Amy McKeever

Using a Pedagogical Approach to Integrate Evidence-Based Teaching in an Undergraduate Women's Health Course

BACKGROUND Evidence-based practice (EBP) is promoted as a foundation for nursing practice. However, the 2005 U.S. survey of nurses revealed that they do not have requisite skills for EBP. PURPOSE AND GOALS: To evaluate a pedagogical approach aimed at (1) fostering undergraduate nursing students EBP competencies, and (2) identifying gaps in the literature to direct future womens health research. METHODS A secondary analysis of data abstracted from required EBP clinical journals for an undergraduate womens health course in which students (n = 198) were asked to find evidence to answer their clinical questions. Content analysis was used to identify main themes of the topics of inquiry. RESULTS Students identified 1,808 clinical questions and 30.3% (n = 547) of these could not be answered or supported by evidence in the literature. CONCLUSIONS This assignment was an important teaching and assessment tool for EBP. Questions reflected critical thinking and quest for in-depth knowledge to support nursing practice. Some students lacked skills in searching databases and a significant number of knowledge gaps were identified that can direct womens health research.

Drug Shortages and the Burden of Access to Care: A Critical Issue Affecting Patients With Cancer

Pharmaceutical drug shortages are multifaceted and complex problems that affect all aspects of health care, including patients, caregivers, healthcare providers, third-party payers, the pharmaceutical industry, and regulators. Drug shortages have increased significantly since 2000, which cause increases in healthcare costs and compromised patient care. New government regulations have led the U.S. Food and Drug Administration to focus efforts on updating policies and improving regulation of the pharmaceutical industry to limit and avoid drug shortages. This article discusses the current issues surrounding the pharmaceutical drug shortage and the implications for patients and healthcare providers. A review of the literature presents the multidimensional impact of the pharmaceutical drug shortage, and the analysis shows patients who are most burdened by drug shortages and have experienced substandard care, increased cost of care, and compromised quality of health care.

Focusing on Maternal Health Beyond Breastfeeding and Depression during the First Year Postpartum

Nursing experts reviewed publications between 2003 and 2013 to identify practices for the care of women during the recovery year after childbirth. They focused on maternal transition, role and function, and psychosocial support. Findings indicated that clarification of the psychosocial meanings of childbirth and motherhood and family support systems that strengthen or hinder optimal wellness and functioning are needed. In addition, evidence is required to promote healthy transitions during this transition year.

Human papillomavirus vaccination uptake and completion as a preventive health measure among female adolescents

BACKGROUND National coverage for the human papillomavirus (HPV) vaccine falls short of the targeted goals for Healthy People 2020 with disparities in completion rates noted in minority adolescent female populations. The purpose of this study was to provide a review of the literature on HPV vaccination uptake and completion rates among female minority adolescents as well as a discussion of the financial and policy dimensions of HPV vaccination with implications that impact uptake and completion rates. METHODS By reviewing the literature, the authors show that the two human papillomavirus (HPV) vaccines, Gardasil and Cervarix, have presented unprecedented opportunities to prevent morbidity and mortality from cervical cancer. CONCLUSION The authors recommend that nurses and advanced practice nurses take an active role at the point of care to educate families about HPV vaccination. Nursing interventions for practice changes are provided to improve vaccination initiation and completion rates in disadvantaged populations.

The Role of Nurses in Comprehensive Care Management of Pregnant Women With Drug Addiction

Drug addiction during pregnancy is a complex health and social issue that requires an interdisciplinary health care team providing nonjudgmental, comprehensive care. Critical challenges include onset of and attendance at prenatal care, potential obstetric complications, transition to extrauterine life and potential neonatal abstinence syndrome for the neonate, newborn feeding issues, postpartum depression and risk of relapse for women.

