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1.
J Nurs Adm ; 54(7-8): 397-403, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-39028562

RESUMO

This project aimed to evaluate the DNP projects at an academic medical center, assess the sustainability of DNP final projects, and explore potential opportunities to enhance the organizational review processes. The organization's graduate student review committee reviewed DNP projects implemented at the organization over the last 8 years. The sustainability of projects was less than anticipated. Recommendations are provided to enhance the DNP project approval process and improve strategies for sustainability.


Assuntos
Educação de Pós-Graduação em Enfermagem , Liderança , Enfermeiros Administradores , Educação de Pós-Graduação em Enfermagem/organização & administração , Humanos , Enfermeiros Administradores/educação , Estudantes de Enfermagem , Avaliação de Programas e Projetos de Saúde , Centros Médicos Acadêmicos/organização & administração
2.
Nurs Adm Q ; 47(2): 107-117, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-36862564

RESUMO

Senior nurse leaders are accountable for improving patient outcomes efficiently and cost-effectively. Nurse leaders often find heterogeneous patient outcomes across comparable nursing units in the same enterprise, presenting a challenge for nurse leaders tasked with making system-wide quality improvements. Implementation science (IS) offers a promising new approach to guide nurse leaders in understanding why certain implementation efforts meet with success or failure and the barriers faced in making practice changes. Knowledge of IS builds upon evidenced-based practice and quality improvement knowledge, adding to the armamentarium of tools at nurse leaders' disposal for improving nursing and patient outcomes. In this article, we demystify IS, differentiate it from evidence-based practice and quality improvement, describe IS concepts every nurse leader should be familiar with, and outline nurse leaders' role in building IS in their organizations.


Assuntos
Ciência da Implementação , Papel do Profissional de Enfermagem , Humanos , Melhoria de Qualidade
3.
Nurs Ethics ; 30(6): 803-821, 2023 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-36971185

RESUMO

BACKGROUND: Nurses experienced intense ethical and moral challenges during the COVID-19 pandemic. Our 2020 qualitative parent study of frontline nurses' experiences during the COVID-19 pandemic identified ethics as a cross-cutting theme with six subthemes: moral dilemmas, moral uncertainty, moral distress, moral injury, moral outrage, and moral courage. We re-analyzed ethics-related findings in light of refined definitions of ethics concepts. RESEARCH AIM: To analyze frontline U.S. nurses' experiences of ethics during the COVID-19 pandemic. RESEARCH DESIGN: Qualitative analysis using a directed content methodology. PARTICIPANTS AND RESEARCH CONTEXT: The study included 43 nurses from three major metropolitan academic medical centers and one community hospital in the northeastern, mid-Atlantic, midwestern, and western United States. ETHICAL CONSIDERATIONS: Participant privacy and data confidentiality were addressed. FINDINGS: Moral dilemmas arose from many situations, most frequently related to balancing safety and patient care. Moral uncertainty commonly arose from lacking health information or evidence about options. Moral distress occurred when nurses knew the right thing to do, but were prevented from doing so, including with end-of-life issues. Moral injury (accompanied by suffering, shame, or guilt) occurred after doing, seeing, or experiencing wrongdoing, often involving authority figures. Nurses expressed moral outrage at events and people within and outside healthcare. Despite difficult ethical situations, some nurses exemplified moral courage, sometimes by resisting policies they perceived as preventing compassionate care, guided by thinking about what was best for patients. DISCUSSION: This content analysis of ethics-related subthemes revealed conceptual characteristics and clarified distinctions with corresponding exemplars. Conceptual clarity may inform responses and interventions to address ethical quandaries in nursing practice. CONCLUSIONS: Ethics education in nursing must address the moral dilemmas of pandemics, disasters, and other crises. Nurses need time and resources to heal from trying to provide the best care when no ideal option was available.


