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Brimdyr K, Stevens J, Svensson K, Blair A, Turner-Maffei C, Grady J, Bastarache L, Al Alfy A, Crenshaw JT, Giugliani ERJ, Ewald U, Haider R, Jonas W, Kagawa M, Lilliesköld S, Maastrup R, Sinclair R, Swift E, Takahashi Y, Cadwell K. Skin-to-skin contact after birth: developing a research and practice guideline. Acta Paediatr 2023. [PMID: 37166443 DOI: 10.1111/apa.16842] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Revised: 05/05/2023] [Accepted: 05/10/2023] [Indexed: 05/12/2023]
Abstract
AIM Skin-to-skin contact immediately after birth is recognized as an evidence-based best practice and an acknowledged contributor to improved short- and long-term health outcomes including decreased infant mortality. However, implementation and definition of skin-to-skin contact is inconsistent in both practice and research studies. This project utilized the World Health Organization guideline process to clarify best practice and improve the consistency of application. METHODS The rigorous guideline development process combines a systematic review with acumen and judgement of experts with a wide range of credentials and experience. RESULTS The developed guideline received "strong recommendation" from the Expert Panel. The result concluded that there was a high level of confidence in the evidence and that the practice is not resource intensive. Research gaps were identified and areas for continued work delineated. CONCLUSION The World Health Organization guideline development process reached the conclusion immediate, continuous, uninterrupted skin-to-skin contact should be the standard of care for all mothers and all babies (from 1000 grams with experienced staff if assistance is needed), after all modes of birth. Delaying non-essential routine care in favor of uninterrupted skin-to-skin contact after birth has been shown to be safe and allows for progression of newborns through their instinctive behaviors.
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Affiliation(s)
| | - Jeni Stevens
- New South Wales Health, Western Sydney University
| | | | | | | | | | | | | | | | | | - Uwe Ewald
- Department of Women´s and Children´s Health, Uppsala University
| | - Rukhsana Haider
- Training and Assistance for Health and Nutrition Foundation (TAHN)
| | | | - Mike Kagawa
- Makerere University College of Health Sciences
| | - Siri Lilliesköld
- Department of Women's and Children's Health Karolinska Institutet, Stockholm, Sweden
- Department of Neonatology, Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden
| | | | | | - Emma Swift
- University of Iceland, Reykjavik Birth Center
| | - Yuki Takahashi
- Nursing Sciences, Department of Integrated Health Sciences, Nagoya University Graduate School of Medicine
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Salinas A, Crenshaw JT, Gilder RE, Gray G. Implementing the evidence: Routine screening for depression and anxiety in primary care. J Am Coll Health 2023:1-6. [PMID: 36701422 DOI: 10.1080/07448481.2022.2138406] [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] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Revised: 06/29/2022] [Accepted: 07/28/2022] [Indexed: 06/17/2023]
Abstract
Background: Primary care providers are qualified to treat, diagnose, and manage common mental health issues like anxiety and depression. Anxiety and depression are common among college age students, with the average age of onset occurring in one's late teens to early 20s. Screening tools are commonly used to recognize patients who may be at risk for anxiety and depression. Purpose: The purpose of this evidence-based practice project was to (a) implement evidence-based guidelines for screening and management of college-aged patients with anxiety and/or depression and (b) to develop an algorithm that describes evidence-based management to guide providers at two student health centers. Methods: All patients who registered for a sick visit or other appointment at the project site were screened for anxiety and depression using two validated tools. An algorithm to help healthcare providers properly assess and better treat anxiety and depression was developed and implemented for this project. Results: A total of 366 patients were screened for depression and anxiety over a 3-month period. Using the created algorithm, patients received education on anxiety and/or depression and a counseling referral. If warranted, patients were prescribed medication therapy for depression and/or anxiety. Conclusion: Screening for anxiety and depression has become the standard of care in primary care clinics. Routine screening tools help healthcare providers identify patients with anxiety and depression. Early identification and diagnosis of anxiety and depression leads to better outcomes in treatment.
