Nursing Delivery Research Articles

Nurse Perceptions of Barriers to Infection Prevention and Control in Labor and Delivery

ObjectiveTo identify nurse perceptions of barriers to performing recommended infection prevention and control practices in labor and delivery to inform future resources tailored to this setting. DesignQualitative focus groups. SettingThe 2023 annual convention of the Association of Women’s Health, Obstetric and Neonatal Nurses, New Orleans, LA. ParticipantsA convenience sample of 16 labor and delivery nurses. MethodsStaff of the Centers for Disease Control and Prevention conducted two focus groups using a standardized script. Coding was performed by three reviewers using Krueger’s systematic analysis process. ResultsAmong the 16 participants, 94% were registered nurses, and 6% were advanced practice registered nurses. From our analysis of the data, five major themes emerged, including the following: Lack of Individual and Organizational Accountability in Implementing Recommended Infection Prevention and Control Practices; Inconsistent Application of Guidance Across State, Hospital, and Specialty; The Unpredictable Nature of the Labor and Delivery Setting; Labor and Delivery Is Not Prioritized in the Hospital for Infection Prevention and Control Resources; and Lack of Coordination Across Stages of Care From Prenatal to Postpartum. Conclusion(s)We identified barriers experienced by nurses to consistently implementing infection prevention and control practices in the labor and delivery setting. These barriers can be addressed through targeted interventions and the development of obstetric-specific infection prevention and control resources.

Information Needs and Seeking Behavior of Nurses for Effective Health Care Delivery: A Case Study of Federal Medical Center, Owerri.

Information Needs and Seeking Behavior of Nurses for Effective Health Care Delivery: A Case Study of Federal Medical Center, Owerri.

Labor Nurses' Experiences During the COVID-19 Pandemic

Abstract 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.

Perceptions and Lived Experiences of Nurses After Completion of a Perinatal Nurse Residency Program.

This study was designed to explore the perceptions and lived experiences of new graduate or new-to-specialty labor and delivery nurses. These nurses had completed a perinatal nurse residency program at a high-risk metropolitan medical center in the Pacific Northwest region of the United States. Eight nurses were interviewed for this study with qualitative individual interviews. Qualitative content analysis was used. Three main themes emerged: assimilating a specialized knowledge base and skill sets, navigating challenging circumstances, and coping with the transition to independence. Nurse residency programs can ease the transition to practice in the labor and delivery specialty. Revisions to future perinatal residency programs should include enhanced preceptor education, prolonged night shift orientation, assessment of nurse learning style and needs, and increased consistency of debriefing after traumatic events. [J Contin Educ Nurs. 202x;5x(x):xx-xx.].

The Effect of Spinning Babies® Education on Confidence in Implementing Techniques and Knowledge Regarding Safety Related to Labor Positioning Among Birth Professionals.

In order to support labor and delivery nurses' desire for education regarding labor positioning, we hosted an 8-hour class presenting the Spinning Babies® class for birth professionals. Labor and delivery nurses and certified nurse midwives (CNMs; N = 109) from three hospitals participated in a study evaluating the effect of the Spinning Babies® class on their confidence in implementing techniques and knowledge regarding safety related to labor positioning. After the class, participants demonstrated significant improvement in scores related to the variables of interest. This study supports educating labor and delivery nurses and CNMs on how to support laboring women using positioning techniques to promote physiologic (vaginal) birth.

