Strategies to Successfully Implement an Eat, Sleep, Console Protocol.

ABSTRACT: Neonatal opioid withdrawal syndrome is pervasive, reflected in a case rate increase among most demographics in the United States from 4.0 newborns per 1,000 hospitalized births in 2010 to 7.3 newborns per 1,000 hospitalized births in 2017. Historically, assessments have been based on present symptomatology, excluding the mother's input, and increasing the likelihood of pharmacotherapy. The Eat, Sleep, Console approach provides an opportunity for the mother to act as the treatment for her newborn as she performs nonpharmacologic interventions that reduce withdrawal severity. Maternal confidence to help her newborn grows with this level of involvement and mother/infant dyad care improves, as do nurse and mother interactions. Assessments are less subjective and less time-consuming for nurses to conduct than those of the often-used Finnegan tool, and are conducted in collaboration with the mother. Facilities implementing this approach have seen a reduction in newborn hospital length of stay, pharmacotherapy, associated medical costs, and improved breastfeeding rates. Implementing an Eat, Sleep, Console protocol involves a stepwise approach to ensure all stakeholders are effectively prepared for the transition. We present strategies to implement an Eat, Sleep, and Console clinical protocol. A stepwise approach to implementation along with a clinical nursing maternal education protocol exemplar is included. Methods to overcome barriers to implementation and recommendations for further development are discussed.

Obstetrician-gynecologist and patient factors associated with intimate partner violence screening in a clinical setting.

Screening for intimate partner violence is recommended by the medical community. This study investigated obstetrician-gynecologists' intimate partner violence screening patterns and physician and patient factors associated with screening. Four hundred obstetricians-gynecologists completed the Physician Readiness to Manage Intimate Partner Violence Survey between December 2014 and July 2015. Their patients completed the Patient Safety and Satisfaction Survey. Hierarchical generalized linear modeling analyzed physician and patient variables related to the likelihood of being screened. Forty-four physicians responded. The viable patient response rate was 81.3 percent (n = 894) of patients from included physicians. Less than half (43.2 percent) of physicians reported screening during annual exams. There was a statistically significant difference for patient race/ethnicity (p < .03) and the number of previous doctor visits (p < .03) with not being screened. These patient-level variables accounted for approximately 68.3 percent of the variance screening odds. There was no significant difference (p < .10) between physicians' perceived preparation, knowledge, and attitudes for not being screened. The hierarchical generalized linear modeling analysis showed a trend for physicians with a high-perceived preparation for screening was related to initial visits. This study identified that obstetrician-gynecologists do not routinely screen for IPV and race/ethnicity and number of visits are factors in screening for intimate partner violence.

Incivility in nursing: Implementing a quality improvement program utilizing cognitive rehearsal training.

BACKGROUND: Workplace incivility can be a factor in unhealthy work environments. Addressing unit culture improves job satisfaction and organizational commitment. AIM: The purpose of this quality improvement program was to educate nurses to identify and respond to hospital incivility. SETTING: A community hospital in the Northeastern United States. Participants-A convenience sample of nurses. METHODS: A quality improvement program was conducted, which included an incivility education module and cognitive rehearsal training. The nursing incivility scale (NIS) was used to evaluate the effectiveness of the educational module. Participants completed the NIS before, immediately after, and 1 month after the program. Cognitive rehearsal training included role playing using scripted responses to uncivil behavior. RESULTS: A one-way repeated measures analysis of variance was conducted to compare total score and eight subscale scores on the NIS before, after, and 1 month after implementation of the intervention. There was a statistically significant difference for effect of total time as well as for five of the eight subscales. CONCLUSIONS: Incivility programs can provide nurses with the needed tools to identify uncivil behaviors and react in a proactive, professional manner; this promotes a safe working environment for nurses and their patients.

Continued Intimate Partner Violence During Pregnancy and After Birth and Its Effect on Child Functioning.