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Affiliation(s)
- Aaron Salinas
- University of Texas Rio Grande Valley, Brownsville, Texas, USA
| | | | - Richard E Gilder
- Texas Tech University Health Sciences Center, Lubbock, Texas, USA
| | - Glenn Gray
- University of Texas Rio Grande Valley, Brownsville, Texas, USA
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Haugland WA, Crenshaw JT, Gilder RE. Implementing a Resilience Bundle for Emergency Nurses: An Evidence-Based Practice Project. J Emerg Nurs 2023; 49:40-49. [PMID: 36184334 PMCID: PMC9534550 DOI: 10.1016/j.jen.2022.08.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2022] [Revised: 08/21/2022] [Accepted: 08/23/2022] [Indexed: 01/11/2023]
Abstract
INTRODUCTION Resilience bundles are designed to work within and enhance existing routines. In the wake of COVID-19, nurses are reporting high levels of burnout and are leaving the field at an alarming rate. Hospital system leaders across the country are working to develop wellness programs to improve nurse morale, decrease burnout, and enhance resilience. Resilience can help mitigate nurse burnout, and using a bundle of tools to help nurses develop resilience is more effective than a single strategy. METHODS Using the Connor-Davidson Resilience Scale-10 and the Perceived Stress Scale 4, emergency nurses were surveyed to measure resilience and stress before and after implementation of a 3-strategy resilience bundle. We surveyed at baseline, phase 1 (6 weeks after implementation), and phase 2 (15 weeks after implementation). RESULTS A statistically significant increase in the Connor-Davidson Resilience Scale-10 scores was identified between the baseline and phase 1 surveys. A measurable decrease in the Perceived Stress Scale 4 was found between the baseline survey and the phase 1 and phase 2 postintervention surveys. DISCUSSION Although evidence suggests a multifocal approach to improving resilience, use of resilience bundles is new. To enhance nurse resilience and mitigate burnout, nurse leaders may consider resilience bundles to prioritize the mental health and wellness of their staff.
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Crenshaw JT, Adams ED, Gilder RE, Nolte HG. Measuring health professionals' beliefs about skin-to-skin care during a cesarean. Matern Child Nutr 2021; 17:e13219. [PMID: 34159712 PMCID: PMC8476431 DOI: 10.1111/mcn.13219] [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] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/19/2020] [Revised: 05/04/2021] [Accepted: 05/06/2021] [Indexed: 11/28/2022]
Abstract
Women and their newborns are at risk of delayed or withheld skin‐to‐skin care (SSC) during a caesarean, which is about one‐third of births, worldwide. To date, no instrument exists to assess health professionals' (HPs) beliefs, and potential barriers and strategies for implementing SSC during a cesarean. The study aims were to (1) develop an instrument, Health Professionals' Beliefs about Skin‐to‐Skin Care During a Cesarean (SSCB), (2) establish its validity and reliability and (3) describe HPs' beliefs about SSC during a caesarean. Quantitative and qualitative analyses were used to test the SSCB and describe HPs' beliefs. SSCB analysis yielded a content validity of 0.83 and reliability of α = 0.9. We grouped all practice roles as either nurses or physicians. The mean rank score for nurses (n = 120, M = 90) was significantly higher (p = 0.001) than physicians (n = 46, M = 79). Despite this difference, scores for both roles reflected support for SSC. Participants identified hospital readiness to implement SSC and maintaining maternal and newborn safety as major issues. SSCB is a valid, reliable instrument to measure HPs' beliefs about SSC during a caesarean birth. HPs can use the SSCB during quality improvement initiatives to improve access to immediate SSC for women who have a caesarean birth. Improved access can enhance breastfeeding outcomes and promote optimal maternal and child health.
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Affiliation(s)
- Jeannette T Crenshaw
- School of Nursing: Professor, Texas Tech University Health Sciences Center, Lubbock, United States, USA
| | - Ellise D Adams
- College of Nursing; PhD Program Coordinator, The University of Alabama in Huntsville, Huntsville, AL, USA
| | - Richard E Gilder
- Owner, The Gilder Company, Dallas, TX, USA.,Adjunct Faculty: School of Nursing, Texas Tech University Health Sciences Center, Lubbock, United States, USA
| | - Hannah G Nolte
- School of Nursing, Vanderbilt University, Nashville, TN, USA.,Private practice: Psychiatric Mental Health Nurse Practitioner, Hayden and Associates TMS Therapy Huntsville, Huntsville, AL, USA
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Crenshaw JT, Budin WD. Hospital Care Practices Associated With Exclusive Breastfeeding 3 and 6 Months After Discharge: A Multisite Study. J Perinat Educ 2020; 29:143-151. [PMID: 32760183 DOI: 10.1891/j-pe-d-19-00033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Maternity care practices influence breastfeeding outcomes long after women leave the birth setting. We conducted this study to describe, from mothers' perspective, maternity care practices associated with breastfeeding at 3 and 6 months. Mothers who recalled having skin-to-skin care (SSC) and rooming-in for 23 or more hours/day were more likely to report exclusive breastfeeding when surveyed at 3 months. Perception of not enough milk and difficulty latching explained more than 85% of supplementing and weaning at 3 months. Women also reported that returning to work influenced their decision to supplement or wean. Our multisite study supports implementing low cost and evidence-based interventions such as immediate and uninterrupted SSC and rooming in to improve breastfeeding exclusivity. Findings highlight the ongoing need to bridge the gap between hospital discharge and community breastfeeding support, including workplace accommodations.
