Community Health Nursing Service Learning

Through the Service Learning Course, College of Nursing and Health Sciences, RN-BS Online Program, Senior Level Course, Community Health for RN’s and NU 461, 6 credits Student Body Registered Nurses (70-105 each semester) throughout the state seeking to obtain a Bachelor in Science of Nursing. The Institute of Medicine, Future of Nursing Report recommends increasing the proportion of nurses with a baccalaureate degree to 80% by 2020. Instructional Aim Students obtain a better understanding of public health and nursing theory and practice as they further develop their professional and civic identities through meaningful service to their communities. Service Learning Requirement develop a service learning portfolio including a sustained service experience (60 hours), two short-term community activities, three journal reflections, and a written report based on a service project conducted within the context of the sustained experience

Obstetric Interventions: Assessment of Differential Practices by Race/Ethnicity

Cesarean sections constitute approximately 30% of the over 4 million live births a year in the United States, and a rising number of primary cesarean sections contribute significantly to the overall rate. Studies suggest that the rate of primary cesarean section is disproportionately higher among non-white women, even when controlling for demographic, behavioral and medical risk factors. Our study investigates the interrelationships between racial/ethnic characteristics and obstetric interventions among low risk pregnancies. We included nulliparous women with full term, singleton pregnancies and fetus in vertex presentation who delivered at UMass between April 2006 and March 2011. We excluded non-live births, women with antepartum complications or pre-labor indications for cesarean, and cases with unspecified race or missing data. Our sample consisted of 4,483 subjects, of which 7% were black, 70% white, 4% Asian, and 17% Hispanic. 74% had spontaneous vaginal deliveries, 9% had operative vaginal deliveries, and 17% had cesarean sections. 40% of the indications for cesarean were related to fetal distress, 25% to first stage labor, and 34% to second stage labor. Average maternal age was 26.2, average BMI was 24.9, average birth weight was 3381g, and average gestational age at delivery was 39.7 weeks; there were no significant differences in these variables across racial groups. We examined racial/ethnic differences in mode of delivery (spontaneous vaginal, operative vaginal and cesarean) using logistic regression models while adjusting for maternal age, BMI, and birth weight. We found that Asian women were more likely than white women to undergo cesarean section compared with spontaneous vaginal delivery (OR 1.49, 95% CI (1.02, 2.17)). We also found that Black women were more likely than white women to undergo cesarean section compared with spontaneous vaginal delivery (OR 1.43, 95% CI 1.07, 1.91)). This may warrant further investigation of racial differences in risk adjusted primary cesarean rates

Racial and ethnic differences in primary, unscheduled cesarean deliveries among low-risk primiparous women at an academic medical center: a retrospective cohort study

BACKGROUND: Cesarean sections are the most common surgical procedure for women in the United States. Of the over 4 million births a year, one in three are now delivered in this manner and the risk adjusted prevalence rates appear to vary by race and ethnicity. However, data from individual studies provides limited or contradictory information on race and ethnicity as an independent predictor of delivery mode, precluding accurate generalizations. This study sought to assess the extent to which primary, unscheduled cesarean deliveries and their indications vary by race/ethnicity in one academic medical center. METHODS: A retrospective, cross-sectional cohort study was conducted of 4,483 nulliparous women with term, singleton, and vertex presentation deliveries at a major academic medical center between 2006-2011. Cases with medical conditions, risk factors, or pregnancy complications that can contribute to increased cesarean risk or contraindicate vaginal birth were excluded. Multinomial logistic regression analysis was used to evaluate differences in delivery mode and caesarean indications among racial and ethnic groups. RESULTS: The overall rate of cesarean delivery in our cohort was 16.7%. Compared to White women, Black and Asian women had higher rates of cesarean delivery than spontaneous vaginal delivery, (adjusted odds ratio {AOR}: 1.43; 95% CI: 1.07, 1.91, and AOR: 1.49; 95% CI: 1.02, 2.17, respectively). Black women were also more likely, compared to White women, to undergo cesarean for fetal distress and indications diagnosed in the first stage as compared to the second stage of labor. CONCLUSIONS: Racial and ethnic differences in delivery mode and indications for cesareans exist among low-risk nulliparas at our institution. These differences may be best explained by examining the variation in clinical decisions that indicate fetal distress and failure to progress at the hospital-level

Type, Content, and Source of Social Support Perceived by Women during Pregnancy: Evidence from Matlab, Bangladesh

Specific and contextualized data on social support during distinct health events are needed to improve social support interventions. This study identified the type, content, and source of social support perceived by women during pregnancy. In-depth interviews with 25 women, aged 18-49 years, living in Matlab, Bangladesh, were conducted. The findings demonstrated that women perceived, the receipt of eight distinct types of support. The four most frequently-mentioned types included: practical help with routine activities, information/advice, emotional support and assurance, as well as the provision of resources and material goods. Sources varied by type of support and most frequently included-\u2014mothers, mothers-in-law, sistersin-law, and husbands. Examples depicting the content of each type of support revealed culturally-specific issues that can inform community-based social support interventions

Cultural Theories of Postpartum Bleeding in Matlab, Bangladesh: Implications for Community Health Intervention

