Prevalence of Nursing Students With Background Check Findings.

BACKGROUND: Background checks (BGC) have been used in nursing education since the 2000s. Little is known about the prevalence of BGC among nursing students or how these students compare to the general population. METHOD: This retrospective study describes aggregated, de-identified BGC data from 2014-2019 in 16 large nursing programs in the United States. An independent samples t test was used to compare U.S. regional means and Federal Bureau of Investigation (FBI) regional arrest data. RESULTS: The mean percentage of nursing student BGC with findings was 3.2% (minimum .00%, maximum 13.33%, SD 2.98%). The mean prevalence of BGC findings does not significantly differ among U.S. regions. There was no significant difference between BGC results in nursing students and regional FBI arrest data. CONCLUSION: Excluding students with BGC findings has not been studied but may represent a structural barrier to diversification of the nursing profession. Additional research linking BGC findings to public protection is required. [J Nurs Educ. 2024;63(1):32-37.].

Perinatal psychiatric practitioner consultation program delivers rapid response to OB/GYN practitioners.

INTRODUCTION: Screening and treatment initiation for perinatal psychiatric conditions is a recommended competency in OB/GYN practitioners, yet perinatal psychiatry is rapidly evolving. Practitioner-to-psychiatrist consultation programs have the potential to improve the management of psychiatric conditions in perinatal women. This study describes utilization of a statewide perinatal psychiatric consultation service by OB/GYN practitioners through examination of the volume, responsivity, content and outcomes of clinical inquiries, and satisfaction. METHODS: This quality improvement study describes the 460 telephone or e-mail consultations requested by OB/GYN practitioners over 2 years and housed within a REDCap database. Data include the characteristics of consult users, month-over-month and total utilization, the patient's perinatal status, the reason for contact, current symptoms and medications, and the consulting psychiatrist recommendations. Practitioner satisfaction with consultation is also described. RESULTS: After completion of triage, the psychiatrist returned the practitioner's call ≤5 min in 59% of consultations. The most common inquiries were for pregnant (64%) women for depressive (51%) or anxiety (46%) symptoms with 47% of inquiries reporting the patient was currently taking a psychiatric medication. Had consultation not been available, referral to mental health (41%) or starting a medication (15%) were most often reported. CONCLUSIONS: This perinatal psychiatric consultation service rapidly and effectively met the needs of practitioners practicing in OB/GYN settings across a state having a critical psychiatry shortage and varying urban and rural geography. Future recommendations include the assessment of direct patient outcomes, practitioner skill attainment, and long-term cost savings of this perinatal psychiatric consultation model.

Deciding on Home Birth.

OBJECTIVE: To explore the decision-making processes of women who planned home births and to generate an emerging theoretical description of these processes. DESIGN: Qualitative descriptive study using grounded theory. SETTING: A certified nurse-midwifery home birth practice in a midsized city in the United States. PARTICIPANTS: Eleven adult women who planned home births with certified nurse-midwives. METHODS: We conducted semistructured, in-depth interviews with participants to discuss their decision-making processes regarding planning for their home births. Interviews were recorded and transcribed verbatim. We used open, selective, and theoretical coding and constant comparison to analyze the data. RESULTS: The core category in the decision-making process regarding home birth was Claiming Maternal Space. The three main themes under this core category were Awareness of home birth, Movement from conventional perinatal care, and Shelter Building for labor and birth. CONCLUSION: Our results suggest that women who plan home births greatly value agency during perinatal care. The core category Claiming Maternal Space represented how participants solved the problem of decreased agency in conventional perinatal care. Further research is needed to validate the emerging theoretical description and explore the association between agency and perinatal outcomes.

Feasibility of model adaptations and implementation of a perinatal psychiatric teleconsultation program.

OBJECTIVE: Given the critical shortage of perinatal psychiatrists, combined with the prevalence of psychiatric conditions in the perinatal period, teleconsultation may help to maximize the efficiency of psychiatrists to reach this population. The Periscope Project (TPP) is a Wisconsin-based program offering real-time provider-to-provider teleconsultation, community resource information, and provider education. This paper describes model adaptations and implementation of TPP and the first 18 months of program data. METHOD: Enrollment and satisfaction data was collected via self-reported online surveys. Encounter data was entered by TPP team members through communication with providers. All data was housed in REDCap. RESULTS: Four hundred eight-five providers enrolled and 268 unique providers accessed services at least once. There were 594 encounters with 85% of encounters resulting in a teleconsultation. Mean call-back time from the psychiatrist was 6.8 min. Over half of utilizing providers practiced in obstetrical settings and 23% practiced in mental health settings. Provider satisfaction with the service was 100%. CONCLUSIONS: Utilization and satisfaction with TPP suggest that perinatal psychiatry access program models can vary in structure and process and experience similar utilization rates. Model adaptations are feasible and demonstrate the teleconsultation service is accepted by providers and may improve the population's health over time.