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Abstract
Introduction: Our aim was to describe feasibility and outcomes of skin-to-skin care (SSC) that began during cesarean surgery and continued, uninterrupted, for about 5 hours. We described maternal/newborn measures of physiologic stability and stress; maternal measures of comfort; maternal satisfaction with surgery and SSC; and exclusive breast milk feeding at discharge. Materials and Methods: We used a quasiexperimental, time-interrupted design and randomly assigned women to receive SSC that began during surgery (Group 1, intervention; n = 20) or after surgery, before transfer to recovery (Group 2, standard care; n = 20). We analyzed differences across time and for five observations: before transfer to the operating room (OR); in the OR, about 20 minutes after birth; in the recovery room, about 1 hour after admission; in the New Family Center (NFC), about 1 hour after admission; and in the NFC, about 2 hours after admission. Results: Group 1 began SSC an average of 0.89 minutes after birth and continued an average of 300 minutes and Group 2 began an average of 46 minutes after birth and continued an average of 126 minutes. Women who began SSC during surgery were more satisfied with the experience (p = 0.015) and had lower levels of salivary cortisol across time (p = 0.003). We found no negative effects on maternal or newborn measures of physiologic stability and no difference in exclusive breast milk feeding rates at discharge. Conclusion: Immediate and uninterrupted SSC during medically uncomplicated cesarean surgery is a feasible, low-cost intervention that can safely begin during surgery and continue, uninterrupted, for extended durations.
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Affiliation(s)
| | - Ellise D Adams
- College of Nursing, University of Alabama in Huntsville, Huntsville, Alabama
| | - Richard E Gilder
- School of Nursing, Texas Tech University Health Sciences Center, Lubbock, Texas
| | - Kristine DeButy
- Women and Children's Services, Baylor University Medical Center, Dallas, Texas
| | - Kristin L Scheffer
- Perinatal Education, Women and Children's Services, Baylor University Medical Center, Dallas, Texas
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DeButy K, Scheffer K, Adams ED, Crenshaw JT. Research as an Effective Strategy to Implement Practice Change. J Obstet Gynecol Neonatal Nurs 2019. [DOI: 10.1016/j.jogn.2019.04.094] [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: 10/26/2022] Open
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Abstract
Mothers and newborns have an emotional and physiological need to be together at the moment of birth and during the hours and days that follow. Keeping mothers and newborns together is a safe and healthy birth practice. Evidence supports immediate, undisturbed skin-to-skin care after vaginal birth and during and after cesarean surgery for all medically stable mothers and newborns, regardless of feeding preference; and, no routine separation during the days after birth. Childbirth educators and other health-care professionals have an ethical responsibility to support this essential healthy birth practice through education, advocacy, and implementation of evidence-based maternity practices.
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Rivas CL, Crenshaw JT, Gilder RE. Use of Nitrous Oxide for Labor and Birth Pain Management. J Obstet Gynecol Neonatal Nurs 2018. [DOI: 10.1016/j.jogn.2018.04.086] [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: 10/14/2022] Open
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Schneider LW, Crenshaw JT, Gilder RE. Influence of Immediate Skin-to-Skin Contact During Cesarean Surgery on Rate of Transfer of Newborns to NICU for Observation. Nurs Womens Health 2017; 21:28-33. [PMID: 28187837 DOI: 10.1016/j.nwh.2016.12.008] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2016] [Revised: 09/29/2016] [Indexed: 06/06/2023]
Abstract
We conducted an evidence-based practice project to determine if skin-to-skin contact immediately after cesarean birth influenced the rate of transfer of newborns to the NICU for observation. We analyzed data for 5 years (2011 through 2015) and compared the rates for the period before implementation of skin-to-skin contact with rates for the period after. The proportion of newborns transferred to the NICU for observation was significantly different and lower after implementing skin-to-skin contact immediately after cesarean birth (Pearson's χ2 = 32.004, df = 1, p < .001). These results add to the growing body of literature supporting immediate, uninterrupted skin-to-skin contact for all mother-newborn pairs, regardless of birth mode.
