1
|
Heelan-Fancher L, Moore Simas TA, Mazzawi J, Dumont T, Edmonds JK. Nulliparous Women's Expectations and Experiences of Early Labor. MCN Am J Matern Child Nurs 2024; 49:22-28. [PMID: 37773194 DOI: 10.1097/nmc.0000000000000972] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/01/2023]
Abstract
PURPOSE To describe the expectations of early labor by nulliparous pregnant women in their third trimester and first-time mothers' experiences of early labor after they had given birth. STUDY DESIGN AND METHODS A descriptive qualitative approach involving semi-structured, video-call interviews conducted between September 2020 and April 2021. Data were analyzed using content analysis. RESULTS Twenty-two women took part in this study. Only 3 of the 10 nulliparous pregnant participants reported pain as an expected symptom of early labor. There were two themes identified from interviews with pregnant participants: Desire to stay at home in early labor and Lack of knowledge and two themes from interviews from postpartum participants: Expectations didn't match experiences and Feelings of anxiety and uncertainty during early labor . CLINICAL IMPLICATIONS Nulliparous women lack knowledge of and skills to effectively cope with pain during early labor while at home. There is a need for an innovative labor support program for childbearing women to remain safely at home in early labor.
Collapse
|
2
|
Zhang Y, Heelan-Fancher L, Leveille S, Shi L. Health Disparities in the Use of Primary Cesarean Delivery among Asian American Women. Int J Environ Res Public Health 2023; 20:6860. [PMID: 37835130 PMCID: PMC10572660 DOI: 10.3390/ijerph20196860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Revised: 09/19/2023] [Accepted: 09/22/2023] [Indexed: 10/15/2023]
Abstract
This study examined the health disparities in primary cesarean delivery (PCD) use among Asian American (AA) women and within AA subgroups. We examined 22 years of birth registry data from one diverse northeastern state in the United States, including singleton vertex live births between 24 and 44 weeks of gestation without congenital abnormalities. Multivariate logistic regression was used to test the association between PCD and race and ethnicity groups adjusting for maternal demographic and health behaviors, infant gender and birth weight, gestational age, initiation of prenatal care, and other risk factors. Among the eligible sample, 8.3% were AA. AAs had the highest rate of PCD (18%) among all racial and ethnic groups. However, extensive heterogeneity was found among the AA subgroups. After controlling for confounding variables, compared to non-Hispanic White women, Filipino, Asian Indian, and Other Asian subgroups had a higher risk for PCD (Adj OR = 1.40, 1.37, and 1.21, p < 0.001), while Japanese, Chinese, and Korean had a lower risk (Adj OR = 0.57, 0.83, and 0.90, p < 0.001), and Vietnamese had no significant difference in PCD use. Although AA as a single racial and ethnic group had higher prevalence of PCD, more studies are warrantied to address the disproportional distribution of health disparities in PCD use within AA subgroups.
Collapse
Affiliation(s)
- Yuqing Zhang
- College of Nursing, University of Cincinnati, Cincinnati, OH 45040, USA
- Robert and Donna Manning College of Nursing and Health Sciences, University of Massachusetts Boston, Boston, MA 02125, USA; (L.H.-F.); (S.L.); (L.S.)
| | - Lisa Heelan-Fancher
- Robert and Donna Manning College of Nursing and Health Sciences, University of Massachusetts Boston, Boston, MA 02125, USA; (L.H.-F.); (S.L.); (L.S.)
| | - Suzanne Leveille
- Robert and Donna Manning College of Nursing and Health Sciences, University of Massachusetts Boston, Boston, MA 02125, USA; (L.H.-F.); (S.L.); (L.S.)
| | - Ling Shi
- Robert and Donna Manning College of Nursing and Health Sciences, University of Massachusetts Boston, Boston, MA 02125, USA; (L.H.-F.); (S.L.); (L.S.)