Establishing enablers and barriers to implementing the HIRAID® emergency nursing framework in rural emergency departments

BackgroundRural Australia has large geographic distances between emergency departments with variability of services and medical support. Emergency nurses must be appropriately skilled to assess and manage unpredictable and diverse presentations. HIRAID® is an evidence-based framework to support emergency nurses in assessment and care delivery. To inform implementation, the study aimed to identify the enablers and barriers to introducing HIRAID® in practice. MethodsThis embedded mixed methods study was conducted in 11 rural, regional emergency departments in Southern New South Wales, Australia. Respondents completed a 22-item survey, indicating their level of agreement on statements related to practice change, free text responses were optional. Quantitative data were analysed using descriptive statistics and qualitative data using content analysis. Results were identified as barriers or enablers, then integrated and mapped to the Theoretical Domains Framework. ResultsThe survey was completed by 102 (54 %) nurses. Two enablers and four barriers to implementation were identified and mapped to 10 Theoretical Domains Framework domains. Key barriers were workplace limitations, such as time and resources, and knowledge of the HIRAID® intervention. ConclusionBarriers varied between facilities related to adequate support to implement and the impact on patient care. The results will inform a strategy to implement HIRAID®.

Attitudes and Likelihood of Outpatient Cervical Ripening via Single Balloon Foley Catheter Among OB/GYN Providers, Nurse Practitioners, and Obstetric Labor & Delivery Nurses

Introduction/Objectives: In certain parts of the United States and other developed nations, cervical ripening using the Foley catheter has already been introduced into the outpatient setting. An approved protocol exists at Loyola University Medical Center (LUMC), however usage is nonexistent. The primary aim of this study was to determine the current level of knowledge and familiarity regarding outpatient cervical ripening among OBGYN physicians and labor and advanced practice nurses at LUMC. The secondary aim of the study was to elucidate willingness to offer outpatient cervical ripening and potential reasons for support and hesitancy of this practice. Methods: We created an 8-question anonymous survey to elucidate the current level of knowledge regarding outpatient cervical ripening and potential reasons that a provider may have in support of and against outpatient cervical ripening. The survey was distributed among General OBGYN attendings, fellows, residents, labor and delivery (LD) and advanced practice (APN) nurses at LUMC. Descriptive statistics and Fisher’s exact test was performed on categorical data. An ordinal logistic regression model was used to compare the odds of being more likely to offer outpatient cervical ripening between attendings and resident physicians and the odds of being familiar with outpatient cervical ripening. Results: 45 obstetric care providers completed the survey (comprising 20 OB/GYN residents, 10 General OB/GYN attendings, 13 LD, and 2 APN nurses). The response rate was 72%. 73% of all respondents had some degree of familiarity with outpatient cervical ripening, while 84% were familiar with the current body of research on this practice. Overall, the willingness to offer outpatient cervical ripening was 55% for the group, with only 11% unwilling. There was no difference in the willingness to offer outpatient cervical ripening between attendings and resident physicians (OR = 1.25, 95% CI: 0.32 – 4.88; p = .75) (Table 1). Major factors that drove willingness to offer were decreased induction to delivery time (77%) and patient convenience (85%). Major factors that drove unwillingness to offer OP cervical ripening were lack of fetal monitoring (66%), increased communication from patients (66%), and additional utilization of clinic resources/time for protocol implementation (66%). Resident physicians were significantly more likely to report familiarity with the current research on outpatient cervical ripening than nurses (OR=5.04; 95% CI: 1.24-20.45; p=.02) and attending physicians (OR=4.13; 95% CI: 1.05-17.78; p=.04). There was no difference in familiarity with research behind the practice between physicians and nurses respondents (p=.85). There was no association between those who reported the level of familiarity with the concept of outpatient cervical ripening and their willingness to offer (OR = 1.52, 95% CI: 0.40 – 5.78; p = .54) (Table 2). Conclusions: Moving preinduction cervical ripening to an outpatient setting is equally efficacious and safe when compared to inpatient cervical ripening. However, despite having an existing protocol for cervical ripening using a Foley Balloon, this practice is not currently utilized at LUMC. Our survey suggests that though physicians and nurses are familiar with the concept and the research behind the practice, there are limiting factors for use. Further education regarding outpatient cervical ripening are essential for increasing practice adoption.

Communication, Training, and Debriefing After Stillbirth in U.S. Hospitals: A National Survey.