Assuntos
COVID-19 , Ética em Enfermagem , Enfermeiras e Enfermeiros , Humanos , Pandemias , Princípios Morais , Incerteza , Pesquisa Qualitativa
4.
Nurs Adm Q ; 47(2): 118-125, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-36745183

RESUMO

Nurses and nurse leaders directing clinical organizations can elevate scholarly inquiry by employing a PhD-prepared hospital-based nurse scientist (HBNS). This individual will shape the culture of clinical inquiry, leading and driving efforts to close the gap between knowledge and practice. As the nursing workforce struggles to recover from the COVID-19 pandemic, now more than ever, collaborations between HBNSs and nurse leaders are essential to explore and test new nursing care delivery systems. Given the national shortage in the PhD-prepared nurse scientist talent pool, attracting and hiring the right candidate is critical. The purpose of this article is to provide practical recommendations for nurse leaders to introduce an HBNS into an organization as an important building block for nursing science and improved clinical practice. The role of the HBNS has evolved in tandem with increased education in the nursing workforce, evidence-based practice, and the explosion of implementation science. Before recruiting an HBNS, the organization must create a job description that outlines responsibilities, paying attention to the HBNS position within the organizational structure. Additionally, leaders must consider the candidate's characteristics for interacting with clinical staff. The senior nursing leadership team must recognize and appreciate the HBNS as a scholar and advisor.


Assuntos
COVID-19 , Cuidados de Enfermagem , Humanos , Pandemias , COVID-19/epidemiologia , Liderança , Hospitais
5.
AORN J ; 117(3): 177-186, 2023 03.
Artigo em Inglês | MEDLINE | ID: mdl-36825915

RESUMO

Preference cards are a foundation for perioperative inventory management processes; however, they can add to nurses' perceived workload, introduce variability into supply management processes, and increase costs. The purpose of this quality improvement project was to implement an automated perioperative inventory management system to decrease nurses' workload and increase their efficiency. Goals included improving preference card accuracy, decreasing add-on supplies, and decreasing the supply costs for each procedure. Using a preintervention-postintervention survey design, the project team evaluated the outcomes of workload, preference card accuracy, add-on supplies, and procedural cost. Nurses' perception of workload decreased in the supply management processes and cost of supplies categories and increased in the documenting supply use category. A four-month 7.7% improvement in preference card accuracy reduced the average procedure supply cost by $86.72 for each procedure and saved the hospital $260,467. The number of add-on supplies was reduced by 4,177 for a 20% reduction.


Assuntos
Melhoria de Qualidade , Carga de Trabalho , Humanos , Eficiência
6.
J Nurs Scholarsh ; 55(1): 22-28, 2023 01.
Artigo em Inglês | MEDLINE | ID: mdl-35727078

RESUMO

INTRODUCTION: The purpose of this qualitative study was to synthesize frontline U.S. nursing perspectives about the current state of U.S. public health emergency preparedness and response. The study findings may inform public health policy change and improve future national pandemic planning and responses. DESIGN: We conducted a secondary thematic qualitative analysis using grounded theory methodology. METHODS: Data collection occurred through semi-structured, in-depth focus groups between July and December 2020, from 43 frontline nurses working in hospitals in four states (Ohio, California, Pennsylvania, and New York). Data were analyzed deductively, aligned with Khan et al.'s Public Health Emergency Preparedness Framework and inductively for emergent themes. RESULTS: Three themes emerged: (1) Validation of the presence of health disparities and inequities across populations; (2) Perceived lack of consistency and coordination of messaging about pandemic policies and plans across all levels; and (3) challenges securing and allocating nursing workforce resources to areas of need. CONCLUSION: From a frontline nursing perspective, this study demonstrates the critical need to address health inequities and inequalities across populations, a consistent national vehicle for communication, and national plan for securing and allocating nursing workforce resources.


Assuntos
COVID-19 , Defesa Civil , Recursos Humanos de Enfermagem , Humanos , Pandemias , Saúde Pública , Pesquisa Qualitativa
7.
J Nurs Adm ; 52(11): 569-571, 2022 Nov 01.
Artigo em Inglês | MEDLINE | ID: mdl-36301865

RESUMO

As healthcare faces the great resignation, it is important that nurse leaders understand the impact of generational variations in the recruitment of nursing staff. This article discusses the specific characteristics of millennials and Generation Z nurses and offers suggestions for tailoring recruitment strategies for these 2 generational groups.


Assuntos
Enfermeiras e Enfermeiros , Recursos Humanos de Enfermagem , Humanos , Relação entre Gerações
8.
J Nurs Adm ; 52(6): 345-351, 2022 Jun 01.
Artigo em Inglês | MEDLINE | ID: mdl-35536878

RESUMO

OBJECTIVE: The objective of this multisite study was to explore the professional and personal experiences of US nurse managers (NMs) during the COVID-19 pandemic. BACKGROUND: NMs are the most accessible and visible nurse leaders to the frontline staff during this pandemic. METHODS: Thirty-nine NMs from 5 health systems across the US participated in focus groups in this qualitative study. Data were analyzed using a constant comparative method. RESULTS: Three major themes were identified: challenges, feelings and emotions, and coping. Subthemes emerged within each major theme. CONCLUSION: NMs across the country accepted considerable responsibility at great professional and personal consequence during the pandemic. NMs experienced challenges, ethical dilemmas, and expressed negative emotions. As the usual coping strategies failed, NMs reported that they are considering alternative career choices. This work provided evidence to help senior leaders strategize about mechanisms for reducing managerial dissonance during times of stress.