A Comparison of Infant Sleep Safety Guidelines in Nine Industrialized Countries.

Many countries have guidelines that recommend safety practices for infant sleep. However, it is not known whether guidelines between countries are similar or different. The purpose of this paper is to compare national public health infant sleep safety guidelines among highly developed countries. Criteria for inclusion were: countries defined by United Nations as "very high human development," guideline related to infant sleep position and safety practices, evidence of it being a national guideline, and published in English. Guidelines from nine countries met inclusion criteria, and data were extracted across 13 categories. All guidelines recommended the supine sleep position and avoidance of smoke exposure. While most guidelines addressed the remaining 11 categories, specific recommendations varied among guidelines. These findings can inform the broad context of SIDS reduction work, offer opportunities for collaboration among countries, and promote multi-country and global conversations about how research evidence is translated into recommendations for practice.

A Postpartum Sleep and Fatigue Intervention Feasibility Pilot Study.

The purpose of this pilot study was to evaluate the feasibility, acceptability, and cost of a self-management intervention for postpartum fatigue and sleep in socioeconomically disadvantaged urban women. Helping U Get Sleep (HUGS) is a theory-guided intervention developed from the Individual and Family Self-Management Theory. Medicaid-enrolled participants in the United States were recruited from an inpatient postpartum unit. Treatment and attention control interventions were delivered (15 HUGS, 12 comparison) at a week 3 postpartum home visit and 4 follow-up phone calls. Over the 9-week protocol, the HUGS group demonstrated significant improvements in subjective fatigue and subjective sleep disturbance relative to the comparison group. The HUGS intervention was feasible and acceptable, delivered on average, in 100 min and costing US$79 per participant.

Prevention Messages in Parent-Infant Bed-Sharing: Message Source, Credibility, and Effectiveness.

Objective. Despite educational outreach, bed-sharing prevalence is rising. Mothers' and fathers' bed-sharing practices, prevention message source, perceived source credibility, and the effectiveness of the prevention message were evaluated. Methods. Data were collected from 678 community parents via an online survey. Results were analyzed using descriptive statistics and phi tests. Results. Bed-sharing reasons focused on comfort and ease. Mothers were more likely to receive prevention messages from individual professionals or organizations, whereas fathers were more likely to hear prevention messages from spouses/coparents and grandfathers. Physicians were the most common source, and physicians and grandmothers were rated as the most credible and effective. Conclusions. Prevention message source varies between mothers and fathers, highlighting the need for continued research with fathers. Grandmothers and physicians are effective and credible sources of prevention messages. Although less frequent, prevention messages from grandmothers were most effective. There was no evidence of effective messages from educational campaigns.

NEEDS AND CHALLENGES OF HOME VISITORS CONDUCTING PERINATAL DEPRESSION SCREENING.

This article describes the needs and challenges faced by home visitors, supervisors, and clients when conducting perinatal depression screening. Home visitors (n = 11), supervisors (n = 5), and clients (n = 9) representing rural and urban practice settings in Wisconsin were recruited into three separate focus groups. Themes were identified from the transcribed audio-recorded interviews using content analysis. Results indicate that a trusting relationship was leveraged to facilitate depression screening and referral. Home visitors personalized care to a client's context and to protect confidentiality. Home-visiting practice demanded flexibility and negotiation in decision-making with clients and families. Coordinating access to mental health evaluation in areas of limited access was a common challenge. Participants reported a need for further training on safety management. With adequate training and support, home visitors are well-positioned to promote access to mental health services in vulnerable families to support infant mental health.

Sleep Quality and Quantity in Low-Income Postpartum Women.

PURPOSE: To describe and explore patterns of postpartum sleep, fatigue, and depressive symptoms in low-income urban women. STUDY DESIGN AND METHODS: In this descriptive, exploratory, nonexperimental study, participants were recruited from an inpatient postpartum unit. Subjective measures were completed by 132 participants across five time points. Objective sleep/wake patterns were measured by 72-hour wrist actigraphy at 4 and 8 weeks. Mean sample age was 25 years, high school educated with 3.1 children. Over half the sample reported an annual income less than 50% of the federal poverty level. RESULTS: Objectively, total nighttime sleep was 5.5 hours (week 4) and 5.4 hours (week 8). Subjectively, 85% met criteria for "poor sleep quality" at week 4, and nearly half were persistently and severely fatigued through 8 weeks postpartum. CLINICAL IMPLICATIONS: The majority (65%) of women in this study met the definition of "short sleep duration," defined as sleeping ≤ 6 hours per night. Adverse effects of this short sleep on physical and mental health as well as safety and functioning, especially within the context of poverty, may be profound. There is an urgent need for further research on sleep in low-income underrepresented women to identify interventions that can improve sleep and fatigue as well as discern the implications of sleep deprivation on the safety and physical and mental health of this population.