Background: Stillbirth is a devastating event for families as well as hospital staff. Hospital practices around internal and external staff communication, debriefing, and training are unknown. Methods: We systematically sampled U.S. hospitals that provide obstetrical care. Staff knowledgeable of bereavement care on labor and delivery were invited to participate in an anonymous survey linked to hospital descriptors. We evaluated stillbirth communication, debriefing, and training for staff. Results: We received 289 usable surveys from 429 eligible staff (67% response). Most (94%) noted hospitals' marked rooms housing bereaved families, but only a third (37%) reported a marker on the paper or electronic medical record. Half of the hospitals had no standard debriefings post-loss, and 38% reported no perinatal loss training for labor and delivery nurses. Conclusions: Hospitals have significant variations and gaps in staff communication, support, and training, which are key aspects of respectful stillbirth care.

A concept analysis of psychological trauma in labour and delivery nurses.

To facilitate an understanding of the risk for psychological trauma in labour and delivery nurses. Concept analysis. The Walker and Avant method of concept analysis was applied to 56 articles. The characteristics, antecedents, and consequences of psychological trauma in labour and delivery nurses were identified. Peer-reviewed articles in English from CINAHL, PubMed and Google Scholar were reviewed on July 2023. The characteristics of psychological trauma in labour and delivery nurses are overwhelming distress, intrusive symptoms, avoidance and numbing behaviours, hypervigilance or hyperarousal, emotional dysregulation, cognitive distortions, and interpersonal challenges. The antecedents are exposure to one or more of the following nurse-specific traumas: natural or person-made disasters, historical role limitations, second victim situations, secondary trauma, system-mediated or over-medicalized care, insufficient resources, or workplace incivility. The consequences are disruptions in mental health, diminished physical health, alterations in relationships, and variable work performance. Labour and delivery nurses experience unique causes of psychological trauma due to their practice environment and patient population. The consequences of labour and delivery nurses' psychological trauma extend beyond individual health and impact the quality of patient care and organizational capacity. Furthermore, research is needed to inform education, support and policy measures to mitigate harm effectively. WHAT PROBLEM DID THE STUDY ADDRESS?: Nurse-specific trauma theory has not been applied to the unique labour and delivery environment with a high incidence of patient trauma. WHAT WERE THE MAIN FINDINGS?: Multiple causes of trauma in the perinatal context have created a pervasive yet largely preventable issue. WHERE AND ON WHOM WILL THE RESEARCH HAVE AN IMPACT?: This research will impact labour and delivery nurses, their leadership, and their patients. No patient or public contribution.

Support Needs of Labor and Delivery Nurses After Traumatic Experiences

ObjectiveTo examine the effect of psychological distress, overall distress, and institutional support following a traumatic workplace event on absenteeism, turnover intention, and resilience among labor and delivery nurses. DesignA quantitative cross-sectional survey. SettingOnline distribution from January 13, 2021, to February 2, 2021. ParticipantsA nationwide convenience sample of labor and delivery nurses recruited from the Association of Women’s Health, Obstetric and Neonatal Nurses (N = 171). MethodsParticipants completed a survey that included the Second Victim Experience and Support Tool–Revised and the Second Victim Support Desirability survey. We compared available versus desired support options using descriptive analyses. We examined levels of psychological distress and lack of institutional support in relation to turnover intention, absenteeism, and resilience using multiple regression analyses. ResultsParticipants identified and described various traumatic experiences in the workplace, including neonatal and maternal death, complicated births, and workplace violence. Participants indicated that the available support services did not meet their needs. Psychological distress, overall distress, and lack of institutional support were associated with absenteeism and turnover, whereas only institutional support was associated with resilience. ConclusionLabor and delivery nurses encounter various traumatic events in the workplace, and the support services provided after an event do not meet their needs. Additional research is needed to understand the scope of the problem and investigate best practices to assist labor and delivery nurses following traumatic events.