OBJECTIVE: To investigate the effect of intimate partner violence (IPV) during pregnancy with continued IPV up to 6 months after birth and its effect on child functioning. DESIGN: Nonexperimental descriptive design. SETTING: Safe shelters and the District Attorney's office in a large urban community in the United States. PARTICIPANTS: Abused women (N = 284) who reported IPV and reached out for services. METHODS: Abused women who reported IPV answered a questionnaire on the effects of abuse during pregnancy and continued abuse after birth and child behaviors. Women who continued to experience abuse during pregnancy were compared with women who did not report abuse during pregnancy and after birth. The Achenback Child Behavior Checklist was used to evaluate child behavior. Research questions were analyzed through the use of nonparametric analyses. RESULTS: Between the two groups, the relationship between IPV during pregnancy and IPV during the first 6 months after birth was significant (p < .001). The relation between women who reported abuse during pregnancy and conception rape was significant (p < .001). Most abused women (76%) were not screened for IPV during pregnancy (p = .025). Significant findings related to child behaviors and IPV during pregnancy were found for internalizing behaviors (p < .009), externalizing behaviors (p < .001), and total behavioral problems (p < .001). CONCLUSION: Intimate partner violence during pregnancy increases the risk of IPV 6 months after birth. These findings also indicated a negative intergenerational effect of IPV during pregnancy on child behavior. Screening for IPV during pregnancy is vital to interrupt ongoing IPV and possible negative outcomes for mother and child.

Interrupting Intimate Partner Violence During Pregnancy With an Effective Screening and Assessment Program.

Intimate partner violence is a public health problem that affects many women during pregnancy and can compromise the health and safety of mothers and infants. Identification and routine assessment of intimate partner violence during pregnancy is essential, and health care providers must be afforded training and resources that support an effective screening and assessment program. The essential components of an intimate partner violence assessment program for women who are abused during pregnancy are explored.

Effect of abuse during pregnancy on maternal and child safety and functioning for 24 months after delivery.

OBJECTIVE: To evaluate the long-term safety and functioning outcomes for abused women reporting abuse during pregnancy and their children's behavior compared with abused women who do not report abuse during pregnancy. METHODS: Forty-six abused women seeking assistance for partner abuse and reporting being pregnant during the preceding 4 months were evaluated every 4 months for 24 months to compare levels of abuse, danger for murder, anxiety, depression, somatization, and posttraumatic stress disorder (PTSD) for abused women who report abuse during pregnancy (n=24) compared with abused women reporting abuse only outside of pregnancy (n=22). Internalizing and externalizing behavior scores were evaluated for the children. RESULTS: At entry into the study, abused women reporting abuse during pregnancy reported significantly greater (P<.05) threats of abuse, sexual abuse, physical abuse, danger for murder, and PTSD compared with abused women not reporting abuse during pregnancy. Effect sizes were large. When evaluated over the course of 24 months after delivery, risk for murder remained higher for women reporting abuse during pregnancy for 8 months after delivery, depression was higher at 4, 8, 16, and 20 months after delivery, and PTSD was appreciably higher for 24 months. Children living with mothers abused during pregnancy displayed more behavioral problems for the entire 24-month period, especially problems of depression and anxiety. CONCLUSION: The study documents the negative safety and function effects of abuse in pregnant women that remain for at least 24 months after delivery. This warrants incorporating abuse screening during the antenatal and postdelivery periods and a protocol of care during the antenatal period and beyond.

Rapid assessment to identify and quantify the risk of intimate partner violence during pregnancy.

BACKGROUND: Abuse during pregnancy is common and affects upwards of one in six pregnant women worldwide. The objective of this study is to describe the demographics, frequency, and severity of abuse, and the risk of murder for women who report abuse during pregnancy compared with women who do not report abuse. METHODS: A total of 300 women seeking assistance for partner abuse were recruited to participate in a 7-year prospective study. Of the 300 women, 50 reported they had been pregnant within the last 4 months; 25 of the women (50%) reported they were "beaten" during the pregnancy; and 25 women (50%) reported they had not been "beaten." Analysis was completed on differential severity for abuse and risk for murder between the two groups. RESULTS: Women reporting abuse during pregnancy had statistically significant (p < 0.001) higher scores for Threat of abuse, F(1, 49) = 14.37, p < 0.001; Physical abuse, F(1, 49) = 21.21, p < 0.001; and Danger for murder weighted F(1, 49) = 22.99, p < 0.001. All effects sizes were large. CONCLUSION: Women abused during pregnancy are at greater risk for further abuse and in severe danger for murder. To ensure the safety of pregnant women, screening policies are essential.

A practical approach to labor support.

In the United States, intrapartum nurses are present at 99% of births. These nurses have a unique opportunity to positively affect a laboring woman's comfort and labor progress through the use of labor support behaviors. These nonpharmacologic nursing strategies fall into four categories: physical, emotional, instructional/informational, and advocacy. Implementation of these strategies requires special knowledge and a commitment to the enhanced physical and emotional comfort of laboring women.