The Interface Among Poverty, Air Mattress Industry Trends, Policy, and Infant Safety.

Infants can suffocate on air mattresses, even when the mattress is fully inflated. The interfacing issues of poverty, the bedbug epidemic, and changes in the design and marketing of air mattresses may be increasing consumer use of air mattresses as primary sleep environments and thus increasing the potential for infant death. Despite recent changes to improve air mattress safety labeling, the National Child Death Review Case Reporting System found that between 2004 and 2015 across 24 states, an air mattress was the incident sleep place for 108 infants whose deaths were either during sleep or in a sleep environment. At the same time, design components such as inflatable headboards and memory foam pillow tops potentially increase the hazard to infants, and marketing changes represent air mattresses as a preferred low-cost primary sleep environment. Analysis of current data surveillance systems, published position statements, and consumer materials from national organizations and federal agencies reveal opportunities for changing policy to better protect infants from this hazard.

Parent decision factors, safety strategies, and fears about infant sleep locations.

Infant sleep safety is a primary concern of parents. Infant sleep locations vary around the world. PURPOSE: This pilot study investigated the decision factors, fears, and safety strategies reported by parents internationally. METHODS: participants (n=49) recruited online from 10 countries completed an anonymous Internet survey in English and submitted a picture of the infant's primary nighttime sleep location. Pictures were coded into 'shared' (29%) or 'separate' (71%) sleep surfaces. RESULTS: primary decision factors about infant sleep location were safety, comfort, family sleep quality, and overall ease. Parents maximized safety by providing a clear sleep surface, no blankets, no toys, sleep sack use, and a firm mattress. Different worries and fears emerged depending on the sleep surface. CONCLUSION: differences in the specific worries and strategies used by parents when deciding whether to share or not share a sleep surface with an infant may be used to tailor future interventions.

How Postpartum Women With Depressive Symptoms Manage Sleep Disruption and Fatigue.

Postpartum sleep and fatigue have bidirectional relationships with depressive symptoms and challenge women's everyday functioning. The everyday process of managing postpartum sleep and fatigue in the context of depressive symptoms remains unexplored. We conducted a grounded theory study with a sample of 19 women who screened positive on the Postpartum Depression Screening Scale (PDSS™) Short Form at 3 weeks postpartum. Women completed semi-structured in-home interviews and the full PDSS and Modified Fatigue Symptoms Checklist at 1, 3, and 6 months postpartum. The sample was on average 27 years old, with 2.8 children, and 63% were African-American. They described a basic social process of Finding a Routine Together, during which women's experiences with their infants progressed from Retreating at month 1 toward Finding a New Normal at month 6. In their work to Find a Routine Together, mothers' patterns of change over time were continuous, gradual, or prolonged. Their progress was influenced by depressive symptoms, social support, work and daycare, stability in social circumstances, and underlying stressors. This study's findings suggest the need to allocate resources and tailor interventions to meet the needs of women who are most vulnerable to the health effects of ongoing persistent severe fatigue, disordered sleep, and sub-clinical and clinical levels of depressive symptoms. © 2017 Wiley Periodicals, Inc.

Career cartography: a conceptualization of career development to advance health and policy.

PURPOSE: The purpose of this article is to propose a conceptualization of career development that emphasizes the interdependence between research, practice, and policy. ORGANIZING CONSTRUCT: Career cartography applies three decades of career development experience to lay out a systematic, comprehensive, and iterative approach for planning and communicating the outcomes of science at any career stage. To inform practice and policy, nurse researchers must be clear on the intended destination and trajectory of the science, and be skilled in communicating that science and vision to diverse stakeholders. Career cartography builds on the science of cartography, is developed within the context of public and health policy, and is composed of several components, including a destination statement, career mapping, a supportive career cartography team, and use of communication and dissemination strategies. CONCLUSIONS: The successful utilization of career cartography may accelerate advancement of individual careers, scientific impact, and the discipline as a whole by guiding nurse researchers to be deliberative in career planning and to communicate successfully the outcomes of research across a wide variety of stakeholders. Career cartography provides a framework for planning a nurse researcher's program of research and scholarship to advance science, policy, and health of the public. CLINICAL RELEVANCE: Career cartography guides nurse researchers to realize their full potential to advance the health of the public and inform public and health policy in academic and practice environments.

Application of a socio-ecological model to mother-infant bed-sharing.