Assuntos
COVID-19 , Enfermeiros Administradores , COVID-19/epidemiologia , COVID-19/enfermagem , Humanos , Enfermeiros Administradores/psicologia , Pandemias , Pesquisa Qualitativa , Estados Unidos/epidemiologia
9.
J Addict Nurs ; 33(4): 299-308, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-37140417

RESUMO

BACKGROUND: Opioid use disorder (OUD) is a public health crisis, yet most acute care nurses are not educated to deliver evidence-based OUD care. Hospitalization provides a unique opportunity to initiate and coordinate OUD care in people presenting for other medical-surgical reasons. The aim of this quality improvement project was to determine the impact of an educational program on self-reported competencies of medical-surgical nurses caring for people with OUD at a large academic medical center in the Midwestern United States. METHOD: Data were collected from two time points using a quality survey examining self-reported nurse competencies related to (a) assessment, (b) intervention, (c) treatment recommendation, (d) resource use, (e) beliefs, and (f) attitudes toward caring for people with OUD. RESULTS: Nurses surveyed before education (T1G1, N = 123) and, after education, those who received the intervention (T2G2, N = 17) and those who did not (T2G3, N = 65) were included. Resource use subscores increased over time (T1G1: x = 3.83, T2G3: x = 4.07, p = .006). Results from the two measurement points found no difference in mean total scores (T1G1: x = 3.53, T2G3: x = 3.63, p = .09). Comparison of mean total scores of nurses who directly received the educational program with those who did not during the second time point showed no improvement (T2G2: x = 3.52, T2G3: x = 3.63, p = .30). CONCLUSIONS: Education alone was insufficient in improving self-reported competencies of medical-surgical nurses caring for people with OUD. Findings can be used to inform efforts to increase nurse knowledge and understanding of OUD and to decrease negative attitudes, stigma, and discriminatory behaviors perpetuating care.


Assuntos
Enfermeiras e Enfermeiros , Transtornos Relacionados ao Uso de Opioides , Humanos , Competência Clínica , Melhoria de Qualidade
10.
J Clin Nurs ; 31(3-4): 435-444, 2022 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-33326657

RESUMO

AIMS: The aims of the study were to compare characteristics, resources, benefits and outcomes of academic-clinical collaborations of nursing researcher leaders from academic, clinical and joint-employer sites. BACKGROUND: Few research-based publications addressed academic-clinical research collaborations. New knowledge could increase nursing and multidisciplinary research productivity, including implementation science. DESIGN: An anonymous survey using a 40-item questionnaire. METHODS: Information letters with a link to the questionnaire were emailed to United States nursing research leaders. Data were grouped by institution type: academic, clinical or joint-employer. Analyses included Kruskal-Wallis tests for ordered responses, Pearson's chi-square test or Fisher's exact test for categorical responses and Cohen's Kappa agreement statistic for expected and actual time devoted to research. STROBE guidelines were followed. RESULTS: Of 120 respondents from academic (n = 60; 50.0%), clinical (n = 53; 41.2%) and joint-employer (n = 7; 5.8%) sites, 78.3%, 92.3% and 100%, respectively, were from metropolitan areas. Mean (SD) priority for active collaborations was higher at joint-employer sites; p = .002. Clinical sites were more likely to have directors of evidence-based practice (p = .031) and informatics (p = .008) and librarians (p = .029). Sites with collaborations were more likely to have access to research subjects (p = .008) and post-award research account management (p = .045). By collaboration status, there were no differences in the number of ethics board-approved studies. Collaborating site benefits were perceived to be executive leadership support (p = .003), greater research engagement by clinical nurses (p = .048), more co-authored publications (p = .048) and more abstracts accepted at national meetings (p = .044). Despite more resources and perceived benefits, outcomes did not differ by collaboration status. CONCLUSIONS: Sites with and without academic-clinical research collaborations differed; however, outcomes were similar. Future efforts should focus on nurse scientist collaboration to address important clinical questions aimed at improving clinical outcomes. RELEVANCE TO CLINICAL PRACTICE: Despite some successful outcomes, potential benefits of academic-clinical research collaborations have not been fully actualised.