Understanding the role and impact of electronic health records in labor and delivery nursing practice: A scoping review protocol.

Electronic health records have a significant impact on nursing practice, particularly in specializations such as labor and delivery, or acute care maternity nursing practice. Although primary studies on the use of electronic health records in labor and delivery have been done, no reviews on this topic exist. Moreover, the topic of labor and delivery nurses' organizing work in the electronic health record-enabled context has not been addressed. To (a) synthesize research on electronic health record use in labor and delivery nursing and (b) map how labor and delivery nursing organizing work is transformed by the electronic health record (as described in the reviewed studies). The scoping review will be guided by a modified methodology based on selected recommendations from the Joanna Briggs Institute and the Preferred Reporting Items for Systematic reviews and Meta-Analyses Extension for Scoping Reviews. A comprehensive search will be conducted in the following databases: CINAHL Complete, MEDLINE, Academic Search Complete, Web of Science, Scopus and Dissertations and Theses Abstracts and Indexes. Included sources will be primary research, dissertations, or theses that address the use of electronic health records in labor and delivery nursing practice in countries with high levels of electronic health record adoption. Data extracted from included sources will be analyzed thematically. Further analysis will theorize labor and delivery nurses' organizing work in the context of electronic health record use by utilizing concepts from Davina Allen's Translational Mobilization Theory. Findings will be presented in tabular and descriptive formats. The findings of this review will help understand transformations of nursing practice in the electronic health record-enabled labor and delivery context and identify areas of future research. We will propose an extension of the Translational Mobilization Theory and theorize nurses' organizing work involving the use of the electronic health record.

From hashtags to headaches: The risks of social media use for nurses.

A 2022 incident involving a group of labor and delivery nurses who posted a social media video criticizing patients has put a spotlight on the importance of maintaining professional conduct on social media. This article outlines the risks of social media use among nurses, the possible consequences of social media misuse, and the benefits of providing social media guidance in nursing curricula.

Nursing activities for health promotion in palliative home care: an integrative review

Palliative care in community contexts is undergoing significant change as a result of public policy and new models of care, which link health promotion principles with palliative care practices. These models support the creation of partnerships between formal care structures and the communities in which care is provided. Given the central role of nurses in the institutional delivery of palliative care, particularly in the home, it is important to provide a systematic description of the activities of nurses that fall within the principles of health promotion. The objective was to describe the diverse range of nursing activities for health promotion that are provided in the palliative home care setting. This is an integrative review. Fifty-five studies listed in the MEDLINE, CINAHL and EMBASE databases, and published between 1999 and December 2022, were identified. Data analysis and presentation of the results were guided by Kellehear’s Health-Promoting Palliative Care (HPPC) model. Six themes were identified to describe nursing activities for health promotion in the context of palliative home care: creating a meaningful relationship, supplying medical information, promoting self-care throughout the trajectory, providing emotional support, involving professional or community services and supporting change. The findings point to nurses focusing more on the individual context and on direct care. The relationship with communities in which they work remains unidirectional. However, some HPPC principles are relevant to nursing activities through the contextualization of nurses’ actions and their moral responsibility to work towards the respect of patient’s values. Being poorly described, how nurses can truly engage their practice towards health-promoting principles, such as the enhancement of support and control over their lives for people living with serious illness, still requires further empirical research.

Developing a Surgical Training Program for New Labor and Delivery Nurses.

Developing a Surgical Training Program for New Labor and Delivery Nurses.

Continuing Education Intervention: Trauma-Informed Pain Management in Labor and Delivery.

There is a gap in the availability of continuing education opportunities for labor and delivery nurses regarding trauma-informed perinatal care. A continuing education module on trauma-informed pain management in labor was created and distributed to 17 nurses in an intrapartum unit at a hospital in the Midwestern United States. Changes in knowledge, attitudes, skills, and intent to use trauma-informed principles were assessed using a pretest-posttest design and paired t test analyses. Change in knowledge (p = .043) and skills (p = .011) was statistically significant. There were no statistically significant changes in attitudes. Continuing education opportunities in trauma-informed perinatal care are needed for health care team members who provide care to trauma survivors in labor. Further research on the effectiveness of trauma-informed pain management in labor and birth is necessary to provide additional resources and recommendations for labor and delivery nurses. [J Contin Educ Nurs. 2024;55(1):21-25.].