Mother-infant bed-sharing has been associated with an increased risk of sleep-related infant deaths, and thus, health messaging has aimed to discourage this behavior. Despite this messaging, bed-sharing remains a common practice in the United States, especially among minority families. Moreover, rates of accidental suffocation and strangulation in bed (often related to bed-sharing) are on the rise, with Black infants at two to three times greater risk than Whites. Multiple studies have identified risk factors for bed-sharing, but a gap remains between findings and translation into interventions. The socio-ecological model (SEM) has been suggested as a way to study and design interventions addressing complex public health issues. This article reconceptualizes the literature on mother-infant bed-sharing using the SEM. PubMed, POPLINE, ERIC, and Psych Info were searched for articles that (a) included bed-sharing as the outcome variable, (b) were published between 2000 and 2013, (c) were conducted in the United States, and (d) included quantitative comparison of more than one factor. The following data were extracted: sample characteristics, bed-sharing definition, methods, factors examined, key findings, and conclusions. Data were summarized into five SEM levels--infant, maternal, family and household, and community and society, nested within the historical context of race. Sixteen studies met inclusion criteria. Significant factors associated with bed-sharing were present within each SEM level of influence. Educational interventions may increase efficacy by attending to multiple levels of the SEM, especially when implementing such interventions within minority subpopulations. Using a harm reduction approach to reducing the risk around bed-sharing may be one way to account for the multiple influences on bed-sharing. The science and practice of minimizing mother-infant bed-sharing may be advanced through use of the SEM.

The physical and social environment of sleep in socioeconomically disadvantaged postpartum women.

OBJECTIVE: To describe the physical and social environment of sleep self-management in postpartum socioeconomically disadvantaged women. DESIGN: Descriptive, exploratory design. SETTING: Participants were recruited in the hospital after giving birth. Data were collected in participant homes after discharge. PARTICIPANTS: Postpartum women on Medicaid with normal healthy infants. METHODS: Participants completed a survey about features within their physical and social sleep environment at 2 weeks postpartum. Participants then completed 3 days and nights of sleep diaries at 4 and 8 weeks postpartum to document perceived awakenings, select sleep hygiene practices, bed sharing, and reasons for sleep disruption. RESULTS: The sleep environments of participants were dynamic from night to night. Bed sharing was common with nearly one half of participants sharing with a partner, approximately 25% with the infant, and 20% with older children. Fifty-two percent of participants slept with the television on part (31%) or all (69%) of the night. Eighty-five percent of participants drank caffeine and 24% smoked. CONCLUSIONS: These results inform theory-driven postpartum sleep interventions. Modifications to the physical and social sleep environment that attend specifically to how sleep hygiene and environmental factors are manifested in the postpartum period have the potential to improve sleep for socioeconomically disadvantaged women. Future research is needed to articulate which changes can be effectively self-managed by mothers through nursing interventions.

Transition to the tenure track for nurse faculty with young children: a case study.

Recent efforts to ease the nursing shortage focus on recruiting and retaining younger faculty. The first years in a tenure-track position are especially challenging for new faculty who struggle to negotiate demands of academia along with parenting young children. These struggles may influence retention and require further exploration. A case study using qualitative content analysis was conducted on the transitioning experiences of three assistant professors of nursing, who had young children, during their first two years on tenure track at a research-intensive public university. Three main content areas emerged: adapting to the academic role, negotiating work/life demands, and benefiting from mentoring. To help ease the nurse faculty shortage, colleges and universities should strive to implement family-friendly policies and mentoring programs to retain faculty with young children.

Outcome of clinical nurse specialist-led hyperbilirubinemia screening of late preterm newborns.

PURPOSE/OBJECTIVE: The purpose of this project was to implement universal screening of all late preterm newborns for hyperbilirubinemia in a level I newborn nursery. RATIONALE/BACKGROUND: Late preterm newborns have traditionally received the same level of care and monitoring as term newborns despite being at increased risk for morbidity and mortality. DESCRIPTION OF THE PROJECT: An interdisciplinary clinical nurse specialist-led team guided by the Iowa Model of Evidence-Based Practice developed, piloted, and evaluated a standardized, coordinated approach to universal screening, assessment, and management of hyperbilirubinemia for late preterm newborns. OUTCOMES: The readmission rate of late preterm newborns with hyperbilirubinemia in the 30 days after birth was reduced to zero, providing evidence of programmatic effectiveness. INTERPRETATION/CONCLUSION: Universal screening of late preterm newborns for hyperbilirubinemia significantly improved outcomes in this vulnerable population. IMPLICATIONS: Detection of hyperbilirubinemia through universal screening of late preterm newborns is recommended in newborn nurseries.