are needed. However, this evidence of benefit without harm for preterm infants is sufficient for hospital nursery staff to encourage the use of cups instead of bottles for supplementary feedings. Featured Review: Peters, M. D., Lisy, K., Riitano, D., Jordan, Z., & Aromataris, E. (2016). Providing meaningful care for families experiencing stillbirth: A meta-synthesis of qualitative evidence. Journal of Perinatology, 36(1), 3–9. http://dx.doi.org/10.1038/jp.2015.97 Stillbirth, defined as the death of a fetus after 20 weeks gestational age, can be a devastating experience for parents (Peters et al., 2016Peters M.D. Lisy K. Riitano D. Jordan Z. Aromataris E. Providing meaningful care for families experiencing stillbirth: A meta-synthesis of qualitative evidence.Journal of Perinatology. 2016; 36: 3-9https://doi.org/10.1038/jp.2015.97Crossref PubMed Scopus (19) Google Scholar). Although it is known that expediting birth can decrease distress for mothers whose fetuses die in utero (Malm et al., 2011Malm M.C. Radestad I. Erlandsson K. Lindgren H. Waiting in no-man's-land—Mothers’ experiences before the induction of labour after their baby has died in utero.Sexual & Reproductive Healthcare. 2011; 2: 51-55https://doi.org/10.1016/j.srhc.2011.02.002Abstract Full Text Full Text PDF PubMed Scopus (24) Google Scholar), there is little consensus on other ways that health care providers can best support families that experience perinatal death during hospitalization or after discharge (Koopmans et al., 2013Koopmans L. Wilson T. Cacciatore J. Flenady V. Support for mothers, fathers and families after perinatal death.Cochrane Database of Systematic Reviews, 6. 2013; : CD000452https://doi.org/10.1002/14651858.CD000452.pub3Crossref Scopus (72) Google Scholar). This comprehensive systematic review and meta-synthesis of 10 qualitative studies was conducted to explore the effectiveness, meaningfulness, and appropriateness of nonpharmacologic care provided to families that experience stillbirth to improve their psychological well-being in the time from diagnosis until months to years following the experience. The reviewers provided the following strategies to decrease psychological harm in these families: (a) individualized, genuine, and personal care wherein health care providers show emotion, empathy, and human reactions to the tragic experience; (b) treatment of these births in a non-medicalized manner by health care providers; (c) information provided in a forthcoming, step-by-step manner in advance of every procedure and event; (d) respect and emotional validation that identity as a parent is not diminished by stillbirth; (e) warm, empathetic communication and non-verbal gestures to help families feel nurtured and supported; (f) careful guidance as families decide on post-death investigations to determine cause of death with the understanding that knowing the cause of death can reassure many parents; and (g) training for health professionals to prepare them to offer appropriate support to parents and families affected by stillbirth at every stage of the experience. Comment: The experience of stillbirth can be devastating for parents, and medicalized, rushed, and mechanistic care from health care providers can be further damaging. In this systematic review and meta-synthesis, the reviewers collected key components of empathetic, evidence-based care to decrease psychological stress in families experiencing stillbirth. These findings should be the focus of future programming, training, and further investigations. Nicole S. Carlson, CNM, PhD is an assistant professor at Emory University's Nell Hodgson Woodruff School of Nursing in Atlanta, GA.