| |
Collapse
|
3
|
Brewer K, Leung K, Forest C, Gupta A, Kliskey E, Yeboah T, Heelan-Fancher L, Dumont T. Racial disparities in birth satisfaction among nulliparous women. Am J Obstet Gynecol 2023. [DOI: 10.1016/j.ajog.2022.11.611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
|
4
|
Gazarian P, Ballout S, Heelan-Fancher L, Sundean LJ. Theories, models, and frameworks used in nursing health policy dissertations: A scoping review. Appl Nurs Res 2022; 67:151234. [PMID: 32303375 DOI: 10.1016/j.apnr.2020.151234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Revised: 12/16/2019] [Accepted: 01/10/2020] [Indexed: 11/24/2022]
Affiliation(s)
- Priscilla Gazarian
- University of Massachusetts Boston, 100 Morrissey Boulevard, Boston, MA 02125, United States of America.
| | - Suha Ballout
- University of Massachusetts Boston, 100 Morrissey Boulevard, Boston, MA 02125, United States of America.
| | - Lisa Heelan-Fancher
- University of Massachusetts Boston, 100 Morrissey Boulevard, Boston, MA 02125, United States of America.
| | - Lisa J Sundean
- University of Massachusetts Boston, 100 Morrissey Boulevard, Boston, MA 02125, United States of America.
| |
Collapse
|
5
|
Nguyen HH, Heelan-Fancher L. Female Relatives as Lay Doulas and Birth Outcomes: A Systematic Review. J Perinat Educ 2022; 31:111-123. [PMID: 35386493 PMCID: PMC8970136 DOI: 10.1891/jpe-2021-0010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Continuous labor support provided by professional doulas is associated with improved birth outcomes for pregnant women and their infants. However, there is limited data on the impact of using female relatives as lay doulas. This systematic review included nine published studies that examined the association between use of female relatives as lay doulas with childbirth outcomes. In some study populations, there was a decrease in the number of cesarean births and length of labor, and in all studies, there was improved maternal birth satisfaction. However, the woman’s chosen female relative often did not receive education regarding labor support skills before providing continuous support. Educational programs designed to teach labor support skills to female relatives are needed.
Collapse
|
6
|
Cuccovia BA, Heelan-Fancher L, Aronowitz T. A policy analysis of nurse practitioner scope of practice in Massachusetts. J Am Assoc Nurse Pract 2021; 34:410-417. [PMID: 34652300 DOI: 10.1097/jxx.0000000000000657] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Accepted: 08/20/2021] [Indexed: 11/27/2022]
Abstract
ABSTRACT Nurse practitioner (NP) practice has evolved since inception of the role in 1965. Educational requirements have been standardized requiring a master's degree, yet variation in NPs scope of practice exists across the United States. As the population ages and more Americans have health insurance coverage, the demand for health care continues to increase. Shortages of clinical providers and changes in hospital models of care continue to burden the health care system. Nurse practitioners have been found to provide safe, high-quality patient care and are a potential solution to ease the burden on our health care system. Nurse practitioner scope of practice restrictions limit the ability for NPs to practice independently. The purpose of this article was to analyze the advanced practice registered nurse's (APRNs) scope of practice policy in Massachusetts (MA) where APRNs just recently obtained full practice authority. Legislation to remove NP scope of practice restrictions in MA had been presented several times but was met with resistance from physician advocacy groups stating that NPs lack the education requirements to practice independently. A recent report from the MA Health Policy Commission demonstrates the impact that NPs have on lowering health care costs and servicing individuals in underserved areas of the state. During the pandemic, restrictions on NP scope of practice in MA were temporarily removed. It was realized that if NPs can practice independently during a pandemic, then they certainly are competent to practice independently at other times. A reassessment of NP scope of practice to allow for full authority should be completed nationally.
