PubMed Health⌕ Search

Biomedical subjects

Kathleen Rice Simpson

Publications and source records attributed to Kathleen Rice Simpson.

35 records · Page 2Linked to original sources
PubMedDate not supplied

Effects of immediate versus delayed pushing during second-stage labor on fetal well-being: a randomized clinical trial.

BACKGROUND: Although there are two methods of caring for women with epidural anesthesia during second-stage labor (coached closed-glottis pushing immediately at 10-cm cervical dilation or delayed pushing until the woman feels the urge to push, passive fetal descent, and encouragement of open-glottis pushing when the woman has the urge to push), there are limited data concerning which method is most optimal for fetal well-being. OBJECTIVE: To evaluate effects on fetal well-being, as measured by fetal oxygen saturation, of two different methods of second-stage labor nursing care for women with epidural anesthesia. METHODS: Forty-five nulliparous women who had progressed to the second stage were randomized to 1 of 2 groups (immediate or delayed pushing). Fetal oxygen saturation was continuously monitored and values at 10 cm, initiation of pushing and immediately prior to birth, as well as the amount of time that fetal oxygen saturation values were abnormal (< or =30%) were compared between groups. Also evaluated were additional measures of fetal well-being such as fetal heart rate patterns, Apgar scores, and umbilical cord blood gases and maternal outcomes including length of labor, method of birth, and perineal status. RESULTS: There was a significant difference between groups in fetal oxygen desaturation during the second stage (immediate: M = 12.5; delayed: M = 4.6) F(1, 43) = 12.24, p = .001, and in the number of > or =2-min epochs of fetal oxygen saturation <30% (immediate: M = 7.9; delayed: M = 2.7), F(1, 43) = 6.23, p = .02. There were more variable decelerations of the fetal heart rate in the immediate pushing group (immediate: M = 22.4; delayed: M = 15.6) F(1, 43) = 5.92, p = .02. There were no differences in length of labor, method of birth, Apgar scores, or umbilical cord blood gases. Women who pushed immediately had more perineal lacerations (immediate: n = 13; delayed: n = 5) chi(1, N = 45) = 6.54, p = .01. DISCUSSION: Delayed pushing results in less fetal oxygen desaturation and less > or =2-min epochs of fetal oxygen saturation <30% during second-stage labor than the immediate pushing method; thus, delayed pushing is more favorable for fetal well-being as measured by fetal oxygen saturation.

Adjuvants, Anesthesia↗
PubMedDate not supplied

Measuring perinatal patient safety: review of current methods.

Methods to measure patient safety include structure, process and outcome measures, safety attitude and climate surveys, focus groups, storytelling, executive walk rounds, and external review. Ideally, measures of patient safety should be meaningful, science based, psychometrically sound, feasible, and actionable. Accurate and timely data feedback to caregivers is critical to effect required changes. A balanced set of patient safety measures provides valuable data to guide efforts to improve perinatal patient safety.

Adult↗
PubMedDate not supplied

Nurse-physician communication during labor and birth: implications for patient safety.

OBJECTIVE: To describe communication between nurses and physicians during labor within the context of the nurse-managed labor model in community hospitals and its relationship to teamwork and patient safety. DESIGN: Multicenter qualitative study involving focus groups and in-depth interviews. SETTING: Labor and birth units in 4 Midwestern community hospitals. PARTICIPANTS: 54 labor nurses and 38 obstetricians. METHODS: Focus groups and in-depth interviews were conducted using open-ended questions. Data were analyzed using inductive coding methods to gain understanding from the perspective of those directly involved. MAIN OUTCOME MEASURES: Description of interdisciplinary interactions during labor. RESULTS: Nurses and physicians shared the common goal of a healthy mother and baby but did not always agree on methods to achieve that goal. Two clinical situations critical to patient safety (fetal assessment and oxytocin administration) were frequent areas of disagreement and sources of mutual frustration, often leading to less than optimal teamwork. Minimal communication occurred when the mother and fetus are doing well, and this seemed to be purposeful and considered normal. Physicians and nurses had distinct opinions concerning desirable traits of members of the other discipline. CONCLUSIONS: Interdisciplinary communication and teamwork could be improved to promote a safer care environment during labor and birth.

Attitude of Health Personnel↗
PubMedDate not supplied

Trends and issues in labor induction in the United States: implications for clinical practice.

The labor induction rate is at an all-time high in the United States. Although induction of labor is recommended as a therapeutic option only when the benefits of expeditious birth outweigh the risks of continuing the pregnancy, a "psychosocial indication" has become a common rationale for elective induction in the United States. It is unlikely that all women are provided with a complete discussion of the cascade of interventions that frequently accompany labor induction and the risks of cesarean birth. Although at first glance elective labor induction may seem more convenient, an appreciation of the inconvenience of the greater rates of interventions, the longer labor and overall hospital stay, the higher costs, the additional attention required by the primary health care provider when complications occur, and the risk of an adverse outcome for a mother or baby after an elective procedure with subsequent litigation should cause everyone to exercise caution and reevaluate current practice. Professional organizations should take proactive steps to advocate for pregnant women so they are fully aware of the risks and benefits. A public campaign to discourage elective labor induction for nulliparous women is worth serious consideration.

Adult↗
PubMedDate not supplied

How do expert labor nurses view their role?

OBJECTIVE: To examine how expert perinatal nurses in a nurse-managed labor model view their role in caring for mothers during labor and birth. DESIGN: Focus group methodology. Data were analyzed using inductive coding methods to gain understanding from the perspective of those providing the care. SETTING: Labor and birth units in four large Midwestern medical centers. PARTICIPANTS: Fifty-four expert labor nurses. INCLUSION CRITERIA: 5 years experience in nursing care during labor and birth in institutions where nurse-managed labor was the predominant practice model. RESULTS: Four common themes related to nursing roles were identified. These included knowing the labor process and the intuitive nature of nursing care provided by expert labor nurses based on years of experience, knowing the woman and letting her body guide labor, advocacy for laboring woman, and the autonomous nature of the nurse-managed labor model. CONCLUSIONS: Expert labor nurses developed a keen sense of intuitive knowledge based on their years of experience. They reported using hands-on high-touch supportive care techniques with the potential to affect labor and birth outcomes. Autonomy is perceived as a key component of practice within the nurse-managed labor model.

Anecdotes as Topic↗