Eleanor L. Stevenson

Students as active learners and teaching partners in the clinical setting.

S tudents engaged actively in the learning process and not just listening to instructor-presented lectures have an experience of ‘‘deeper learning.’’ By directly working with and applying the content, students translate the information from ‘‘not knowing’’ to the long-term memory and skill acquisition. There are many benefits of active learning for nursing students. These include encouraging students to be engaged in the learning process and taking an active role in meeting their personal goals. Active learning fosters critical thinking because students can explore multiple perspectives, consider different decisions pathways that are possible in a particular situation, analyze and weigh consequences of those decisions, and arrive at reasoned judgments. Active learning shifts the responsibility for learning from the instructor to the student and places the instructor in the role of a coach, rather than the primary disseminator of key clinical information. In active learning, the student is central to the process, not the instructor that is common in traditional lecture-style methods. Active learning strategies provide a focus on the content for students and support learning in a sequential manner, allowing for knowledge retention and attention span. Increased student performance has been reported when instructors create opportunities for students to become actively engaged with content and peers. This approach implemented was in Nursing Care of the Childbearing Family (NCCF) course, 1 of the core clinical courses in our accelerated BSN course at Duke University School of Nursing. Students are in their 3rd of 4 semesters. In the NCCF course, there are 3 hours of didactic classroom time per week and 16 hours of clinical. The students’ clinical experiences are at several local maternity units. The clinical focus is on the nursing care of normal birthing families, including mother-baby couplets and transition newborn experiences. In addition, faculty recognize there are specific topics that must be introduced to provide students with a comprehensive maternal-newborn knowledge base. These topics, although necessary, compress an already full course. It was decided to test a new model of streamlining selected course content and shifting some of the topics to the clinical arena for instruction. This was done by developing a list of core topics that could be shifted from classroom content and charging clinical instructors (CIs) with disseminating the information with the assistance of the cohort of students in the clinical setting.

Evidence-Based Care for Couples With Infertility

When couples cannot achieve pregnancy, they often seek health care from medical and nursing specialists. The care the couple receives begins with a thorough assessment to determine the possible cause of infertility and to plan appropriate care to ensure the best chance for the couple to have a biological child. In this article, we provide an overview of the etiology and evaluation of infertility, the various treatment options available, and the appropriate clinical implications.

It Takes a Village”: An Interprofessional Patient Safety Experience for Nursing and Medical Students

Background: Interprofessional education (IPE) is a “core” competency in professional school education. Challenges to successful collaboration include: aligning student abilities/experience, providing meaningful clinically-based interaction, and the need for extensive planning. Methods: Curriculum. A 3-1/2 hour IPE patient safety experience for final-semester medical and nursing students was developed. The content included an introduction, small-group low-fidelity simulation, and a large-group discussion of patient safety events observed by students during clinical rotations. Logistics. A planning committee met monthly to plan the curriculum and train faculty facilitators. Four sessions were held, accommodating 92 medical and 82 nursing students. Thirty faculty facilitators and 10 support personnel were needed for each session. Results: Over 70% students reported that the experience resulted in new learning and prompted self-reflection; 57% said it would change their practice. Students confirmed that the experience taught them about the importance of patient involvement in the team, the development of a shared mental model, and the importance of everyone’s role on the team. Conclusions: This collaboration successfully aligned students with similar levels of clinical experience, involved many faculty from both professional schools, and gave students opportunities to discuss differences in their roles and responsibilities, while highlighting patient-centered care.

Multidimensional Psychological Stress During Pregnancies in Women Who Conceived via In Vitro Fertilization

Purpose: To explore relationships among the 3 psychological dimensions of stress, stimulus/environmental, perceptual, and emotional response, and then to develop a multidimensional composite measure of overall stress, and to determine demographic and clinical characteristics associated with stress in women who became pregnant via in vitro fertilization (IVF). Methods: Cross-sectional design using self-report questionnaires during the second trimester. Multidimensional stress was assessed with the Prenatal Life Events Scale, Life Event Distress Scale, Perceived Stress Scale, State-Trait Anxiety Index-State, and the Pregnancy-Related Anxiety Measure. Results: Participants (n = 144), aged 25–40 years, were enrolled June 2010–August 2011 from a private fertility clinic. Exploratory principal factor analysis was used to develop an overall stress score from the stress measures. Multiple stepwise regression analyses were conducted to determine characteristics related to the stress measures. White race tended to be associated with lower stress scores (p = .079). White participants also had lower perceived stress (p = .007), and those with a history of miscarriage had higher pregnancy-related anxiety (p = .035). Conclusions: White women had lower perceived stress. History of one or more miscarriage was associated with higher pregnancy-related anxiety. Additional research examining multidimensional stress is needed across the pregnancy trimesters as well as comparisons to women who conceived without IVF both in United States and internationally.