Collapse
Affiliation(s)
| | | | - Teri Aronowitz
- UMass Medical School, Tan Chingfen Graduate School of Nursing, Boston, MA
| |
Collapse
|
7
|
Heelan-Fancher L, Edmonds JK. Intrapartum Nurses' Beliefs Regarding Birth, Birth Practices, and Labor Support. J Obstet Gynecol Neonatal Nurs 2021; 50:753-764. [PMID: 34384771 DOI: 10.1016/j.jogn.2021.07.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/12/2021] [Indexed: 10/20/2022] Open
Abstract
OBJECTIVES To examine the relationships among intrapartum (IP) nurses' beliefs regarding birth (physiologic birth/medicalized birth) and their experience, education, and certification; to assess IP nurses' beliefs about birth practices and labor support; to describe the birth practices of the most effective IP nurses; and to elicit recommendations from IP nurses for quality improvement in IP nursing practice. DESIGN Cross-sectional, descriptive study. SETTING Three urban hospitals from one state in the northeastern United States. PARTICIPANTS One hundred twelve IP registered nurses who were primarily staff nurses. METHODS We collected quantitative and qualitative data using a Web-based survey that included the Intrapartum Nurses' Beliefs Related to Birth Practice-Modified scale. We used Burgess's conceptual definition of laborsupport as the framework to analyze findings. RESULTS Participants favored physiologic birth and not medicalized birth, and their beliefs were associated with experience (p = .01) and certification (p = .04). Participants reported that effective IP nurses demonstrate labor practices supportive of physiologic birth. Recommendations from participants for quality improvement in IP nursing practice included ways to optimize physical support, emotional support, informational support, and advocacy for women during labor. Participants made no recommendations related to partner support. CONCLUSION Participants held beliefs that favored physiologic birth and supported many labor practices that can facilitate physiologic birth. However, some labor practices associated with medicalized birth were also supported. Further quality improvement strategies to provide partner support during labor are needed.
Collapse
|
8
|
McCloskey L, Bernstein J, The Bridging The Chasm Collaborative, Amutah-Onukagha N, Anthony J, Barger M, Belanoff C, Bennett T, Bird CE, Bolds D, Brenna BW, Carter R, Celi A, Chachere B, Crear-Perry J, Crossno C, Cruz-Davis A, Damus K, Dangel A, Depina Z, Deroze P, Dieujuste C, Dude A, Edmonds J, Enquobahrie D, Eromosele E, Ferranti E, Fitzmaurice M, Gebel C, Blount LG, Greiner A, Gullo S, Haddad A, Hall N, Handler A, Headen I, Heelan-Fancher L, Hernandez T, Johnson K, Jones E, Jones N, Klaman S, Lund B, Mallampalli M, Marcelin L, Marshall C, Maynard B, McCage S, Mitchell S, Molina R, Montasir S, Nicklas J, Northrup A, Norton A, Oparaeke E, Ramos A, Rericha S, Rios E, Bloch JR, Ryan C, Sarfaty S, Seely E, Souter V, Spain M, Spires R, Theberge S, Thompson T, Wachman M, Yarrington T, Yee LM, Zera C, Clayton J, Lachance C. Bridging the Chasm between Pregnancy and Health over the Life Course: A National Agenda for Research and Action. Womens Health Issues 2021; 31:204-218. [PMID: 33707142 PMCID: PMC8154664 DOI: 10.1016/j.whi.2021.01.002] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Revised: 01/09/2021] [Accepted: 01/12/2021] [Indexed: 12/16/2022]
Abstract
BACKGROUND Many pregnant people find no bridge to ongoing specialty or primary care after giving birth, even when clinical and social complications of pregnancy signal need. Black, indigenous, and all other women of color are especially harmed by fragmented care and access disparities, coupled with impacts of racism over the life course and in health care. METHODS We launched the initiative "Bridging the Chasm between Pregnancy and Health across the Life Course" in 2018, bringing together patients, advocates, providers, researchers, policymakers, and systems innovators to create a National Agenda for Research and Action. We held a 2-day conference that blended storytelling, evidence analysis, and consensus building to identify key themes related to gaps in care and root causes of inequities. In 2019, more than 70 stakeholders joined six working groups to reach consensus on strategic priorities based on equity, innovation, effectiveness, and feasibility. FINDINGS Working groups identified six key strategic areas for bridging the chasm. These include: 1) progress toward eliminating institutional and interpersonal racism and bias as a requirement for accreditation of health care institutions, 2) infrastructure support for community-based organizations, 3) extension of holistic team-based care to the postpartum year and beyond, with integration of doulas and community health workers on the team, 4) extension of Medicaid coverage and new quality and pay-for-performance metrics to link maternity care and primary care, 5) systems to preserve maternal narratives and data across providers, and 6) alignment of research with women's lived experiences. CONCLUSIONS The resulting agenda presents a path forward to remedy the structural chasms in women's health care, with key roles for advocates, policymakers, researchers, health care leaders, educators, and the media.