Periop 101: Improving Perioperative Nursing Knowledge andCompetence inLabor andDelivery Nurses Through an Evidence-Based Education andTraining Program.

To reach the highest levels of health care quality, all nurses providing intraoperative care to surgical patients should have a firm grasp of the complex knowledge, skills, and guidelines undergirding the perioperative nursing profession. In military treatment facilities, either perioperative registered nurses or labor and delivery (L&D) nurses provide skilled intraoperative nursing care for cesarean deliveries. However, L&D and perioperative nurses occupy vastly different roles in the continuum of care and may possess widely differing levels of surgical training and experience. The purpose of this project was to improve surgical care quality by standardizing and strengthening L&D nurse perioperative training, knowledge, and competence. Our population, intervention, comparative, and outcome question was, "For labor and delivery nurses of a regional military medical center (P), does implementing an evidence-based training program (I), as compared to current institutional nursing practices (C), increase nursing knowledge and perioperative nursing competence (O)?" We implemented Periop 101: A Core Curriculum-Cesarean Section training for 17 L&D nurses, measured knowledge using product-provided testing, and assessed competence using the Perceived Perioperative Competence Scale-Revised. We found that perioperative nursing knowledge and competence significantly improved and were less varied among the nurses after completing the training program. Nurses demonstrated the greatest knowledge area improvements in scrubbing, gowning, and gloving; wound healing; and sterilization and disinfection, for which median scores improved by more than 100%. Nurses reported significantly greater perceived competence across all six domains of the Perioperative Competence Scale-Revised, with the largest improvements realized in foundational skills and knowledge, leadership, and proficiency. We recommend that health care leaders develop policies to standardize perioperative education, training, and utilization for nurses providing intraoperative care to reduce clinician role ambiguity, decrease inefficiencies, and enhance care.

Effect of an automated dispensing cabinet system on drug distribution effectiveness in a surgical unit

The use of the automated dispensing cabinet (ADC) for drug distribution in hospitals has become increasingly common and has numerous benefits.This retrospective study assessed the effectiveness of an ADC that uses integrated information technology in the drug distribution process in a surgical unit as part of a smart medical process improvement project at Taichung Veterans General Hospital in 2019. The outcomes include medicine delivery time, working time of healthcare professionals, transportation manpower, dispensing errors, and satisfaction of nursing staff with the medication distribution process. After ADC implementation, the average waiting time of standing orders decreased significantly for both on and off duty periods (40.0 ± 27.6 to 3.0 ± 3.9 min, P < 0.001; 45.2 ± 25.8 to 2.9 ± 2.9 min, P < 0.001; respectively). Similar results were observed with immediate or temporary medication orders (54.4 ± 31.5 to 2.0 ± 3.0 min, P < 0.001; 64.0 ± 47.5 to 1.5 ± 1.8 min, P < 0.001; respectively). The average time spent by operation room and post-operation room (OR/POR) nurses on communicating with ward nurses for medication delivery to OR/POR was shortened by 46.9 ± 4.4 h per month, and the average time pharmacists spent on dispensing immediate or temporary medication orders was shortened by 5.6 ± 0.2 h per month. The satisfaction of nursing staff with the OR/POR drug delivery process was significantly improved after ADC implementation (3.2 ± 0.8 vs 4.2 ± 0.7, P < 0.001).Our results showed that ADC implementation in surgical units simplified drug delivery processes, shortened drug delivery time, improved drug delivery timeliness for surgical patients, decreased dispensing errors, and increased nursing staff satisfaction. In conclusion, the implementation of ADC was beneficial for surgical units. To the best of our knowledge, there have been no studies on a similar ADC system.

