Committed to Safety: Ten Case Studies on Reducing Harm to Patients

Presents case studies of healthcare organizations, clinical teams, and learning collaborations to illustrate successful innovations for improving patient safety nationwide. Includes actions taken, results achieved, lessons learned, and recommendations

Toward a Fluid Dance in Seamless Dress: The Field of Pre- and Perinatal Development Challenges Researchers to Integrate Scientific and Spiritual Orientations

The response of humankind to mystery is explored here, relative to the historically sharp distinction between scientific and spiritual ways of knowing. The evolving image of a dancer in a half-male/half-female costume serves as a metaphor for the rapport between these two basic research orientations, and for how they might be reconciled—in the interest of both research and the researcher. Findings from the highly interdisciplinary field of pre- and perinatal development illustrate the need for an integrated approach to understanding \"reality.\

What Are The Relationships Among Cumulative Trauma, Posttraumatic Stress Disorder, Sleep Quality, And Perinatal Outcomes In African American Women?

WHAT ARE THE RELATIONSHIPS AMONG CUMULATIVE TRAUMA, POSTTRAUMATIC STRESS DISORDER, SLEEP QUALITY, AND PERINATAL OUTCOMES IN AFRICAN-AMERICAN WOMEN? NANCY J. HAUFF, MSN, RN May 2015 Advisor: Judith Fry-McComish, PhD, RN, FAAN, IMH-IV, E Major: Nursing Degree: Doctor of Philosophy Trauma, primarily in the form of intimate partner violence and automobile accidents, accounts for 6-8% of all pregnancy complications. Much less is known about cumulative trauma (CT) exposure especially in African-American women. Women exposed to several types of trauma including childhood abuse, discrimination, or witnessed family violence may develop symptoms of posttraumatic stress or have difficulty sleeping. The purpose of this study was to examine the relationships among cumulative trauma, posttraumatic stress, sleep, and perinatal outcomes. A sample of 150 essentially healthy African-American women who had given birth were recruited at Hutzel Women\u27s Hospital and St. John Providence Hospital Southfield, and asked to complete the Cumulative Trauma Scale, Community Safety Questionnaire, Conflict Tactics Scale, Clinician-administered PTSD Scale, Pittsburgh Sleep Quality Index, Edinburgh Depression Inventory, and Demographic Data Form. The prenatal and hospital medical records were reviewed for multiple maternal and neonatal outcomes. Regression analysis was used to determine if relationships between the variables exist, and the strength of those relationships. The findings of this study showed: 1) African- American women experience traumatic events. 2) cumulative trauma is associated with PTSD, depression, poor sleep quality, and neonatal outcomes; 3) nursing must go beyond the assessment of intimate partner violence, report active trauma, and record findings in the medical record; and 4) more research is needed to better understand mothers\u27 use of over the counter and other medications to help them sleep. The relevance to maternal child health is that a better understanding of cumulative trauma exposure, PTSD, poor sleep, and the risk for poor perinatal outcomes among African-American women can lead to earlier identification and the development of nursing interventions

Intra- and intergenerational effects of migration and the role of the psychosocial environment in the development of perinatal depression

Background: Perinatal depression is a significant public health issue that affects women and their families. Studies conducted outside of the United States (US) have found a higher prevalence of perinatal depression in immigrant compared to native-born women. US studies have been less consistent but have relied on convenience samples and lacked appropriate comparison groups. Objectives: To characterize the relationship between migration to the US and risk for perinatal depressive symptomatology and to examine the role of the post-migration psychosocial environment on the occurrence of perinatal depressive symptoms. Methods: The dissertation used two data sources, the NYC Pregnancy Risk Assessment Monitoring System (PRAMS) and the Centering Pregnancy Plus (CPP) Project. In cross-sectional analysis of PRAMS data (2009¬¬-2010) using log-binomial regression, we assessed the association between nativity and early postpartum depressive symptomatology, including by duration and age of entry into US for immigrant women. Psychosocial mediators were tested with joint tests of significance. In longitudinal analysis using growth mixture modeling and multinomial logistic regression, we characterized perinatal depressive symptom trajectories among adolescent women and examined the effects of generational status and acculturation strategy on trajectories, testing also for psychosocial mediators. Results: Prevalence of postpartum depressive symptoms was comparable between immigrant and US-born women (aPR=1.08, 95% CI 0.74-1.58), but varied by race/ethnicity, with non-Hispanic White immigrant women at elevated risk compared to their US-born counterparts. There was a slightly elevated, non-significant risk of postpartum depressive symptoms among immigrant women with greater compared to less exposure to the US, and partner stress partially mediated this relationship. Among adolescent women, we identified three distinct trajectories of depressive symptoms: `stable no/low\u27 (58%), `moderate declining\u27 (32%), and `high stable\u27 (11%). Compared to second or greater generation women, first generation women had a 69% lower odds of being classified in the `high stable\u27 group versus the `stable no/low\u27 group (aOR=0.31, 95% CI 0.17-0.57). Social support partially mediated the association between immigrant generation and chronically high symptomatology. Conclusions: Routine screening and referral to culturally and age appropriate support/treatment might be offered to immigrant and second generation adolescent women as well as non-Hispanic White immigrant women of all ages

Postpartum Support: Application of a Local Peer Support, Community Care Model

The postpartum period is one of the most influential developmental stages of a women’s life and represents a time of heightened risk for mental health decline. Perinatal mood and anxiety disorders have been implicated as a key influence of negative parenting experiences, poor newborn psychological outcomes, delayed newborn development, and inadequately adaptive family development behaviors. Integrating established resiliency components against mental illness, such as social support, into a postpartum care model can benefit postpartum women and secondarily positively impact the aforementioned outcomes. A community care model highlighting social support for postpartum mothers was integrated into a rural Minnesota region and was found to positively impact maternal experiences according to the 14 participants. Identified outcomes included improved perception of role identity, increased awareness of maternal self-care value, and enhanced peer relationships around a shared developmental experience. Future implications for nurse practitioner care include a recommendation to integrate group community care into postpartum wellness with facilitation by an experienced perinatal health provider knowledgeable in community resources. It is imperative that nurse practitioners caring for postpartum women validate dependent care agency, encourage and aid in facilitating support mobilization, and collaborate with women throughout the postpartum time