Holistic Care Partners: A Black woman-led nurse navigation program to improve care, reduce harm, and enhance perinatal wellbeing for Black birthing people

整体护理合作伙伴：由黑人女性主导的护士导航计划，旨在改善黑人分娩者的护理、减少伤害并增强围产期福祉

• 批准号: 10743468
• 负责人: AUDREY L LYNDON
• 金额: $ 44.66万
• 依托单位: NEW YORK UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-08-18 至 2025-07-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10743468
• 关键词: Address; Affect; Birth; Black Populations; Black race; COVID-19 pandemic; Caring; Cessation of life; Childbirth; Communities; Data; Discipline of obstetrics; Disparity; Early Intervention; Education; Emergency Situation; Enrollment; Family; Feasibility Studies; Fright; Future; Gender; Goals; Harm Reduction; Health; Health care facility; Hospitals; Human Milk; Individual; Inequity; Infant; Infant Health; Injury; Institution; Intervention; Intervention Studies; Interview; Lactation; Maternal Health; Maternal Mortality; Measures; Medical; Medical center; Midwifery; Modeling; Modification; New York; New York City; Not Hispanic or Latino; Nurses; Outcome; Parents; Participant; Patients; Perinatal; Perinatal Nursing; Personal Satisfaction; Persons; Physical Restraint; Physicians; Population; Postpartum Period; Pregnancy; Premature Birth; Prenatal care; Prevention; Publishing; Questionnaires; Race; Reporting; Research; Safety; Strategic Planning; Stress; Support Groups; Supportive care; System; Testing; Time; United States; Universities; Vaginal delivery procedure; Woman; acceptability and feasibility; adverse birth outcomes; black women; care seeking; child bearing; comorbidity; depressive symptoms; design; efficacy testing; experience; feeding; follow-up; health disparity; health equity; improved; infant death; maternal morbidity; maternal wellbeing; mortality; neglect; perceived discrimination; perceived stress; pregnancy associated death; premature; prenatal; prevent; programs; racism; response; retention rate; satisfaction; severe maternal morbidity; social health determinants; uptake; video visit

Project Summary/Abstract The broad, long-term objective of this research is to address inequities in birth outcomes for Black women and birthing people, which manifest most starkly in severe maternal morbidity and maternal mortality. While there are disparities in maternal health outcomes for multiple populations, Black communities are particularly affected by adverse birth outcomes. Maternal morbidity and mortality rates for the Black population are 2-4 times higher than those of the non-Hispanic White population. These disparities are even greater in some communities, like New York City, where pregnancy-associated mortality among non-Hispanic Black women remains 8 times higher than among non-Hispanic White women. Similarly, severe maternal morbidity occurs 2- 2.5 times as frequently among non-Hispanic Black women compared to non-Hispanic White women. In addition to having higher rates of medical and obstetric co-morbidities, mortality, preterm birth, and infant death, Black women and birthing people are likely to experience obstetric racism manifesting as dismissiveness, disrespect, loss of autonomy, and abuse while seeking care during pregnancy, labor, and birth. Opportunities for preventing maternal death and severe maternal morbidity have been identified at multiple levels including through clinicians, health facilities, systems, and the community. Interventions are needed at all of these levels to create systematically healthy and uplifting conditions for pregnancy and birth among Black women and birthing people. However, many upstream interventions will take considerable time to have an impact. Addressing factors that are modifiable now is urgent. We propose that important progress can be made by employing the expertise of the current perinatal nurse workforce to address information, coordination, referral, and care experience needs for Black women and birthing people seeking traditional prenatal and hospital-based maternity care. This study will evaluate the feasibility and acceptability of a Black- woman-led perinatal nurse navigation program designed to address disparities in maternal health outcomes, reduce experiences of obstetric racism, and improve maternal wellbeing by centering the needs of Black women and birthing people engaging in traditional prenatal care and hospital-based birth in New York City. The specific aims are to (1) assess the feasibility and acceptability of a perinatal nurse-led navigation program, (2) collect and examine descriptive data on program outcomes to inform future efficacy testing, and (3) explore participant, partner/support person, and clinician stakeholder responses to the nurse-led navigation program. This formative intervention study of an integrated model of supportive care will lay the groundwork for future efficacy testing. If successful, perinatal nurse navigation programs have the potential to reduce preventable severe maternal morbidity and mortality. Such programs would also have the potential for rapid scalability using an existing workforce, and for adaptation to multiple contexts and cultural groups.

项目概要/摘要 这项研究的广泛、长期目标是解决黑人妇女和黑人妇女出生结果的不平等问题 生育人群，最明显的表现是严重的孕产妇发病率和孕产妇死亡率。在那里 多个人群的孕产妇健康结果存在差异，黑人社区尤其如此 受不良分娩结果的影响。黑人的孕产妇发病率和死亡率为 2-4 比非西班牙裔白人高出几倍。这些差异在某些地区甚至更大 社区，如纽约市，非西班牙裔黑人妇女与怀孕相关的死亡率 仍然是非西班牙裔白人女性的 8 倍。同样，严重的孕产妇发病率发生在 2- 非西班牙裔黑人女性的频率是非西班牙裔白人女性的 2.5 倍。在 除了医疗和产科合并症、死亡率、早产和婴儿的发生率较高之外 死亡、黑人妇女和分娩者可能会经历产科种族主义，表现为 在怀孕、分娩和怀孕期间寻求护理时的轻视、不尊重、丧失自主权和虐待 出生。已确定了预防孕产妇死亡和严重孕产妇发病的机会 多个层面，包括通过临床医生、卫生设施、系统和社区。干预措施是 所有这些层面都需要为怀孕和分娩创造系统性的健康和令人振奋的条件 在黑人妇女和生育人群中。然而，许多上游干预措施需要相当长的时间才能 有影响。现在迫切需要解决可改变的因素。我们建议取得重要进展 通过利用当前围产期护士队伍的专业知识来处理信息， 寻求传统黑人妇女和分娩者的协调、转介和护理经验需求 产前和医院产妇护理。本研究将评估黑人的可行性和可接受性 由妇女主导的围产期护士导航计划，旨在解决孕产妇保健结果的差异， 通过关注黑人的需求来减少产科种族主义的经历并改善孕产妇福祉 纽约市从事传统产前护理和医院分娩的妇女和分娩者。这 具体目标是 (1) 评估围产期护士主导的导航计划的可行性和可接受性，(2) 收集和检查有关计划结果的描述性数据，为未来的功效测试提供信息，以及 (3) 探索 参与者、合作伙伴/支持人员和临床医生利益相关者对护士主导的导航计划的反应。 这项支持性护理综合模式的形成性干预研究将为未来奠定基础 功效测试。如果成功，围产期护士导航计划有可能减少可预防的疾病 孕产妇发病率和死亡率严重。此类程序还具有快速扩展的潜力 利用现有的劳动力，并适应多种环境和文化群体。