Exposing the Role of Labor and Delivery Nurses as Active Bystanders in Preventing or Perpetuating Obstetric Violence

Obstetric violence is an issue of global scope and magnitude. Its widespread and continued presence indicates cultural tolerance enabled by policies and procedures that uphold paternalism. Labor and delivery nurses are the health care professionals who spend the most time at the point of care during birth, and their role must be examined. As active bystanders, labor and delivery nurses are uniquely positioned to prevent or perpetuate obstetric violence during labor and birth. Reflection on the nurse role is necessary to provide optimal care, enhance relationships with patients, and continue to evolve as a professional discipline. Perinatal nurses must lead the change to trauma-informed care practices to mitigate obstetric violence and reduce birth trauma.

Barriers to community healthcare delivery in urban China: a nurse perspective

ABSTRACT Purpose There is considerable research on China’s community healthcare, but little examining its delivery from a nurse perspective. This article, set in the context of Shenzhen, elicits community nurses’ views on barriers to healthcare delivery, providing an initial evidence framework to improve community nursing practice at organizational and policy levels. Methods We used qualitative methods. Data from semi-structured interviews with 42 community nurses in Shenzhen underwent inductive content analysis. Consolidated criteria for reporting qualitative research were consulted to structure our reporting. Results Our analysis suggests four elements discouraging community nurses in care delivery: lack of equipment, stressful work environments, staff incompetence, and patient distrust. Centralized means of procurement, management indifference to nurses’ well-being, unsystematic training and reluctance to enter the community healthcare sector, and public prejudices against nursing contributed to these constraints, preventing community nurses from performing patient-centred care, devoting energy to caring, freeing themselves from heavy workloads, and building trust-based care relationships. Conclusions Delivery barriers devalued community health services systematically and undermined nurses’ professional advancement and psychological well-being. Targeted management and policy inputs are necessary to reduce caring barriers and enhance the ability of community nursing to safeguard population health.

Impact of Educational Intervention on the Knowledge of Polycystic Ovarian Syndrome among Lady Health Visitors

Background: PCOS, a common endocrine disorder, is more common in adolescent girls and young women during their reproductive years. According to the World Health Organization (WHO), 116 million (3.4%) of women worldwide have PCOS in 2012. PCOS increases a woman's risk of type 2 diabetes, cardiovascular disease, infertility, anxiety, and depression, as well as a poor quality of life related to her health. Objectives: To determine the impact of education intervention on the knowledge of poly cystic ovarian disease among lady health visitors in Public Health Nursing School Lahore. Methodology: A Quasi- experiment one group pre-test post-test study design was conducted at Public Health Nursing School in Pakistan. A total of 141 people were recruited through random sampling. First- and second-year lady health visitor (LHV) students aged 17 to 30 participated in the study. It was done with full knowledge and consent. To analyze the data, the most recent version of SPSS 24 was employed. Results: According to the study's findings, the bulk of participants, 114 (80.9%), were between the ages of 17 and 20, with 75 (53.2%) of them living in metropolitan regions. The results showed that the data was normally distributed because the P-value was less than 0.05. The findings showed that, in comparison to their values at the pretest, the mean post intervention knowledge score was significantly higher after educational intervention (p 0.0001). Practical Implications: The midwives and labor and delivery nurses (LHVs) play a key role in the healthcare industry. Women should receive counselling, information, and encouragement related to polycystic ovary syndrome. The long-term advantages of education would help women understand how to adjust their lifestyles according to polycystic ovarian syndrome. Conclusion: It is concluded that the post intervention score of participants was high than pre-intervention. As a result, educational sessions had a positive effect on improving knowledge scores about polycystic ovarian syndrome. Keywords: Polycystic Ovarian Syndrome; Knowledge; Educational Intervention; Lady Health Visitor