Collapse
Affiliation(s)
- Lois McCloskey
- Community Health Sciences Department, Boston University School of Public Health, Boston, Massachusetts(b) The names and affiliations of all authors in the Bridging the Chasm Collaborative are listed in Table 1..
| | - Judith Bernstein
- Community Health Sciences Department, Boston University School of Public Health, Boston, Massachusetts(b) The names and affiliations of all authors in the Bridging the Chasm Collaborative are listed in Table 1
| | | | | | | | - Mary Barger
- University of San Diego, Hahn School of Nursing
| | | | - Trude Bennett
- University of North Carolina Gillings School of Global Public Health
| | | | | | | | | | - Ann Celi
- Brigham and Women's Hospital, Harvard Medical School
| | | | | | - Chase Crossno
- University of North Texas Health Sciences Center/Texas Christian University School of Medicine
| | | | - Karla Damus
- Boston University Medical Campus, Office of Human Research Affairs
| | | | | | | | | | - Annie Dude
- University of Chicago School of Medicine
| | | | | | | | | | | | | | | | | | | | | | | | - Arden Handler
- University of Illinois at Chicago School of Public Health
| | - Irene Headen
- Drexel University Dornsife School of Public Health
| | | | | | | | - Emily Jones
- University of Oklahoma Health Sciences Center, Ziegler College of Nursing
| | | | - Stacey Klaman
- University of North Carolina Gillings School of Global Public Health
| | | | | | | | | | | | | | | | - Rose Molina
- Beth Israel Deaconess Medical Center / The Dimock Center
| | | | | | | | | | | | | | | | | | | | | | | | - Ellen Seely
- Brigham and Women's Hospital, Harvard Medical School
| | | | | | | | | | | | - Madi Wachman
- Boston University Center for Innovation in Social Work and Health
| | | | - Lynn M Yee
- Northwestern University, Feinberg School of Medicine
| | - Chloe Zera
- Beth Israel Deaconess Medical Center, Harvard Medical School
| | | | | |
Collapse
|
9
|
Abstract
BACKGROUND Intermittent fetal monitoring (IFM) is a recommended strategy for intrapartum fetal heart rate assessment in low-risk pregnancies; however, this "high touch, low tech" approach is underutilized. OBJECTIVE The aim of the study was to examine the relationships between labor and delivery nurses' intellectual capital and their perceptions of barriers to research utilization in the work setting. METHODS A cross-sectional correlational design using data derived from a larger study of labor and delivery nurses (N = 248) was used. Covell's theory of nursing intellectual capital was used as the conceptual and analytic framework to examine labor and delivery nurses' intellectual capital and their perceived barriers to research utilization. RESULTS Nurses who receive paid time off from their employer to attend conferences (p < .01) and nurses who do not report nurse-to-patient ratios as a problem in providing IFM (p < .01) perceive fewer barriers to research utilization. DISCUSSION Time, especially available time, has an effect on labor and delivery nurses' attitude toward IFM and their perceptions of barriers to research utilization.