Implementation of a Hydrotherapy Protocol to Improve Postpartum Pain Management

Introduction: A growing number of women are seeking alternatives to traditional pharmacologic pain management during birth. While there has been an extensive array of nonpharmacologic options developed for labor, there are limited offerings in the postpartum period. The purpose of this quality improvement project was to implement a hydrotherapy protocol in the early postpartum period to improve pain management for women choosing a nonmedicated birth. Process: The postpartum hydrotherapy protocol was initiated in a certified nurse‐midwife (CNM) practice in an urban academic medical center. All women who met criteria were offered a 30‐minute warm water immersion bath at one hour postpartum. Pain scores were assessed prior to the bath, at 15 minutes after onset, and again at the conclusion (30 minutes). Women who completed the bath were also asked to complete a brief survey on their experience with postpartum hydrotherapy. Outcomes: In women who used the bath (N = 45), there was a significant reduction in pain scores (P < .001) between the onset of the bath and scores at both 15 minutes and 30 minutes. There was no significant difference between pain scores at 15 minutes and 30 minutes (P = .97). Of those women who completed a survey (n = 43), 97.7% reported both that the bath reduced their pain and improved their birth experience. One hundred percent reported they would use it again in another birth. Discussion: This project demonstrated successful implementation of a hydrotherapy protocol as an alternative or adjunct to medication for early postpartum pain management that significantly reduced pain and improved the birth experience for those who used it. It offers a nonpharmacologic alternative where there have traditionally been limited options.

Pregnancy-Related Anxiety in Women Who Conceive Via In Vitro Fertilization: A Mixed Methods Approach

ABSTRACT The process of in vitro fertilization (IVF) causes anxiety, but it is unclear whether this anxiety continues into pregnancy and affects childbirth preparation. This study administered the pregnancy-related anxiety measure to 144 women during their second trimester. Anxiety scores were slightly higher among IVF compared to non-IVF pregnant women. Thirty-one participants provided narrative data about their pregnancy-specific anxiety. Themes emerged from qualitative analysis related to anxiety about the health of their babies, perception of maternal health and safety, and perception of their abilities to fulfill the role of mother. Because of their relationship with patients during pregnancy, nurses and perinatal educators play a critical role in identification of women with pregnancy-specific anxieties and providing relevant care to address these anxieties.

Stress and Quality of Life for Taiwanese Women Who Underwent Infertility Treatment

Objective To describe the psychological stress and quality of life experienced by women who underwent fertility treatment in Taiwan. Design Cross‐sectional, correlational study. Setting Recruitment was conducted and questionnaires administered at a reproductive medicine center in Chiayi City, Taiwan. Participants Informed consent to participate was obtained from 126 women who sought fertility treatment at the center. Methods The Chinese Fertility Problem Inventory and Fertility Quality of Life scale were used to measure participants’ levels of fertility‐related stress and fertility‐related quality of life. Descriptive statistics, correlation, and regression analysis were used. Results Overall, participants reported low levels of fertility‐related stress and fertility‐related quality of life; however, they had relatively high levels of stress related to need for parenthood. Women who were older, had greater body mass indexes, and consumed coffee regularly had lower fertility‐related quality of life. Social and relationship concerns and stress related to need for parenthood were significant predictors of low fertility‐related quality of life. Conclusion In a culture in which childbearing is generally an expectation and an important part of family life, women who experience infertility are at risk to experience fertility‐related stress. Social support and family consultation might be offered to improve women’s fertility‐related quality of life.

Long-acting reversible contraception: Assessment of knowledge and interest among college females

Abstract Objective: To implement the Long-Acting Reversible Contraception Quality Improvement (LARC QI) project using evidence-based contraceptive counseling techniques to improve knowledge and intent to use among college females. Participants: The project, conducted from April through September 2017, involved 41 female students, from a 4-year public college in North Carolina. Methods: Students participated in group educational sessions on all methods of birth control with an emphasis on LARC. Surveys were administered to group participants and descriptive statistics were used to determine the difference in knowledge scores and intent to use. Descriptive and qualitative analysis described usage of LARC methods. Results: LARC knowledge scores significantly improved. Intention to use also increased compared to reported actual use. The final chart review demonstrated an increase usage of the subdermal implant, but no change for intrauterine device. Conclusions: The college setting offers a unique opportunity to use evidence-based contraceptive counseling techniques to guide use of LARC.

Oocyte Cryopreservation for Fertility Preservation in Healthy Women

Advancements in methods of fertility preservation have resulted in more options available to women seeking to postpone reproduction. Preservation of unfertilized oocytes provides women with the possibility for reproduction even after age-related declines in fertility might make conceiving a child difficult to impossible. As oocyte cryopreservation rises in popularity among women, it is crucial for nurses and other clinicians to understand the background, process, ethical issues, and risks involved to help women make informed medical decisions.

Implementation of a Modified Bedside Handoff for a Postpartum Unit

The most frequent cause of sentinel events is poor communication during the nurse-to-nurse handoff process. Standardized methods of handoff do not fit in every patient care setting. The aims of this quality improvement project were to successfully implement a modified bedside handoff model, with some report outside and some inside the patients room, in a postpartum unit. A structured educational module and champion nurses were used. The new model was evaluated based on the change in compliance, patient satisfaction, and nursing satisfaction. Two months after implementation, there was an increase in nursing compliance in completing all aspects of the model as well as an increase in both patient and staff satisfactions of the process. Replicating this project may help other specialty units adhere to safety recommendations for handoff report.