Early recognition can reduce maternal disability and deaths due to postpartum haemorrhage. This study identified cultural theories of postpartum bleeding that may lead to inappropriate recognition and delayed care-seeking. Qualitative and quantitative data obtained through structured interviews with 149 participants living in Matlab, Bangladesh, including women aged 18-49 years, women aged 50+ years, traditional birth attendants (TBAs), and skilled birth attendants (SBAs), were subjected to cultural domain. General consensus existed among the TBAs and lay women regarding signs, causes, and treatments of postpartum bleeding (eigenvalue ratio 5.9, mean competence 0.59, and standard deviation 0.15). Excessive bleeding appeared to be distinguished by flow characteristics, not colour or quantity. Yet, the TBAs and lay women differed significantly from the SBAs in beliefs about normalcy of blood loss, causal role of the retained placenta and malevolent spirits, and care practices critical to survival. Cultural domain analysis captures variation in theories with specificity and representativeness necessary to inform community health intervention

A cross-country survey of attitudes toward childbirth technologies and interventions among university students

Problem & Aim: Cultural beliefs that equate birth technology with progress, safety and convenience contribute to widespread acceptance of childbirth technology and interventions. Little is known about attitudes towards childbirth technology and interventions among the next generation of maternity care users and whether attitudes vary by country, age, gender, childbirth fear, and other factors. Methods: Data were collected via online survey in eight countries. Students who had never had children, and who planned to have at least one child were eligible to participate. Findings: The majority of participants (n= 4569) were women (79.3%), and the median age was 22 years. More than half of students agreed that birth technology makes birth easier (55.8 %), protects babies from harm (49.1 %) and that women have a right to choose a medically non-indicated cesarean (50.8 %).Respondents who had greater acceptance of childbirth technology and interventions were from countries with higher national caesarean birth rates, reported higher levels of childbirth fear, and were more likely to report that visual media or school-based education shaped their attitudes toward birth. Positive attitudes toward childbirth technology and interventions were also associated with less confidence in knowledge of birth, and more common among younger and male respondents. Discussion/Conclusion: Educational strategies to teach university students about pregnancy and birth in ways that does not frighten them and promotes critical reflection about childbirth technology are needed. This is especially true in countries with high rates of interventions that reciprocally shape culture norms, attitudes, and expectations

Chronic fatigue syndrome in an ethnically diverse population: the influence of psychosocial adversity and physical inactivity

<p>Abstract</p> <p>Background</p> <p>Chronic fatigue syndrome (CFS) is a complex multifactorial disorder. This paper reports the prevalence of chronic fatigue (CF) and CFS in an ethnically diverse population sample and tests whether prevalence varies by social adversity, social support, physical inactivity, anxiety and depression.</p> <p>Methods</p> <p>Analysis of survey data linking the Health Survey for England (1998 and 1999) and the Ethnic Minority Psychiatric Illness Rates in the Community (EMPIRIC) study undertaken in 2000. The study population comprised a national population sample of 4,281 people ages 16 to 74 years. CF and CFS were operationally defined on the basis of an interview in the EMPIRIC study, alongside questions about psychosocial risk factors. Previous illnesses were reported in the Health Survey for England during 1998 and 1999, as was physical inactivity.</p> <p>Results</p> <p>All ethnic minority groups had a higher prevalence of CFS than the White group. The lowest prevalence was 0.8% in the White group, and it was highest at 3.5% in the Pakistani group (odds ratio (OR), 4.1; 95% confidence interval (95% CI), 1.6 to 10.4). Anxiety (OR, 1.8; 95% CI, 1.4 to 2.2), depression (OR, 1.4; 95% CI, 1.1 to 1.8), physical inactivity (OR, 2.0; 95% CI, 1.1 to 3.8), social strain (OR, 1.24; 95% CI, 1.04 to 1.48) and negative aspects of social support (OR, 2.12; 95% CI, 1.4 to 3.3) were independent risk factors for CFS in the overall sample. Together these risk factors explained ethnic differences in the prevalence of CFS, but no single risk factor could explain a higher prevalence in all ethnic groups.</p> <p>Conclusions</p> <p>The prevalence of CFS, but not CF, varies by ethnic group. Anxiety, depression, physical inactivity, social strain and negative aspects of social support together accounted for prevalence differences of CFS in the overall sample.</p

A Survey of University Students’ Preferences for Midwifery Care and Community Birth Options in 8 High‐Income Countries

Background: Midwifery care is associated with positive birth outcomes, access to community birth options, and judicious use of interventions. The aim of this study was to characterize and compare maternity care preferences of university students across a range of maternity care systems and to explore whether preferences align with evidence- based recommendations and options available. Methods: A cross-sectional, web-based survey was completed in 2014-2015 by a convenience sample of university students in 8 high-income countries across 4 continents (n=4,569). In addition to describing preferences for midwifery care and community birth options across countries, socio-demographic characteristics, psychological factors, knowledge about pregnancy and birth, and sources of information that shaped students’ attitudes towards birth were examined in relation to preferences for midwifery care and community birth options. Results: Approximately half of the student respondents (48. 2%) preferred midwifery-led care for a healthy pregnancy, 9.5% would choose to birth in a birthing center, and 4.5% preferred a home birth. Preference for midwifery care varied from 10.3% among women in the United States to 78.6% among women in England. Preferences for home birth varied from 0.3% among US women to 18.3% among Canadian women. Women, health science students, those with low childbirth fear, who learned about pregnancy and birth from friends (compared to other sources, e.g. the media) and those who responded from Europe were significantly more likely to prefer midwifery care and community birth. High confidence in knowledge of pregnancy and birth was linked to significantly higher odds of community birth preferences and midwifery care preferences Conclusions: It would be beneficial to integrate childbirth education into high school curricula, to promote knowledge of midwifery care, pregnancy and childbirth and reduce fear among prospective parents. Community birth options need to be expanded, to meet demand among the next generation of maternity service users