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Abstract
Today's nurse executive is likely to find himself or herself in the middle of a merger, acquisition, and/or partnership (MAP). This is the result of health care agencies vying for market share in the midst of stiff competition, as well as decreased reimbursement in a rapidly changing payment system. The phenomenon of MAPs is fueled by the focus on care coordination and population health management. To be prepared for the ongoing and increasing MAP activity, nurse executives need to develop the skill of risk taking as an essential competency for leading change. This article emphasizes the need to maintain and improve health care quality and patient safety.
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Affiliation(s)
- Sylvain Trepanier
- Premier Health, Dayton, Ohio (Dr Trepanier); and Texas Tech University Health Sciences Center School of Nursing, Lubbock (Drs Crenshaw and Yoder-Wise)
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Brinzo JA, Crenshaw JT, Thomas L, Sapp A. The effect of yoga on depression and pain in adult patients with chronic low back pain: a systematic review protocol. ACTA ACUST UNITED AC 2016; 14:56-66. [PMID: 26878920 DOI: 10.11124/jbisrir-2016-2409] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Affiliation(s)
- Julie A Brinzo
- 1 Texas Tech University Health Sciences Center, Texas, USA2 Texas Woman's University, Texas, USA3 Texas Christian University Center for Evidence Based Practice and Research: a Collaborating Center of the Joanna Briggs Institute, Texas, USA
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Abstract
Mothers and babies have a physiologic need to be together at the moment of birth and during the hours and days that follow. Keeping mothers and babies together is a safe and healthy birth practice. Evidence supports immediate, uninterrupted skin-to-skin care after vaginal birth and during and after cesarean surgery for all stable mothers and babies, regardless of feeding preference. Unlimited opportunities for skin-to-skin care and breastfeeding promote optimal maternal and child outcomes. This article is an updated evidence-based review of the "Lamaze International Care Practices That Promote Normal Birth, Care Practice #6: No Separation of Mother and Baby, With Unlimited Opportunities for Breastfeeding," published in The Journal of Perinatal Education, 16(3), 2007.
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Abstract
Don't overlook the importance of charge nurses. Learn how one organization redefined the role and strengthened these leaders, increasing patient and staff satisfaction.
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Affiliation(s)
- Lorrie Normand
- At Texas Health Harris Methodist in Cleburne, Tex., Lorrie Normand is a CNO, Denise Black is a manger of Clinical/Community Education and Professional Practice, and Kathleen M. Baldwin is a nurse scientist. Jeannette T. Crenshaw is an assistant professor at Texas Tech University Health Sciences Center's School of Nursing in Lubbock
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Affiliation(s)
| | - Jeannette T. Crenshaw
- Texas Tech University Health Sciences Center; School of Nursing; Lubbock TX USA
- Texas Health Presbyterian Hospital Plano; Family Education; Plano TX USA
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Crenshaw JT. Happy 20th Birthday to the Cochrane Collaboration. J Obstet Gynecol Neonatal Nurs 2013; 42:503-5. [DOI: 10.1111/1552-6909.12244] [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: 11/29/2022] Open
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Crenshaw JT, Champion JD. Newly graduated Swedish nurses show a trend for increasing research use in the 5 years following qualification, with the trend starting after the second year. Evid Based Nurs 2012; 16:27-8. [PMID: 23060435 DOI: 10.1136/eb-2012-100832] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
- Jeannette T Crenshaw
- School of Nursing, Texas Tech University Health Sciences Center, Lubbock, Texas, USA.
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Crenshaw JT, Brimdyr KH, Champion JD, Gilder RE, Winslow EH, Svennson K, Widström AM, Cadwell K. Use of a Video-Ethnographic Intervention, PRECESS Immersion Method, to Improve Skin-to-Skin Care and Breastfeeding Rates. J Obstet Gynecol Neonatal Nurs 2012. [DOI: 10.1111/j.1552-6909.2012.01362_44.x] [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: 11/26/2022] Open
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Crenshaw JT, Cadwell K, Brimdyr K, Widström AM, Svensson K, Champion JD, Gilder RE, Winslow EH. Use of a video-ethnographic intervention (PRECESS Immersion Method) to improve skin-to-skin care and breastfeeding rates. Breastfeed Med 2012; 7:69-78. [PMID: 22313390 DOI: 10.1089/bfm.2011.0040] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
PURPOSES Skin-to-skin care after birth often is absent, interrupted, or delayed for routine procedures. The purposes of this project were to improve skin-to-skin care and exclusive breastfeeding at hospital discharge. METHODS For Part 1, we used a descriptive observational design, with video-ethnography and interaction analysis (PRECESS-Practice, Reflection, Education and training, Combined with Ethnography for Sustainable Success), during a 5-day quality improvement pilot study in a U.S. hospital (August 13-17, 2010). For Part 2, we used electronic health record review to test for differences in monthly rates of skin-to-skin care and exclusive breastmilk feeding (baseline, July 2010; post-intervention, August-December 2010). RESULTS In Part 1, 11 mothers and babies participated: 10 (91%) received immediate skin-to-skin care, eight (73%) received uninterrupted skin-to-skin care, nine (82%) planned to breastfeed, six (67%) of these babies were exclusively breastfeeding at hospital discharge, and five (83%) of the six babies who completed all nine instinctive stages during skin-to-skin care were exclusively breastfeeding at hospital discharge. In our subsequent review (Part 2), we found a significant improvement (25% above baseline) in the overall rate of skin-to-skin care across post-intervention months (Pearson χ(2)=23.798, df=5, p<0.000), predominantly from improvements in the cesarean section population. The rates of exclusive breastfeeding showed no significant change. CONCLUSIONS The PRECESS immersion method may help to rapidly improve skin-to-skin care. Babies who undergo all nine stages during skin-to-skin care may be more likely to exclusively breastfeed. Mothers need support during skin-to-skin care to recognize their baby's readiness to breastfeed. Skin-to-skin care during cesarean surgery may reduce maternal stress and improve satisfaction with the surgical experience.