Correlates of Postpartum Maternal Functioning in a Low-Income Obstetric Population:

BACKGROUND: Perinatal mental health has been characterized primarily via depression evaluation. However, there may be advantages to complementary assessment of postpartum functional status. OBJECTIVE: The purpose of this study was to examine sociodemographic and clinical factors associated with maternal functioning in low-income obstetrics patients. DESIGN: One hundred and twenty-eight women receiving postpartum obstetrical care at a large medical center in medically underserved, Middle Georgia were screened for depressive symptoms with the Edinburgh Postnatal Depression Scale. The women also completed the Barkin Index of Maternal Functioning and a sociodemographic survey. Multivariate analysis was performed to elucidate factors independently associated with maternal functioning. RESULTS: Higher Edinburgh Postnatal Depression Scale scores (p < .0001) and being married (p = .043) were associated with decreased maternal functioning. CONCLUSIONS: Health care providers should be cognizant of the relationship between postnatal depression and maternal functioning and its potential implications for family health.

Assessment and Care of Childbearing Women With Severe and Persistent Mental Illness.

Severe and persistent mental illness (SPMI) refers to complex mood disorders that include major depressive disorder with or without psychosis; severe anxiety disorders resistant to treatment; affective psychotic disorders including bipolar affective disorder, schizophrenia, and schizoaffective disorder; and other nonaffective subtypes of schizophrenia. SPMIs affect 1 in 17 people and are among the leading causes of disability and impaired health-related quality of life in the United States. Caring for childbearing women with preexisting SPMI can be challenging for maternal-child health clinicians. This article provides an overview of SPMI during pregnancy and challenges for clinicians, including early identification, accuracy of diagnoses, and appropriate management through care coordination among an interdisciplinary team that includes obstetric providers, psychiatrists, nurses, and others.

Perinatal Nurse Home Visiting Referral Patterns Among Women With Diabetes and Hypertension in Philadelphia

Objective To examine access to perinatal nurse home visiting services for high‐risk pregnant women who have diabetes or hypertension. Design Secondary data analysis. Setting Philadelphia, PA. Participants Pregnant women who had a live birth during 2012 and those referred to a community‐based agency for perinatal nurse home visiting because of their diagnosis of diabetes or hypertension. Methods Access to services was measured by examining referral information (dosage, diagnosis, gestational age at time of referral, and insurance type) retrieved from administrative logs of the community‐based organization that provides perinatal home visiting to high‐risk pregnant women. The population‐based prevalence rates of hypertension and diabetes were calculated from birth record data provided by the Philadelphia Department of Public Health. Results During 2012, 595 pregnant women were referred for perinatal nurse home visiting services. The mean gestational age when referred for services was 24.9 weeks (standard deviation = 8.5) with a mean number of 8.8 authorized visits (standard deviation = 8). Associated with more authorized visits was having Medicaid as the insurance type and medical diagnoses that included hypertension (p < .01). Philadelphia prevalence rates for diabetes and hypertension varied by race and ethnicity (p < .001); Asian mothers had the greatest rates for diabetes and Black mothers the greatest rates for hypertension. Conclusion Various models of home visiting programs exist to improve maternal and child health outcomes. Because maternal morbidity and mortality rates are rising in the United States, further research about perinatal nurse home visiting programs for pregnant women with diabetes and hypertension is warranted.

Achieving Safe Motherhood Addressing the Healthcare and Education Needs of the Mothers with Comorbidities; Reenvisioning Prenatal Care and Education

The health and wellness of mothers has been identified as the cornerstone of public health, and it is well documented in the literature that mothers define the health of the family [1-3]. Safe Motherhood has been described as practices, and guidelines that ensure all women receive the care they need for a safe and healthy pregnancy and childbirth (World Health Organization [4]. The safe motherhood initiative begun with discussions in the 1980s in order to address the growing need for women to progress through pregnancy and childbirth ensuring with little health risks and little to no short-term and long-term morbidities [5,6]. Historically safe motherhood was thought to be a public health concern in developing nations, however the United States ranks well below many developed nations [3]. The current rate of maternal and infant mortality is abysmal, with national rates greater than 27 other developed nations. The latest 2014 data reported that the infant mortality rates stood at 6.1 per 1,000 live births. An infant born in Hungary, Poland, Slovakia, and Cuba has a greater chance of surviving past the first year of life than an infant born in the United States. More disconcerting is the fact that an infant born in Mississippi has the same chance of survival as an infant born in Bahrain or Botswana [7,8].