Listening to Haitian Women and their Health Care Providers: Insight into Shared Decision-making After Cesarean Section.

INTRODUCTION: Haitian women in Massachusetts have high rates of cesarean section and low rates of vaginal birth after cesarean, despite evidence suggesting that many are eligible to attempt vaginal birth after a previous cesarean. This qualitative study explored the cultural impact of previous surgical birth for Haitian women to inform the development of a patient-centered decision support program. METHODS: Key stakeholders included Haitian women with previous cesarean and their obstetric care providers. Haitian women participated in focus groups; care providers participated in focus groups and in-depth interviewing. RESULTS: Four prominent themes emerged surrounding childbirth decision-making: the importance of Haitian culture and beliefs; need for more information on birthing options; influence of family/friends; and pain as a considerable factor. CONCLUSION: We hypothesize that group counseling tailored to meet cultural values and needs of Haitian women may support all stakeholders as they work towards sharing decisions about birth after cesarean.

Continuing Education for Haitian Nurses: Evidence from Qualitative and Quantitative Inquiry.

BACKGROUND: There is increasing evidence that to improve nursing practice, nurses must embrace lifelong learning. Research indicates that engagement in lifelong learning positively affects the quality of nursing care, improves patient outcomes, and increases nurses' job satisfaction. Both lack of standardized initial education and nurses' limited opportunities for lifelong learning are challenges in Haiti. It is crucial to ensure adequate continuing education in order to support the professional growth and development of Haiti's existing nursing workforce. OBJECTIVES: The objectives of this study were to: 1) assess the continuing education nursing needs and desires of practicing Haitian nurses and 2) contribute to the body of knowledge about nursing in Haiti to help inform practice and policy. METHODS: A multimodal needs assessment approach was used, with semi-structured focus groups and written surveys. The results were analyzed, and common themes were identified. FINDINGS: The results were analyzed from 100 surveys and four focus groups (n = 33). Overwhelmingly, Haitian nurses desire continuing nursing education. Major themes include: recognition that continuing education is necessary to provide high quality patient care, continuing education saves lives, and more consistent and standardized initial nursing education is needed. Barriers to participation in continuing education opportunities were also identified. CONCLUSIONS: This study was one of the first formal studies that addressed continuing education needs of Haitian nurses. By identifying the barriers to important resources, we hope to continue to collaborate with our Haitian nursing colleagues to build curriculum and improve education programs. We also hope that this research will ensure that Haitian nurses voices are heard and will serve to foster change within the Haitian nursing education system. These results were shared with our nurse colleagues in Haiti.

Addressing the Global Zika Epidemic Locally: An Interprofessional Model of Universal Screening at One Center.

Escalating evidence for the fetal impact of Zika virus infection required a change in care by all prenatal providers. This article describes an effective model of rapid implementation of universal prenatal screening at one hospital and its network of community health centers for a large and diverse immigrant population exploring the challenges, experiences, and lessons learned. Implementation of national recommendations required a workflow change, challenging a system with a heterogeneity of settings and providers. Using a physician clinical champion and advanced practice nurses in the roles of logistical coordinator and liaison to the network, Zika screening was embedded into prenatal intake visits at both the hospital and community health centers. Challenges addressed include varied medical record systems, acceptance by patients, providers, and community health center leadership, as well as culturally appropriate outreach to diverse ethnic and linguistic communities. In 6 months, the prenatal screening rates increased from 20% to 88%, which resulted in the identification of more than 300 pregnant patients at risk of exposure to Zika virus. This model offers key lessons for emergency preparedness in heterogeneous, safety net hospital settings.