Expanding Our Understanding Complex Decision-Making in Emergent, Routine, and Urgent Ethically Challenging Clinical Situations

Study Purpose The purpose of this study was to discover and identify the continuum between conscientious objectors and designated staff in the provision of nursing care to women seeking abortions. More specifically, we sought to gain a deeper understanding of processes that nurses use when making clinical decisions in ethically challenging situations using abortion as the clinical contex

What about the men? Perinatal experiences of men of color whose partners were at risk for preterm birth, a qualitative study.

BACKGROUND:Preterm birth in the United States is associated with maternal clinical factors such as diabetes, hypertension and social factors including race, ethnicity, and socioeconomic status. In California, 8.7% of all live births are preterm, with African American and Black families experiencing the greatest burden. The impact of paternal factors on birth outcomes has been studied, but little is known about the experience of men of color (MOC). The purpose of this study was to explore the experiences of MOC who are partners to women at medical and social risk for preterm birth. METHODS:This study used a qualitative research design and focus group methods. The research was embedded within an existing study exploring experiences of women of color at risk for preterm birth conducted by the California Preterm Birth Initiative. RESULTS:Twelve MOC participated in the study and among them had 9 preterm children. Four themes emerged from thematic analysis of men's experiences: (1) "Being the Rock": Providing comfort and security; (2) "It's a blessing all the way around": Keeping faith during uncertainty; (3) "Tell me EVERYTHING": Unmet needs during pregnancy and delivery; (4) "Like a guinea pig": Frustration with the healthcare system. Participants identified many barriers to having a healthy pregnancy and birth including inadequate support for decision making, differential treatment, and discrimination. CONCLUSIONS:This study shows novel and shared narratives regarding MOC experiences during pregnancy, birth, and postpartum periods. Healthcare providers have an essential role to acknowledge MOC, their experience of discrimination and mistrust, and to assess needs for support that can improve birth outcomes. As MOC and their families are at especially high social and medical risk for preterm birth, their voice and experience should be central in all future research on this topic

Research priorities of women at risk for preterm birth: findings and a call to action.

BACKGROUND:Traditional hierarchical approaches to research give privilege to small groups with decision-making power, without direct input from those with lived experience of illness who bear the burden of disease. A Research Justice framework values the expertise of patients and communities as well as their power in creating knowledge and in decisions about what research is conducted. Preterm birth has persisted at epidemic levels in the United States for decades and disproportionately affects women of color, especially Black women. Women of color have not been included in setting the agenda regarding preterm birth research. METHODS:We used the Research Priorities of Affected Communities protocol to elicit and prioritize potential research questions and topics directly from women of color living in three communities that experience disproportionately high rates of preterm birth. Women participated in two focus group sessions, first describing their healthcare experiences and generating lists of uncertainties about their health and/or healthcare during pregnancy. Women then participated in consensus activities to achieve 'top-priority' research questions and topic lists. The priority research questions and topics produced by each group were examined within and across the three regions for similarities and differences. RESULTS:Fifty-four women participated in seven groups (14 sessions) and generated 375 researchable questions, clustered within 22 topics and four overarching themes: Maternal Health and Care Before, During, and After Pregnancy; Newborn Health and Care of the Preterm Baby; Understanding Stress and Interventions to Prevent or Reduce Stress; and Interpersonal and Structural Health Inequities. The questions and topics represent a wide range of research domains, from basic science, translational, clinical, health and social care delivery to policy and economic research. There were many similarities and some unique differences in the questions, topics and priorities across the regions. CONCLUSIONS:These findings can be used to design and fund research addressing unanswered questions that matter most to women at high risk for preterm birth. Investigators and funders are strongly encouraged to incorporate women at the front lines of the preterm birth epidemic in research design and funding decisions, and more broadly, to advance methods to deepen healthcare research partnerships with affected communities

In Situ Fabrication and Repair (ISFR) Technologies; New Challenges for Exploration

NASA's human exploration initiative poses great opportunity and great risk for manned missions to the Moon and Mars. Engineers and Scientists at the Marshall Space Flight Center (MSFC) are continuing to evaluate current technologies for in situ resource-based exploration fabrication and repair applications. Several technologies to be addressed in this paper have technology readiness levels (TRLs) that are currently mature enough to pursue for exploration purposes. However, while many technologies offer promising applications, these technologies must be pulled along by the demands and applications of this great initiative. The In Situ Fabrication and Repair (ISFR) Element will supply and push state of the art technologies for applications such as habitat structure development, in situ resource utilization for tool and part fabrication, and repair and non-destructive evaluation W E ) of common life support elements. As an overview of the ISFR Element, this paper will address rapid prototyping technologies, their applications, challenges, and near term advancements. This paper will also discuss the anticipated need to utilize in situ resources to produce replacement parts and fabricate repairs to vehicles, habitats, life support and quality of life elements. Overcoming the challenges of ISFR development will provide the Exploration initiative with state of the art technologies that reduce risk, and enhance supportability