Assuntos
Liderança , Pesquisa em Enfermagem , Estudos Transversais , Humanos , Estados Unidos
11.
J Clin Nurs ; 31(15-16): 2167-2180, 2022 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-34606133

RESUMO

OBJECTIVE: The objective of this study was to explore nurses' experiences and perceptions at selected United States (U.S.) healthcare sites during the COVID-19 pandemic. BACKGROUND: The COVID-19 pandemic brought rapid changes to the healthcare community. While a few studies have examined the early pandemic experiences of nurses in China and Europe, nurses' experiences across the United States have remained relatively underexplored. DESIGN: A qualitative study design was used. METHODS: Using a constructivist grounded theory methodology and methods, we conducted eight focus groups across four hospital sites in the eastern, midwestern and western United States. Registered nurses with a minimum of six months' experience working in all clinical specialties were eligible. Forty-three nurses participated. Data were analysed iteratively using the constant comparative method. The COREQ guidelines supported the work and reporting of this study. RESULTS: The nurses experiencing a pandemic (NEXPIC) grounded theory emerged positing associations between four interrelated themes: Challenges, Feelings, Coping and Ethics. Nurses reported Challenges associated with changes in the work environment, community and themselves. They expressed more negative than positive feelings. Nurses coped using self-care techniques, and teamwork within the healthcare organisation. Moral dilemmas, moral uncertainty, moral distress, moral injury and moral outrage were ethical issues associated with nurses' Challenges during the pandemic. Moral courage was associated with positive Coping. CONCLUSIONS: Awareness of frontline nurses' complex and interrelated needs may help healthcare organisations protect their human resources. This new theory provides preliminary theoretical support for future research and interventions to address the needs of frontline nurses. RELEVANCE TO CLINICAL PRACTICE: Nurses face added distress as frontline at-risk caregivers. Interventions to promote nurses' ability to cope with personal and professional challenges from the pandemic and address ethical issues are needed to protect the nursing workforce. This study offers a new substantive theory that may be used to underpin future interventions.


Assuntos
COVID-19 , Enfermeiras e Enfermeiros , COVID-19/epidemiologia , Teoria Fundamentada , Humanos , Pandemias , Pesquisa Qualitativa , Estados Unidos/epidemiologia , Local de Trabalho
12.
J Nurs Adm ; 52(1): 19-26, 2022 Jan 01.
Artigo em Inglês | MEDLINE | ID: mdl-34897205

RESUMO

OBJECTIVE: The aim of this study was to identify the challenges, barriers, and solutions for conducting nursing administration and leadership science (NALS) research. BACKGROUND: Evidence from leadership science should be at the forefront of nurse leaders' decision making. Yet, challenges remain in building the evidence and moving it into nursing administration and leadership practice. METHODS: This study used a Delphi technique with open-ended questions and direct content analysis to evaluate survey responses of members of the Association for Leadership Science in Nursing and American Organization for Nursing Leadership. RESULTS: Open-ended responses were coded to yield super categories and supportive codes for areas with limited evidence to guide leadership practice and the challenges for conducting NALS research. CONCLUSIONS: These findings provide future directions for continuously driving NALS research and for building and leveraging leadership science to support nursing administration decision making.


Assuntos
Tomada de Decisões , Liderança , Enfermeiros Administradores , Ciência , Humanos , Pesquisa em Administração de Enfermagem
13.
J Nurs Adm ; 51(9): 430-438, 2021 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-34411063

RESUMO

OBJECTIVE: The aim of this study was to identify and prioritize research topics for nursing administration and leadership science. BACKGROUND: Nursing administration and leadership research priorities should provide a framework for building the science needed to inform practice. METHODS: The Association for Leadership Science in Nursing (ALSN) and American Organization for Nursing Leadership (AONL) Foundation (AONL-F) for Nursing Leadership and Education collaborated on a Delphi study. Initial input on research priority items were received from ALSN and AONL members. National experts participated in a 3-round Delphi study. RESULTS: Top-ranked priorities included: 1) nurses' health, well-being, resiliency, and safety in the workplace; 2) developing and managing a nursing workforce to meet current and future healthcare needs; 3) healthy work/practice environments for direct care nurses; 4) healthy work/ practice environments for nurse leaders; 5) quantification of nursing's value across the healthcare delivery system; and 6) nurse leader development and essential competencies. CONCLUSIONS: Researchers and funders should use these priorities to guide future studies.