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Affiliation(s)
- Jeannette T Crenshaw
- College of Nursing, University of Texas at Arlington, 411 South Nedderman Drive, Arlington, TX 76019, USA.
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Crenshaw JT, Winslow EH. Actual versus instructed fasting times and associated discomforts in women having scheduled cesarean birth. J Obstet Gynecol Neonatal Nurs 2006; 35:257-64. [PMID: 16620252 DOI: 10.1111/j.1552-6909.2006.00029.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVES To measure actual and instructed preoperative fasting durations in women undergoing scheduled cesarean birth, to compare these times with national guidelines for healthy patients undergoing elective procedures, and to describe discomforts associated with preoperative fasting. DESIGN One group, nonexperimental, comparative, descriptive. SETTING Nonprofit private medical center in Texas with 6,000 births/year. PATIENTS Convenience sample of 51 hospitalized postpartum women. INTERVENTIONS Participants were interviewed an average of 44 hours after their cesarean birth, and their medical records were reviewed for fasting information. MAIN OUTCOME MEASURES Duration of actual and instructed fasting, comparison with national guidelines, and ratings of thirst and hunger. RESULTS The participants fasted from liquids and solids an average of 11 and 13 hours, respectively. Both actual and instructed fasting durations were significantly longer than national guidelines. Most participants (70%) were instructed to be nulla per os after midnight whether they were to have a.m. or p.m. surgery. Thirst and hunger scores averaged 5 and 4, respectively, on a 0-10 scale. CONCLUSION Patients having scheduled cesarean birth fast for unnecessarily long periods. Nurses should be knowledgeable about evidence-based preoperative fasting practices and collaborate with physicians to implement them.
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Affiliation(s)
- Jeannette T Crenshaw
- Texas Health Resources, The Center for Learning Dallas, Presbyterian Hospital of Dallas, Dallas, TX 75231-4496, USA.
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Abstract
OVERVIEW Prolonged preoperative fasting is a time-honored tradition. The typical order of "npo after midnight" (or no liquid or food after 12 am on the day of surgery) has been challenged in recent years-so much so that in 1999 the American Society of Anesthesiology (ASA) revised its practice guidelines for preoperative fasting in healthy patients undergoing elective procedures. The newer, more liberal recommendations, based on studies showing that pulmonary aspiration occurs only rarely as a complication of modern anesthesia, allow the consumption of clear liquids up to two hours before elective surgery, a light breakfast (tea and toast, for example) six hours before the procedure, and a heavier meal eight hours beforehand. There is a well-known lag between the dissemination and implementation of practice guidelines, so the authors sought to determine whether the publication of the revised ASA recommendations had changed preoperative fasting practices. They interviewed 155 patients in one hospital about their preoperative fasting, comparing instructed, actual, and ASA-recommended fasting durations for liquids and solids. Their findings demonstrate that the majority of patients continued to receive instructions of npo after midnight for both liquids and solids, whether they were scheduled for early or late surgery. On average, the patients fasted from liquids and solids for 12 and 14 hours, respectively, with some patients fasting as long as 20 hours from liquids and 37 hours from solids. These fasts were significantly longer than those recommended by the ASA, indicating that inappropriate preoperative fasting is an issue that demands attention. The authors conclude that more collaboration between nurses and physicians is needed to assure that fasting instructions are consistent with the ASA guidelines and that patients understand these directives.
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