Collapse
Affiliation(s)
- Lisa Heelan-Fancher
- Lisa Heelan-Fancher, PhD, FNP-BC, CNE, is Assistant Professor, University of Massachusetts Boston College of Nursing and Health Sciences. Emily J. Jones, PhD, RNC-Ob, is Associate Professor, University of Massachusetts Boston College of Nursing and Health Sciences. Joyce K. Edmonds, PhD, MPH, RN, is Associate Professor, Boston College Cornell School of Nursing, Chestnut Hill, Massachusetts
| | | | | |
Collapse
|
10
|
Heelan-Fancher L, Shi L, Zhang Y, Cai Y, Nawai A, Leveille S. Impact of continuous electronic fetal monitoring on birth outcomes in low-risk pregnancies. Birth 2019; 46:311-317. [PMID: 30811649 DOI: 10.1111/birt.12422] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2018] [Revised: 01/31/2019] [Accepted: 01/31/2019] [Indexed: 01/13/2023]
Abstract
BACKGROUND Continuous electronic fetal monitoring (CEFM) is a standard of hospital care during the intrapartum period. We investigated its use on childbirth outcomes in low-risk pregnancies, and examined whether outcomes differed by gestational age within a term pregnancy. METHODS A retrospective secondary data analysis using birth registry data from two diverse northeastern US states from 1992 to 2014. Chi-square test and the Fisher exact tests were used to examine associations between CEFM and childbirth outcomes. Multivariable Poisson regression models were used to estimate risk ratios of childbirth outcomes related to CEFM use, adjusting for potential confounders. RESULTS Use of CEFM was independently associated with a 10% (State 1) and 40% (State 2) increased risk for primary cesarean delivery and an increased risk for assisted vaginal births (14% and 24%, respectively) after adjustment for confounders. CEFM use was not associated with reduced risk for infant mortality (neonatal mortality, 0-27 days, and post-neonatal mortality, 28-364 days) in term births (37-41 weeks' gestation). After stratifying term pregnancies into early term, full term, and late term, use of CEFM was associated with reduced risk for neonatal mortality in early-term births (37 0/7 weeks' to 38 6/7 weeks' gestation) in State 2 (RR 0.44 [95% CI 0.21-0.92]), but not in State 1. There was no association between CEFM use and infant mortality (neonatal and post-neonatal) in full-term or late-term births. CONCLUSIONS The study results do not support universal use of CEFM in pregnancies that are low-risk and at term.
Collapse
Affiliation(s)
- Lisa Heelan-Fancher
- College of Nursing and Health Sciences, University of Massachusetts Boston, Boston, Massachusetts
| | - Ling Shi
- College of Nursing and Health Sciences, University of Massachusetts Boston, Boston, Massachusetts
| | - Yuqing Zhang
- College of Nursing and Health Sciences, University of Massachusetts Boston, Boston, Massachusetts
| | - Yurun Cai
- College of Nursing and Health Sciences, University of Massachusetts Boston, Boston, Massachusetts
| | - Ampicha Nawai
- Boromarajonani College of Nursing, Chiang Mai, Thailand
| | - Suzanne Leveille
- College of Nursing and Health Sciences, University of Massachusetts Boston, Boston, Massachusetts.,Division of General Medicine and Primary Care, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| |
Collapse
|
11
|
Fortier ME, Perron T, Fountain DM, Hinic K, Vargas M, Swan BA, Heelan-Fancher L. Health Care in the Community: Developing Academic/Practice Partnerships for Care Coordination and Managing Transitions. Nurs Econ 2015; 33:167-181. [PMID: 26259341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
The delivery of health care is quickly changing from an acute care to a community-based setting. Faculty development and mastery in the use of new technologies, such as high-definition simulation and virtual communities are crucial for effective student learning outcomes. Students' benefits include opportunities for hands-on experience in various patient care scenarios, realtime faculty feedback regarding their critical reasoning and clinical performance, interdisciplinary collaboration, and access to a nonthreatening learning environment. The results of this study provide some evidence of the benefits of developing faculty and nursing curricula that addresses the shift from an ilness-based, acute hospital model, to a community and population health-based preventive model.
Collapse
|