Assuntos
Liderança , Supervisão de Enfermagem , Técnica Delphi , Humanos , Recursos Humanos de Enfermagem , Estados Unidos
14.
Nurse Lead ; 19(6): 616-621, 2021 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-34335118

RESUMO

The purpose of this article is to share gaps in knowledge and research related to pandemic management identified by nurse leaders during the COVID-19 pandemic. As part of a larger Delphi study, nurse leaders responded to an open-ended question about gaps in research they saw as important following the pandemic. Responses were analyzed using directed content analysis. Results are presented as 4 supercategories: Organizational leadership preparedness, adaptive leadership in crisis, innovations in care delivery, and health, well-being, and resilience.

15.
J Nurs Adm ; 51(5): 237-239, 2021 May 01.
Artigo em Inglês | MEDLINE | ID: mdl-33882549

RESUMO

Increasingly, nurse executives are embracing evidence-based practice (EBP). Yet, it takes 17 years to move only 14% of research evidence into practice. Implementation science (IS) aims to reduce this gap through the study of factors that influence dissemination, adoption, implementation, and sustainability of evidence-based interventions. Nurse leaders aiming for EBP must be well equipped to support IS. This article introduces IS, leadership competencies essential for supporting implementation research and practice, and preparing an IS-ready workforce.


Assuntos
Medicina Baseada em Evidências/organização & administração , Ciência da Implementação , Liderança , Enfermeiros Administradores/organização & administração , Pesquisa em Enfermagem/organização & administração , Enfermagem Baseada em Evidências , Prática Clínica Baseada em Evidências , Humanos , Cultura Organizacional , Projetos de Pesquisa
16.
Ergonomics ; 63(12): 1535-1550, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-32781904

RESUMO

Lower extremity musculoskeletal discomfort (MSD) is prevalent, but understudied, in nurses. A comprehensive, theoretical, aetiological model of lower extremity work-related MSD in hospital in-patient staff nurses was developed through a review of the literature to provide a framework for aetiological and intervention research. The framework informed the design of a survey of 502 hospital staff nurses. Symptom prevalence ranged from 32% in hip/thigh to 59% in ankle/foot regions. Logistic regression modelling using survey data showed that different work and personal factors were associated with discomfort in different regions of the lower extremity. Individual factors (e.g. older age, higher BMI or having any foot condition), physical factors (e.g. higher frequency of patient handling), psychosocial factors (e.g. lower job satisfaction) were associated with discomfort in one or more parts of the lower extremity. Future research should target these factors for intervention, to attempt to reduce occurrence of lower extremity discomfort in nurses. Practitioner Summary: Practitioners may find useful the illustrated, theoretical aetiological model of factors that could influence the prevalence of lower extremity discomfort in nurses. The model could guide conversations with nurses and observational analyses of nursing work. The model and survey results may provide ideas for intervention exploration. Abbreviations: MSD: musculoskeletal discomfort; BMI: body mass index; MSK: musculoskeletal; ICU: intensive care unit; NLERF: nurses' lower extremity MSD risk factor; NASA-TLX: NASA-task load index.


Assuntos
Extremidade Inferior/fisiopatologia , Doenças Musculoesqueléticas/epidemiologia , Recursos Humanos de Enfermagem Hospitalar/psicologia , Recursos Humanos de Enfermagem Hospitalar/estatística & dados numéricos , Doenças Profissionais/epidemiologia , Adulto , Feminino , Humanos , Masculino , Prevalência , Fatores de Risco , Inquéritos e Questionários , Estados Unidos/epidemiologia
17.
Worldviews Evid Based Nurs ; 17(2): 136-143, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32233009

RESUMO

BACKGROUND: Anecdotal reports from across the country highlight the fact that nurses are facing major challenges in moving new evidence-based practice (EBP) initiatives into the electronic health record (EHR). PURPOSE: The purpose of this study was to: (a) learn current processes for embedding EBP into EHRs, (b) uncover facilitators and barriers associated with rapid movement of new evidence-based nursing practices into the EHR and (c) identify strategies and processes that have been successfully implemented in healthcare organizations across the nation. METHODS: A qualitative study design was utilized. Purposive sampling was used to recruit nurses from across the country (N = 29). Nine focus group sessions were conducted. Semistructured interview questions were developed. Focus groups were conducted by video and audio conferencing. Using an inductive approach, each transcript was read and initial codes were generated resulting in major themes and subthemes. RESULTS: Five major themes were identified: (a) barriers to advancing EBP secondary to the EHR, (b) organizational structure and governing processes of the EHR, (c) current processes for prioritization of EHR changes, (d) impact on ability of clinicians to implement EBP and (e) wait times and delays. LINKING EVIDENCE TO ACTION: Delays in moving new EBP practice changes into the EHR are significant. These delays are sources of frustration and job dissatisfaction. Our results underscore the importance of a priori planning for anticipated changes and building expected delays into the timeline for EBP projects. Moreover, nurse executives must advocate for greater representation of nursing within informatics technology governance structures and additional resources to hire nurse informaticians.


Assuntos
Registros Eletrônicos de Saúde/normas , Prática Clínica Baseada em Evidências/métodos , Pesquisa em Enfermagem/instrumentação , Registros Eletrônicos de Saúde/tendências , Prática Clínica Baseada em Evidências/normas , Prática Clínica Baseada em Evidências/tendências , Grupos Focais/métodos , Humanos , Pesquisa em Enfermagem/métodos , Pesquisa em Enfermagem/tendências , Ohio , Pesquisa Qualitativa
18.
Front Digit Health ; 2: 12, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-34713025

RESUMO

We identify useful functions and usability characteristics of a historical cognitive artifact used by nurses working in a hospital unit, the Kardex. By identifying aspects of a widely used artifact, we uncover opportunities to improve the usefulness of current systems for hospital nurses. We conducted semi-structured interviews with registered nurses about their prior experience with the Kardex. Questions included what elements of the Kardex are missing from their current electronic support. Memos were generated iteratively from interview transcript data and grouped into themes. Eighteen nurses from multiple clinical areas participated and had a median of 25-29 years of nursing experience. The themes were: (1) a status at a glance summary for each patient, (2) a prospective memory aid, (3) efficiency and ease of use, (4) updating information required to maintain value, (5) activity management, (6) verbal handover during shift-to-shift report, (7) narrative charting and personalized care, and (8) non-clinical care communication. Implications for digital support are to provide immediate, portable access to a standardized patient summary, support for nurses to manage their planned activities during a series of shifts, provide unstructured text fields for narrative charting, and to support adding informal notes for personalized care.

19.
J Midwifery Womens Health ; 65(2): 216-223, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31489975

RESUMO

INTRODUCTION: Although the safety of water immersion during labor is largely supported by evidence from research, the risks to women and neonates during waterbirth are not well established. The purpose of this study was to generate evidence regarding maternal and neonatal outcomes related to water immersion in labor and during birth. METHODS: A retrospective cohort study included a convenience sample of women receiving prenatal care at a nurse-midwifery practice. Participants were categorized into 3 groups: 1) waterbirth, 2) water labor, or 3) neither. Participant characteristics, maternal outcomes, and newborn outcomes were collected at time of birth and health record abstraction. At the 6-week postpartum visit, another maternal outcome, satisfaction with birth, was measured using the Care in Obstetrics: Measure for Testing Satisfaction (COMFORTS) scale. Analysis included effect size, descriptive statistics (sample characteristics), and maternal and neonatal group differences (analysis of variance and chi-square) with a significance level of P < .05. RESULTS: Women in the waterbirth (n = 58), water labor (n = 61), and neither (n = 111) groups were primarily white, married, and college educated and did not differ by age or education. Women in the waterbirth group were more likely to be multiparous. Nulliparous women who had a waterbirth had a significantly shorter second stage of labor than nulliparous women who did not have a waterbirth (P = .03). The most commonly cited reasons for discontinuation of hydrotherapy were maternal choice (42.6%) and need for pain medication (29.5%). Significantly more women in the waterbirth group experienced a postpartum hemorrhage, compared with water labor or neither (n = 5, n = 3, n = 1, respectively; P = .045); there was no difference in related clinical measures. Neonatal outcomes were not significantly different. Maternal satisfaction was high across all groups. DISCUSSION: The results of this study suggest that waterbirth, attended by qualified intrapartum care providers in hospital settings in the United States, is a reasonable option for low-risk women and their neonates.


Assuntos
Parto Obstétrico/enfermagem , Imersão , Tocologia/métodos , Parto Normal/métodos , Adulto , Comportamento de Escolha , Tomada de Decisões , Feminino , Humanos , Recém-Nascido , Parto Normal/psicologia , Gravidez , Cuidado Pré-Natal/métodos , Estudos Retrospectivos
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